The long-awaited date of the Fulkerson Osteotomy, with bonus cartilage transfer, finally arrived on Monday. To be honest, I wasn’t all that nervous (because I was an idiot). I’m a surgery pro, these days. Instead of being scared, I was dreading the pending little irritants that come with any medical procedure. For example, there is nothing worse than the wait between getting in the gown, and getting wheeled back to suck down the knock-out gas. This time, I was only a tiny bit joking when I told both the nurse and the anesthesiologist, that anytime they felt like knocking me out, I’d be fine with it. Or, it gets mildly annoying to repeat your name, date of birth and drug allergies to everyone who walks by; why the janitor needs to know that you are allergic to Cipro is baffling. I understand, of course, that it’s a safety issue ensuring that they are always talking to, and working with, the correct patient. It doesn’t make it less tedious when you are already stressed, and in your altogether, barely covered by a gown they’ve asked you to leave untied (why??).
It started at about noon, and I came around from anesthesia at around 5 pm. So, deduce from that, what you will, about how complex of a procedure it was, and how fucked up my knee was, and is. The surgeon did what surgeons always do, handed me some pictures that he took during the operation that make perfect sense to him, but look like scribbles done by a two-year-old with only two colors in in crayon box: red and flesh. “Ahh, yes,” you say when he points at things. “I see,” and “great!” you acknowledge, when he looks for reassurance and praise for how he rearranged the fleshy bits. From my special photos, I was supposed to glean, generally, that my knee was far more of a disaster than it was since the last time he was in there, and that he made it all better. Hopefully,
The general plan of a Fulkerson Osteotomy is terrible. The surgeon drills holes in your shin-bone, then “gently” cracks it, and uses the break to stretch the shin out a bit, leaving it easier to line you knee up with it later. In case that last part was unclear: HE BREAKS YOUR LEG. This is important because when it’s time to do the second bit, which is picking up your kneecap, which happens to be securely held in by muscles and ligaments that he has to get out of the way by slicing them, he’s got to have a nice secure place to line it up with. He drills a few holes in that broken leg, and then, puts in some surgical bolts, realigns the knee cap to allow it to track in the right place sews all the muscles and ligaments back where they go, and viola, new knee. Sort of.
My surgery was special, mostly because I’m special, of course. But, it was also special because I was lucky enough to have a few spare cells of cartilage left under my knee that weren’t too ravaged by arthritis. And, when I say, a few, I’m not exaggerating. I had such a small amount left, that when the surgeon went in to harvest them, that was literally all that was left. I had such a small amount of cartilage that my knee had been rubbing bone on bone so long that it had created a new shape on the underside of my kneecap, a giant pothole. It’s nice to have your body compared to a bumpy road.
Anyway, they used my tiny few cells to clone a whole new “sheet” of cartilage to slap under my knee cap while it was being shifted to its new spot. While my leg is wide open, ain’t no thing to flip my knee cap over like a bowl and glue (yes glue!) some new cartilage under there. It’s like an empty cup, fill ‘er up. This part of the surgery is immensely fascinating to the people in my corner of the medical community, apparently. For example, my primary care doctor is obsessed with the details of the cloning laboratory, which is in Boston. He wants to know everything about the lab, the process, and the transfer. And, my physical therapy office has therapists fighting over who gets to be my post-op provider because this is such interesting technology; they want to watch the recovery evolve real-world, instead of in theory.
“In theory,” was how I treated this whole thing since I started planning for it. I “imagined” the recovery. I was told that it would be at least about nine months before I’d be about to return to a modified “normal” activity level, and about a year before the cartilage fully adhered to my body. So, I’d still have to be exceedingly careful about how I used my knee for quite some time. Okay, got it. I knew that I’d be in a lot of pain, for quite a long time, as well. In the reading about prep, it’s recommended that if I had a job with NO physical requirements, I should plan to take a minimum of 12 weeks off. I should’ve seen that as a warning, but I didn’t. Every doctor I saw, (the surgeon, primary care, pain management) all told me that there was no real way to describe the pain I was about to be in, that this was a major surgery, and that it’s exceedingly painful. Okay, got it. Filed away in the part of my brain labeled, “Rachel is an idiot who ignores important stuff.” To be honest, that file drawer is more of a room that that looks like a hoarder house.
Of course, surgery is painful. I even filed the “exceedingly painful” part away. It’s all relative, right? When they all told me that the pain and recovery was best described as “brutal” for the first two weeks, I didn’t so much ignore them as file it in my brain as a theoretical event. It’s like I thought it was a thing that happened, but not so much to me. What the fuck was I thinking?
We’re on day seven, and today, I only broke down in hysterical sobs for a total of about two hours. This is less than yesterday, and I’m counting that a victory. So far, today, I’ve only shaken, in uncontrolled pain for several hours, and they weren’t all consecutive. But, the biggest victory of all is that I got out of bed, all by myself, and returned to bed, all by myself. I went a distance of three feet, to get a sweatshirt. While the distance itself is not the victory, I lifted my leg both out of the bed, and back into the bed, without breaking into a cold sweat, and without breaking into tears.
As you can tell, being theoretically prepared probably didn’t leave me especially mentally ready for what was to come. Although, if I had known, I don’t know that I’d have liked to have lived with the fear of what was coming. This is, hands down, the most painful surgery that I’ve been through. I can safely say that because I was so doped up during brain surgery recovery, that I don’t remember a lot of it. Bryon assures me that I had bad moments then too, but watching me go through this, he’s pretty sure that, now, this is quickly overtaking a surgery in which a doctor sliced my neck muscles like a curtain, drilled a hole in my skull, and then shoved my brain around, squashing it back through the skull hole. Yep, this is more painful than a surgery that required my body to be bolted to a table.
In the last seven days, my leg has been having a contest with itself. It’s trying to decide which hurts worse: the broken leg, or the knee cap that the doctor fucked around with, including the ligament and muscle movement. For several hours at a time, my shin will hurt as if I have the worst shin splints known to man, times a million. Then, suddenly, as if from nowhere, my knee will feel as if…actually, there truly are no words. The only way to describe the pain is to say that I wish I had no knee. I wish I had no leg at all, in fact. I’m sure that in a few weeks, or maybe months, I’ll take that sentiment back; but, there have been so many moments in the past seven days that I’ve genuinely felt that. I feel like I owe the amputee community an apology for wishing to be disabled (“especially” abled?? What’s the right way to say it) in that particular way.
The “best” part of this whole procedure is this torture device. I don’t know what it’s actually called. I’ve been coming up with medical-sounding names for it, and alternative casual names for it. I feel like we can be on first name basis, after all; I mean, it’s seen me cry. For example, I have called it things like, simply, “the device,” or “the knee re-inventor.” But, I use my best horror movie preview announcer voice. Or, I call it Helga, or some other brutal-sounding name to American ears, like Oleg. I think it was invented by a masochistic doctor, who, in his private time had a murder dungeon and went undetected as the nation’s most prolific serial killer.
This machine’s job is to keep my knee from developing too much scar tissue, too quickly. Additionally, it’s to help keep me from losing basic mobility, while in the first stage of the healing process. I have to strap my leg into the machine, set the angle, which for this week is a maximum of 30-degrees, and then let the machine raise and lower, ever so slowly, repeatedly. This sounds easy enough. However, I have to do it for a minimum of six hours a day, and considering it hurts my knee even to breathe, raising and lowering thirty degrees for six hours feels like a bridge too far most of the time.
Still, I’m not going through all this recovery pain for a knee that heals wrong; so, I suffer through it. I do what the doctor orders. I literally clench my teeth, and do it. I sweat in pain, shake, and whimper. I cry, sometimes scream, sometimes moan, and sometimes simply put my brain in a place no one, and nothing, can find me. It’s been an adventure in suffering that I have been unprepared for. Truly, with what I’ve already been through, I thought I’d be ready for this. I was wrong.
If all this isn’t enough, the humility that a surgery like this forces you into is pretty astounding. First of all, I farted at my first post-op appointment, so loudly, in front of the X-ray technician, that it echoed, and I had no choice but to own up to my flatulence, and apologize. Thanks to all the opiates, my stomach is a mess, and I have tons of gas. I was valiantly holding it in when the X-ray tech wanted an image of one leg over the other. I was laying on my side, squeezing that poor ball of gas in with the might of a thousand clenched butt cheeks. But, she grabbed one leg and twisted my hip to rotate the back leg over the front leg, basically wringing out all hope of my holding my fart in. I will, forever, call that position the fart-wringer.
The care your loved ones provide for you, especially personal care, is also humbling. I’m no stranger to this kind of care, of course, thanks to my history, but this time it has gotten even more personal, which I didn’t know was possible. Because I can’t bend my knee at all, Bryon has to hold my leg up in the bathroom. There’s no room for a stool. You know it’s love and commitment when your husband holds your leg up while you pee, and worse. Obviously, he’s got to wash me, feed me, and bring me everything I need. I cannot, and I mean cannot get up from the bed without assistance. I’m one-hundred percent reliant on him.
Wish me luck because today we are attempting my first post-op shower. Yep, seven days and I haven’t had a shower yet. I’m a little ripe. The pain has been so intense that the idea, while we’ve been throwing it around, has seemed like suggesting going out for a Forrest Gump-style run. Now, it’s gotten so long that we sort of have to do it, regardless of pain. I’m a little scared. Bryon is putting on his brave face, and I’m bracing myself.
I have learned a few things so far though:
Move your leg from the horizontal to the vertical position as slowly as possible. As the blood flows down, it is the most painful sensation you can imagine. Poor Bryon has claw marks on his shoulders and arms from my death grip, as I shrieked in agony, every time he helped me up to pee, until we figured out this little trick.
Use your good leg to support your bad leg, in bed. It doesn’t matter how many pillows you’ve got, or how you have them arranged, it’s not good enough. Use your foot, and nestle it against your bad leg until it’s just right. You’ll be able to fall asleep. You’ll wake up a tangled mess, but the rest is worth it.
Ice. Ice. Ice. Ice. Ice. Then, more ice. Ice. Ice. There can never be enough ice. Always ice. You will be given (actually, be forced to buy) an ice machine. Use it. Instead of putting ice and water in it, get those tiny water bottles and freeze them. Use those as “ice” in the machine. They stay colder longer, and they work better. But also pack on the traditional ice packs too. The ice machine pad isn’t big enough to cover your leg from the knee to the ankle. This surgery can cause bruising from the thigh to the tips of the toe for up to six months. Obviously, you need lots of ice packs.
Miralax, in a steady stream. Never stop mixing it with your drinks. Yes, I’ve “heard” the weird study about how Miralax is supposedly dangerous with kids; I’ve also got critical thinking skills, and can evaluate how to recognize a flawed and biased study. Use it at least once, maybe twice a day. If you have a serious surgery like this, you will be on serious opiates. You will never poop again if you don’t do something really proactive about it. It seems like a small issue, until it isn’t. Trust me.