This universe was not made for you.
You are unallocated in list of
Participators and only consume… and we’ve entirely forgotten about you.
You do nothing.
You deserve an even smaller potion of happiness than the
Everything you neglect,
A unit so close to zero, it can only be limited to
The lowest number you can squeeze out of
your tube.

Most of the doors are shut at your approach, and we’re
Glad to see your nose close, but far
From the other side of plexi.

If they destroy you, and when they will –
Nothing will happen; you’ve allowed the science
And majesty of prediction to take the place of
Sweet, unreasoned faith.

Die, fruitless laborer. Crumble into your dry skin and
Rot.
Snap your femur with the flat plate of head-bone
Before you go,
And limp… limp into the dark underworld you hardly deserve,
But where else can they put you?

grumazul elevator benign

creație de viermi eviscerați

tare mascat comoție la indigo

deux nox rex vox

acr penitență primul sărut

luna apune și în loc soarele nu răsare

întuneric etern pînă viitorul va sucomba

doctor docil tegumentat facial

ape stătute vis ideal

lostrița cîntă veste rea

fără sfîrșit înainte noaptea

în pragul iadului

erau 5 cadavre mutilate

pentru fiecare se completa un formular

cu motivul morții ora și autorul

după aceste formalități leșurile pătrund

prin portalul de foc și apă

ajung într-un spațiu nemărginit

plin de flori și copaci gri

printre copaci se zăresc piramide nedescoperite

din egiptul antic

colorate în gri sau poate prăfuite

o mare atenție era necesară în

drumul spre mîntuire

în iad dumnezeu a fost interzis

deși cadavrele răspîndite pe flori

aparțineau unor buni cretini

pentru a se mîntui încercau

să ajungă în piramide

era greu întrucît picioarele lor

putreziseră din cauza credinței

imense pe care aceștia o aveau

în dumnezeu

nemaigăsind calea spre piramidele

fluxului antropologic de ură

nu se vor mai mîntui niciodată

și iubirea le va mișuna prin pancreas

odontoblast  catalige ecologie iris  împrăștiere  ferestrui

incremental adenocarcinom cosmodrom portbaionetă  portavoce  hipo

aromitor ecliptic fonologie maniament  eolian almintere

oftare  făuriște  hidronim  inerent homopter  integra

protomă  fîsăitură buiestru plămădeală  primăriu ponderabil

întortochere  șampon mina anagnost orb țiteră

marsupializare  pus plinișor bimbașă  chimen corodare

îndrăzneală  asonantă

###WARNING### — this post will contain very graphic description of surgery and operating room stuff.  If you’re not cool with reading that, stop reading now and go here.  This means you, S, J, R, M, and Y.*

*I totally made these people up, by the way.  Unless your name starts with S, J, R, M, or Y, and you’re easily skeeved by blood and guts.

Let’s try writing in the present tense for this entry.  Change it up a bit.

So.  Let’s see.  Friday morning I wake up at 5AM.  This is early.  Normally I’m dreaming about car fires or delicious little impossible cupcakes at this point.  But I wake up to my alarm (set to 93.3 WMMR, because it’s the only station I receive clearly on my 20-year-old clock radio), shave, shower, eat some breakfast (per my instructions … don’t wanna be passing out in the OR), and make my way to the hospital.  This time I am in the main hospital building, which houses some 30 or 40 operating rooms, I believe.  I take the elevator up to the floor with some of the ORs.  I knock on the door of the OR nursing suite.  “Hello?” I say to no one in particular.  It is 6:45AM, and I don’t see anyone here.  Finally, a woman sees me and says, “Ok, grab some purple scrubs (yes!), put them on in that bathroom, lock your stuff in the locker, and wait in that room over there across the hall.  Someone will come to get you.”

Hmm, ok, I think, this isn’t so bad.  I change into my sweet purple scrubs, lock my stuff away in the locker, put the key around my ankle, and turn the corner into the OR lounge.  Yikes.

There are about 40 people in here.  All wearing either teal or green.  All drinking coffee and eating danish or donuts.  All talking to each other.  I stick out, but people ignore me.  I sit down on a couch and wait.  To my left is a bug zapper.

Wait, a bug zapper?

To my right is another bug zapper.  I can only assume, given the vast amounts of food and drink to be seen in this lounge, that they’ve had a little problem with lil’ critters.  Hence the bug zappers.  I assume.

At precisely 7:01AM, all the green- and teal-clad folks begin checking a master sheet, file through a door, and disappear down the hall.  I take it that these people are all nurses and techs and have disappeared to start the day.  I am left alone in the lounge, watching the sad news from Ft. Hood.  I am tempted to stuff my hole with donuts, but I resist.  At 7:30, another student comes in and we chat.  She changes into her purple scrubs, and we sit together for a while.  At around 7:50, a nurse comes over and introduces herself, saying she’s sorry, but someone called out sick, and she’s been tasked to take care of us.  For the next 15 minutes, she goes over the “house rules.”  This includes things such as:

• Do not talk to the surgeons unless they talk to you.
• Do not touch anything blue or clear plastic.
• If you feel faint, sit down immediately and tell the circulating nurse.

So after these rules are hammered home, she says, “Ok, let’s go, follow me!”  She gives us booties for over our shoes and a hairnet/cap.  She is perusing what looks to be a master list of all the surgeries scheduled for that day, and is trying to figure out where to put us for the morning.  We follow her downstairs and to the next building (which is connected with a bridge).  And then we finally enter the OR suites.

At this point we are standing in a very long hallway, with ORs on either side.  The nurse gives us a duckbill mask here, and instructs us to wash our hands.  As I’m stepping toward the giant sinks they have for the surgeons to scrub in, I hear the following:

WOMAN #1: Oh man I gotta go wash my eye out!

RANDOM MAN:  Why, what you get in it?

WOMAN #1:  Oh, just some blood.

Our friendly nurse says we should always wear that mask inside the OR.  She also gives us a flimsy-looking coat of some sort, because it gets very cold inside the ORs.  Lastly, we are told to wear disposable plastic glasses to protect our eyes.  We follow this nurse down to OR #5, at which she drops off the other student.  She wants me to go into OR #3, and we enter through the door.  Five people turn around and stare at me for a few moments, then turn back to the patient, who is lying on the table, completely under anesthesia, with her abdomen exposed.  They’re about to start a laparoscopic resection of the colon.  Cool!  I think this is my lucky day.  Then things turn sour.

The surgeon seems upset.  He’s going on about some machine that isn’t working properly, and they can’t start the operation.  The nice nurse who’s been taking me around says, “Ok, let’s find you another room — this one’s quite ornery.”  She then says, “I think there’s some ortho surgeries going on, let’s go down there.”

We knock on OR #36, which seems to already have a surgery going on.  I’m allowed in this room, introduced to the circulating nurse, who will be taking care of me here all morning, and then the charge nurse disappears.  Ok, this is it.  I’m alone now.  On my own.  Gotta keep it together and be professional.

I’m introduced to the people in this OR.  Right in the middle of their surgery.  From left to right:

1. Circulating Nurse, who is the only one not in the sterile field.  She wears a mask and cap, but normal scrubs.  No gloves.
2. Scrub Nurse, who is in the sterile field.  She seems to be standing next to the instruments and handing them to the surgeons.
3. Scrub Nurse, who is in the sterile field.  He seems to be manning the hooks and retractors.  That seems to be his only job.
4. Chief Resident, who is in the sterile field.  His job seems to be opening the case, making the incisions and getting started.
5. Registered Nurse First Assist (RNFA), who is in the sterile field.  She is manning the suction and other tools.
6. Patient, who is in the sterile field (duh).  He doesn’t seem to know what’s going on.

I should mention here that this OR is different-looking.  They do only “joint” cases here (involving joints and bones and such).  Because of this, they use some sort of strange air-flow system.  All the people in the sterile field, which is represented by a giant box drawn on the floor (I was instructed to never step over this line, by the way), are wearing these futuristic-looking helmets with battery packs.  Over these helmets they have what appear to be space suits.  They really look like the scary government guys from the movie “ET.”  Hilarious.  Apparently these draw the air up and into the ceiling or something.  I never did figure out what that was.  There is a giant apparatus attached to the ceiling, to which they have taped plastic sheeting in front of the patient’s face.  Only the anesthesiologist, who is not in the sterile field, can see the patient’s face.

This first case is a bilateral total hip replacement.  As I arrived, they had just finished this man’s right hip.  They are ready to start the left hip now, and I have arrived just in time.  I’m told to stand where I can see what’s going on (which is still about 6 feet away), and this is pretty much where I stand for the rest of the morning.  They have a giant flat-screen TV, which is showing a close-up camera view of the operation.  I sneak a few peeks at this from time to time, but it’s much more interesting to look at the surgical field.  There is an iPod hooked up to a miniature speaker system sitting on the floor to the side, and this is pumping out some tunes at a reasonable volume.

So, onto the first surgery I witnessed.

As I mentioned, this is the left hip replacement.  The patient is a man in his 40s, and has severe degenerative joint disease, which has rendered both his hips in pretty crappy shape.  This patient has a spinal epidural in place, and is under only conscious sedation — Versed and Demerol.  So the anesthesiologist talks to him from time to time, and the patient answers back.  Amazing.

At this point they’re ready to get going.  The chief resident and the RNFA seem to be doing most of the prepping — they have shaved this patient’s left hip and leg down to just below the knee.  Then the circulating nurse applies liberal amounts of betadine to the patient’s leg.  Then the Chief and RNFA wrap the hip and leg in some sort of yellow material from 3M.  I think they call it Ioban.  It wraps skin-tight and stays on throughout the surgery.  They actually just cut right through this material when they make their incisions.  The chief asks for the scalpel, and starts his incision, which runs about 8 inches down the outside of the left leg.  As for the surgery and operating room … some observations:

• There is a giant drape/blanket sitting on the floor in front of me (between me and the operating table).  The chief and RNFA, who is in charge of soaking up the blood with sterile sponges, throw their trash onto this blanket.  Sometimes when this trash lands on the drape, it splashes onto my lower legs a bit.  I don’t mind this.
• At the beginning of the surgery, the scrub nurse and circulating nurse write down everything they are using for this surgery (25 sponges, 2 scalpels, etc.).  At the end of the surgery, these nurses go over this list again, and ensure everything that went into the patient has also come out of the patient.
• The circulating nurse does a lot of paperwork during the surgery.  Every now and then she is asked to get something from the surrounding cabinets or outside the OR, and she gets this, opens up the package very carefully, and extends her arm into the sterile field, where the scrub nurse grabs it from the package.  The circulating nurse also calls over to the PACU to let them know the patient is almost ready after surgery.
• After prepping the patient for surgery, the 1 scrub nurse, the chief resident, and the RNFA all go out to scrub in for surgery.  The other scrub nurse remains behind to continue prepping the room, and when the other 3 come in, she and the circulating nurse help them get their gowns and gloves on.  It’s really a well-oiled machine and team.
• The anesthesiologist has an interesting role.  A lot of the time during the surgery he is just sitting there looking bored.  Other times he is hanging some blood on the IV pole or monitoring other numbers.  During the entire surgery, he is often chatting with the other members of the team.
• Speaking of chatting, there is rarely any silence.  They talk often and loudly, about many topics including vacation spots, the Phillies, and dinner plans.  I’m sure they’re concentrating, but you couldn’t tell from the mood in the room.
• The chief resident starts the surgery, and opens up the patient and does most of the work.  Then, in the middle of the surgery, the attending surgeon walks in, takes over, does the actual implanting of the titanium hip the patient will receive, and then walks out again.  The attending surgeon is there for, at most, 15 minutes.  The surgery lasts about 75 minutes in total.
• During the surgery, lots of random people (all wearing scrubs, of course) walk in and out of the OR.  Some of them start talking to the operating members, and some of them just watch for a while, and then leave.  Apparently these are other nurses from other ORs who just feel like visiting.  I didn’t know this happened during surgeries.
• The attending surgeon and the chief resident are both triple gloved.
• It is astounding how much the surgeons manhandle the patient.  After the hip is implanted, the RNFA and attending take this patient’s leg and turn it every which way, sometimes appearing to discolate his hip.  They are doing this to ensure he will have proper range of motion, as well as to ensure he won’t dislocate his hip when he walks on it.  However, they aren’t exactly gentle when they do this.
• Once the thighbone is exposed, the chief and attending break out the big tools.  They have to attach the new hip to the hip and thighbone, so they basically just take out this giant chisel and hammer, and WHACK WHACK WHACK WHACK away at the bone.  It seems almost barbaric, but I suppose there really isn’t any other way to do it.  Then they take out this extremely loud bone saw and just saw away at precisely measured places of bone.
• The smell of burning bone is one I will never forget.  When the chief is burning some of the areas, and chiseling away at the femur, there is that distinct smell that I can still remember.
• Even standing about 6 feet away, the chiseling of the bone makes some blood and bone marrow spray on my glasses.  But only a little bit.  The chief and RNFA have liberal amounts of it on their face shields.  From time to time they take a sterile towel and wipe it off, like surgical windshield wipers.

Some other thoughts about my experience:

• Some other nurses and HCPs talk about something called “Imposter Syndrome.”  This is especially true in my OR observation.  How is it that I, a little old nursing student in my 2nd month, am allowed to just wander in and out of rooms where they are performing major operations on people a few feet away?  It’s crazy!  Such trust!  It’s amazing to me that I’m still allowed to do these things and be given access to these ridiculously cool scenarios.
• Orthopedic surgeries are super bloody.  The patient has given 2 units of his own blood to use during surgery.  Cutting into bone is very messy.  Lots of blood and marrow and other gunk.  Because of this, the blanket in front of me is filled with bloody sponges by the time the surgery is done.
• After the total hip, I get to stay for a 2nd operation, which turns out to be a total knee replacement.  This is less bloody because they use a tourniquet on the patient.  However, it’s infinitely cooler, as I get to see the entire knee exposed 4 feet in front of me (I lean in a little closer by this point).  All the tendons and ligaments they talk about on TV — all right there.  Incredible.
• Patients fart a lot during surgery.  At least my 2 patients sure do.
• After the range of motion is confirmed and the titanium hip implant is secured, the chief and RNFA measure the length of each of the patient’s legs.  I can imagine it would be a bad thing if the patient’s legs were two different lengths, right?

The soundtrack for the surgery (iPod edition) includes:

1. The Killers:  Somebody Told Me
2. Matchbox 20:  3AM
3. Nickelback:  Rockstar
4. Maroon 5:  This Love
5. Modest Mouse:  Float On
6. 5 For Fighting:  Superman
7. Radiohead:  Karma Police
8. Weezer:  Beverly Hills
9. Sublime:  What I Got
10. Third Eye Blind:  Jumper

I wonder who gets to pick the songs.

After seeing the total knee, it’s time for me to leave.  I go back through the doors into the lounge, where I see … 25 people eating lunch.  There are pizza boxes everywhere, and people are digging in for the lunchie munchies.  I change back into my regular scrubs, return the purple scrubs to the charge nurse, and leave the hospital.  My back hurts from standing.  My feet hurt from standing.  But my mind is spinning with intrigue.  I love the OR.

Merg pe strada. Cu un prieten. Apar doi caini.

Eu: Ai ceva de mancare la tine?

El: Da, un femur!

primele impresii despre nebunia dezlegată se sting

noaptea explodează în acorduri mizerabile

fumul roșu îneacă ultimele urme de viață

imbold imperativ de scîrbă și acid

precursorul fanatismului religios scoate arta la lumină

creierul are o forță fantastică la fel și armele de distrugere în masă

chemat la apel sau transpus în altă dimensiune arborele se usucă

final de zi final de seară hoardele au amuțit la vederea nevăzutului

trimis spre a sugruma primatele albe se gîndește că va muri curînd

dar soarele îi dă speranță și vigoare emblematică

torța seacă a amuțit spre alte enigme

nesecat lac deșeuri anonime, fruntea de suspine

vara neagră ochii negrii articolul iscat cognitiv secera sună

pericol destupat inadvertențele se adună

scop oniric testamentul fals droguri la morgă

avea două coaste rupte
şi stătea legat în clădire de-un parapet mirosind a var proaspăt
trecut de ora cinci a dimineţii
cu grumazul sec
aşteptând-o pe hol în halat

uitase cum se mişcă degetele
cum se strânge pumnul plin cu oase
cum arde femurul când e lovit cu nojiţe din cauciuc

şi o muşca de coapse
crezând că se joacă de-a eroticul,
dar nu ştia că durerea îi înfigea Evei ace groase-n piept

şi o muşca de buza de jos mai groasă
crezând că trezeşte din cenuşă un eros mort,
dar nu ştia că veninul răsufla stricat prin aortele ei.

pe faţă i-au apărut bube,
şi azi dimineaţă, la ora opt, au găsit-o moartă
pe covor, în mijlocul camerei
cu ochii deschişi, cu mâinile împreunate spre icoane.

Einsatz mit dem RTW in einem Wohngebiet. Während der Anfahrt mit Sonder- und Wegerechten teilt uns die Leitstelle mit, es handele sich dort um eine gestürzte ältere Dame und ihren Ehemann mit Kreislaufproblemen. Wir sollen dort erstmal abklären, ob weitere Rettungsmittel erforderlich sind.

Bei unserem Eintreffen wird die Wohnung im 2. Stock vom Ehemann geöffnet, dieser ist auffällig blass und wirkt kurzatmig. In der Wohnung finden wir seine Frau in einem kleinen Flur seitlich auf dem Boden liegend vor. Sie klagt über Schmerzen im rechten Oberschenkel.

Nach einem kurzen Gespräch mit beiden Beteiligten entspinnt sich folgender Unfallhergang: Der Ehemann fühlte sich den ganzen Vormittag schon schlecht, war kurzatmig und hatte Übelkeitsattacken. Dann überkam ihn ein Schwindelanfall und sackte im Stehen zusammen. Dabei riss er seine Frau zu Boden, die versucht hatte, ihn aufzufangen.

Wir teilen uns auf, um kurz einen Status beider Patienten zu erhalten. Der Ehemann ist weiterhin kurzatmig, wirkt blass und zyanotisch. Der Blutdruck liegt bei 130 mmHg systolisch, der Puls bei 60/min. und die gemessene Sauerstoffsättigung bei 92%. Bekannt sind bereits medikamentös eingestellte Diabetes mellitus Typ II und eine Linksherzinsuffizienz.

Die Ehefrau hat seit dem Sturz mäßig starke Schmerzen im linken Oberschenkel. Das Bein ist zwar verkürzt, aber nicht außenrotiert, der Umfang des linken Oberschenkels hat im Vergleich zum Rechten deutlich zugenommen. Der Oberschenkel ist bewegungseingeschränkt, ein Druckschmerz besteht etwa mittig des Femurschaftes, allerdings nicht über dem Hüftgelenk. Die periphere Durchblutung, Sensorik und Motorik sind intakt. Bis auf einen Hypertonus sind keine weiteren Vorerkrankungen bekannt. Der Blutdruck beträgt systolisch 150 mmHg, die Sauerstoffsättigung liegt bei 98% und die Pulsfrequenz bei 88 Schläge/min.

Das Team beschließt nun, die Leitstelle zu kontaktieren, einen weiteren RTW und eine Drehleiter der Berufsfeuerwehr nachzufordern.

Der Ehemann erhält Sauerstoff über eine Nasenbrille, wird im Wohnzimmer sitzend belassen und weiterhin per EKG überwacht. Um auf eventuelle Veränderungen aufmerksam zu werden, wird der R-Zacken-Ton aktiviert und die Alarme entsprechend eingestellt.

Die Ehefrau erhält einen venösen Zugang der Größe 17G (weiß) und eine zügig laufende Ringerinfusionslösung.

Zeitgleich werden aus dem RTW die Schaufeltrage, Vakuummatratze und Absaugpumpe geholt. Anschließend werden ein großes Fenster in der Küche und der Bereich davor großzügig freigeräumt und dort die Vakuumatratze ausgebreitet.

Vorsichtig wird die Patientin in beide Richtungen zur Seite gedreht und unter ihr werden die Schaufeltragenteile zusammengeführt.

Zur rechten Zeit trifft der zweite RTW zusammen mit der Berufsfeuerwehr ein. Nachdem sich alle einen Überblick verschafft haben, wird der Ehemann vom zweiten RTW-Team versorgt und mittels Tragestuhl über das Treppenhaus in den Wagen verbracht.

Zu Viert wird die Ehefrau per Schaufeltrage auf die Vakuummatratze umgelagert und dort eingebettet. Das Oberteil unserer Trage wird mit der Drehleiter ans Fenster gefahren und die Patientin zusammen mit der Vakuummatratze darauf fixiert.

Nach dem Zusammenräumen des Materials wird die Wohnung sorgfältig verschlossen und der Hausschlüssel dem Ehemann übergeben.

Nach kurzer Flugreise wird die Trage mit der Patientin auf dem Rollgestell gesichert und in den RTW gebracht. Es werden nochmals alle Vitalwerte ermittelt und anschließend die Patientin schonend unter Nutzung von Sonder- und Wegerechten in die Unfallklinik transportiert, nachdem wir uns dort telefonisch angemeldet hatten.

Leider konnte der Ehemann aufgrund der internistischen Erkrankung und dem Zustand, dass die selbe Klinik keine entsprechenden Betten mehr gemeldet hatte, dort nicht aufgenommen werden und wurde in ein anderen Krankenhaus transportiert.

Die Patientin wurde direkt im Röntgen der Klinik übergeben. Nach dem Aufrüsten des RTWs haben wir noch die Möglichkei gefunden, die Aufnahmen zu sehen. Dort zeigte sich eine mediale Spiralfraktur des Femurschaftes. Die Patientin wurde noch am selben Abend operativ versorgt.

Fractura de femur en zona cancerosa

El tratamiento de fracturas y luxaciones es cada vez mas quirurgico, y esto debido a que se necesita la rapida movilizacion de la articulacion o de las articulaciones vecinas, esto debido a que cuanto mas tiempo se inmovilice una articulacion mas dificil es que tenga su movimiento normal por lo cual se decide cada vez mas por un tratamiento en quirofano.

Las fracturas son tratadas en mejor forma en su etapa mas aguda osea cuando recien se ha producido el accidente, aunque cuando ya tienen tiempo (secuelas) el tratamiento tambien se puede otorgar teniendo en cuenta que se necesita muy probablemente hueso de otro sitio o un tipo de fijacion mas fuerte.

¿tienes alguna fractura que no te trataste bien? muchas veces el dejar los huesos que solden solos no es la mejor opcion ya que impide que los musculos tengan la fuerza que deberian tener y los movimientos que deberian hacer.

Al tratar como debe de ser una fractura se obtiene una mejor movilidad, mas fuerza en los musculos y una rapida rehabilitacion.

Well. It’s been one of those weeks and I keep hoping I’ll wake up from a bad dream. Last Saturday hubs fell about 15 feet from our truck shed. Luckily, he is alive. Luckily he will walk again. Unfortunately, he broke his femur on his right leg ending up with a steel rod and pins in his leg as well as crushing both of his heels… The femur is on it’s way to recovery but the heels will have to have surgery in the coming weeks. We are just hoping the tissue swelling is down soon so they can go ahead with the surgery. The longer we wait, the more the body will start healing itself which will kill the chances of fixing what needs to be fixed.

We have two trucks and two businesses that we run and a farm place that I will be in charge of for the next good while. We have 14 chickens and 5 cats that depend on us…  Hubs will be in a nursing home for a while at least until they do the surgery on his feet and then we will go from there. We have been so lucky with working on our farm place, climbing on barns, trucks, trailers, and everything else in between… And I guess our luck ran out. Or hubs did anyway.

Next week I will have to go back to work. I will have to leave hubs two hours from home. Alone. Tonight I came home. Alone. It’s really quiet here, and although I love the country, and the piece and quiet, it’s really quiet tonight… My parents have my dog and although I love my cats I miss having another set of ears that knows what’s happening outside before I do.

Life 101… Some days it isn’t so great is it? Some days you expect one thing and get another. Some days you think life will roll along like it always has. Some days it jerks out of control like a bad car accident. I guess you just have to roll with it. And take it as it comes. One day at a time. But, like my vacation, I have learned to enjoy every moment you get because it can change so fast it’ll make your head spin!

Translated from original blog post at http://www.LiYeSen.com

Knee replacement surgery, or also known as knee arthroplasty is the treatment for degenerative arthritis (also known as degenerative joint disease, degenerative knee, Osteoarthritis, proliferative knee arthritis, hypertrophic arthritis, senile arthritis). It is treatment when surgery is the last thing that is needed.

However, recently, I came across with some news about some doctors are so advocating in the benefits of this technique, and encouraging patients to have early surgery. For me, it is really hard to understand!

Knee joint is the largest and most complex structure joint in our human body. Because of its superficial position;  its bearing of heavy burden; its huge amount of activities; its complicated structure but unstable  structure (especially during activities), it is easily lead to injury. Knee joint is also a common place for hyperosteogeny. The structure of knee is formed of articular cartilage, muscle, ligament, and articular cavity materials. Its functional activities is a process of mechanical movement.

The structure of a joint.

Knee is made up of distal femur, proximal tibia and patella (or known as knee cap).  The surface of the knee joint is attached with  articular cartilage. While the surface of the articular cartilage is very smooth, as to prevent any friction.

The degenerative knee arthritis is due to degenerative changes of the knee joint, and also chronic accumulation of joint abrasion. The main pathology behaves for degenerative arthritis are degenerationof articular cartilage in the knee, reactive proliferation of articular cartilage, and spur formation. For the clinical records, this kind of disease is normally seen on elderly people, especially those at the age of 50 to 6o years old. While female patients are more than male patients who suffered of this degenerative knee arthritis.

Knee replacement or knee arthroplasty is a surgery that makes a cut at the knee of the patient, as to resect the rough surface of both the patella and the tibia. The resection  is to insect and install the artifical knee joint. This is done by inserting two metal components, or so called artificial knee joint onto the femur and the tibia, using a special bone cement, i.e. polymethylmethacrylate (PMMA) cement to fix them.

Knee Replacement

Does it sound like I’m a carpenter making furniture, or I’m an engineer doing some mechanical engineering?

If from the aesthetic point of view, this surgery can be done prefectly. But, after all, human body is not a furniture, not even a machine. Human body is living body, that must possess the normal physiological abilities. To be honest, sure this surgery can restore the knee’s ability of mechanical locomotion, within a certain period of time. But the impacts and damages brought by this surgery is totally inevitable.

Left: Resection of tibia. Right: Image after the knee replacement.

Let us take a look at the impacts and damages caused by the knee arthroplasty, or knee replacement surgery.

As I mentioned earlier, the structure of our human knee joint is very complicated. Just only the movement of knee joint, it involves bone, muscle, ligament, and joint capsule. These include the tibia, femur, patella, musculi quadriceps femoris, musculi gastrocnemius, medial collateral ligament, lateral collateral ligament, cruciate ligament and so on. The injuries of all these organs and tissues caused by surgery are often inreversible. The most common inreversible injuries are the thigh and calf atropy, knee joint pain, limited activities, nerves injury and so on.

Based on traditional Chinese medicine theory, let us analyze these damages.

There are six meridians that pass by the knee joint, i.e. three Foot-Yin meridians, and three Foot-Yang meridians. Operation can cause damage to the meridians that affected the flow of vital energy, qi. Thus, after the surgery, whenever there is weather changes, often occur joint pain.

Beside this, knee joint is where the HeXue acupoints of “Five Streaming Points” is located. The physiological function of HeXue acupoints, is “to unite the internal organs”. That is why the knee replacement surgery always cause the dysfunction of the internal organs. It is most obvious seen in the dysfunction of spleen and stomach, and often appears abdominal pain and abdominal distention.

From the Yi-ology point of view, the analysis result is the same. Any injuries on leg will appear discordance between both the liver and the spleen. While the syndrome shown is abdominal distention and abdominal pain.

Degenerative knee arthritis is one of the most common disease among elderly people. The human body functions degenerate, and proliferate is a compensatory physiological phenomenon. Using X-ray to observe, for the same type of knee joint hyperplasia phenomenon, some people do show clinical symptoms. While some do not.

I persoanlly think that, the action of those doctors who advocate the benefits of surgery patients, as to have early surgery, is really irresponsible. They think that early surgery can help the patients to avoid from suffer and pain. But, in fact, Traditional Chinese Medicine treatment methods such as acupuncture, TuiNa massage, and other methods can be very effective for treating the degenerative joint disease. I have many such cases, that some even fly from Kelantan to Kuala Lumpur, just as to have treatment.

Therefore, as long as the is early treatment, the knee can be sure completely. If so, why still need to suffer from that cut, and install a mechanical divice?

Din cand in cand avem motive de mandrie nationala, ca sa zic asa, cand nici nu ne mai asteptam. Cine ar fi crezut ca printr-o poveste, fals catalogata ca erotica in registru comic, “Povestea, scuzati-ma, Pulii”, Creanga sa-l tavaleasca pe Jules Verne si viziunile sale futuriste? Pentru ca el e adevaratul vizionar al lumii de maine, omul care intrevazut viitorul! Ei bine, taranul care se trezeste cu câmpul plin de membruţe care mai de care mai sanatoase, si care se duce cu ele la targ in speranta de a face ceva bani, nu mai e de azi o alegorie. E un fapt de viata normala in viitorul apropiat. Iar discutii de genul:

” -  Buna ziua vecina, da’ ce fleici frumuşele ai in gradina. Io-te, vad si cevaşilea cefe de purcel ! Ia zi-mi, de la ce laborator ai luat celule? Io unu am luat o teapa cat casa cu copanelele de aligator de Florida. Noroc cu nevasta mea, care cultiva de cativa ani niste penisi, numa’ unu si unu. Si sa vezi ce grija are de ei si cum le canta si-i dezmiearda, de ti-e mai mare dragul. E asa de absorbita de ei ca uita sa vina in casa sa mai manance. Trebuie sa-i aduc eu un sandwich si sa ies repede ca ma da afara scurt!

–   Ia mai lasa-ma Costele, fite-ar coarnele ale dracu’,  ca iar mi-ai speriat copii, de si-au luat piciorusele si coditele la spinare si nu s-au mai oprit decat in varful baobabului! Las’ ca si eu am avut cerere slaba de ficatei kenieni, ca nu mai fuge lumea ca pe vremuri. S-a puturoşitără ai dracu’! “

or sa fie normale intre satenii viitorului.

Pentru ca, un grup de destepti a descoperit, din lipsa de ocupatie, un mod de a creste carne in laborator. De la muschiul tiganesc la ceafa de porc, dexterii nostri is pe cale sa se intalneasca cu ailalti savanti dr. ing. care cultiva organe si chiar membre umane noi noute si astfel sa intinda o hora pe campii, de o sa ne sara ochisorii si creierasii din cap de bucurie.

Sa fie clar, nu am nimic impotriva, ba mai mult, ii felicit, dar parca mi se strage un pic pitpalacul cand vad ce si cum. Si ca sa mi se para ca am ajuns intr-un univers cu totul paralel, niste italieni simpatici au mesterit ei acolo in treaba lor, fara sa deranjeze pe nimeni, dintr-un copac cinstit un femur in toata regula, in timp ce MIT-ul din fostul meu cartier, vine ca de obicei cu o chestie surprinzătoare si nemaipomenita: adezivul de tesuturi umane.

Nu e greu de facut niste supozitii despre cum o sa arate viitorul, mai ales ca toate descoperirile astea or sa fie accesibile si vitei care o sa vrea sa-si implanteze membre in plus sau inca o pereche de ţâţe pe spate.

Cinstit vorbind din toata avalansa asta de informaţii, una singura imi da fiori sinceri si ai dracului de reci intre omoplati. Un prof de la Univ. din Standford a descoperit o modalitate prin care maparea ADN-ului uman e posibil sa fie facuta de catre o singura persoana si la costuri infime. Descoperire epocala in sine, ma face totusi sa ma gandesc cu groaza ca orice dement,  pe baza faptului ca are acces la asa ceva o sa se apuce sa ne arunce cu mutatii si boli extrem de mizerabile in cap.

Plus ca nu toti cercetatorii sunt foarte destepti. Dupa cum reiese dintr-un studiu care ne anunta ca violatorii si cremenalii au rotite care nu conecteaza bine in creier. Nu ma inebuni, jura-te! Si io care credeam ca e din cauza stresului!

Sincer, acuma cand scriu chestiile astea, nu stiu pe unde mai e Doamne Doamne in toata afacerea asta, dar pun pariu ca in cateva decade o sa-i rostim numele mult mai des decat am vrea.

Dar nu va speriati, ingeniozitatea umana va prevala de fiecare data si sigur ne vom descurca cumva. Cum a facut si geniul penitenciarelor, omul surpriza, Che Guevara-ul Gherlei: George Vera, care a introdus in inchisoare, desi fusese dezbracat si perchezitionat, o frumusete de pistol. Ascuns sub straturile de grasime de pe burta, vitelul cantarind peste 2 chintale, a dat un nou sens diagnosticului de obezitate morbida cand a pus pistolul pe masa anchetatorilor. Ceea ce i-a provocat blandului politist John P. Horseshoe, ofiterul insarcinat cu perchezitia corporala, (ce tocmai se sfarsise) un mic atac cerebral.

So I was so over the two years of not running that I had just decided I would get cortisone shots in my knee and figure everything else out as I went along.  I just wanted to run.  Thankfully, my dad had a better perspective on my popliteal tentonitis issue.  He told me that if I really wanted to get the shots, I needed to have a plan first.  Otherwise, I’d be wasting precious time trying to figure out what rehab I needed to do instead of actually using the time to do the rehab.

We therefore scheduled an appointment with a chiropractor who specializes in sports injuries and bone extremities.  Of course we knew he’d be anti-cortisone shot, but we wanted to hear him out anyway.  This particular chiropractor had worked with many members of my high school cross-country team in the past and had helped a lot of people recover from injuries they had otherwise thought to be hopeless.  I was still a little skeptical because while even my best friend had had success with this chiropractor, she had never been directly told by a doctor that she’d never be able to run again.  I had.

However, I agreed to the appointment, and I actually learned a lot.

My left leg is apparently shorter than my right, which is part of what is making me lock my left knee every time it hits the ground.  Also, the condyles (basically the knobs at the end) of my femur are apparently not lining up quite right with the condyles of the proximal end (the end closer to my body) of my tibia.  Therefore, every time my knee locks, the bones hit my popliteal tendon, eventually inflaming it.

This somehow has something to do with the way my foot is structured.  I have high arches and had issues with my metatarsals (basically think of the knuckle part of your hand, except on your foot) all through high school.  I got orthotics to help with my metatarsals sometime around when I was fifteen, but they apparently were shaped in a way that also messed with my knee.  The medial side of the orthotics is basically a really high arch that matches my foot, but then they almost completely flatten out across to the lateral side, therefore not giving me enough support across my longitudinal arch.  Some of the bones in my foot that aren’t getting support (I’m thinking at least the cuboid bone and lateral and intermediate cuneiform bones…maybe even my calcaneus and talus) are basically collapsing downward every time I step.  That then forces my tibia to come down harder, locking my knee faster and messing with the alignment of my knee condyles.

So first my chiropractor did something where he kind of pulled my knee back into place because it was so jammed together.  I could instantly tell a difference in the strength of my leg from this.

Then he taped my foot, giving my arch more support and kind of keeping my bones in place.  He told me to just see how it felt for a couple days and let him know at our next appointment.

(It is important to note that I walked the Peachtree Road Race (6.2 miles) with a friend less than a month ago and was limping for a few days after because my popliteal tendon was so inflamed.  The same was the case after I went to Cedar Point with my family.  My knee has even been irritated from trying to stand too long, like at a football game.)

Well, I forgot to mention to him that I was going on a camping trip that weekend, where I would be hiking five miles each way, with a thirty pound pack on my back.  It ended up not mattering, because I didn’t even think about my knee one time the entire weekend…because it didn’t hurt once!  Definitely a big improvement!

I’m not saying my knee is all better, because it’s definitely not.  I’ve still had some inflammation since my last visit with my chiropractor (the visit following my hiking trip).  I still can’t run, and I still think that I want to get cortisone shots.  That being said, this is definitely a step in the right direction, and it’s helping to understand why my knee has the problems it has and therefore what I can be doing to help it.

Let me start with a little background about myself. I was born with Myelomeningocele (Spina Bifida) at the L5 S1 level. This cause paralysis from my waist down, in a “spiraling effect.” I can feel the front of my legs but not the back. I have muscle tone in my thighs but not my calves, so this makes it very difficult to walk. I have always walked with my knees slightly bent, for stability – and this has caused pain for as long as I can remember. With all of my weight on my knees, they were constantly giving out when I was younger, and consequently have been a source of chronic pain my whole life.

I have had about 12 surgeries in my lifetime related to Spina Bifida. The majority of them have been Orthopedic in nature. My most recent surgery took place on April 9th, 2009. I was diagnosed with a bulging disc at L2-3 and a stress fracture in my femur (hip). The location of the bulging disc was very dangerous, as this is so close to my lesion from birth. I had noticed some sensation differences in my legs within the last year or so. I had also been noticing an increase in occurrence of my kidney infections (something I fight on a regular basis). All of these signs pointed to a more severe possible diagnosis of a tethered spinal cord. A tethered cord happens when the base of your spinal cord (in my case, this goes all the way down to my tailbone) gets attached to scar tissue. It “tethers” itself to the scar tissue, pulling the cord taught, making it more difficult for nerve impulses to travel the length of the spinal cord. So…in January of 09, after nearly 3 months of severe hip pain, I went in for an MRI of my hip and Lumbar Spine. The hip MRI showed a stress fracture at the femoral head/neck. The L Spine MRI showed 2 bulging discs and a tethered spinal cord. So…which came first?? Nobody knows. There is no medical explanation for my hip fracture and one of my bulging discs was bad enough to need surgery. My doctor still wasn’t sure if my pain was coming from the disc or the tethered cord. After 3 more months of tests and waiting, I had surgery to repair the L2-3 disc and stress fracture.

Six weeks of medical leave is pretty boring, but definitely necessary after such major surgery. I came home using a walker (barely) and it took me a good 2 weeks to be able to get up without it. The next two weeks were spent walking for as long as I could (which was only for about 10 minutes or so). And the final 2 weeks were just for me to get back into a “normal routine.” I went back to work on May 27th – still with some pretty significant hip pain. Every time I took a step, pain would shoot down from my hip to my knee. I have always walked with a different gait than the “normal” person, but since the surgery there was an obvious change for the worse – even for ME. I had decided I was no longer going to take any pain medication – I’m not one to become dependent on those sorts of things. So I just decided to deal with the pain. I took it easy and only walked when I HAD to. The first step or two after sitting for long periods of time were excruciating.

Now we fast forward to last Wednesday, June 17th at the Monarch Hotel in Clackamas. I attended the meeting with my Grandpa, Don Alanen. My parents had been to the lunch meeting and told me how amazing the stories were. They were so amazing in fact, that I was hard pressed to believe them. I have a medical background, so I look at the science of things…but I also recognize the value of Natural Medicine – I have had tremendous success with previous supplements my parents had introduced to me from Enrich and other companies of the sort…but you know that part. So…as I sat in the meeting, I loved learning the science behind it and hearing just how phenomenal this product truly could be! I was pleasantly surprised when it actually tasted great too! I could drink that whole bottle in one sitting!

I went home that night and decided to wait until Thursday morning to start drinking TRIVITA’S Nopalea. So at 7:30am, I started for the day. I know the recommended is 1-3 times per day, but I figured it wouldn’t hurt to do more – especially since I’d just had major surgery. It took from 7:30am-10am, and I noticed a small change. When I got up to go to the back of the office to take my next dose at 10am, my leg didn’t hurt when I stood up to walk. It was a little sore and I still favored the leg, but nothing like the day before. I ended up taking Nopalea 5 times on Thursday – once each time I had something to eat (Breakfast, AM snack, Lunch, PM Snack and Dinner). On Friday morning, I had NO pain in my leg or my knees. I didn’t really believe it, and thought it might be the placebo effect. When I got to work on Friday morning, I have the option of either taking the stairs or the elevator. I opted for the stairs on Friday – just to test it out and see if the pain really was gone. I took the stairs up to my office (on the 5th floor) and only had to stop at the 3rd floor because I was a little winded. By the time I reached the 5th floor, I was amazed I wasn’t falling over completely out of breath or unable to walk due to pain! I actually did it – pain free! In my entire life, I have never been able to walk up ONE flight of stairs without at least my knees bothering me or having to stop halfway up to catch my breath…and I just did 5 flights – with no problem! My family can even attest to that story – they know I wouldn’t dare take stairs. Even on the night of the Nopalea meeting, the elevator was broken so we had to take the stairs up one floor. I had to put all my weight on the rail whenever I stepped with my right leg because it was just too painful.

My body knows I need this. I can tell when I haven’t had in for a while…my hip starts bothering me, so I go for more TRIVITA’S Nopalea…and almost immediately my hip feels better. I can’t explain it – and don’t really need to. I’m pain free and that’s all that matters!

Hope this story helps others! Thank you for taking the time to read it, and let me know if you need anything else from me. I am happy to talk to ANYONE who might have questions for me or want to know more about my story (as this is a condensed version of the last 26 years). )

Thank you!

Ashley St. Clair

p.s. My home address is:

2896 NW Moda Way #913

Hillsboro, OR 97124

Phone: (503) 758-7999

Your quality of life and your success, in large part, will depend on your health.
TRIVITA

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