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We can rebuild him … we have the technology

A shoulder replacement ended up with an unexpected heart attack. Now Dan braces himself as he embarks upon an ankle replacement.

Well, here we are again folks. One week from today I will be on my way to the hospital for yet another joint replacement. This time I will be losing my right ankle and inserting a metal one instead. Ankle replacements are much less common than hips and knees, so I’m going to become a member of an exclusive club, it seems. I already have three joints replaced, so this will be the fourth. Considering there are about 200 major joints in the body, I’m going to be approximately 2% machine. I wonder what the world record is for percentage of the body being replaced (while still being considered a human). Whatever it is, I’m sure I’ll break it someday.

Seeing as how this is just the latest in the long line of surgeries, you’d think I’d be old hand at it by now. You might think I could simply pop in, get cut open, have a few days rest, and pop back home to recover. Unfortunately, each time I go under the knife, it’s as if I am undergoing surgery for the first time all over again. Let me explain to you just how the day of the operation goes, for those who have been lucky enough never to experience a stay in the hospital.

Most of the time, the actual surgery is scheduled for a time before noon. Many surgeons like to start very early in the morning, I assume to make sure they can get in as many procedures as possible before they get tired. This is the norm, but by no means is it a hard and fast rule. I have had procedures that have been scheduled for dinnertime. Frankly, I prefer a later time, as it makes one day in the hospital go by much faster than if you are out of surgery before lunch. Either way, you must arrive at least three to four hours before the scheduled time. This is not only to give you enough time to get ready for the surgery, but to allow for any changes in schedule that arise because of a previous patient’s medical complications.

During the hours you await your turn in the OR, you will likely die of boredom if you don’t make sure to bring something to do.  Most of the time is just spent waiting; the actual surgical prep takes only a half-an-hour at most. During the prep, you are shaved (if need be), an IV is inserted, and you are given a gown to change in to. After that, unless there are some special instructions given, you are pretty much ready to go. So, you wait. And you wait. And you wait some more. And finally, if you are lucky, you walk to the OR and get up on the table.

Once you are on the table and secured, the anesthesiologist comes in and tells you he is going to give you something to “relax.” He then pushes something into your IV, and that’s about it. Before you know it, you are either asleep for the duration, or put into a twilight sleep while your surgery is performed. That’s about the extent of surgery, and once you wake up in recovery, the annoying part begins – waiting to be discharged.

So, this is what I am in store for on Monday. Like I said, just because I have done it before doesn’t make it any easier to face. Those of you who read my column know that last time I went in for a “routine joint replacement,” I ended up having a heart attack and losing 20% of my heart muscle function. You can’t ever take anything for granted when it comes to a hospital stay and you must always treat it as a serious event. 

As I said, not many people get ankles replaced. In fact, most people get their ankles fused, which means exactly what it sounds like – the bones in the ankle are fused together in order to prevent the joint from moving, and hopefully, prevent it from hurting. Unfortunately, it makes you walk a little like Frankenstein. My ankle is being fully replaced because it has already fused itself.

When you have an aggressive case of Rheumatoid Arthritis like I do, joints are frequently swollen for years at a time. Because the swelling means increased blood flow, this increase of circulation results in increased bone growth. My right ankle has overgrown to such a point that it is literally a blob of bone. Unfortunately, somehow, somewhere during the fusing process, the right ankle curled under toward my left foot so that I am basically walking on the outside of my right foot. So much so that, in fact, I have formed a callus. Because my gait is being thrown off by the position of my right ankle, my hips, my back, and countless other joints are being affected. Apparently, if I don’t have the surgery now, it may result in irreparable damage to the rest of my body. Since the ankle can’t be fused, replacement was the only option.

So here I am, waiting for the surgery date to arrive. Frankly, I won’t lie to you all and act like I am facing this surgery with all the composure and stoic bravado that I am supposed to. I honestly don’t want to have this procedure done. I don’t want to get the pre-op testing, I don’t want to wait for the anesthesia to take effect, I really don’t want to spend four days in some crap hospital room, and I certainly don’t want to spend six weeks in a cast. Because of this, I have really had some trouble getting ready for this particular procedure. Sleepless nights, breakdowns, bad days – I’ve dealt with more than my share this time around.

So, it’s now six days until D-day, and I sit here and put my thoughts to paper for all of you to follow. As usual, I will be making entries in my column, but I will also be posting an ankle replacement special, this being the first entry. Since there is not much info out there on ankle replacement from a patient’s perspective, it should help those who have to deal with it, and those who don’t might get a better understanding of what some of us have to go through. So stay tuned, and check back when you read my bi-weekly column for another entry in the ankle replacement blog. See you guys on the other side.

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