Wednesday, September 8, 2004
Carolyn Scherar could no longer walk without severe pain. She could not get out of bed or rise out of a chair without hanging onto nearby furniture. Her lunch hour walks had become a thing of the past.
Degenerative arthritis was slowly crippling the 57-year-old lifelong resident of Steamboat Springs. The cartilage in her right knee had worn away, causing her bones to rub against each other at each step. "It hurt terribly," Scherar said. "I was limping badly, and my knee would just lock up. It also was beginning to affect my back because I was trying to compensate for my bad knee."
Scherar decided it was time to see an orthopaedic surgeon. She consulted Eric Verploeg, M.D., who recommended knee replacement surgery. Scherar had her surgery at Yampa Valley Medical Center in May.
She spent four days at the hospital, getting specialized nursing care and physical therapy treatments. Her rehabilitation continued at home, provided by a physical therapist from Northwest Colorado Visiting Nurse Association. Scherar depended on a metal walker at first, graduated to a cane and then began walking without assistance.
Within a month she was back at work. By the end of summer she had resumed recreational walking. "I feel like I have a new leg," Scherar said. "I'm having my other knee replaced in October."
When Scherar has her second surgery, she will be one of the first patients to participate in the newly enhanced joint replacement program at Yampa Valley Medical Center. Since January, a multidisciplinary team has reviewed all aspects of knee and hip replacement surgery at YVMC and studied best practices at other Colorado hospitals.
Judy Zuccone, YVMC's director of quality services, and David Wilkinson, M.D., medical director of quality, lead the team. They have met with orthopaedic surgeons, other physicians, physical and occupational therapists, nurses, scrub techs, case managers and patients.
"Part of improving any program is a prospective and retrospective review," Wilkinson said. "We looked at what we were doing and some improvements we wanted to create."
"Our team approach focuses on creating care that results in optimal outcomes, so that the needs of residents of the Yampa Valley are met," Zuccone added. "We are getting the patient involved very early in the process. Ideally this occurs at the time of the first discussion with an orthopaedic surgeon, but certainly within two weeks prior to surgery."
Five orthopaedic surgeons on YVMC's medical staff perform joint replacement surgery. They are Bryan Bomberg, M.D., Greg Sarin, D.O., Michael Sisk, M.D., Verploeg and Jerome Wiedel, M.D.
Every patient will receive an educational booklet that is a step-by-step guide through surgery and rehabilitation, beginning with pre-operative management. The patient fills out a medical history and receives a physical exam and physical therapy evaluation. Then come meetings with a preoperative care nurse to discuss surgery and a case manager to talk about post-hospital care needs. "We believe that increased involvement of the patient can result in fewer complications, decreased length of hospital stay and generally better outcomes," Zuccone said.
Inpatient physical therapy is provided very quickly after surgery. This is followed by a specific, prescribed physical therapy routine in an outpatient physical therapy setting. Some patients also need a short-term rehab setting such as the Doak Walker Care Center; others may receive home health care from the VNA.
"We have recognized a significant need in the Yampa Valley for joint replacement surgery, and we feel we can meet this need here," Zuccone said. "It is better for people to recover in their own community rather than go elsewhere."
Scherar felt well-cared-for in her hometown. Her own hard work also played a key part in her recovery.
"Exercise is so important," she said. "The nurses call me 'the poster child' for knee replacement. One of my co-workers even told me that I seem taller, because I can finally stand up straight."