A Blistering Start to Recovery

From what I've been told, the procedure itself went well. After I was put to sleep, an epidural was inserted into my back (for pain control—the thing, which stayed in for about three days, more or less paralyzed my right leg) and a catheter, required thanks to the epidural. At which point the surgery itself began, bone growths were removed, my tibia and fibula surgically broken, the frame put on. The breaks in the bone were achieved by drilling many small holes into the bone, then connecting the holes and are really rather clean. The frame itself is fixed to my leg by way of five six mm pins and two piano wire pins, all of which are attached to the tibia (the fibula is being left to its own devices, as far as I can tell). Apparently the thing is stable to the point that, if I wanted to and didn't mind the pain, I could walk on the leg immediately post-op. For the moment, for reasons which I hope are relatively self-explanatory, I've been trying to avoid putting too much weight on that leg.

Aside from the details, after about three hours in the OR, during which, according to what my anesthesiologist told me later, I lost only 50-75 milliliters of blood—the equivalent of about a fifth of a can of soda, I was moved to the recovery room, woke up and promptly proceeded to try to tell everybody I knew that I was out of surgery and it went well.

The trouble was, my spelling (and grammatical proficiency) had been somewhat altered by the fact that I had just been exposed to anesthesia, as evidenced by the following Facebook status update:

Out of surgery! Apparently operstion proper went well. Logs of windows in my my hospital room—always a positive. Surgical sites at a dull ache but still very happy surgery went well and optimistic for recovery ahead.

Why AutoCorrect didn't fix "operstion" is beyond me. And as far as the rest, well, grammar and morphine were not created to co-exist. Still…I was out of surgery, which counted for a lot. Even better, as much as I was terrified the surgery would result in lots and lots of pain, at the moment, I was feeling decently comfortable. A dull ache at the pin sites, no complaints from the incisions. And it stayed that way. Using the ten-point scale of pain (one: low pain, ten: worst pain you can imagine), the frame itself only ever got up to a three or a four as I was eased from the combination of epidural and morphine through an IV to oral pain medicine alone over the course of my six day stay.

Unfortunately, as things worked out, the most painful part my hospital stay would not be due to this friendly fellow:

Notes: 1) Clearly, the leg still needs to be straightened out a bit from this shot. 2) What looks like blood around the pin sites is actually just little plastic clips which keep the nice soft sponges over the pin sites themselves. Why the clips are red and not, say, blue or green, is beyond me. 3) The actual blood is from the incision to break the tibia and remove one of the bone growths. 4) Really isn't that bad, is it? At least not in this photo…

But rather thanks to this more innocent-looking bystander:

This boot, which placed on my foot in the OR for reasons explained below, is more or less evil incarnate. While some aspects of my hospital stay came home with me (i.e., polar fleece blankets the hospital let us keep, the frame itself, the tools needed to take care of the frame), the boot stayed behind. And good riddance.

The worry after placing the frame was that, due to the tendency to not hold my foot at a 90˚ ankle while lying in bed pumped full of pain medicine, my Achilles tendon would shorten or something, causing some problems down the line. The solution was the following set-up:

Foot in boot. Velcro straps attached to frame pull foot towards my head, stretching tendon and avoiding bad tendon problems. Ice packs help leg not swell up to extreme amounts.

The problem with that set-up was that, unbeknownst to us prior to my hospital experience, the bottom of my foot sports an impressive array of bone growths, which, combined with my blister from the Christmas Day walk and lots of pressure from the Velcro, resulted in lots of pain (I'd say up to a six or seven at points). After two days of having the boot and complaining about the boot (the most my complaints got me, at least for the first bit, was some time where the Velcro was removed to relax the pressure on the foot), Dr. Sundberg removed the boot.

This is what he saw:

Technically this is after two to three days of healing (for the first several days of boot-free foot, the pressure sore remained fairly constant, though it's started healing now). But still.

On the whole, my hospital experience was pretty positive (save for the foot, some of the food (their ability to prepare vegetables was…questionable), delays in being discharged on my final day, and one night where I got behind on pain medications). But at the same time, the whole experience with the boot was really not fun. Though I kept complaining, without a doctor's order, the nurses refused to remove the boot, which probably made things worse.

And that was more or less how my recovery began.

In Which I Meet the Frame

As should be fairly clear, it has been far, far too long since I wrote on this blog despite (I assure you) the best of intentions. As promised, the surgery was December 26, starting at roughly 9:00 AM and ending about noon. Heading into the procedure, my leg bore no Taylor Spatial Frame. Leaving the procedure, despite my unspoken hopes, wishes, aspirations, etc., my leg bore one very new, very attached Taylor Spatial Frame. At which point the blisters I got from my Christmas walk exploded in the most dramatic way possible, I got to experience the effects of narcotics first-hand, went through my first pin site cleaning (more on that later), eventually had all the tubes removed from my body, felt free, got clean and went home on New Year's Eve to our annual viewing of It's a Wonderful Life. At which point the deadline for college applications reared its ugly head and now, at last, free of things I need to do, I have time to relax, recover, and write the blog updates I've been meaning to write for a week or more now but haven't actually written.

First up: the surgery proper.

Truth be told, it wasn't the most exciting of mornings. I got up around six, we left the house shortly thereafter, drove to St. Paul, struggled to find a parking spot. Then we were checked in, rapidly whisked off to the pre-op waiting area, visited by the anesthesiologist and surgeon. Then it was off to the OR for the procedure proper.

The fuller version to report is that, for the first time, I got some say in how my surgery was handled. For all of my previous surgeries, I was under eighteen. This surgery, at a whopping eighteen years of age, I was legally able to dictate my own fate. Practically speaking, this means I repeated whatever my parents said—my father, after all, is a transplant surgeon with something like ten thousand years of medical training and my mother practiced as a nurse in the intensive care unit for a while. Most of this dictation came in handy during my initial encounter with the anesthesiologist (who, it should be noted, was simply incredible—on top of being incredibly nice, he did a wonderful job and after the procedure I had not a lick of nausea and no aftertaste from the anesthesia itself).

To set the stage: it is the morning after Christmas. I am nowhere near as groggy as I should be despite not actually having gotten a lot of sleep. I am also very well aware that this surgery is by far and away the most serious surgery I have ever had, which makes me very nervous. I am also very well aware, thanks to previous experience, that one option of going to sleep involves being jabbed with a needle. Needles scare me to no end.

My parents pointed out that I hate the other option, which is the gas mask. This is also true, since the gas mask involves being bombarded with one of my least favorite smells (scratch that: least favorite).

I ask the anesthesiologist if there's some more desirable alternative. After a bit of negotiating, we come up with a game plan: I'll be given some oral medicine in the waiting room which will calm me down considerably. Then, in the OR proper, the IV will be inserted. I agree.

The other discussion to be had prior to my surgery was with the surgeon, Dr. Sundberg, himself, to go over what the procedure would entail, if any modifications should be made, if we understood what was going on. Also, to complete the ever-important step of marking the future surgical sites on my leg with a purple Sharpie. I think, a week post-op, some of those markings still remain.

Now, there are two major things to note from my discussion with the surgeon:

1) Apparently, plans for these procedures are flexible within reason. Given that I was already going to be operated on, I wanted to see if we could possible remove some bone growths. Target number one was the little bother on my ankle which forced me to wear larger boots on my Christmas hike. Dr. Sundberg took one look at the growth I was pointing out and said he would remove it (he did). The other growth I wanted done with was a bit more problematic. It was a massive kneecap-sized thing just beneath the kneecap on my right leg which has given me grief because it made kneeling rather difficult and because I had serious aesthetic issues with it. While Dr. Sundberg couldn't promise to remove it altogether, he did at least reduce it somewhat in size. Since I haven't done a thorough enough investigation of that part of my leg yet, I don't know how reduced it is, but the improvement is substantial.

The large growth beneath my kneecap gets Sharpie'd

The annoying thing on my ankle does not get left out of the Sharpie action

2) Taylor Spatial Frames look considerably less scary when they are not bolted onto your leg. My frame tagged along to the discussion so my parents and I could get a sense of its dimensions and weight before it was attached to me. Here it is, pre-op:

Looking almost inoffensive…

Now, a quick note on how the Taylor Spatial Frame functions: The frame can correct leg deformity in an absurd number of ways. Developed by a math PhD, it has six struts. Each strut can be individually lengthened or shortened. The doctor plugs initial measurements into a computer program and the program then prints out a menu for strut adjustments (for example, my menu includes fifteen days of strut adjustments). The goal is for the two rings on the frame to be parallel by the end. Considering that the frame seen above is set to how my leg was before starting this whole procedure, well…my main thought was, there's a reason I'm doing this.

I also got to try the frame on for size:

Note how the thing doesn't touch my skin. Also, it looks much better without pins, incisions and blood entered into frame.

For those of you wondering how life, such as walking and wearing pants, works while wearing a frame, the answer is that both are doable. On its own, the frame weights about a pound and a half, though with pins added it's probably closer to two pounds. There's a definite weight discrepancy between my legs now, but nothing I won't be able to overcome once I'm weight-bearing. Also, many loose sweatpants will fit over the thing. Since I'm still in the early days of wearing clothes and a frame at the same time (most of my time with this thing has been spent in a hospital gown, which doesn't exactly count as clothing in my book), I can't really offer any particular tips.

With those festivities completed, it was time for me to swallow some decisively non-tasty liquid which would calm me down. Then, as promised, ten to fifteen minutes later, I was wheeled back to the operating room. Compared to November 2004, the first operating room I can remember being wheeled into, I was much calmer. Maybe that was just the drugs talking, or maybe I was just more mature, but the panic wasn't there.

The operating room, from what I can remember, was fairly manageable. I could recognize many of the people in there—the OR nurse, who had come by to see me and reassure me before the procedure, the anesthesiologist and even the lights were merely reasonably bright.

Rhino, the stuffed hippopotamus from all my earlier procedures, wears a hospital wristband around its neck (I've never been able to decide on a satisfactory gender for Rhino). The sticker, at that point seven years old, was fading. I asked my anesthesiologist for a new sticker. He obliged.

I think it was then that I was moved to the operating table proper. I can't remember if somebody else moved me or if they let me move myself. I do remember that my arm was resting on a little swinging extension of the table, which I thought was very cool. With the arm swung out, the anesthesiologist placed some sort of device on my wrist which made a noise like a soda can and sprayed foam on me, numbing the site.

Then the IV went in and the surgery began.

Before the procedure, my legs looked like this:

For bonus accuracy, this picture was taken shortly before heading back into the operating room (or because we forgot to take it earlier)

Every time I see just how crooked the right leg was, I'm stunned.

Thanks to this frame, it won't look like that any more.