Update on Betsy from Dan 11/20/2007

Tue, Nov 20, 7:45 AM

Hi guys,

Here's the current scoop on Betsy (actually as of last night -- I haven't seen her yet today).

Kelsey took her in to hosp at 5:30 AM yesterday morning for final pre-op. I got Festus and Jake going and got in there a little after 7. They took her to OR at 7:20.

She went OR to recovery at 9:40, recovery to room (Maine Medical Center, Room 614, 207-662-7724 direct) at 1 PM.

She was very aware and very comfortable as soon as she arrived at her room. She has two self-administered pain medication pumps available to her -- one is a nerve block specific to the front of her knee, and the other is dilaudid for general pain not handled by the first. As of last night, she was getting all the relief she needed from the nerve block. That lets her avoid the side effects of the general pain med.

She is on the CPM (Continuous Passive Motion) machine for several sessions a day totaling 4-6 hours. This machine continuously and gradually extends and flexes her knee for her. (Check with Melinda -- apparently she's been on one). At present, it goes from 0 degrees to 40 degrees and back. The idea is to keep new adhesions from forming inside her knee joint. It is very gentle and Betsy can even sleep while she's on it.

Dr. Murray was pretty upbeat about most things after the surgery. You may remember there were three goals:

- Remove the lactic acid screws that apparently were being rejected or otherwise not playing nice in there -- Dr. Murray got 3 of 4 out -- he said the last one didn't appear to be causing a reaction, and taking it out would have made the ACL unstable, so he left it. For the ones he did remove, he packed the resulting holes with bone graft material.

- Patch the medial retinaculum (the fibrous band on the inside of the knee that helps hold the patella in place) -- this had been weakened by the second surgery and was the cause of the left lobe of the 'hammerhead', as Kelsey so delicately named it. The patch is intended to prevent the bulging.

- Release any existing adhesions -- Dr. Murray knew that there were significant adhesions around the patella, but when he got in there he found adhesions 'at every level' - in other words, all over the place. He released all of them, and told us that he could get about 45 degrees more flexion after the surgery than before.

Now the goal is to prevent new adhesions. The CPM is one tool. Dr. Murray also implanted some plastic (I guess) film that is designed to keep adjacent tissues from adhering. And he plans early and aggressive PT. He says he is going to do anything and everything he can think of to prevent adhesions, since he says adhesions are something that Betsy's body is unusually good at producing.

The one bad thing that Dr. Murray had to say was that there is some indication of post-traumatic arthritis. It sounds like this is a wait-and-see thing at this point -- could turn out to be anywhere from nothing to significant.

The only other bad thing isn't a prognosis thing, it's more of a convenience/expectations thing: Betsy was counting on getting out this morning, but from what Dr. Murray told us, it will be more like tomorrow afternoon or even Thursday morning. She's not happy about that, and I don't blame her, but she needs to look at the long term.

All in all, I think right now we're right where we hoped to be. Betsy now will need to make it her priority to follow orders in regard to preventing new adhesions. She's pretty much in a last-chance situation, and if she decides she's going to 'play through the pain' in a way that ignores or violates her PT instructions, she may pay in a big way.

Thanks for all your encouragement and best wishes. Have a great Thanksgiving at Hidden Valley. If I know Betsy, she'll be hoping you're all having enough fun to counterbalance her temporary setback!

Dan P Barrett L.L. Bean Information Services dbarrett@llbean.com Office: 207-552-2098 Cell: 207-838-3021 Cell Text: 2078383021@mobile.mycingular.com