A Life Restored

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This submission came via email from Marilyn Bates, a Mayo Clinic patient.

Bulbs crack the soil as sleet clears from Pittsburgh streets. Spring is almost here or so I think. Not so in Rochester, Minnesota, where my sister and I journey along I-90 to the Mayo Clinic. Here, plains are snow-swept and box elders border an occasional farm, the landscape stark and icy.

Procedures performed at the Clinic are often above and beyond those achieved at other medical establishments. Physicians there are not afraid to undo medical mistakes made by others. I am looking for a solution to my dilemma of coping with a missing left kneecap.

Previously, I suffered a broken kneecap (patella) in a fall in my driveway. The physician who initially mended my knee removed the patella entirely because it was fractured in five pieces. Regrettably, the inevitable happened. When walking down steps, my knee collapsed, my leg buckling, unable to bear weight. In the process, I damaged the tendon that held the knee together. I broke both elbows in falls over the next few months as the knee collapsed regularly. The only advice I could receive from local physicians was to use a walker and wear a rigid brace that required both hands to release it when bending into cars or sitting down. It was life-altering and made living autonomously impossible.

Simply stated, the kneecap is central to walking because it acts as a fulcrum when leg bones move from a fully straight leg to a bent knee. The powerful quadriceps muscle (thigh muscle) inserts into the upper surface of the kneecap. When contracted, it pulls on the patellar tendon to straighten or flex the knee joint.

Most people think a missing kneecap can be mended with knee-replacement surgery -– not so. Metal parts, used in knee replacement surgery, cannot be substituted for a kneecap which is a bone attached to living tissue. This complex extensor mechanism can be replaced but only with a “transplant” from a cadaver, called an allograft.

My appointment in the Orthopedics Department at Mayo was late in the day. We’d been keeping an eye on the weather for days, hearing of snow storms to the south in Wisconsin, watching the skies warily from the 14th Floor of the Gonda Building.

The Mayo culture is conservative. Everyone is professionally attired with neat haircuts -– no ostentatious jewelry, facial hair or earrings. Even the pharmacists in St. Marys Hospital wear suits and ties.

Like all Mayo personnel, the young resident who initially interviewed me wore an elegantly understated suit. He was extremely friendly as he recorded my medical history -– heart by-pass surgery, back surgery, a popiteal bypass in my left leg, breast cancer and most foreboding of all, 60 years of diabetes. Trying to minimize my anxiety as I showed him my leg, he remarked, “Nice lined slacks for the winter weather.“ I chuckled, “Only someone of your sartorial splendor would recognize the lining.” We all laughed.

“Dr. Pagnano will be in to see you shortly,” he said. “I know what he is going to say, but I’ll let him tell you.” My sister and I sat in silence, wondering what his remark meant. Was Dr. Pagnano going to give me the bad news -– that my medical history rendered me unfixable? Experiences in the past led me to see myself as a “broken person” who was better off “patched” with paraphernalia and assistive devices than subjected to additional assaults on the body. Inferentially, I was a risk to the surgeon’s reputation.

Dr. Pagnano entered the exam room with an entourage of physicians and his Physician’s Assistant, Pat Taylor. After asking a few questions and seeing me walk, he described an involved surgery called an extensor mechanism repair using an allograft, which is another name for a cadaver kneecap and tendon. During the operation, I would receive a new patella tendon, using a cadaver’s achilles tendon which would be connected to my shin bone. The tendon would be tunneled upward and implanted in my quadriceps muscle. The kneecap replacement was really like putting together a puzzle -– selecting a cadaver kneecap that was suitably sized to my anatomy and etching the piece to “click” in place under maximal pressure. Then the leg would be encased in a formidable toe-to-upper-thigh cast until it healed, 6 to 8 weeks later. After, a brace is worn for another six weeks as my knee acclimates to a 90 degree bend. And then he paused.

A long period of silence elapsed before I realized he was waiting for me to respond. I didn’t understand that he was actually offering this operation to me because it sounded so radical and no one in the Pittsburgh area ever suggested it.

Finally, I realized it was my turn to speak and asked in disbelief, “You mean you would actually do this for me?”
And he responded simply, “Yes.”

After the operation, enduring the cast was rigorous because I could do very little unassisted, but I kept telling myself all that mattered was that I had received a new knee and would one day walk. I kept saying, “You can do this.”

Mine was a good tenure at Mayo, which included a wonderful woman at Samaritan Bethany residence, where I rehabbed. Her name was, “Comfort.” She helped me during the long nights when sleep was impossible. Terms that I use when telling others of Dr. Pagnano are that he was brilliant and fearless because he knew he could “fix me,” and wasn’t afraid to proceed. He made me feel that I deserved to have a better life, unlike others who viewed me only in terms of my physical risks. Compassion was the true healer in my experience at Mayo -– one person’s reaching out to lift a little of the suffering of another.

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12 Responses to “A Life Restored”

  1. Jonah Cucuta Says:

    gah, nothing on your site is loading fast for me. I click something and it just waits for around 20 seconds, then my anti virus thing pops up and says there’s a threat and asks if I want to continue. Anyone else getting this or do I just have a crappy antivirus?

  2. Joe Says:

    What is the risk of getting an infection in a hip – or knee-replacement operation? Is it one out of 100 operations? more?less?

  3. Susan C. Davis Says:

    I had a total knee replacement in January and am still not able to bend my leg. I have been told that my body builds scar tissue and this is what is preventing me from using my knee properly. I have had 4 manipulations and my leg has been cast 5 times I even had orthoscopic sergy in August to remove the scar tissue. My leg is at 90% on the bend and 10 in being streight. Is there any hope for me as I havebeen in constant pain since Jan 25th…Please Help

  4. Mary Wilson Says:

    After a number of revisions to my original knee replacement, an ifection in that same knee, an explantation for 3 months (requiring total immobilization and no weight bearing for the 3 months) and a re-implant with a hinged knee, I fell when my knee buckled and broke my kneecap several months later.. I now have an active Baker’s cyst behind my knee and require it be drained quite frequently. My pain is not only constant, but often excruciating — in my knee and thigh. I have oxycontin and oxycodone, but they do little or nothing. I cannot use NSAIDS due to ulcer issues. Elevation of my leg doesn’t do much other than keep the cyst from draining into my calf and sometimes slightly relieves my pain. My orthopedist is frustrated — doesn’t want to “go in there” again. I feel pretty much useless and dependent on others to a ridiculous point. I still haven’t givien up hope that somewhere, somehow there’s an answer. In the meantime, my derrier seems to be expanding at an exponentioal rate as I spend more time on it.

  5. Debbie Says:

    I read what Ms Bates had to say about her knee and it gives me hope. I have been fighting with a knee problem for 3 years. I have seen 10 doctors and they are clueless what is wrong with my knee. My last doctor mentioned that I need to come to Mayo. I am so looking forward to finally finding out what is wrong with me and to get this fixed.

  6. sizzix big shot Says:

    I normally bounce all over the ‘net because I have the tendancy to read too much (which isn’t always a good thing because the majority of sites just copy from each other) but I have to say that yours contains some great substance! Thanks for stopping the trend of just being another copycat site! 😉

  7. COOKIE Y. CUSTER Says:

    I HAVE ALMOST ALL OF THE SAME PROBLEMS EXCLUDING DIABETES AND INCLUDING A STAPH INFECTION THAT REQUIRED THE REMOVAL OF MY AFFECTED SHATTERED PATELLA. THE INFECTION IS GONE BUT AFTER 8 SURGERIES THE TISSUE LEFT CANNOT SUCCESSFULLY BE CLOSED OVER THE ARTIFICIAL KNEE, AT LEAST NOT BY DR.H. FINN IN CHICAGO.IL. HE DID NOT FEEL A CADAVER KNEECAP WOULD WORK…I AM EXTATIC TO HEAR THERE IS A DOCTOR THAT CAN ACHIEVE THIS.

  8. jan guardiano Says:

    Mayo Clinic is obviously proud to have been pointed out as an example of providing health care with better outcomes at lower cost, one for our nation to learn from.

    On Mayo Clinic’s website:

    “Obama cites Mayo Clinic in advance of White House Conversation on Health Care

    “In an exclusive interview with Diane Sawyer on ABC’s Good Morning America President Obama continued to point to Mayo Clinic as an example of health care that delivers better outcomes at lower cost. The interview precedes a town hall meeting on health care reform being held at the White House on June 24, 2009. Responding to a question about whether Americans will need to make do with fewer tests and procedures in the future, President Obama commented, “I think what’s important is to say to the American People that you should get the best possible care to make you well. And that the measure of the quality of care is not quantity, but whether or not it is making you better. Now, what we’ve seen is that there’s some communities and some health systems that do this very well. Mayo Clinic, a classic example. In Rochester, Minnesota. People go there. They– spend about 20-30 percent less than some other parts of the country, and yet have better outcomes.”

  9. Mary Says:

    No, cadavers are not used in joint replacement. They are usually artificial parts made of metal and plastic. (I am a Surgery nurse) I have 2 bad patellas that the cartilage is worn away and was told that just a knee cap replacement does not do well. I thought I would check the internet and see if there was a possibility of a cadaver replacement. I was not told of that option. I will now talk to my Dr about it and I am sure it is only done at select hospitals as Mayo. goodf luck to you , i am interested in your progress

    • judy Says:

      Hi Mary – I’m interested to know what the Dr’s suggested as options for you, with two bad patella’s. My Mom is also trying to find info. on her options, she has one patella that has worn away to about a half the size of her ‘normal’ patella. She has arthritis in both knees. The Dr. we saw seemed to think there may not be enough bone to ‘resurface’ and add some patella prosthesis. He also was not too enthusiastic sounding about patella replacement. Just wondering what your other options are? Thanks.

  10. kim Says:

    Why was this surgery so unusual? Are cadevars not usually used in joint replacement? Or was it the other health issues that made this so unique?

  11. Janet Yontz Says:

    Another wonderful Mayo story!!!! I wonder how a NATIONAL HEALTH CARE PLAN will affect all that Mayo has done and what will Mayo be able to do in the future to continue to bring this care to the world. I am concerned and all should be !!!!!!!

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