November 3-15, 2010: North Dakota

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The Hospital Stay from Hell

We have had a challenging time here the last 10 days.  We came to North Dakota expecting Chuck to have arthroscopic surgery, but were shocked to discover that he needed a knee replacement.  The cartilage in his knee was totally gone.  The surgeon (who Chuck used last year for surgery on his other knee) worked him into a busy surgery schedule and Chuck had his surgery on Thursday, November 4th.  We expected that he would be home by Saturday, the 6th.  But things didn’t work out as expected.  The doctor came out saying that the operation had been clean and easy, and that Chuck’s bones were large and healthy.   But circulation and feeling were slow to return to the affected leg.   The importance of this development was not immediately realized, because Chuck had also received a femoral shot designed to postpone the inevitable pain after surgery.   Finally, on Friday morning tests revealed an arterial blockage. The doctors did a thrombectomy and used a balloon embolectomy to open up the arteries by mid-morning.   A flap had come loose on the innermost of the three layers of the main artery, and the eddies caused three clots below the blockage.    (The doctor was extremely distressed to have such a good operation go so bad, and later opined that the only way the inner layer could be damaged without damaging the outer layers would be if the artery were inadvertently stretched at some point.)  The long delay in discovering and dealing with the flap meant that Chuck went a long time without adequate blood supply to his lower leg.   Opening the flap was not a complete solution, however, since the arterial clots remained.   So a strong clot buster was administered.  A few hours later Chuck’s leg got really swollen and painful, and it was evident that there was excessive bleeding at the site.  He was soon rushed back down to surgery where they reopened his knee (using the same incision) and took apart the new knee in order to access the artery at the back of knee.  They cleaned up the site and then closed him up again.  They kept him on a very mild dose of blood thinners and kept a drain in his knee for the rest of his stay in the hospital (another week).   After three days in ICU, he was finally moved back to a regular room and was able to begin physical therapy.  We then had one scare after another.  Kidney and muscle enzymes too high, hemoglobin too low requiring a blood transfusion, remaining clot in the vein, etc.   He had a total of ten doctors attending to him at one time or another. 

Fortunately, things finally settled down and the doctors agreed to send him home on Friday, the 12th.  He is now recuperating but has lots of appointments scheduled to have weekly ultrasounds of his vein, an appointment to measure the pressure in his legs and arms, another to see a doctor about the status of various enzyme/blood levels (they are moving toward normal and it was expected that the problems were due to toxins in the leg from the blood deprivation), another for physical therapy, another to get his staples out, etc.  We are in the perfect location for recovery though.  We are staying at the home of Chuck’s sister Zona and her husband Mike, where Chuck’s 91 year old mother Evelyn also lives.  Their house is very large, they have an extra vehicle for us, and they are the perfect hosts.  We expect we will be here at least until the New Year.  Time will tell whether we need to stay longer for Chuck’s recovery.  The doctors know that some damage was done to his nerves, muscles, and tissues from the blood deprivation, but hope that his good blood flow now will revive things over time.   They are concerned about the clot in the vein but can’t treat it too aggressively for fear he will start bleeding again and they will have to open the knee up again.  That is something no one wants to see happen. 

In addition to the usual stiffness that can be expected from a total knee replacement, Chuck has other problems:  there is a loss of feeling in parts of the foot, and extreme “tightness” in the calf (presumably at the site of the venal clot) that prevents raising the front of the foot upward.

So that is a summary of the last ten days here.  Things are on the mend and we hope to resume our hikes and walks when we get back to the boat.   Tusen Takk II is safely on the hard in Curacao.  We are not sure what our plans will be for the rest of the winter when we return to her.  Depends on when we get back and what the weather is like.  We wouldn’t mind spending some time in Curacao and then going back to Bonaire for some more diving before we head back to the Eastern Caribbean.  We spent three months in Bonaire this summer and absolutely loved it.  Chuck developed shoulder problems while we were there though from lifting scuba tanks up to a high dock several times a day to be filled.  The doctors say all of his years of weight lifting have taken their toll and the heavy scuba tank lifting really inflamed the shoulders.  He was in a lot of pain during September and October with the shoulders and had also gotten so he could not walk more than five minutes without a lot of pain in his knee.  Fortunately the guys at the dive center took over the tank lifting and we were able to continue diving from our dinghy.  He was pretty bummed about these aches and pains after being in such good health all his life.  Fortunately, he got some cortisone shots and started physical therapy for the shoulders a week before his knee surgery.  The shoulders have improved a lot so we are hopeful that by the time we get out of here, they will be fine.  It’s a good thing Chuck was in such good shape before going in for surgery or he might have lost his leg (so some doctors have said).  Pretty scary!  His auxiliary arteries continued to provide some blood flow to the lower leg and foot when the main artery was blocked for 18 hours.  His foot is still numb but he is getting back some feeling and the doctors think it might be a number of months before things get back to normal.

Before surgery

Getting the knee shaved

After the (first) surgery

Chuck's mom Ev and sister Zona come to visit...

... as does Zona's husband Mike

Chuck gets some TLC from his Mom

Chuck's favorite nurse Carla

Sitting ...

... and walking ...

... and practicing navigation of stairs



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