And now I am a bionic cyborg: Part II

Part 1 of this series told the events that led to September, 5. 2017, my Bionic Cyborg Day. This post, complete with pictures, tells the story of my operation and continues to the point when I’m walking—about four hours after hitting recovery—and peeing—another four hours or so.

TL;DR

Tuesday:
9:00 AM I arrive.
11:50 AM wheeled off to surgery
1:26 PM I’m in recovery
2:22 PM awake
4:05 PM out of recovery
5:30 PM achievement unlocked: walking (with a walker)
8:50 PM achievement unlocked: pee in a jar
10:21 PM achievement unlocked: 250 ml of pee!
Wednesday:
7:02 PM I leave
8:30 PM I’m home (at Alyssa’s)

9 AM I arrive

We arrive at the Faulkner at 9 AM. I register and go up to 6th floor orthopedic surgery. There I get checked in, they make a chart for me.

And after a brief stay in the waiting room, and a near-miss on my pre op protocol (Me: “Is there a water fountain around? I’m dehydrated.” Them: “Did you forget? Not even water for three hours before the operation.” Me: “Just testing you.” Not) I’m off to be prepped in pre op/recovery.

Prep

They issue me a bag for my stuff, a jolly blue johnny, and a pair of white boxer shorts to keep my dingaling from dangling. All jewelry comes off. My ring made off it at home with help from a little olive oil but I forgot the silver chain that I wear. Bobbi gave it to me (otherwise I’d never wear it.) That came off in the hospital and went in a bag.

They put in plumbing for an IV line. The red “Alergies” band is because once upon a time Vyvanse gave me an an erratic heartbeat. So careful.

And after I’m all prepped. Or maybe they put the magic anti-DVT leggings on me. They’ll be attached to an annyoning machine that has been my companion since. It flows air into little bladders that circle my legs and keep the blood flowing, so no blood clots. We hope. They let Bobbi and Mira come in and stay with me.

Everyone who talks to me starts by asking me my name and my date of birth. Except Mira and Bobbi. I’m at the top of my cognitive game and I get it right every time. Every single time.

And which knee, they ask? Right knee, right? A couple of days before the operation I went to a site that sells temporary tatoos and thought of getting one that says, “This knee!” and another that says “Not this knee, dummy” but I worried that the ink would have some bad effect. Or Dr. Fitz would be so not-amused that he’d cancel the operation. Good imagination. Low liklihood. Very high penalty. So no tattoo.

My anesthesiologist, comes in and introduces himself: Dr. Jong. Jason, he says. He checks name, date, and knee. Dr Fitz comes in and checks name, date, and knee. And he autographs the knee and puts some brackets on it. Somewhere along the line I get my knee shaved.

I meet the surgical nurse who will be attending me and several other staffers. I wish I’d written down their names so that I could acknowledge them individually. Everyone is terrific. Very friendly. Obviously intelligent and on top of their job. It’s hard to imagine how Bangor could have delivered more personal service than the Faulkner did. These guys were all great.

I got droidy back (Mira’s name for my Android) and took pictures and sent messages in the family Hangout. They’re all date stamped and from the painless real-time record I was able to construct the timeline for the procedure. Next time I have an operation, pictures of all the staff, along with releases so that I can use them in publication.

Off to the OR

The picture below is time-stamped 11:56 AM. I’m wheeled off to the OR, Dr. Yong at my head. Sadly, they won’t let drody in there.

Whee! Once I’m in the OR they move me from the gurney to an operating table. The table is narrower than I would have thought, but it makes sense. They want to get right at the patient, so minimal obstruction. A table next to mine is loaded with stuff. I see my very own Conformis kit, rows and rows of metal instruments, and…”Oh, look!” I say, pointing “There’s the drill. And there’s the saw.” I’m referring to the instruments that were featured in the video of a Conformis total knee replacement. Here’s a PDF of the surgical guide for anyone who wants a guide.

Dr. Jong has me sit on the operating table, and hunch over so he can inject a spinal anesthetic. Some probing. A pinch for a local so I won’t feel the big needle. Some more probing and he tells me that it’s done. I lie down. I don’t feel any different. I try to wiggle my feet. They wiggle just fine. Then they don’t wiggle quite so well. Then I have to try really, really hard to wiggle them even a little tiny bit. Then no amount of intended wiggling produces actual wiggling.

Meanwhile, my arms are being spread on attachments to the operating table, crucifixion style. Someone run an IV line into my plumbing. They do other things, but my memory is getting hazy. The last thing I remember: “I feel burning in my left (plumbing) hand,” I say. “It’s getting stronger.” “That’s OK,” Dr Jong says. “It’s some medication we gave you to…” And I’m out.

Blackout. Not fade out. Blackout.

Recovery

Next, I’m awake and in recovery. Not wide awake and chirpy, but not groggy either. I feel fine. Except I can’t move my feet or wiggle my toes or feel anything below my waist. I reach down and check my package. It feels like a floppy toy, not a body part. Kind of fun. I chat with the nurse attending me and practice toe wiggles, and she pokes me for sensation checks, and I do occasional package checks. Things keep getting better. And soon it’s all kind of normal.

After a while Bobbi and Mira show up. With droidy! And there’s my knee. There’s a plastic square over the area and a tire patch over the kneecap, and that’s it. No dressings to change. No redness. Some inflamation. But it’s done.

And there’s me, at 2:22. Remember, I went in to the OR at about noon. So this is just an hour post surgery, doing fine.

And then at 3:19, just a little sleepy.

To room 702

And then, just a bit later, awake, droidy in hand, I’m ready to go to my room

They wheel me off to my room on the 7th floor. Room 702. Whee! (Part 1; Part 2) that would be my home for the next 26 hours, or so.

First walk

And then at 5:30 PM, just four hours after surgery, in comes one of the physiotherapists to take me for a walk.

“Will it bend,” Alyssa wonders. It does. You can see the ant-DVT stockings in this photo, fine.

And I’m off on my first walk at 5:32 PM

Then exhausted by my triumph, I crash. Watch cap on my head and over my eyes. Sleep mask to make sure no light gets in. CPAP for breathing. I’m folded up and sleeping, at 8:24 PM.

Pee achievements

Later I wake up. And at 8:50 PM, I unlock an achievement. I pee in a jar! I am beside myself with excitement. Not.

At 10:21, I’ve got the hang of peeing. I unlock another achievement: 250 ml of pee.

Daniel sends me a series of celebratory gifs. This is the best of the lot.

I pass out again. The next day I’ll sleep, take medicines, and continue my rehab and by night I’ll be back home at Alyssa and Konrad’s.

To infinity…and beyond

As I write this it’s a week and a day since surgery. I’m pain-free. Well, pain-free if I don’t push things. I can walk without crutches, without a cane, and without a limp. Not very far. But still. I’m not where I was before the operation, but way beyond where I thought I’d be.

Stay tuned for the next chapter.

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And now I am a bionic cyborg: Part I

I’m a bionic cyborg. I’ve been a cyborg for a while. Recently I wrote that I was looking forward to my bionic future. And to the pain, suffering, and stupidity that would accompany my transition. Well, it’s done. I’m a bionic cyborg and the pain, suffering, and stupidity are past and were far below expectations. Here’s the story.

TL;DR

At 74.68 years old I got my knee replaced by Dr. Wolfgang Fitz at Brigham and Women’s Faulkner Hospital. In at 9:00 AM on Tuesday. Back home, walking with crutches, Wednesday night.

A little more detail:

Tuesday:
9:00 AM I arrive.
11:50 AM wheeled off to surgery
1:26 PM I’m in recovery
2:22 PM awake
4:05 PM out of recovery
5:30 PM walking (with a walker)
Wednesday:
7:02 PM I leave
8:30 PM I’m home (at Alyssa’s)

It’s Sunday night as I write this, and Monday as I edit it. My brain is not 100% but good enough to write this; I’m in no pain sitting or walking; and I’m walking without a cane. (Though carefully, for short distances, on level ground).

But still!

Now the full story

In the beginning

When I was in my 60’s and tried to kneel for a tea ceremony in Japan I found that my right knee was not kneelable. When I tried, my knee produced a spike of agonizing pain. But how often did I have tea ceremonies? No biggie.

A year or two later my knee gave out while I was shoveling the driveway. I fell to the ground and literally screamed. Yes, I know what literally means. The doctor told me I had a torn meniscus. It had ragged edges that were getting caught between the bones as they turned and…yeeeaaaaahhhhhhhh! But how often did that happen? Turns out that the answer is “often enough.” After few near-screams I opted for arthroscopic knee surgery to get the ragged edges cleaned up.

A few years later, I hurt my knee again. They did X-rays, told me that I was bone-on-bone in my right knee and a candidate for knee replacement. But there were other options. I took another option. They injected corticosteroids and hyaluronic acid, a knee-grease made from rooster combs. After some weeks I was able to move normally. But the problem would only get worse over time.

I year or two later I hurt my knee again. I got the injections, but they did not take, so I started making appointments with surgeons. Their schedules were backed up for about three months which was a good thing because by the time I was able to see my first surgeon, time or the injections had gotten my knee back functioning. But still.

About two years ago I injured my knee again, then hurt my back. The combination put me in the emergency room twice in two weeks. I never go to the emergency room. Never. It took me several months to recover from the back and longer for the knee. Plenty of time to see surgeons.

I’d learned, from dealing with Bobbi’s back pain, that I could only get answers by talking to a lot of people, reading a lot on the web, and asking questions that extracted information a bit at a time. I saw six surgeons before I saw Wolfgang Fitz, the doctor that I eventually picked. Five of them were mostly useless. I’m sure that they knew things and could do surgery like champs, but I wanted someone I was confident in, not just someone with a certificate. Most told me little that I hadn’t already learned from Wikipedia. One exception, Dr. Stephen Walsh in Bangor, told me that I was bone on bone in one compartment, but not the whole knee. So I could get a partial knee replacement rather than a total, with less cutting, faster healing, better flexibility. But there were tradeoffs. I might later need a total anyway. He walked me through the imaging so I could see what he saw. Why didn’t any others suggest that? Or propose it and then explain why they rejected it?

I really liked Dr. Walsh—he was a bright, personable guy whose undergraduate work IIRC was in engineering. He had my kind of vibe and I seriously considered him if I could not find anyone in Boston that I liked. I asked him about the tradeoffs between Bangor and Boston, and he was helpful a second time. He said that in Bangor I’d get more personalized care, and in Boston, the latest technology. I asked him what that technology might be, and he told me about Conformis—a customized knee implant built on a 3D model from a CAT scan of my knee. For a tech guy, that sounded at least interesting.

Many vectors point to Dr. Fitz

So I Googled conformis and found conformis.com and a lot of links to background reading. I learn that they had some early problems, long since solved. I looked for surgeons who used Conformis. None in Maine. In Boston there were many, and Dr. Fitz was one of them. This was his third time on my radar. Jacques Gagne, at the rehab center at Blue Hill Memorial Hospital, had both his knees done by Fitz. ProPublica is a public service organization that—among other things—scrapes Medicare data and produces scorecards for surgeons and hospitals based on outcomes for six different kinds of surgery. I’d looked to see who was good for knee surgery, Brigham and Women’s was, and still is the best in Boston. And Doctor Fitz was the best at Brigham and Women’s—and in Boston. So Conformis. Jacques. ProPublica. All pointed Fitzward.

Meeting Dr. Fitz sealed the deal. Of all the surgeons—seven of them now—he was the only one who gave me this sensible advice: whatever else I did, exercise my knee until surgery. I was getting surgery sooner or later, and it would speed my rehab. He told me to get on a recumbent bicycle, starting tomorrow, set it to zero resistance pedal for half an hour and increase resistance a week at a time. Made total sense. Why was he the only one who said that?

He also told me that he could do my knee now—I was qualified—but it wouldn’t give me much benefit. I wasn’t feeling any pain, and my range of motion was about as good as it would be post-surgery. I might also wait for it to get worse before he made it better. He also told me that a partial knee was possible, but he wouldn’t make that decision until he had better imaging. So I decided to wait. And I got on my bike.

About six months later the knee went again. I put myself in Dr. Fitz queue, three months long, hoping that my knee would recover by the time he got to me. He scheduled me for imaging at Brigham and Women’s Faulkner hospital—to decide on a partial and to capture my knee for Conformis. Afterwardhe called me and said that my knee was too far gone for a partial. So total it was. In another couple of months. If it didn’t get better.

It didn’t get better. It got worse. I could still walk long distances, but after five to fifteen minutes my knee would lock up and I’d find myself limping. I could stop, then painfully bend my knee to unlock it and then walk some more, but more painfully. It was annoying. And did I say painful? Painful.

Preoperative

Dr. Fitz scheduled me for a preoperative visit two weeks before surgery at Faulkner. They were very thorough. They started with series of videos that introduced some of the staff, told me about the facility, and what I should expect during and after the procedure. Two very capable, smart, and personable ladies took a thorough medical history, including all my medications. I got an EKG. They drew blood for a panel of tests. They took swabs to check for MERSA and told me that I’d have antibiotics prescribed if the tests were positive. They told me that ( with, what I think was admiration) Dr. Fitz was very particular about how things were done and he got great results—which I already knew from my research. I went upstairs and got new X-rays of both knees.

Before I left they gave me a detailed set of instructions. Stop these medications a week before surgery. These are OK to take until the day before. This is OK on the day of. Nothing to eat after midnight. Only water or clear liquids the morning of. Nothing three hours before. Not even water, which I nearly slipped up on. They gave me a hexachlorophene soap solution with instructions to shower with it the last two nights before the operation and the morning of.

No worries

Was I worried? Not really. I knew there was a risk, and I knew that it was low. Besides, I’d stopped worrying about dying on 9/11. I was flying that day. The night before I had decided to stick with my original ticket, a low-cost one-hopper through Chicago, rather than spending a few extra bucks of my employer’s money and switching to the United non-stop from Boston to Los Angeles that I would usually have taken and that would have landed me early, in flames, in the World Trade Tower in New York. When I got off the plane in Chicago and saw the towers in flames my first thought was “Argh! That could have been me.” My second thought was “If it was me, not my problem.” So I stopped worrying about my own death. It’s never going to be my problem. Dying might be my problem. Other people’s deaths might be my problem. But me dead? Not my problem at all.

Operation Day

The weekend before the operation the whole family got together for Labor Day weekend in Chebeague Island Maine, where we’d spent many lovely weekends with our friends Tom and Peggy Rothschild and their family. Bobbi was now 75. I would soon be (if I didn’t die). So the kids thought it would be nice to celebrate this way.

Daniel, Dana, and baby Siena flew in from the coast. Mira, John, and their kids, Kaya Lucas, and Tasman drove up from Acton. Alyssa and Konrad and their kids Michael, and Sylvia drove up from Somerville with Daniel, Dana, and Siena. It was great to have everyone together in this wonderful place full of family memories and to introduce the new members of the family (all of the kids and most of the husbands) to the Island. I idly thought that if I did die the next week it would be a poetic ending. The whole family gets together to see me one last time. Then I sail off into the great unknown— as sadly Tom had 10 years ago. This was the kind of the strange fantasy that my mind conjures up from time to time. Nothing serious. Kind of amusing to me. But I did not share this with the kids until now. One or two might have been amused. Most would not have been, and probably still are not.

Bobbi and I drove down to Boston on Monday with Dana, Daniel, and Siena, spent the night at Alyssa and Kon’s and on Tuesday, bright and early, we took a Lyft to Faulkner. As usual, I got in the front seat to talk to the driver and see what I could learn. Ebrick was from Haiti. He had a strong accent and a ready smile. He’d been in the country for eight years, worked as a driver for another company and drove for Lyft to pick up extra money. After years of painful headaches, he’d gone to the hospital and found that he had blood leaking into his brain and that he needed surgery. The surgery was done at Brigham and Women’s. He’d left surgery with garbled speech, sometimes unable to even find the words he wanted to say, so he went to rehab to learn how to talk again. He recovered. I’ll say! He talked nonstop. Fortunately, Ebrick had healthcare through his regular job. Otherwise, this father of two and productive worker would be in continuing, agonizing pain, or dead or—well, who knows.

At two minutes before 9:00 Ebrick dropped us at the Faulkner, and I was ready for the next part of my journey.

Which I will tell you about in the next post.

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