Friday, 23 March 2018

Knee Arthroscopy – Part Two The Operation

Leaving aside dental work, the last time I had had any form of surgery was as a teenager and the last thing on my mind back then was to avoid being ill beforehand. However, it is an unavoidable hazard of living in my house that between the months of October and March there is a continual cycle of colds, illness, infection, viruses and flu that bounces from child to child and very often to an adult in between. Not wishing to have my knee surgery postponed and therefore have my recovery eat into the spring and summer, I therefore spent the first three weeks of January cramming oranges and Berocca down my neck, washing and dressing my two children at arm’s length and scrubbing my hands so vigorously that anybody witnessing my day to day behaviour would be forgiven for thinking that I had an extreme form of OCD. As such, I just about achieved my aim, though around three days before the operation, I developed a sore throat, which meant that there was a chance of cancellation due to the fact that as a registered asthmatic there was an unnecessary risk posed by my having a general anaesthetic. With this in mind, even as I was shown to my room in the hospital, there were no guarantees that everything would proceed as planned. Once I had been examined by the nurse, the physio, the consultant and even asked what post op meal Id like (courtesy of BUPA) the anaesthetist finally came into assess me. 
“No problem,” he replied briskly, “we’ll give you a spinal block instead. As it’s knee surgery that will shut off the pain and there will be no risk to your breathing as we won’t have to proceed with the general anaesthetic.”
“Great, that makes me feel more relieved,” my wife said. “Right, I’m going to get back so I can pick the girls up from school. See you later.”

Leaving me to contemplate the idea of being fully awake and conscious in an operating theatre whilst my knee was sliced open, she disappeared. I didn’t have long to ruminate on this course of events because within a few more minute a couple of people arrived to escort me downstairs to the theatre. The process was that firstly I required a cannula to be inserted into the back of my hand and this is where the fun really began. As I sat there on the side of the operating couch I realised that not only was I incredibly hungry, having fasted since eight that morning, but also dehydrated - typically I neck water copiously throughout the day but in this case had not had anything to drink for three hours. To say I was light headed would be an understatement, but as I felt the nurse start to fiddle with my veins I remembered how squeamish anything like that makes me feel and knew it spelt trouble. 
“Fuck,” I remember thinking quite clearly as the needle went in.
“What are your children up to today?” the anaesthetist asked, trying desperately to distract me from the sharp instrument being crudely jabbed into my hand right below my eyes.
“Er, at school,” I replied absently, not really able to engage.
“Now just try and relax your hand sir,” the nurse said, indicating that his first attempt had been unsuccessful. I tried my best to relax my hand, something that is more or less impossible when another fat needle is about to be forced into the same vein that has just rejected its first attempt. My head started to spin as I looked at the clock and realised that I had nothing in the tank.
“Sorry I feeling a bit light headed,” I murmured, hoping that they would take this as code for “I’m likely to pass out.” They didn’t cotton on.
“Please try and relax,” I heard him say as the needle went in for the third time and I felt the same grim sensation of veins and pain. I could tell from the smattering of blood over the wires below that his clumsy efforts were failing spectacularly.
“I didn’t sign up for any of this,” I thought as I blacked out completely.
Shortly later, I came to, realising that I had an oxygen mask on my face and I was now lying down.
“Wow, it’s over,” I thought. “They’ve done the operation. Great!”
A horrible stabbing pain, this time in the back of my right hand told me otherwise. I had simply passed out briefly and a different nurse had just successfully managed to get the cannula into my other hand whilst I lay there.
“Urgh,” I murmured.
“Are you okay?” Someone asked.
“Yes fine,” I lied. “Sorry about that.”

Having had to be revived simply from having the IV fitted, I sheepishly got back up and was then made to lean forwards so that they could get a shot to my lower back. I then realised that I hadn’t told them about the ruptured disks in the L4/5 region of my spine and the fact that they were asking me to get into what was precisely the worst position for my condition. However, I was too light headed and frankly traumatised to put together any form of protest.
“Argh!” I groaned as another needle was ploughed into the base of my spine. Ignoring the derisive noises that the staff were clearly making at my lamentable efforts at coping with what I had assumed to be a relatively routine sequence of preparation, I lay down, wondering what fresh horrors lay in wait. It was not lost on me that I had yet to enter the theatre itself and was already in a world of trauma and discomfort, made all the worse by the fact that I could hear every word of their conversations with words such as needles and knives being loosely thrown around as if I were actually asleep.
After a couple of minutes, the anaesthetist started spraying water on my legs to ascertain whether the injection had completely numbed the feeling yet.
“There?” he asked, squirting at my thighs as if they were a hanging basket in July. “And there?”
“No – but I could feel something down there,” I added, alarmed at the speed by which he seemed to want to get me off his desk. “Let’s just make sure, shall we?”
“All good to go,” he announced briskly, ignoring my frantic efforts at slowing things down, clearly with more of a eye on their theatre schedule for the rest of the afternoon. The doors burst open and I was wheeled in beneath the bright lights, entering a chamber that quite frankly I had not really expected to see. As far as I am concerned, the operating theatre is a place for specialists dressing in green gowns and blue masks, something that we the public only get to see if we have an interest in medical documentaries (I really don’t have any interest in them, finding it quite repulsive to see people being sliced open and their organs played around with like Mr Potato Head).
“Right,” said my consultant, who had suddenly appeared. “Would you like me to turn one of the monitors around so you can watch the procedure?”
I withstood the temptation to respond with, “No, I would rather staple my arse cheeks together with one of your surgical devices,” I simply fixed him with a stare that was sufficient for him to realise that my level of medical curiosity was in the negative scale.
“We’ll put a screen up so you can’t see what’s happening,” came a voice.
“Great,” I muttered. “My wife would be interested in seeing it. Not for me though.”
Much to my distress, there was a sharp pain as the first incision was made, before something was administered into the cannula which was likely to have been valium or something similar. For the first time since I had arrived at the hospital, I relaxed, drifting almost space like into a state of nothingness whilst they worked away at my knee.

The next thing I knew, I had been wheeled out of the room into the corroder outside, where a woman in a mask began to tell me all about her children.
“Could I have some water please?” I begged feebly, feeling like I had just been revived in the Sahara desert. She fetched me some water and a straw to drink it from, whilst continuing to explain how much they stressed her out. Of all the topics that could have been used to try and distract and relax me, children would not have been anywhere near the top of my list I reflected, before they finally took me back up to my room.
With my iphone for company and a large jug of water, I was left to recover and start to make sense of what had just happened. It was then that I realised the extent of the spinal block: as I lay there, the entire of my bottom half from my waist down was in complete paralysis. It felt like a solid block of rubber.
Panicking, I tried to lift the tips of my toes, something I was only just able to manage using my hips as a lever. I started to pinch my thighs, only to find them unresponsive – complete dead-weights without any feeling. As I did so, my right hand flashed with pain and I realised the cannula was still stuck in and had knocked against the sheets. My left hand was also sore where the three unsuccessful attempts had bruised the vein. All in all I felt a complete wreck.

After an hour of lying there, my sandwiches were brought in and I was checked by the nurse, who informed me that I wouldn’t be allowed to leave until I had walked upright and been to the toilet. By this stage, I was able to move my feet up and down, though the feeling was still completely gone from my knees up to my waist.
“It will wear off from your toes first and work its way back up,” the nurse said, as I frantically began to Google how long spinal blocks take to wear off.

At seven in the evening, I asked to sit on the side of my bed to try and get some blood flowing back to my legs, though was warned not to try walking by myself by the nurse. Stupidly I then attempted to stand and immediately found myself wobbling alarmingly before grabbing hold of the bed rails and vowing not to try that again in a hurry. Thirty minutes later my wife arrived and with the feeling starting to sour down my legs I made a successful effort at walking to the bathroom, where I sat down on the toilet and then realising that I wasn’t exactly sure how I was going to go. Usually having a wee is something of an automatic process, but in this case all the equipment required to execute this essential activity from the bladder down was still in a state of complete paralysis, being right in the immediate zone of the injection and therefore being the final part to wear off. In desperation I turned the tap on and closed my eyes, willing nature to take its course, which after a minute or two it did. 
Having ticked the two requirements off and not wishing to have to spend a night in a hospital bed, I asked my wife to call the nurse and I was given my painkillers and to my blessed relief had the cannula plucked out of my hand, the brief sting being replaced by a feeling of utter bliss.

And then, supported by a walking stick and armed with a bag of paraphernalia, including surgical stockings, rehab advice, dressings and painkillers, I went home.

Monday, 19 March 2018

Knee Arthroscopy – Part One The Background

Was it years of playing cricket, rugby and football that did it? Probably a contributing factor. How about the few years working on building sites and lugging things around that were far too heavy for my frame? Definitely a cause. And more recently, the extensive landscaping clearance on my house, filling multiple builder’s skips with stone and rubble, having dug out countless tree roots and levelled the back garden.? Certainly the final straw.

I have always been injury prone and it is only in recent years that I have tried to get exclusively to the core of these issues in an attempt to do as much as possible to extend my shelf life as an active being and understand the problem. Since my early twenties my back had been playing up and then at the age of 28 I finally had an MBR scan which showed two discs bulging in the L5 section of my spine. Sporadic acupuncture did little to solve the issue and in desperation I sought the help of a chiropractor who happened to practice just down the road from my house. His positive mindset immediately helped and I was able after several weeks to start exercise again, slowly building up to running and lifting weights and understanding the muscles I needed to work on to strengthen my core (whilst actively avoiding the things that tended to exacerbate the issue). My right knee was another long-term casualty, having always been slightly more susceptible to twinges, strains and aches. During my acupuncture sessions I was briefly diagnosed with plantar fasciitis which was apparently caused by my right leg being ever so slightly shorter than my left, meaning that I was advised to wear (very uncomfortable) heel inserts to try and bring the legs straight. The problem was that my posture was not correct at the time of measurement so the inserts did not properly help, but it did point to a possible cause for my knee pain, especially when considering that as a outside half / centre I used to boot a rugby ball fairly hard and also almost exclusively used my right foot when playing five a side football or training at University. Indeed in recent years when I have been messing about with a rugby ball I have forced myself to kick with my left leg and have noticed how technically correct I am and how gently I strike the ball when power is taken out the equation.

It was the summer of 2015 that I really felt my right knee start to click badly following the gruelling landscaping work on my back garden and then the following year it would continue to cause me issues when kneeling down with the girls in the playroom, especially if I had been running long distances. Last year I entered myself in the Wolf Run in Warwickshire, a 10km cross country run across rugged farmland with a heap of obstacles thrown in and a swim across a lake. Halfway through my calf started to ache, which told me that once again my knee had started to give way forcing my other muscles to compensate. When mentioning this to my chiropractor he advised me to get it seen to as I have private medical cover and if the root cause was identified and fixed it might help to prevent other issues from arising.

The insurance company accepted my request and I was put onto a consultant who assessed me, reviewed my back story and suggested an MRI scan. This in itself triggered a lengthy process as the first scan had been arranged by my GP and the NHS promptly messed it up, losing the scan results and wasting around two months in the process. I eventually had a second scan at the Priory in Birmingham and waited for the results. Finally I went back to the consultant who stated that it had showed an enlarged plica – a membrane that is part of the fat pad of the knee, a redundant piece of our anatomy that for some reason is enlarged some people and causes friction in the knee, especially around the edges. His suggestion was keyhole surgery to get a camera in for a better look and a possible “tidy up” of the knee in the process.

So once the admin part had been dealt with, I was given a date of the 26th January 2018 for a knee arthroscopy. It was to be a day case treated at the West Midlands hospital, providing of course that I remained fit and free from illness in the meantime…