One of the concerns that have been expressed by many full-time RVers in their blogs and on Facebook is medical treatment. That is one of the reasons that I wanted to write this post. Also many of my friends have or may face the same problem that I did and this is for them as well.
For many years my knees had been bothering me. I attributed this to my ninety-nine military parachute jumps and hundreds of miles of running. I tried treating myself with ice and exercise without success before I saw an orthopedist, Dr. Steven Drayer. Dr. Drayer had successfully repaired my wife’s broken ankle years ago and has performed thousands of joint replacements. He advised me that I had worn out the cartilage in my knees and had bone on bone impact in some areas. He treated me with shots to cushion the knees and advised me that I was a prime candidate for partial knee replacement surgery. For the next few years I stopped running and started walking. The shots helped a lot, but I was still experiencing aching pain and it was certainly taking a toll on my quality of life. Finally, last fall Dr. Drayer said he wasn’t going to give me shots for the rest of my life and we needed an end game. I decided to go with the surgery and we tentatively planned to do it this summer (2018).
Before – the left knee
Before – the right kn ee
Before – knee caps
If you look close at these before the surgery x-rays, you can see the bone on bone contact.
Pat and I determined we had to be in one spot for about three months so I wouldn’t have the physical stress of packing, hitching up, and moving. We made arraignments for a three month reservation at the Lansing Cottonwood Campground. Cottonwood is a nice RV park and a convenient 15-20 minute drive to the hospital and Dr. Drayer’s office.
I was presented with many options, but chose to have both knees done, two weeks apart. I had originally planned to have them done one month apart, but Dr. Drayer was having surgery done on his shoulder and would not be available until July. When I asked about a two week interval, Dr. Drayer said it depended on how well I could tolerate pain. Given that we wanted to be heading south by early fall, I opted for the shortest possible interval of two weeks.
Dr. Drayer uses MAKO Robotic-assisted Surgery and is one of the pioneers in this method. He told us that it results in less trauma and blood loss, and a shorter healing time. In preparation for the surgery I had to have CT scans of both knees, and an exam by my primary care doctor to clear me for the procedure. Other preparations included stopping some of my normal medications and starting new ones, and washing with an antibacterial soap for five days.
For both surgeries we arrived at Sparrow Hospital in Lansing at 5:00 in the morning. After I was prepped and met with the Anesthesiologist and Dr. Drayer I don’t remember much as I was sedated through the whole procedure. On the first operation (the left knee) he removed the diseased bone from my femur and replaced it with titanium and replaced the underside of the kneecap with titanium. Two weeks later he only had to replace the underside of the kneecap, as he determined that there was plenty of good bone and cartilage remaining on the right knee to make any additional repair there unnecessary.
After – right knee
After – left knee
After – left knee
After – right knee cap
After – left knee cap
Everyone talked about using a walker, but no one said it was a requirement. I opted not to get a walker, but to use crutches that I already had. This turned out to be a good decision as the close quarters of the inside of our trailer would have made a walker impractical. It was easy to get around with the crutches and I never regretted that decision.
Getting back from the hospital was an experience, climbing in and out of our pick up truck was quite the effort, especially after the second surgery with my left knee not fully recovered but still the stronger of the two. Also getting into the trailer was an effort. It takes five steps with a nine-inch rise to get inside. Fortunately I had used crutches before and knew the drill, but it was still an effort. However if you look at almost any house with a porch, it would have been almost the same situation.
The surgery was the easy part; after all, I slept through that.
Now the hard part began – the rehabilitation. The skeletal part of my knees was better than it was before, but the trauma from the surgical procedure was painful. After all Dr. Drayer had cut open my knees to the bone with a six inch long incision, sawed away part of the bone, fastened pieces of titanium, and stitched it all back up again. I was prescribed a narcotic (Percocet on the first operation and Norco on the second) as well as prescription level (600mg) Ibuprofen to help me handle the pain. Pat was initially concerned of the possibility of addiction until a nurse told us that as long as there is pain, the pleasure part of the brain does not respond to the narcotic (That’s my layman’s explanation anyway). For the first several days, Pat took charge of my medication until we had a system in place.
I had met with my physical therapist, Sam, before the surgery and he had laid out a series of exercises to begin the day of surgery. You don’t want to wait on these exercises, the sooner you start and the more dedicated you are, the better your recovery. I know people who had undergone knee surgery and had heard good news and bad news. From their stories I determined that the best outcome was a combination of a good surgeon and dedicated physical therapy. I felt Dr. Drayer was the best surgeon I could find, I trusted him, and I was determined to be the best patient Sam had ever had.
The physical therapy exercises were simple, but tough. I knew I had to push myself and I did, I felt pain in almost every exercise I did. I was concerned how much I should push myself, and I talked to Sam about it. He encouraged me to push myself as much as I felt I could and I would know if it was too much. I knew rehab would be tough, but I didn’t realize how much time I would have to commit to it. Here’s the deal – the exercises take about an hour. After the exercise I’m suppose to ice the knee with the Iceman machine I got from the hospital for an hour. Every two hours I’m suppose to walk, then ice for another hour. So let’s say I start exercising at 8:00 in the morning, I’m icing by 9:00, then walk at 10:00, and ice again. This cycle then repeats all day long. I never realized that rehab would be a fulltime job!
A week after the surgery I had my first appointment with Sam. I think Sam is a great therapist, but I also think most therapists are masochists at heart. Every time I met with Sam he gave me a workout, and I gave as good as I got. One of the slogans in the Infantry is “Pain is weakness leaving the body.” Also a line from the Ranger Creed is, “Quit is not a Ranger word.” With these lines repeating themselves in my mind I attacked the exercises, making sure I was doing them properly and completing or exceeding the number of repetitions Sam wanted. I paid close attention to what Sam did in our sessions and modified my own workouts to get the same effect.
Oh, I had my share of low morale. After the second surgery I was trying to do the straight leg raise and, no matter how hard I tried, I didn’t have the strength to lift the leg. I had to put my exercise strap around my foot and lift the right leg with my left foot. As the days went by I no longer had to lift with my left foot, and a few days later the strap became unnecessary – Quit is not a Ranger word.
My walking went from 15 minutes of walking around the inside of our trailer to one and then two laps around our loop in the campground. A week after the second surgery Sam told me to only use one crutch instead of two. A couple of weeks later I began using one of my trekking poles as a cane. Finally, at six weeks after the first surgery I only used the cane when I went walking on the uneven gravel road of the campground, and did without it the rest of the time. I celebrated our anniversary on August 25th by putting the cane away and going without it. During this same week, Sam and I agreed to reduce our therapy sessions from three per week to two. Seven weeks after the first surgery I was able to walk two and a half miles. Like I said you have to push yourself.
Dr. Drayer had told me about a patient that, eight weeks after surgery, was off her pain medication and performing at about 80 – 90%. Because of that I focused on eight weeks of therapy, but as time went on I began to view the eight weeks as a minimum. That seemed to be more realistic. Over Labor Day weekend I felt I turned a big corner. I started doing the step up exercise on a twelve inch stool instead of on a seven inch rise step and used the stool for what Sam called a walk through exercise. That definitely ramped up the effort. I did a two and a half mile walk on Sunday that felt great, very little pain in my knees (Yes, I was still taking Ibuprofen but you can tell the difference.).
Oops! The next week, while doing one of my exercises I may have strained a muscle and it hurt-bad! Of course I continued to push through and the pain just got worse. I started limping and that got me concerned. When I saw Sam for my appointment on Monday he told me that I needed to rest and put ice on it. I continued to exercise while applying ice when I was done, but the pain wasn’t going away. When I saw Sam on Thursday he said I don’t seem to do well with “R words” like Relax and Rest. This time I took his advice and backed off on the exercise, just doing a few stretches and using weights on the other knee. After three days I was already seeing an improvement. I guess the lesson here is you need to push yourself, but you also need to back off when necessary. Trust your therapist and follow their instructions.
I met with Sam for our final session on September 18th and he certified that I no longer needed formal therapy. By the way, this was exactly eight weeks after the second surgery; I guess I was right on schedule! Later that week I met with Dr. Drayer on Friday for our final checkup. He was very pleased with our results and had positive comments on the range of motion I had achieved.
I asked him about resuming activities like running. He said I could do anything I wanted, but cautioned that there could be some negative consequences. He said that if I resumed a serious running schedule that the titanium attachments could become lose and another operation would be needed to correct that. His advice was to stick to walking, or running on a treadmill as it provided more cushioning, but would not recommend running on a sidewalk or trail.
I still had some pain, and Sam and I discussed what exercises I should continue. Both Dr Drayer and Sam suggested that it could be months before all the pain is gone.
It’s now almost four months since the second surgery and things are still improving. I continue to exercise for strength and flexibility, and ice my knees after each workout. The good news is that I can go for ten mile bike rides and four plus mile walks, and I plan to build on that. There is still some pain and stiffness but it is less every week. Yeah, I get discouraged, I wish this pain and stiffness would just disappear one day. I am not known for my patience. However, I passed the point of no return the day I showed up for the first surgery, so I continue – Quit is not a Ranger word.
Was it all worth it? I think so. Before the surgery I knew that the pain would only get worse in the future. Now I can feel the improvement and it should get better. So, thank you Dr. Drayer, Sam, and the best nurse I ever had, my wife, Pat.