Six Weeks: Part One

Most of us have heard of two weeks; a fortnight, 9 1/2 weeks; a racy movie, and even 26 weeks, the age of the first born child who is actually 6 months old. These “weekly” designations don’t bother me, except for the kid thing. My oldest son is 1,547 weeks old by the way.

Six weeks is the one that really bothers me. Six weeks is exactly how long it takes to recover fully from an orthopedic injury or surgery, right? Six weeks also happens to be the length of time that the average human psyche can withstand being down and not in control. Okay, that last one, the control thing, is my own semi-educated observation about my patients, but I think I am on to something here…

As much as I council my patients prior to an elective surgery, yep, you got it, six weeks is still the time that sticks in their minds. I most definitely do not put it there, but someone or something did.

This two-part blog is about the experience, the journey after surgery, not the final result. Most often these are two completely different things. Just to make sure I am clear, one could have a very rocky recovery and end up with a great result and visa versa.

Okay, a patient chooses to have an elective surgery. I have wondered and sole searched (get it?) why even after I vigorously “lay the crepe” they continue to just let it go in one ear and right out the other. Swoosh!

Why even bother? Of course there are several possible reasons why the message doesn’t get through. Maybe I am talking too softly, or they don’t hear so well. Or maybe they just think that I am doing a little cover-my-rear-end maneuver by informing them about all these bad restrictive things that WILL happen. Or they are thinking, and I love this one, “I’m a fast healer” and this stuff just does not apply to them.

While all of these anecdotal reasons are no doubt true in many cases, we docs have boiled it down to one basic inconvertible reason why you are not getting it: you hear exactly what you want to hear. Most of you come in with a preconceived notion as to what your surgical experience will be from whatever source, whether it be Aunt Jane, the World Wide Web, or your bookie. While we are telling you the absolute truth about the surgical experience, you are usually dividing it by six. BTW, good, conservative surgeons, those without alimony payments, are not used car salesmen and we operate only when it is necessary, so we tell you what you really need to hear. I do know a few used car surgeon types.

Having aligned expectations can be the difference between success and failure in our business. There isn’t one of us who does not want your experience, and of course your final result, to be as good as possible.

But here is what we know that you do not know. No matter how great the final result may be, you still have to recover and go through the gauntlet of the post-operative experience. And in most cases that post-op experience is worse than you can imagine. Why? Because you have an unrealistic expectation; you are set on six weeks!

I am not really talking about the pain. Heck, most patients are so scared over the potential for post op pain that they are often pleasantly surprised. Remember the expectations thing?

What you are not expecting is a lengthy recovery that always includes pain, loss of control, swelling, odd color changes — I could go on and on. These are the things we produce by doing the surgery and you acquire from going through the early recovery of immobilization, non-weight bearing, etc. In orthopedics we call it cast disease and it is mostly unavoidable. You see, surgery is nothing more than controlled trauma. Sorry, but this is true. Then comes the recovery, laying around and being less active, setting you back even more. While physical therapists can facilitate things greatly, you still have to go through the gauntlet to varying degrees.

I’ve come up with five simple rules for the best surgical recovery – and eventual outcome. Come back to the blog soon to read these in “Six Weeks: Part Two.”