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state of the knee
May. 8th, 2013 10:01 amIt's been almost two years to the day since I had my left knee arthroscoped. Not that I was aware of the precise date, but I found out when I went back to the orthopaedic surgeon yesterday. Something deeply amusing about that, in a not-at-all-funny kind of way.
The surgeon immediately sent me for an x-ray, and told me to bring it straight back. Things inside that knee were, if possible, even worse. There's no joint space at all on either side between the femur and the tibia, and marked narrowing of the space behind the patella. In other words, the knee is totally fucked. Not that I needed to be told that, but there's a cold sort of comfort in having it recognised.
After pointing out the salient details, he said bluntly, 'The only operation I'm prepared to discuss with you is a total knee replacement'. That was a surprise; I'd been expecting him to suggest another arthroscopy, to delay the replacement until I was older. Apparently, though, there's just no point; it would simply be a waste of money and an unnecessary risk.
Okay, so knee replacement. I'd always known it would come to this. But ... then he told me the risk factors.
Leaving aside the usual risks from a major operation - respiratory infection, wound infection (including deep wound infection), adverse reaction to anaesthetic - there are some specific possible complications. Knee replacements have a 1 in 100 failure rate. If a really deep wound infection sets in, 1 in 1000 need to have the implant removed and live without a knee for six months (wearing a brace and unable to bend the leg), then undergo an operation of up to six hours to try again. Assuming the infection is cured, which isn't a given when you're talking about bone operations.
And the happy news is that all of these risks are doubled in my case. My weight can cause pressure on the chest, increasing the possibility of a respiratory infection. The amount of fat on my leg means greater 'excavation' (don't you just love that word?), so higher possibility of infection there. And the fact I can neither fully flex nor extend the leg makes it harder to get at the tibia.
Oh, and there's always the possibility of even worse consequences.
(Oh, just by the way? The operation itself is incredibly gruesome. My leg would be sliced open down the front, the various layers of fat and muscle released' and retracted, and a metal cup fitted over the end of the femur - held on with screws. Then the tibia would be bent forward until the end protruded well clear of the rest of the leg, a hole drilled down into the end, and a metal cup with some kind of removable, shock-absorbing pad screwed in and secured. Everything would be shoved back in place, drains inserted, and the leg would be sewed up. Ugh. So, yeah, you can see how it would be more difficult to do all of that with a large amount of fat and muscle in the way.)
Naturally, I am less than calm about this. In fact, it would be fair to say I'm fucking terrified.
In order to try to mitigate some of the risks, the surgeon's referred me to a physio for some 'pre-habilitation'. (wince - what a word) The idea is to improve my flexibility, and to build up muscle stamina in both legs, especially my quadriceps. So, I trotted along for an evaluation today.
I came away with a list of twice-daily exercises, an appointment to be assessed for hydrotherapy next week, the threat of gym work to come, a recommendation that I have a knee brace made, and an urgent need for painkillers and warmth. At this stage, I don't know how long this 'pre-hab' is going to take, but the physio seems confident he can get my knee to a point where the flexibility, at least, is no longer a major risk factor.
Other risks are less easy to mitigate. Losing weight is fucking difficult when I can't do any form of cardio exercise, and there's only so far I can cut down my eating before my body decides I'm starving and starts laying down fat as a defensive measure (contrary to popular fucking opinion and shithead reality TV/advertising claims). Add to that the tendency to weight gain as a result of my bipolar meds ...
The surgeon, at least, recognises this. Back in 2011 he told me that losing even 10 kilos would make a big difference. Well, I did that. I don't expect to lose much more quickly. He's willing to do the op, as long as I'm aware of the dangers. That's somewhat reassuring - he definitely wouldn't do it if he thought the risks were too high.
And honestly, 2% failure rate, or 2 in 1000 isn't very high. I keep telling myself that to balance my inner hysteric. Not that this will stop me freaking out while I make out my will, and living will. (And even the thought of that is frightening.)
I haven't fully committed to the idea of the replacement op, but realistically, it's either that or end up in a fucking wheelchair. And that I won't do. It's bad enough having to borrow mobility scooters, or ruling out having dinner at any upstairs restaurant, or even go to a market or festival with my family. I won't spend the rest of my life being left behind and disappointing them.
Update:
I started the physio regime last night. You know how medicos ask you to rate your pain on a scale of 1-10? Well, in the words of the immortal Spinal Tap, 'this one goes to 11'. In a word - excruciating. Have to keep telling myself it's worth it.
The surgeon immediately sent me for an x-ray, and told me to bring it straight back. Things inside that knee were, if possible, even worse. There's no joint space at all on either side between the femur and the tibia, and marked narrowing of the space behind the patella. In other words, the knee is totally fucked. Not that I needed to be told that, but there's a cold sort of comfort in having it recognised.
After pointing out the salient details, he said bluntly, 'The only operation I'm prepared to discuss with you is a total knee replacement'. That was a surprise; I'd been expecting him to suggest another arthroscopy, to delay the replacement until I was older. Apparently, though, there's just no point; it would simply be a waste of money and an unnecessary risk.
Okay, so knee replacement. I'd always known it would come to this. But ... then he told me the risk factors.
Leaving aside the usual risks from a major operation - respiratory infection, wound infection (including deep wound infection), adverse reaction to anaesthetic - there are some specific possible complications. Knee replacements have a 1 in 100 failure rate. If a really deep wound infection sets in, 1 in 1000 need to have the implant removed and live without a knee for six months (wearing a brace and unable to bend the leg), then undergo an operation of up to six hours to try again. Assuming the infection is cured, which isn't a given when you're talking about bone operations.
And the happy news is that all of these risks are doubled in my case. My weight can cause pressure on the chest, increasing the possibility of a respiratory infection. The amount of fat on my leg means greater 'excavation' (don't you just love that word?), so higher possibility of infection there. And the fact I can neither fully flex nor extend the leg makes it harder to get at the tibia.
Oh, and there's always the possibility of even worse consequences.
(Oh, just by the way? The operation itself is incredibly gruesome. My leg would be sliced open down the front, the various layers of fat and muscle released' and retracted, and a metal cup fitted over the end of the femur - held on with screws. Then the tibia would be bent forward until the end protruded well clear of the rest of the leg, a hole drilled down into the end, and a metal cup with some kind of removable, shock-absorbing pad screwed in and secured. Everything would be shoved back in place, drains inserted, and the leg would be sewed up. Ugh. So, yeah, you can see how it would be more difficult to do all of that with a large amount of fat and muscle in the way.)
Naturally, I am less than calm about this. In fact, it would be fair to say I'm fucking terrified.
In order to try to mitigate some of the risks, the surgeon's referred me to a physio for some 'pre-habilitation'. (wince - what a word) The idea is to improve my flexibility, and to build up muscle stamina in both legs, especially my quadriceps. So, I trotted along for an evaluation today.
I came away with a list of twice-daily exercises, an appointment to be assessed for hydrotherapy next week, the threat of gym work to come, a recommendation that I have a knee brace made, and an urgent need for painkillers and warmth. At this stage, I don't know how long this 'pre-hab' is going to take, but the physio seems confident he can get my knee to a point where the flexibility, at least, is no longer a major risk factor.
Other risks are less easy to mitigate. Losing weight is fucking difficult when I can't do any form of cardio exercise, and there's only so far I can cut down my eating before my body decides I'm starving and starts laying down fat as a defensive measure (contrary to popular fucking opinion and shithead reality TV/advertising claims). Add to that the tendency to weight gain as a result of my bipolar meds ...
The surgeon, at least, recognises this. Back in 2011 he told me that losing even 10 kilos would make a big difference. Well, I did that. I don't expect to lose much more quickly. He's willing to do the op, as long as I'm aware of the dangers. That's somewhat reassuring - he definitely wouldn't do it if he thought the risks were too high.
And honestly, 2% failure rate, or 2 in 1000 isn't very high. I keep telling myself that to balance my inner hysteric. Not that this will stop me freaking out while I make out my will, and living will. (And even the thought of that is frightening.)
I haven't fully committed to the idea of the replacement op, but realistically, it's either that or end up in a fucking wheelchair. And that I won't do. It's bad enough having to borrow mobility scooters, or ruling out having dinner at any upstairs restaurant, or even go to a market or festival with my family. I won't spend the rest of my life being left behind and disappointing them.
Update:
I started the physio regime last night. You know how medicos ask you to rate your pain on a scale of 1-10? Well, in the words of the immortal Spinal Tap, 'this one goes to 11'. In a word - excruciating. Have to keep telling myself it's worth it.
I resisted as long as I could, but finally I succumbed to the pull of the gravity well that is A Song of Ice and Fire (or Game of Thrones, if you're watching the TV show). Now, this is a series that - like Twilight and 50 Shades - put the 'fanatic' back in 'fandom', so you can understand my wariness to actually pick up the books and start reading.
The thing is ... I like these books. Really, really like them. They've rekindled my love of fantasy fiction (almost killed by the likes of Terry Goodkind and innumerable vampire/werewolf/fallen angel romance (retch) spin-offs).
This didn't, however, stop me from coming up with a merciless parody. So here it is - hidden behind a cut for those who might want to read the books or watch the shows first. Just remember ... unlike my other parodies/rants/reviews, this one is done with love.
( A long time ago in a fictitious world that isn't modelled on anything in our history at all, honest ... )
The thing is ... I like these books. Really, really like them. They've rekindled my love of fantasy fiction (almost killed by the likes of Terry Goodkind and innumerable vampire/werewolf/fallen angel romance (retch) spin-offs).
This didn't, however, stop me from coming up with a merciless parody. So here it is - hidden behind a cut for those who might want to read the books or watch the shows first. Just remember ... unlike my other parodies/rants/reviews, this one is done with love.
( A long time ago in a fictitious world that isn't modelled on anything in our history at all, honest ... )
On the Boston Marathon Bombings
Apr. 16th, 2013 12:14 pmI woke up this morning to hear about the bombs that ripped through spectators at the Boston Marathon's finish line. Three dead (one, an eight year old boy), 141 injured as things stand right now. According to medical personnel, there are still many people on the critical list. The surgeons have performed multiple amputations and taken bucketloads of shrapnel - ball bearings, nails, and the like - from people's bodies.
The footage is all over both the mainstream and social media, dominating YouTube. It's an understatement to say it's hard to watch.
The thing that got to me most was learning that the last mile before the finish was dedicated to the memory of the children and teachers killed in the Sandy Hook Elementary School shootings. Some of the families were at ground zero. That was widely publicised - so it's hard not to think that these people were deliberately targeted. Especially when the second bomb went off a few moments later, as people - unknowingly - were running towards it.
Add to that it's Patriots Day, this is a televised event, and there's also been a fire (possibly started by an explosion) at the John F. Kennedy Presidential Library, and a really sour taste creeps into the mouth.
They're calling it an 'act of terror' - but not saying that it was perpetrated by 'terrorists'. Apparently, terrorist is now an official, card-carrying thing. You have to be a member of some designated organisation. I wonder if Anders Breivik would find that amusing. Personally, I think you're a terrorist the moment you commit an act like that.
And inevitably, as soon as media go to wall-to-wall coverage, there are the cries of 'Oh, but this happens in Iraq or Afghanistan every day, and hundreds of people die. Western bias, the Americans think they're the only ones, how shameful, etc'. To an extent, that's true. Oddly enough, American media tends to spend a lot of air time on incidents that happen on its own soil. (/sarcasm)
I even read an op-ed that declared the Boston bombing was 'just desserts', because of how prisoners at Guantanamo Bay were treated, so we shouldn't get all upset about it. Right. Because the Sandy Hook families shaped government policy, and somehow deserve it. Seriously. Sometimes I despair of humanity.
I did get to thinking, though. Apart from my initial horror when I first found out about what happened at the marathon, and my admiration for the bravery of those runners who gave up their recovery cots to victims or kept running all the way to the nearest hospital to donate blood - I was scared. Why? I don't live in Boston. I'm fairly sure this will turn out to be an act of 'domestic' terrorism, perpetrated by someone with an extreme right-wing outlook and an axe to grind about 'protecting his right to bear arms', or something similar. There's no reason to suggest this is the beginning of anything larger, or that there's any danger to me or mine.
Yet I'm still scared.
I finally put my finger on it. It's not the incident itself - it's what might happen next. Already, media have started to draw the comparison between this and 9/11, a terrorist event aimed at private citizens (and particularly, at citizens who are already suffering from another act of senseless mass killing). In a way, it's the equivalent of bombing or shooting at an IRA funeral. It's despicable - and America tends to lash out violently and think later if it thinks it's under attack.
There's something about a bombing. It's not the same, in people's eyes, as a disturbed kid with an assault rifle, or even a guy hiding in a van sniping complete strangers and holding an entire city hostage can be grasped. It's personal. A bombing, though, immediately suggests a political motive. And when it comes to America, a political motive immediately suggests al Qaeda or the Taliban.
Take the Oklahoma Federal Building bombing, for example. Two wannabe-militia guys who wanted to 'get revenge' on the FBI for the fiasco at Waco with the Branch Davidians - but when the bomb went off, reports abounded of 'four guys with turbans', and the backlash against Muslims (who don't even wear turbans) was vicious. This was before 9/11.
The FBI announced just a few moments ago that they had issued a BOLO (Be On The Lookout) for a 'darker-skinned, possibly black' man, who they described as a person of interest. Of course, the immediate assumption is that he's Muslim. FOX News is still reporting that the FBI are interrogating a '20 year old Saudi national' - a report that's already been debunked. The Saudi man is being questioned, yes - like all the others in the hospitals. The FBI is trying to find out what happened. But that doesn't matter, does it? It's a terrorist act - it 'must' be Muslims. And therefore terrorist organisations Striking At Our Way Of Life.
'America's enemies' must be punished.
And that's what terrifies me. The idea that America will go to war. Oh, not 'officially'. Maybe a few drone strikes on a terrorist camp or two, but not some massive mobilisation. I'm talking about the America that carries guns and shoots a kid in the back because he's black in a white neighbourhood, beats up or sexually assaults a woman in a hijab, spews hate speech until some idiot thinks they've got a mandate to attack anyone who 'looks Muslim'. (And let's not forget 'Patriot Act'-type laws, straight out of Orwell.)
And as America goes, so goes Australia. We already have hatemongers like Senator Corey Bernadi telling us that we are being 'Islamised' by stealth, 'forced' to eat halal meat and threatened by 'creeping sharia law'. We have Tony Abbott and his disgusting lackey, Scott Morrison, telling us that our borders are under attack from desperate people seeking asylum, who just happen to be Muslims (even when they aren't). We have a cowardly government that panders to xenophobia instead of giving people a well-deserved smack around the ears, because they'd rather see people persecuted than risk losing office. Every time there's an incident that might involve someone who might be Muslim, the rhetoric ratchets up and the violence and the hatred escalates with it. We may not have the guns, but we have the fists and the knives and the hate.
President Obama said, 'We shouldn't jump to conclusions about who might be responsible for this - but ...' - and that 'but' was a warning to 'groups'. And most of the media aren't taking any notice of the President. They've got no problem speculating wildly, and damn the consequences.
So yeah, this bombing scares me. Not because I think this is a prelude to invasion of some foreign land, or because I'm blinded to the suffering of people in other countries who deal with this sort of horror every day - because it's all too likely that this will become the excuse for further violence and suppression.
And in all of it, the most important thing gets lost. People suffered terribly - are still suffering - and that suffering becomes nothing more than a political tool.
I hope I'm wrong. I really do. It would be wonderful to see this handled with a level of sanity, of clarity.
I hope I'm wrong. I fear I'm not.
The footage is all over both the mainstream and social media, dominating YouTube. It's an understatement to say it's hard to watch.
The thing that got to me most was learning that the last mile before the finish was dedicated to the memory of the children and teachers killed in the Sandy Hook Elementary School shootings. Some of the families were at ground zero. That was widely publicised - so it's hard not to think that these people were deliberately targeted. Especially when the second bomb went off a few moments later, as people - unknowingly - were running towards it.
Add to that it's Patriots Day, this is a televised event, and there's also been a fire (possibly started by an explosion) at the John F. Kennedy Presidential Library, and a really sour taste creeps into the mouth.
They're calling it an 'act of terror' - but not saying that it was perpetrated by 'terrorists'. Apparently, terrorist is now an official, card-carrying thing. You have to be a member of some designated organisation. I wonder if Anders Breivik would find that amusing. Personally, I think you're a terrorist the moment you commit an act like that.
And inevitably, as soon as media go to wall-to-wall coverage, there are the cries of 'Oh, but this happens in Iraq or Afghanistan every day, and hundreds of people die. Western bias, the Americans think they're the only ones, how shameful, etc'. To an extent, that's true. Oddly enough, American media tends to spend a lot of air time on incidents that happen on its own soil. (/sarcasm)
I even read an op-ed that declared the Boston bombing was 'just desserts', because of how prisoners at Guantanamo Bay were treated, so we shouldn't get all upset about it. Right. Because the Sandy Hook families shaped government policy, and somehow deserve it. Seriously. Sometimes I despair of humanity.
I did get to thinking, though. Apart from my initial horror when I first found out about what happened at the marathon, and my admiration for the bravery of those runners who gave up their recovery cots to victims or kept running all the way to the nearest hospital to donate blood - I was scared. Why? I don't live in Boston. I'm fairly sure this will turn out to be an act of 'domestic' terrorism, perpetrated by someone with an extreme right-wing outlook and an axe to grind about 'protecting his right to bear arms', or something similar. There's no reason to suggest this is the beginning of anything larger, or that there's any danger to me or mine.
Yet I'm still scared.
I finally put my finger on it. It's not the incident itself - it's what might happen next. Already, media have started to draw the comparison between this and 9/11, a terrorist event aimed at private citizens (and particularly, at citizens who are already suffering from another act of senseless mass killing). In a way, it's the equivalent of bombing or shooting at an IRA funeral. It's despicable - and America tends to lash out violently and think later if it thinks it's under attack.
There's something about a bombing. It's not the same, in people's eyes, as a disturbed kid with an assault rifle, or even a guy hiding in a van sniping complete strangers and holding an entire city hostage can be grasped. It's personal. A bombing, though, immediately suggests a political motive. And when it comes to America, a political motive immediately suggests al Qaeda or the Taliban.
Take the Oklahoma Federal Building bombing, for example. Two wannabe-militia guys who wanted to 'get revenge' on the FBI for the fiasco at Waco with the Branch Davidians - but when the bomb went off, reports abounded of 'four guys with turbans', and the backlash against Muslims (who don't even wear turbans) was vicious. This was before 9/11.
The FBI announced just a few moments ago that they had issued a BOLO (Be On The Lookout) for a 'darker-skinned, possibly black' man, who they described as a person of interest. Of course, the immediate assumption is that he's Muslim. FOX News is still reporting that the FBI are interrogating a '20 year old Saudi national' - a report that's already been debunked. The Saudi man is being questioned, yes - like all the others in the hospitals. The FBI is trying to find out what happened. But that doesn't matter, does it? It's a terrorist act - it 'must' be Muslims. And therefore terrorist organisations Striking At Our Way Of Life.
'America's enemies' must be punished.
And that's what terrifies me. The idea that America will go to war. Oh, not 'officially'. Maybe a few drone strikes on a terrorist camp or two, but not some massive mobilisation. I'm talking about the America that carries guns and shoots a kid in the back because he's black in a white neighbourhood, beats up or sexually assaults a woman in a hijab, spews hate speech until some idiot thinks they've got a mandate to attack anyone who 'looks Muslim'. (And let's not forget 'Patriot Act'-type laws, straight out of Orwell.)
And as America goes, so goes Australia. We already have hatemongers like Senator Corey Bernadi telling us that we are being 'Islamised' by stealth, 'forced' to eat halal meat and threatened by 'creeping sharia law'. We have Tony Abbott and his disgusting lackey, Scott Morrison, telling us that our borders are under attack from desperate people seeking asylum, who just happen to be Muslims (even when they aren't). We have a cowardly government that panders to xenophobia instead of giving people a well-deserved smack around the ears, because they'd rather see people persecuted than risk losing office. Every time there's an incident that might involve someone who might be Muslim, the rhetoric ratchets up and the violence and the hatred escalates with it. We may not have the guns, but we have the fists and the knives and the hate.
President Obama said, 'We shouldn't jump to conclusions about who might be responsible for this - but ...' - and that 'but' was a warning to 'groups'. And most of the media aren't taking any notice of the President. They've got no problem speculating wildly, and damn the consequences.
So yeah, this bombing scares me. Not because I think this is a prelude to invasion of some foreign land, or because I'm blinded to the suffering of people in other countries who deal with this sort of horror every day - because it's all too likely that this will become the excuse for further violence and suppression.
And in all of it, the most important thing gets lost. People suffered terribly - are still suffering - and that suffering becomes nothing more than a political tool.
I hope I'm wrong. I really do. It would be wonderful to see this handled with a level of sanity, of clarity.
I hope I'm wrong. I fear I'm not.
