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The Joys of Being Awake For Orthopedic Procedures

Back in September, I talked about the hope of being able to undergo a stem cell procedure that had a good chance of repairing some of the damage to my knee.  On Monday, I had the procedure done.  It’s too early to tell if it worked, or how much better things will be, but the procedure itself was enough of an experience I thought you might all enjoy the tale.

But first, I will be talking about a medical procedure, and I will share details.  If you get squiggy about such things, you may want to skip that part.

Last time, I did mention I would be looking into the VA covering it.  Turns out, they don’t, since it isn’t FDA approved yet.  Because the procedure is using my body fluids/material, it can be done without FDA approval, but until they can do a double blind study, the FDA won’t sign off on it.  Given what I am about to share, I would hope the FDA would perhaps find an alternative way to approve this.1

I went into this knowing what was going to happen, because the doctor didn’t want to sugar coat it.  The two big things to know are that first, I’m awake for all of this.  Half an hour before, I took a Xanax and a Tramadol, which is a nice effort, but the combo had no discernible effect on me (no loopiness or anything).  The second is that stem cells can’t tolerate local anesthetic (it’s toxic to them), so when they harvest bone marrow and fat cells, they can’t numb the harvest site.

Begin Squiddgy Bit

It started out simply enough, a 60 cc blood draw to recover platelets.2  Then into the paper shorts, a quick stop to void the bladder, and then I climbed up on a surgical table and laid face down for the next 45 minutes.  My lower back and hips got painted with betadyne, complete with me joking that I didn’t know a Trump tan was part of the package.  Then I got a bunch of needle sticks to numb my backside (remember, only the harvest site has to be clear of anesthetic, not the path to it), before the doctor made a small incision and tunneled down to the tip of my left pelvis.

Turns out, the tips of your pelvis play host to a stem cell reservoir, so there is a ton of stem cells there to harvest.  As such, the doctor began to tunnel into the tip of my left pelvis.

And by ‘tunnel’, I mean ‘drive a spike into it’.

I’ve never had a Rockwell test done on my bones before, but I can’t find much to recommend it, even if, if my doctor is to be believed, I’d score pretty high on it.  The doctor had to use the heavy mallet (which he’s never had to pull out before), had to switch to the other hip (because he couldn’t get through the first one), and told me he felt comfortable forgoing his afternoon workout.  He has done over 200 of these procedures and claims that was the hardest he ever had to work to get into the marrow.

Also, I’ve met a lot of orthopedic surgeons, and I’d never qualify any of them as ‘weak’.  They start out at, “Hell yeah, I lift!”, and end somewhere around ‘Offensive lineman’.

Allusions to badassery aside, I was awake during all this, under very mild local anesthetic (and none in the bones), and now my lower back feels like it went 10 rounds with a jackhammer and did not come out victorious.

Also, if you’ve never had a surgery done while you’re awake, it’s hard to describe what it feels like, but the pain nerves inside the body don’t fire the same way the ones on your skin do, or the brain interprets them differently, I’m not sure which.  So having a spike drive into your bone doesn’t hurt the same way it would if it drove through your skin.  It’s not a sharp pain, more like an intense pressure.  It’s nothing to sneeze at, you’ll still be clenching down on something, and the pain will wash over you, but it certainly has a different… flavor to it.

And the marrow extraction was unique as well.  I now know what it feels like to have some of your innards sucked out through a straw, and again, I honestly can’t recommend the experience.

After all that, I hardly noticed it when he harvested the fat cells.

While they were cleaning up my back and patching the holes they made in me, the marrow and fat and platelets got filtered and spun and combined, then loaded into a big ass needle3, which was then driven into my knee and the whole mess was injected.

End Squiddgy Bit

So my knee hurts from the needle, and it feels very full, which is uncomfortable.  I got two holes in my back, and a pelvis that’s taken a pounding, and not in a way that is an innuendo for some sexy fun time.  In short, I’m sore.  I have some Vicodin, and I took two yesterday, (one after the procedure was done, and one a bit before bed, so I could sleep).  I also have 90+ hours of sick time I have to burn before the new year or I lose it, so I’m home taking it easy for the next two weeks.

But it’s done.  I start physical therapy on Friday, and I have to avoid anti-inflammatory meds for the next 4 weeks, but by spring, I should be noticing some effects, so I guess I’ll check in again then.

Image by jacobms Notes:

  1. Because I don’t know how many people suffering osteoarthritis in the knee would be willing to undergo this and wind up with a knee full of saline instead of stem cells.  I’d want a whole lot of money as compensation.  And at least have study procedures done under general anesthetic, because being awake for it was no picnic. []
  2. No biggie, I give blood all the time []
  3. yes, that’s a technical term, I’m betting the gauge on that thing was in the single digits []

Associate Editor

A Navy Turbine Tech who learned to spin wrenches on old cars, Oscar has since been trained as an Engineer & Software Developer & now writes tools for other engineers. When not in his shop or at work, he can be found spending time with his family, gardening, hiking, kayaking, gaming, or whatever strikes his fancy & fits in the budget. ...more →

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15 thoughts on “The Joys of Being Awake For Orthopedic Procedures

  1. Why couldn’t they put you under general anesthesia? That sounds horrible. (I realize this isn’t the same thing at all, but a friend of mine had his wisdom teeth out with only local anesthesia, and he says it was a horrible experience.)

    That said, I wish you a full and complete recovery, and I really hope this works out for you.

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    • That would require the services of an anesthesiologist & a full OR, which would easily double or triple the price. Remember, this isn’t covered by insurance, so the $6200 got put on the credit card until we can pull money out of our HSAs to offset the cost (and again, $5k HSA limit for a family is a joke).

      Hence footnote 1

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  2. A couple years ago I had several lipomas removed while fully conscious. Not nearly as invasive and the areas were numbed with local anesthesia but I very much recall the weirdness of someone poking around in there.

    Hope you have a speedy recovery and that the treatment is a success.

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  3. That sounds brutal, but I hope the tradeoff in reduced future pain is well worth it.

    Wishing a speedy recovery, layoff the foot races and leg wrestling with bug for a couple weeks :)

    (On a related note, my bone density is high enough I’m not naturally bouyant.)

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    • Joe,
      You too? I was wondering if that was just my husband.
      The “dead man’s float” was a bad idea — all the lifeguards just gathered round and watched him sink to the bottom…

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      • Ha, had a navy seal as a diving instructor(long story), he had never seen it, so I jumped in the pool and set cross legged on the bottom for about two minutes. He was completely amazed.

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  4. I hope it works for you.

    My dad has severe knee osteoarthritis – he had one knee replaced, but the outcome was not what he hoped it was, so he never had the second one done. It seriously limits his mobility. He does PT on a regular basis but that, and Tylenol, can only go so far.

    (He is on other meds that rule out most pain medications like NSAIDS. Also, the knee replacement was probably unsuccessful because he waited until “too late” and wound up having to be immobilized for six weeks because of tendon/muscle problems, instead of starting PT right away like many knee replacement patients do.)

    He’s 81, so I doubt this will come in time for him….but maybe it will to help my brother or me if we inherited his problems.

    All that said? I have a horror of general anesthesia and admit I’d probably have whatever procedures I could have done while awake. But the knee procedure sounds pretty brutal, and I didn’t even read the squidgy bit.

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  5. Thanks for the report, Oscar. I hope it works out. On the other hand, if you can comfortablyafford the price (which isn’t more than a Silver plan deductible) and there’s no downside risk, it strikes me as a really smart decision on your part. Especially at that price: if it works, then real quick-like the FDA, the AMA, the CIA and etc will get aholt of it and drive the price up to truly obscene levels.

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  6. Thanks for sharing this with us, Oscar, I thought it was intensely interesting.

    At the same time I wish you didn’t have to go through such a thing – and I hope you recover quickly and end up better off.

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    • Recovery is going pretty well. The knee is still a bit tender, but otherwise functional. My back is still sore, but mostly when I bend over. If I practice good posture, I have almost zero pain.

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  7. I’m very much rooting for you. I did wince at the squidgy bits in sympathy.

    I’m struck by how… crude… the procedure sounds when you distill it to its essential core: Drill a hole to the patients pelvis, suck out some marrow, process it a bit and inject the resulting goop into the knee. Star fleet medical it ain’t.

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    • Way better than a whole knee replacement, which is, “saw off the ends of the femur & tibia, hammer the metal support spike of the artificial knee into the marrow of the leg bones until seated, then connect the muscles, etc.”

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      • Oh yeah. My father-in-law had that done — in the long run, it was well worth it. In the immediate aftermath it was…unpleasant.

        More than anything, the biggest difference in his recovery was the fact that his house has a pool. Turns out there are water therapies for the required daily PT, which he found very easy even as he was unable to handle the dry ones. So once that was sorted, he found the recovery a lot better.

        He’s quite glad he did it now, but the first few months…well, the only thing that kept him going was how bad the thing had already been, and heading downhill.

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