A wee little surgery

I’ve seen so many orthopedists over the years that I’ve lost count. Yesterday, I went to a new one for my left knee which has bothered me since 1986, after a game of beach volleyball. I came away from that game with a Baker Cyst (a fluid-filled sac on the back of my knee) and was in so much pain that I could only walk slowly and with a limp for weeks. The limp went away, but the Baker Cyst often swelled to the point that it was visible. By 2006, my knee hurt so much that I had a surgical meniscus debridement, which didn’t help and during which (I was awake) the surgeon broke my heart by suggesting that I give up hiking. I’ve since been on various NSAIDS, had innumerable steroid injections, two series of orthovisc injections, and a RFA (radiofrequency ablation). I’m now to the point that I don't even take short walks, and even with that, I'm limping by evening each day.

Those of you who recall my three shoulders surgeries, might suspect that I’m a fan of surgery, and indeed I used to be. “Have a problem—cut it out and get on with your life,” I thought. And indeed, that philosophy worked for the first ten or so surgeries that included the removal of anal polyps, oral cysts,  tonsils, and a whopping neuroma on right thigh. Carpel tunnel repair was a breeze, the first surgery on my nasal septum didn't cramp my style, but that changed when it had to be redone at the Oregon Health Science University in Portland as a part of a massive surgery on my sinuses, turbinates, and septum. I had insisted on remaining awake for every surgery but the tonsillectomy. Then the day came when a surgeon took a biopsy of an osteonecrotic cervical vertebra by putting a scope through my throat, and she said there was no way she would do it with me awake. My combination hernia repair and lymph node biopsy was no fun either, and when the doctor refused to give me adequate narcotics, I went down to his office without an appointment and sat there until he did.

Then came those three shoulder surgeries that included such strange sounding elements as subacromial decompression, supraspinatus repair, biceps tenodesis, humeral head resurfacing, and a partial joint replacement. I was in such pain prior to these surgeries that I had to sleep sitting up with ice packs draped over my shoulders, and I was in such pain after them that I had to sleep sitting up with ice packs draped over my shoulders. I wasn’t even allowed to lift a toothbrush for the first six weeks after these surgeries, and nothing over five pounds for the next six weeks. The recovery time was between six months and a year, yet my shoulders still hurt so much that I worry that I might have to return to sleeping in a chair. 

So, I’ve lost my faith in surgery as a quick fix. In fact, I'll never again go into surgery with overwhelming confidence that I’ll emerge alive. After all, the odds of dying from a clot, a nosocomial infection, a pierced organ (a risk during shoulder surgery), a medication error, or the incompetence of any one of the scores of people who have the opportunity to kill me are significant.(https://www.usnews.com/news/articles/2016-05-03/medical-errors-are-third-leading-cause-of-death-in-the-us).

The new doc is tall, muscular, and dripping with testosterone. In Peggy’s words, “He’s full of himself.” Indeed, he needed a mop to clean up his arrogance. He walked briskly into the examining room, took my hand, and stood staring into my eyes as if sizing me up, but sizing me up as what—a man? A patient? I was already upset over a fight with Peggy about a missed highway exit, and feeling like a weakling because I’ve needed so many surgeries. This meant that I was hardly in the mood to deal with a doctor who seemed to regard himself as my overall superior about a problem that I’ve had since he was a lad, but since I had waited for months to get in to see him, I had to do my best. It helped that there were things about him  I liked. For instance, he introduced himself by his first name (Brian); apologized for being late; agreed to my requests (more about them later); is highly rated on the doctor-rating sites; and did his fellowship in adult joint reconstruction at the Anderson Orthopedic Research Institute. I considered his profanity unprofessional, but it certainly went with his macho shtick.

After a brief exam, Brian proposed a full knee replacement. I was agreeably surprised because, since I was a new patient, I had expected the same-old-same-old: a steroid shot, a prescription for an anti-inflammatory, a referral to physical therapy, and the words, “We’ll talk again in a couple of months.” 

I made four requests of Brian: that I could remain awake during surgery; that he would give me a steroid shot to help tide me over until August when I’m ready to have the surgery done (which is the earliest he can do it anyway); that he give me whole lot more post-surgical narcotics than I’m already taking (he said he would double the amount for the first six weeks); and that he give me a prescription for a brace. He agreed to these requests, but I didn’t get the brace because the one they had wasn’t as good as the two that I already own (I’m an hardcore hoarder of medical devices).

Brian is my second orthopedist this year. The first was Alex, and Alex advised against surgery because, as he put it, “Your arthritis just isn’t that bad.” Since this contradicted what every other doctor had said (ten years ago, one had even told me that my knee was in such bad shape that it might collapse out from under me), I asked Brian what he saw in Alex’s X-rays that might justify Alex’s opinion. “Nothing,” he said. “Then why would Alex say it?” “Because he’s unwilling to take on difficult cases.” “Me difficult—but why?” Because you’ve been in knee pain for a long time, because you’re in pain from other sources, and because you suffer from depression.” Such factors could put me among the 5% of knee replacement patients who surgery doesn’t help. 

I try to cheer myself by being grateful that I at least have access to surgery, there being millions of people and other animals who have no choice but to suffer until they die, and some of them will die sooner rather than later because their problem makes them unable to support themselves. Yet, I'm tormented by the knowledge that I'll be going  from being unable to do many of the things that I would like to do because I have a bad knee to being unable to do them because I have an artificial knee. That is why I've waited so long to have the replacement, that and the knowledge that in a mere ten or fifteen years, I would have to have the replacement replaced, and that there would be less hope that the revision would work as well. Brian did have good news on that score. He said that the two metal parts of the joint would last me a lifetime, and that the plastic part should last for many years after which it can be replaced in ten minutes. Maybe I did well to put the surgery off for all of these years, but I sure do dread it now. I suppose it makes sense that past surgeries would leave me less fearful of additional surgeries, but the truth is that they make me more fearful. I think of them as like playing Russian Roulette.