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No Witnesses

March 29, 2013

I returned home from my appointment. My husband was sitting in his recliner reading the local paper.

‘So, how’d it go?’ He inquired.

‘The doctor said I am amazing‘, I told my husband, ‘and, he said it twice, so I, for one, believe him, after all he is a well educated, well respected man, so he knows what he‘s talking about.’

‘Oh really,’ Jim said. Normally, he doesn’t usually believe me when I say these things, no matter how truthful they may be. And this was no exception.

I had knee revision surgery on February 26th, then came down with a cold while I was still in the hospital. After that, I wound up with a hospital-acquired C. diff infection, a very nasty gastro-intestinal infection with all the usual GI symptoms. It occurs when you take antibiotics. The antibiotics mean well, but they kill off too many of the good bacteria in our bellies and then the evil little microbes like C. diff go forth and multiply with absolutely no regard whatsoever for the wellbeing of the host.

And, for the record, this infection was much harder to deal with than the rehab for my knee.

After a month, I went in to see my primary physician to recheck my hemoglobin and assess the status of my infection. The appointment went something like this…

Dr. Donolan reviewed my labs from last Monday, when I was in for the C.diff infection. My hemoglobin had soared from 9.1 on March 1st to 13.1 (in the normal range) on the 18th. He was most amazed by this fact, which was proven by lab tests(that’s laboratory, not Labrador, by the way).

I had a lot of bruising with this surgery…more than I had with the first replacement, and I had a quite a bit back then. Since I’d had significant bruising with the first surgery, I didn’t know it was excessive. I figured that out when the nurse at the rehab center gently turned back the sheets to check my incision and exclaimed, ‘Holy Mackerel, Woman!’ My leg looked terrible…angry purple bruising and swelling from mid-thigh clear down to last joint on my middle three toes. The only portions of my leg weren’t discolored were the front of my thigh, my big and little toes and the sole of my foot.

But, odd as it sounds, all that bruising turned out to be a good thing…my body was reabsorbing and recycling the hemoglobin. That explained why my hemoglobin came back up so quickly. Usually, it comes up about a point per month. Mine went up four points in two and a half weeks. ‘No wonder you’re tired,’ explained Dr. Donolan, ‘that takes a lot of energy. Amazing.‘

My white count was also right smack in the middle of the range. That impressed him, too, given the infection. At least it hadn’t gone systemic.

‘You are amazing…simply amazing,’ he uttered repeatedly while scrolling through the lab reports on his laptop.

I humbly thanked him and fervently wished that my husband had chosen to come with me to this appointment. As it stood, I had no witnesses. Dang!

Since this surgery was a revision of my first knee replacement, I had a fair idea of what rehab would be like. I’d walked this road before…just two and a half years ago…first with a walker, and then a cane, and finally, on my own two legs.

My first artificial knee, for some unknown reason, became loose after about a year…they called it aseptic loosening, meaning that it was loose but not infected. I’ll probably never find out why it loosened, so I’m not wasting my time on trying to figure it out. Life is too short for that. The doctors said that it was never in danger of ‘catastrophic failure.’ I got scared when it started acting up when I was going down stairs. That’s when we figured it was time to bite the bullet and get it fixed. This time, I insisted on a low-nickel-content implant. Just in case my allergies were somehow to blame. You never know.

I was determined to do my part; I prayed for the strength and stamina I would need. I wanted the absolute best result possible, so I was going to physical therapy twice a week and doing my exercises twice a day at home. According to the doctor and my physical therapist, my knee was well ahead of the game. At nine days post-op, I had a better bend than I ever achieved with the first implant. Another indication that the first one wasn’t ever right.

Recovery was not without it’s challenges, though, aside from the C. diff infection. The ankle on my surgical leg was bothering me…hurting quite a bit. Sometimes it was more painful than my knee. So Terri, my physical therapist asked me to request an ankle assessment from the doctor at my next appointment.

I began by explaining my symptoms. Dr. Donolan asked the usual questions…he examined my ankle and asked if there’d been any injuries. I had to admit that there’d been a few incidences where it could have suffered damage. Then, as any good doctor would, he asked me to explain…

First, I said, at age six, I was learning to ride my new bike, and doing pretty well, too, until my older brother tried to scare me by riding really close to me. He was on my mother‘s childhood bike…the one with the questionable steering and brakes. He got a little too close, and my littlest toe got caught in the spokes of his back wheel. My bike fell to the left, and his fell to the right. Since my foot was caught in his spokes, I was sprawled somewhere across the middle. My toe was nearly torn off, and it‘s reasonable to assume that my ankle might have been wrenched in the process.

It didn’t help that I was wearing rubber flip-flops at the time. You’ve got to remember that this was the sixties…we didn’t wear seatbelts back then either, and car seats for babies were flimsy little seats with cute little red steering wheels on them to entertain the child. They hooked over the front seat and lifted the child up so that he or she could have a seat with a view, and therefore be less likely to become fussy. Safety wasn’t even a consideration. We’ve come a long way in the last fifty or sixty years!

The second injury occurred when I was twelve. It was my first significant knee injury, and again, it makes sense that my ankle might have suffered collateral damage. My younger brother and I were racing our bikes down the alley and I crashed into a fire hydrant and wound up face down in the gravel.

By this time, the good doctor was trying really hard not to smile.

Thirdly, I told him about the time we were at our local big box building supply store loading insulation board into the truck, intending to weigh them down with an exterior door with a large window in it. Now, the supply yard was set up so that you showed the guard your receipt and he’d tell you which aisle to drive through to load your purchases. In this instance, the first of our purchases we found was the door…the item we wanted to load last so it would hold all the lighter stuff down. We didn’t want to circle back around after loading the lighter stuff, so we propped the door up against the passenger side of the truck and continued on foot to look for the insulation board.

There’s not a lot of room to spare in those aisles at the building supply yard. Customers are expected to drive their vehicles down the center, leaving room on either side for others to get at the merchandise and load it into their trucks. We had the misfortune to be in front of a very impatient man. This man began honking his horn and swearing at us…yelling at us to hurry up, get out of his way. It was uncomfortable…unnerving to say the least. And soon, Jim got fed up and decided to move the truck and diffuse the situation before it escalated further.

At the last moment, I saw the door start to fall. Naturally, I ran to catch it. Only I fell a little short…not quite reaching the door in time. It fell, and the window end of that heavy door smacked down solidly on the instep of my right foot, smarting like crazy. Jim helped me into the truck and he quickly finished loading our purchases.

On the upside, the glass didn’t break, and neither did my metatarsals (we stopped at Urgent Care and got an x-ray on the way home).

The doctor was listening intently…still trying not to smile, and refusing to make eye contact with me.

Lastly, I told him about the time Jim and I dropped a loaded boat on my foot.

That was the final straw for Dr. Donolan…he threw caution to the wind and laughed aloud. It’s always good to know your doctor has a sense of humor…I think.

In a nutshell, the weather was miserable, and the fish weren’t biting, so we decided to cut our fishing trip short. There’s just no fun to be had when you’re wet, cold, bored, and cranky. Especially when you’re with two others who aren‘t nearly as cheery as you are.

We had some trouble hooking the trailer to the ball hitch on the truck. It wouldn’t open up to accept the hitch, so Jim propped it on a chair and tried to whack it with a hammer to make it work. A fine idea, indeed, right up until the tongue of the trailer slipped off the chair supporting it and fell on my foot and fractured three of my toes. Again, you can see how my ankle might have been compromised.

Dr. Donolan wiped the tears from his cheeks before he walked me over to the x-ray department, saying that after all that, he expected to find an old fracture and maybe some arthritis.

When he saw my x-rays, he was even more amazed. And he said so. Twice. And I still had no witnesses.

He saw no evidence of old fracture on those x-rays. There was no arthritis. My ankle bones were fine. Joint spaces are nice and even. There was no evidence of trauma. He made his diagnosis…ankle pain due to soft tissue injury…my ligaments had stiffened to protect my ankle and simply stayed that way. He said I had a lot of guarding on examination.

My ankle would improve with Physical Therapy. I was instructed to ask for ankle stretches at my next therapy appointment. And to tell the therapist she could do anything she wanted to my ankle.

‘Amaziing!’ Said the good doctor.

I agreed.

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One Comment
  1. Greg Frosig permalink

    You are interface truly amazing, Karen! Happy Easter !

    Sent from my iPhone

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