Pre-op Preparations
After returning home from winterizing our cabin in western Colorado and getting a chance to photograph some Fall Color, it was time to begin the final prep for my ankle replacement surgery. I had received specific instructions from the Vail Hospital and Dr. Clanton’s office. Their goal is for a successful surgery with the least possibility of complications and especially infection.
Other than any prescribed medications, I was to quit taking all anti-inflammatory meds like aspirin, ibuprofen, Alleve etc. and any vitamin E two weeks before surgery. I was to begin taking 1000 mg of Vitamin C to help in the healing process.
Perhaps the most important thing to be done was to begin a pre-op regimen of showering and full body cleansing with Hibiclens, an antibacterial soap found in any pharmacy. The instructions told me to begin it three days prior to surgery. I started it four days before. Why not?
Two days before surgery I was to begin taking Colace, a stool softener. Pain medication often causes constipation. Lord knows, I was likely going to be uncomfortable enough without adding constipation to the mix.
The day before surgery saw alcohol added to the prohibitions. No problem, I had stopped all beer, wine and margaritas, my favorite drink, at least a week before my scheduled ankle replacement surgery. A small price to pay for a successful outcome.
I continued to workout. Each day I did my stretching, yoga, sit ups and pushups. Knowing I would be flat on my back for a minimum of two weeks and possibly even up to six weeks, I wanted to be in as good a shape as possible. Muscles will atrophy even in this short a time. Plus, the stronger you are going into surgery, the easier the recovery.
Working out with weights and on weight machines is something I have always done. Unbeknownst to me, my last workout two days before ankle replacement surgery almost spelled a disastrous postponement.
The Appointment That Almost Nixed My Ankle Replacement
Because of a number of questions I had that hadn’t been fully answered, Terie, Dr. Clanton’s physician assistant, felt it best to schedule an appointment with the doctor the day before my planned surgery. He was scheduled to return from a trip to the east coast the night before. Unfortunately, his flight was cancelled and wouldn’t be arriving until that evening after my appointment.
Terie saw me anyway and answered my questions. She confirmed that installation of two cadaver ligaments were part of the procedure. She also confirmed that a Calcaneal Osteotomy might be required but that Dr. Clanton couldn’t know for certain until he actually got into my foot. This was my biggest fear. He felt it was unlikely but if he did find he had to perform a calcaneal osteotomy, which involves cutting and realigning the heel bone, it would add 6-8 weeks of non-weight bearing to my recovery, a major complication.
Terie then removed my shoes and socks and immediately saw a fresh wound about 3/8” in diameter on the left side of my lower shin. She grew very serious.
I’m always getting scrapes on my shins which, because of the thin skin there take quite a while to heal. I remembered that while at the gym the day before I bumped my shin on a metal plate on one of the machines. Terie immediately called in Dr. Jamieson, one of Dr. Clanton’s resident fellows, Steadman is a teaching clinic after all. She got out her phone and together they took pictures and used measuring sticks to show the size and position of the wound. These they would send to Dr. Clanton to evaluate whether or not the scrape could pose an unacceptable risk of infection requiring postponing the surgery.
They were both very serious saying that if the wound were on my foot or farther down my shin, postponement was imperative until it healed. Dr. Clanton would make the final decision. And he was somewhere in the air between the East Coast and Denver.
So here I was, prepared mentally and physically to have total ankle replacement surgery the next day and everything was up in the air. To say I was disappointed is an understatement. And all from a moment of carelessness at the gym.
Terie called me later that day after hearing from Dr. Clanton. To my relief he gave his go ahead. As scheduled, I was to check in to the Vail Hospital at 8 am the following morning to begin pre-op prep for my ankle replacement surgery. Halleluia!
Finally The Day of My Ankle Replacement Surgery Arrives
After being admitted, Yolanda and I were taken upstairs to a hospital room with a large window looking south at a mountainside covered in fall aspen glory. I exchanged my clothes for one of those lovely hospital gowns that open in the rear and hopped in bed.
Almost immediately nurses began arriving. The first asked questions about who I was, why I was here and which ankle was to have the ankle replacement. Another thoroughly scrubbed my foot and lower leg with a reddish-brown antibacterial solution.
The anesthesiologist came in to introduce herself, discuss what she would be doing in the operating room, give me a sedative and to explain the nerve blocks that would be inserted into my upper thigh.
Next came one of Dr. Clanton’s PA’s to answer any questions and look at the wound that almost nixed the surgery. After confirming with we me again which ankle was to be replaced, he signed that foot just above the ankle.
Two nurses then arrived with an ultrasound machine. After numbing a patch of my upper thigh they began inserting two tiny catheters. The ultrasound display helped them guide the catheters to the proper places adjacent to the main nerves going down to my foot. I’m glad they could read the video display because I couldn’t make heads or tails of it.
Once in place, they attached the catheters to the two pumps that would continually inject anesthetic into my thigh for the next 5 1/2 days. This I learned, is a nerve block, a miracle of modern medicine that effectively numbed my leg and foot preventing any sensation of pain. To be honest, I can’t appreciate the effectiveness of the nerve block because I didn’t feel ANY pain at all after surgery. Some discomfort and numbness for sure, but pain, not in the least. As I said, a miracle.
A Final Word with Dr. Clanton
Finally Dr. Clanton showed up in scrubs with the other of his two resident fellows who would assist in the surgery. His manner is always one of confident humility and warmth. Yolanda hadn’t met him so he introduced himself asking if either of us had any questions. Yolanda, having been married to a cardiologist, wanted to know a bit about him and his background, his training, how he came to Vail and about his family.
After a brief pleasant conversation he examined my ankle and especially the small scrape. Again serious, he emphasized a couple of times that it posed a greater potential for infection.
“Would you prefer postponing the surgery.” he asked.
”Are you trying to talk me out of ankle replacement surgery today?” I queried.
“Not at all.” he replied.
“Then let’s go for it!” I exclaimed.
Confirming once again which ankle he was to operate on, he added his signature above his PA’s signature and said, “If you have no objection, I always like to say a prayer before surgery.”
“That would be most appreciated.” I replied.
Holding my foot and ankle in both hands he closed his eyes and bowed his head requesting guidance for he and his staff during the procedure and for a good outcome and full recovery. I greatly appreciated this humble gesture finding it moving and reassuring during this penultimate point of nominal nervousness.
I will admit to a small degree of nervousness about having ankle replacement surgery. Having never had any surgery before, any apprehension was about the recovery. Deep down though, I was confident that I couldn’t have been in more capable hands.
After a few minutes I was wheeled into the operating room. The anesthesiologist placed a mask over my nose and mouth, told me it was oxygen and to breath deeply. The next thing I knew I was in a recovery room with Yolanda at my side and an enormous bandage covered splint surrounding my foot, ankle and calf.