Thursday, April 17, 2014

Ken's Ordeal Part 15: Knee Surgery

On April 4th the long-awaited replacement of Ken's failed knee prosthetic took place at Milwaukee's VA Medical Center.  His pain had steadily increased in the two weeks or so leading up to surgery, perhaps because he had reduced his level of pain meds or perhaps because the damage in his leg was worse, or both.  At any rate, walking was difficult and his knee looked like a large cantaloupe.  Reducing the level of narcotics meant that post surgery pain could be better controlled, but there had been weeks of increased misery. 

So even though we were aware it might be  a challenge, Ken mostly seemed relieved that the time for this surgery had finally come.  It was last summer when an orthopedic doctor at Mayo had said, "This replaced knee MUST come out, and soon."  No one knew if they would be able to put in a new knee or if they would discover previously hidden infection, necessitating months of immobility and a delay of replacing the prosthetic.

The VA staff was friendly and efficient.  I was a little sad when a tall, smiling black woman came in and introduced herself as the anesthesiologist who would be taking care of Ken during the operation.  I had been looking forward to seeing the doctor I wrote about in my last post--an anesthesiologist who seemed to "get it" more than most had.  As Ken was wheeled away, she gave me a little pat and a large smile, assuring me, "We'll take good care of him."  I nodded, trying to smile and failing.

I waited in a rather unpleasant family waiting room.  It was crowded, noisy, and the opposite of private.  There were rows of uncomfortable chairs.  No coffee, no snacks or fruit, none of the trappings one might see elsewhere.  I had been told that the resection of the failed knee prosthetic would likely take longer than a typical first-time knee replacement and to expect a wait of three to four hours. 

Pastor Sharon came and sat with me in the cafeteria and we talked as we munched on lukewarm biscuits and gravy and drank bad coffee.  A bit later, Rev Gal (and a longtime cyber friend) Julie came and we talked about church and life and how things have changed for us both.  She gave me a hug that was from all my dear Rev Gal Blog Pal cyber friends. 

About three hours after Ken went to the operating room, I received a call from one of the nurses.  "We are still working on getting the old knee replacement out.  He is stable though, and vital signs are good.  It will be a while." 

Our daughter, Kris, arrived and we sat in the waiting room trying to ignore the loud cell phone conversation about someone's bladder infection, the complaints about Obamacare and politics in general, the anxious people.   We talked a little, read, took short walks.  And we waited and waited and waited.  It was three more hours before we were informed that the surgery was finally finished and Ken was in the recovery area.  Ken later told us, "It was really crowded back there."

A surgery resident told us that it had been quite difficult to remove the old prosthetic.  They needed to remove large amounts of inflamed tissue in order to get to it, resulting in quite a bit of blood loss.  The thigh bone had been badly damaged by the "rattling around" of the loose knee replacement, so they had to repair it with cement before they could put in the new prosthetic.  He commented, "That was on the difficult end of the scale of surgery... but it looks good now."  There was no sign of infection in the knee.   This was both good and bad news.  Good news because instead of months of recuperation followed by another surgery, they were able to put in the new knee now.  It was bad news because an infection might have explained Ken's months of illness.

The subsequent hospital stay was a mix of good things and bad.   There were competent and caring nurses, a great physical therapist and occupational therapist, and a pleasant room (unlike some others at the VA).  There were also inexcusable incidents of missed medications and a very evident lack of communication between members of the health care "team."  Ken seemed exhausted, was in great pain and quite depressed, and no one seemed to have been told that the knee pain was not the only issue.  He was told more than once to , "Just grab the trapeze and pull  yourself up; after all you have upper body strength" and similar remarks. 

Kris posted a large sign that read something like:
Ken George is ill. He has lost 130 lbs. with no dieting.  He experiences severe all-over joint pain similar to RA.  He has limited hand and upper body strength. 

After he received two units of blood, Ken felt better. He was discharged after six days in the hospital.  He is still waiting for the authorization to receive physical therapy locally.  He is very tired, but he is walking reasonably well and doing leg lifts as much as he can.

Two days ago we drove to Milwaukee to see the doctors in the rheumatology clinic. The ride to Milwaukee and back was painful for Ken because he can't straighten his knee.  He looked grey and had a hard time talking by the time we arrived.  It was a depressing and mostly pointless visit.  They clearly have no ideas, but they did say they are referring Ken to a VA neurologist.  They also said his blood count was quite low, about the same as when he had received the transfusion after surgery.  They sent him to the lab for some further blood work. 

We have heard nothing about the lab results, but we are going back to Milwaukee today for the follow-up visit at the orthopedic department so we will check to see what they plan to do. As for the knee, hopefully the staples can come out today, and hopefully Ken will be able to get going on  physical therapy. 

And we will wait for the tests that are scheduled in the neurology department.  Some of these tests were undoubtedly done at Mayo--but we shall see.