July 23, 2011
Well, There's Good News, And...
The good news is, I'm still glad to be alive! And we're still glad to be in Paraguay. The bad news is, this leg thing is getting to be a bit complicated as of late. To catch you up, it's now been 5 months since the accident that broke my femur, and the surgery to repair it with the plate and screws just above my knee. I've been continuing with physical therapy about every-other-day, and I'm able to manage the pain most days.
I mostly just use the cane now, and if I'm in a small area, I can take a few awkward steps without it. I have to lean out a lot and kinda swing the leg, but it's possible, at least!! :) I just don't take any long walks anymore. With the cane, my balance isn't as good as it was with the walker, so sometimes I have to have someone on the other side of me, to hold their arm/hand while I'm walking, if it's any distance, or if I'm tired already, or if I'm on uneven terrain.
The last couple of weeks, I've had a new pain in my knee, which the doctor thought was tendonitis. An ultrasound didn't see anything like that, so he ordered an MRI, thinking it may be the meniscus. The image on the MRI didn't show up because of the metal in my plate interfering. At this point, no one knows for sure what it is that's torn or swollen in there. The only thing to do is apply ice and restrict the type of exercises I do, which is already taking its toll. I'm weaker in the leg as a whole, and the knee gives out sometimes while I'm walking.
That's the general overview, but here's where it gets sticky.... When the bone broke, it shattered at the end, and when the surgeon put it back in its place, he just did the best he could. It's in a pretty serious state of what's called valgum. This basically means that when I stand straight up, my right leg is normal, but the left knee veers way over to almost touch the right knee. This is not a good thing at all.
When the surgery first happened, there wasn't much talk about this part of it because, I guess?, the focus was on my physical condition from it being a femur break (blood loss, etc.), and the open wound situation. Then the realization a bit later that my leg had kinda frozen in too much interior rotation and had to be worked back to its proper spot over the next few months. Then the fact that my quadriceps was so emaciated and we had to step up the surgery. Add to that the fact that I stayed in the brace for too long, due to the wound, and the knee had to have a lot of work to start bending again. So in all that, no one mentioned that my leg was warped. I noticed that my kneecap pointed very inward, but the leg was still so swollen and there was the interior rotation problem. Every time I mentioned it, I was told to let all that clear up and we'd see. I had no clue it was anything more than that.
But there came this day when I saw myself in a long mirror and realized that the shape of my leg is all out of whack. I started asking all the right questions and found out that the medical folks already knew this and were just filling me in on a need to know basis. Smart, but I do hate to be the last one to find something out.
I have been speaking with Paraguayan and American doctors about this (I just went for my 4th "second opinion" this week), and the recommended treatment they all seem to agree on is this:
1. Start with a wedge in my left shoe, to try to open up the knee cavity. Right now it's squeezed shut on one side, which may account for the knee pain that we can't diagnose. I just got the wedge a few days ago and have been wearing it constantly. I'm not excited about the damage the wedge can do to the foot, ankle, etc., but the doctors and therapists say it's worth that damage in order to put my knee closer to its proper place. I've already gotten used to how it feels to walk with what feels like rocks in the shoe.
2. Removal of the plate and screws currently in my leg. This is optional, but definitely recommended because the plate is scrubbing against things it shouldn't, and it seems to be a big source of the pain in the outer leg. The doctor told me this week that the surgery itself is worse than the surgery to put it in, because they have to individually get those screws out of where the bone has already healed around them. And afterward, it would be like starting at ground zero again, similar to the recovery I've been doing for the past 5 months. I don't like the sound of that.
3. Osteotomy. This is a surgery to break either my tibia or my femur, on purpose, and take out a wedge of bone. The doctor suggested this as soon as I recover from #2 above. It would mean another expensive plate and screws, and again, a lengthy recovery. This would be a way to further relieve the pressure on the joint, that should give me 5-10 years before having to do #4.
4. Total knee replacement. They both said I'd want to do anything possible to prolong this, because they only last for 10-15 years, possibly 20. But at my age, that's too many possible replacements over my lifetime--I plan to be at least 100--and apparently you can only do so many replacements. They both also agreed that this was a definite thing. Of course, I don't call anything definite until I hear what God has to say about it, but this is what the x-rays and such show for now.
They say that each of these steps is a temporary fix to prolong having to go to the next step. I guess I don't have to tell you that none of this looks like my idea of a good time. I've told all of the medical professionals involved that I'm really holding out for a miracle and that they need not be surprised when it happens, so please join with me in prayer for this. Also, please pray for wisdom and guidance, and for peace. I am trying to remain all smiles and upbeat and positive, but I have to admit that I don't like the idea of more and more surgery, more and more rehabilitation, and starting back at square one a few more times in the "learning to walk" process. I trust God in every minute of this, knowing for sure that He is good, no matter what.