Operation: the waiting game

The second surgery to complete the upgraded implanted neural prosthesis

This second surgery felt different. Everything about it was more relaxed. Besides, we were just going in to implant four cuff electrodes. Simple, right? The typical surgical preparations ensued; pre-op blood and urine tests, skin integrity checks and most importantly don’t get sick. Even I was more relaxed.

Maybe my mind was distracted by the one thing that I had been waiting for over the past six weeks; the ability to stand with the new IST-16. Getting all those channels back into the standing pattern would, hopefully, mean that standing would once again become functional. Recall, I had been standing with the original IRS-8 and with minimal channels. I could stand but I could not take a hand off the walker and the standing duration was relatively short at 1 minute. It was a far fetch to how I was standing before.

The day prior to the second surgery was Dr. Martin Luther King Day. As a holiday, the Louis Stokes VA had a skeleton crew. A medical center that is typically bustling out of the seams felt like a ghost town. Arriving at the main entrance via the hotel shuttle bus, there were no lines of cars, no people waiting for rides and only one man in the lobby. This would be a short day in the lab. We just needed to do some final checks. Above all, I would be able to stand.

We plugged the RF coil into the testing box. Before we could get to a stand, we had to test each channel. Since they replaced the IST-16, the channel assignments have now changed. For instance, what was once channel 6 to control the hamstring muscle was now channel 7. We tested each of the 16 channels to check the programming records and to log the stimulation parameters.

Finally arriving at the moment of truth, the first sit to stand with the new implant. After maneuvering into position and placing the walker in front of me, the engineer pressed the button for standing. My back electrodes fired up a straight posture and then the legs kicked in with a powerful contraction to pop me up from the seated position. The stand felt stronger with the revived channels but the duration was not much longer. Again, those muscles have not been used for nearly six months with the exception of light exercise over the last six weeks. It was apparent exercise was in the order to get back to where I was.

One of the caveats was that the cuff electrodes that wrap around the femoral nerve to control the quad muscles are now different. As you may recall, I was only using two channels previously. This pattern still had two channels but they were different. One of the channels on each femoral nerve was in the original pattern and one of the channels was not being used previously. During the first surgery, the team decided to plug in the two channels for the best performance identified in the optimization analyses. Still I was back to standing with the ability to use one hand for balance.

Now, it was preparations for surgery. From the EMG/NCS study results, we are going with the original plan of placing cuff electrodes on the nerve that innervates the tibialis anterior and gastrocnemius. The PT dropped me off at the hotel with the walker and the standing system. It gave me one more evening of standing before going into recovery mode again. It was time to relax and get ready for the next day. But it is never that simple.

Classic Great Lakes snow showers were in the area and the roads were getting bad. Since my Mom offered to take me to the hospital in the morning, we decided to have her stay at the hotel overnight and not contend with the snow and icy roads around Cleveland. I wish it was just the weather but there was another glitch.

We also received word that we would most likely not start on the scheduled time of 0830. The lead surgeon might have a case prior to ours. Still the reporting time to the hospital was 0700. The team was preparing for the waiting game in the pre-op area. What a better way to kill time than with a classic board game. Possibilities were Uno or Yahtzee but we finally settled on the game of choice — “Operation” — the minion version.

Tuesday morning arrives with the pre-surgery ritual of a Hibiclens shower, a skin cleanser that looks like Pepto-Bismol and stinks. We arrive in the surgical area check in and wait. My name is called and back in pre-op I get the grumpy nurse. She probably woke up on the wrong side of the bed. In fact, we all do occasionally. It finally took about 30 minutes to get her to break a smile and warm up. Regardless, she got the job done and I was ready to go on time. Then the stream of resident doctors started coming in with consent forms, verification of procedure, checking the skin and marking the incision areas.

Then the anesthesia team starts streaming in. They go over the procedure, how I will feel. Since I will be on my belly for the entire surgery we had to come up with some creative padding for the implants in the abdomen. As they left, the lead surgeon stepped in unexpectedly. “Where’s the team?” We were all expecting to be waiting for the lead surgeon and the rest of the research team was not expecting a start time until 1000. To our surprise, he was ready to go at 0830. He left to get suited up and the three amigo anesthesiologists stepped in with their first cocktail. They loaded the mixed cocktail into the IV. That’s the last thing I remember. Out.

Five hours later, I awoke in a drunken haze looking at the principal investigator, the engineer and our PT. They were telling me about the surgery, how well it went and how good the stimulated responses of the cuffs were. But I was still pretty loopy and don’t remember a word they told me. A few hours later, the nurse came in and said “ready to go?” They were discharging me and sending me back to the hotel. A little cognitively slow, I carefully changed into street clothes with bandages on my outer thighs, back of the knees and the front of the calves.

Back at the hotel, the drunkenness was wearing off and my Mom decided to spend one more night at the hotel, just in case. Food was in order. While eating lentil soup with cucumbers and hummus, she started to brief me on what she was told by the research team. During the surgery, they discovered the fibular nerve on the right tibilias anterior had been compressed, much like carpal tunnel syndrome that can occur in the wrist. They decompressed the nerve to relieve the pressure. As my Mom is telling me this, it explained why my right foot was tingling — a sensation I haven’t felt in a long time.

There is a back story to this. Three years ago, I abruptly lost sensation in my right leg from the knee down and the lower leg was swelling unexpectedly. We did a battery of tests attempting to find the cause; EMG, ultrasound, CT scan. You name it. We never solved the case, but I did discover acupuncture as a way to reduce the swelling temporarily but the sensation never came back.

Now, I’m sitting in a hotel restaurant and am finally feeling my right foot again. It is not a normal sensation. It feels like the pins and needles when your foot falls asleep. At this point, we are just letting the body heal over the next six weeks with limitations. Doctor’s orders (technically physical therapist orders) to periodically straighten my legs throughout the day and elevated to allow the incisions on the back of the knee to heal. That means over the next six weeks I’ll need to take it easy but at least I can now exercise my upper body. This will be an interesting balance.