What’s the latest news in the AmericaNepali Household? Tomorrow P is going to have knee surgery…
Back in June I mentioned in this post (“Weird thing #1”), that P had done something to mess up his knee. At the time we didn’t really know what it was and our primary care physician assumed P had a ligament issue. Since then I’ve mentioned P’s leg problem here and there.
His knee problem was almost cyclic. For a few days he would feel pretty good, even gaining confidence to walk around a bit on it, and then he would have days when he was in a lot of pain, and barely wanted to put weight on it. Luckily he felt okay during our wedding weekend, but plenty of other times during the summer he didn’t, which kept him fairly homebound. Most days he didn’t feel well enough to walk to his office, but on the days he did feel okay he was too nervous to push his leg and stayed home anyway. In Nepal we wouldn’t go anywhere unless he could take a taxi from point A to point B with minimal walking effort.
P is a really active guy. For most of his life he has played soccer at least a few times a week. Being housebound all summer has been a real psychological blow. His leg problem cascaded into a series of other issues related to a lack of exercise—a pinched nerve in his neck from sitting in a computer chair working too much, headaches, his legs have lost a lot of muscle mass and are smaller than I’ve ever seen. For a while he was in a real mental funk. He was thinking that his leg would never be the same, and he might have to give up soccer, or not be as active, for the rest of his life. This isn’t the case, but it was tough seeing P in such a low mood when he is the one in our relationship who is always consistently “okay.”
Before we went to Nepal P’s physical therapist finally ordered an MRI, and after months of speculation (he had an x-ray early on, so we knew it wasn’t broken, but the doctors insisted on physical therapy to see if his knee would “improve” on its own before ordering an MRI) he was finally properly diagnosed—a torn meniscus.
What’s a meniscus? I certainly didn’t know either… The meniscus consists of two connecting pads of cartilage at the knee joint in between the thigh bone (femur) and lower leg bone (tibia). The cartilage helps prevent friction in the joint between the two bones.
The doctor gave P a copy of the cd with his MRI images. He and I would look at the images like they were ancient hieroglyphic texts; they didn’t make any sense to us. Of course the American doctors explained the images to P at an appointment, but it wasn’t until we met up with one of P’s high school friends in KTM (who happens to be a leg surgeon) that we had the images fully explained. He came over and sat in P’s family’s living room, and while Mamu supplied him with cups of chai and bowls of nuts and sweets, P’s friend went through the MRI images on P’s laptop, slice for slice, and showed us exactly where the tear was located and how the surgical procedure to fix the problem would be done.
Apparently cartilage doesn’t receive a lot of blood flow, and for body tissue to properly heal it needs to have a flow of blood to help bind the tissues together. The outer edges of the meniscus have blood, but the inner portions have very little. Thus a small outer tear can heal, but if the tear is too deep or long, then it might not properly reconnect.
P’s tear was straight through (of course, we are the bad-luck-juju family!), and the pain he was feeling was from the broken meniscus flap moving. When the flap was out of the way P felt pretty good, but if the flap wedged into the knee joint, he wouldn’t feel so hot. Additionally a small cyst formed near the injury which also caused pain when the joint moved back and forth.
P’s friend explained that during the surgery the doctor would probably shave a bit of the meniscus to see if it bleeds. If it does, then he might try stitching it to see if the edges will re-attach. This procedure takes a lot longer to heal, but protects the knee joint longer into old age. If it doesn’t heal after a month or two, then P might need a second surgery.
If the meniscus doesn’t bleed during the initial shaving, then the tissue would most likely never rebind, so instead of stitching the doctor would simply cut off the torn “flap.” The healing time on this would be much faster (since he only needs to recover from the surgery itself, not the tissue rebinding), but then P would be missing a chunk of cartilage in his knee joint, leaving him more susceptible to arthritis issues in the future.
Obviously procedure #1 is probably best if it is successful, but P’s friend said due to the extent of the tear the doctor would probably have to do procedure #2. We won’t know until the doctor opens P’s knee up and checks out the situation.
“But if you do procedure #2, don’t worry,” P’s surgeon friend reassured us, “If you are missing that chunk perhaps you would get arthritis at age 60 instead of 65. It’s not that big of a deal, even I don’t have a meniscus anymore.”
So tomorrow I’m taking a personal day from work and I’ll be at the hospital with P. I’m not that nervous about the surgery, I’m more nervous about getting P home. We live in a building that used to be an old three story Catholic school. The apartments are converted old classrooms with 12 foot high ceilings. That means that even though we are on the third floor we have to walk up six flights of stairs, and there are no elevators. I’m not sure how I am going to get P up all those stairs with crutches and a cast.
When we moved into the apartment a year and a half ago, while huffing and puffing it up the stairs with heavy boxes of books and kitchen paraphernalia, I remember thinking, “I hope neither of us breaks a leg, we would never make it up these stairs.” Oops.
Meanwhile P’s family is worried in Nepal. They have called every day this week to check in. Last night P’s dad asked if an ambulance could bring him home and paramedics could bring him up all those stairs on a stretcher. P explained to him that ambulances can only be used for “medical emergencies” and insurance wouldn’t cover carrying a post-surgical patient to his apartment because there was no elevator. Meanwhile P’s mom wanted me to make a long list of things to bring to the hospital including black tea (in Nepal after someone wakes up from surgery they are supposed to drink black tea) and extra blankets.
So, hopefully all goes well. I’ll keep you updated.