New elbow, new outlook

March 7th, 2018
Barb Wheeler looks fondly at Delaney, one of her horses.
Barb Wheeler looks fondly at Delaney, one of her horses. Photo by Lindsey Reznicek.

Barb Wheeler can curl her hair. She can pull a shirt over her head. She can gather fresh-laid eggs. She can turn the wheel of her car easily and wash dishes after a meal.

All because her elbow doesn’t hurt any more.

“You don’t realize what your elbows do for you,” she said. “So many motions involve your elbows – picking things up, doing housework, petting an animal. Instead of screaming from the pain, I now have tears of joy because it doesn’t hurt anymore.”

Constant pain

A decorative art piece made of metal, depicting a soldier kneeling at a cross, with his horse nearby.
Barb Wheeler believes in the power of prayer. Photo by Lindsey Reznicek, UCHealth.

Fifteen years ago, Wheeler was diagnosed with rheumatoid arthritis. She traveled frequently to Denver for appointments with a rheumatologist, who through medication and then steroid injections, tried to help her manage the pain.

“I couldn’t keep going like that,” she said. “My husband, Carl, was basically doing everything. He could hear the pain through my ‘ughs’ and ‘ohs’ and sighs, but there was no way I could explain what it felt like.

“The arthritis kept progressing and I wasn’t getting relief. My elbows hurt constantly,” Wheeler said. “My rheumatologist told me I needed to find an elbow specialist. I didn’t even know there was such a thing.”

Upon returning home to Steamboat Springs, Wheeler began praying that she’d find a specialist who could help her. Her prayers were answered when she came across Dr. Patrick Johnston, an orthopedic surgeon specializing in hand and elbow procedures. Much to Barb’s surprise, Johnston was located in Steamboat Springs.

Can we do it tomorrow?

The Wheelers met with Johnston and talked about her options.

“Barb’s rheumatoid arthritis was advanced, and the only surgical option I thought would help her would be a total elbow arthroplasty (replacement),” said Johnston. “It’s an uncommon surgery, especially when compared to total knee arthroplasty.” Johnston estimates about 700,000 knee replacements are done annually in the U.S. In contrast, according to a recent study by the National Institutes of Health, only around 600 elbow replacements are done in the U.S each year, with 400 done for arthritis and the other 200 replacements to treat complex fractures.

“He told me he could do an elbow replacement, and the tears started,” Wheeler said. “I was in so much pain and it hurt so bad. I told him I was ready to do anything to get rid of the pain.” They decided to proceed with the left elbow first. It was only then that Carl realized how extreme the pain was that his wife had dealt with for so long.

While the hope of the surgery was to eliminate her pain, the procedure and outcomes didn’t come without limitation – following the replacement, Wheeler would be limited to lifting fewer than 10 pounds.

“It was either ‘be in pain or be limited to lifting ten pounds,’ ” she said. “I wanted to be pain-free. My strength, literally and figuratively, comes from Carl. He does the heavy lifting. I was only lifting around 10 pounds anyway due to the pain.”

A first in the area

On Jan. 11, 2018, Wheeler became the first person in the region to have an elective total elbow replacement for rheumatoid arthritis at UCHealth Yampa Valley Medical Center.

Dr. Patrick Johnston observes Barb Wheeler's progress during a therapy appointment.
Dr. Patrick Johnston observes Barb’s progress during a therapy appointment. Photo by Lindsey Reznicek, UCHealth.

“From the moment I checked in until I left, the whole experience was amazing – the care I received, the attitude of the staff, everything,” she said. “The nurses, anesthesiologist, the techs, CNAs, they all were so warm. They kept me and Carl informed of what was going on, and Dr. Johnston was there every morning.”

Together with Dr. Johnston, Emily Tjosvold, a certified hand therapist and occupational therapist specializing in upper extremity and hand rehabilitation at UCHealth SportsMed Clinic in Steamboat Springs, quickly worked to outline a plan of care and necessary therapy for Wheeler.

“In therapy, there’s work to do to get the mind and muscles to work together,” Tjosvold said. “Barb’s new elbow is like a new toy, a fragile doll. You want to hold the new toy and use it, but you have to be very mindful and careful with it at the same time.”

“I told Emily, ‘As long as you don’t hurt me, I’ve got a dozen eggs for you,” Wheeler Barb. “She got her eggs.”

Emily Tjosvold uses a device to measure the flexibility in Barb Wheeler's elbow.
Emily Tjosvold measures Barb Wheeler’s progress. Photo by Lindsey Reznicek, UCHealth.

During each therapy appointment, many of which Dr. Johnston attended as well, Tjosvold would measure how many degrees Barb could bend her left elbow.

“I didn’t apply pressure the first time, then gradually we started working to bend it more and applied a little more pressure each time,” Wheeler said. “I can straighten my arm now – I couldn’t do that before the surgery.”

“We take x-rays throughout rehab to make sure the implant is where it should be,” said Dr. Johnston. “Barb is right on track. Therapy and recovery are a big part of a successful outcome. Barb is ready to take on whatever we need her to do so she can get the most out of her new elbow.”

Make that new elbows, plural. Wheeler has already scheduled surgery to have her right elbow replaced as well.

“I wanted to do my right elbow as soon as the left one was done and the pain was gone almost instantly,” she said. “It’s a truly amazing feeling to not be in pain.”

Back on the farm

Once the snow melts, Wheeler is looking forward to getting back in her garden. She likes lupines in the spring, gaillardias in the fall. Hollyhocks are some of her favorites, too.

“I can’t wait to pull weeds and not have it hurt,” Wheeler said. “Carl will still man the wheelbarrow for me, but I can’t wait to dig into the dirt again.”

Carl Wheeler holds Patsy, Barb's miniature fainting goat and steadfast companion.
Carl Wheeler holds Patsy, Barb’s miniature fainting goat and steadfast companion. Photo by Lindsey Reznicek.

Through it all, besides Carl, the constant at her side has been Patsy, a miniature fainting goat. Patsy too, struggles with her elbows, as she was born with her elbow joints bending the wrong way.

“Each evening, we sit together on the porch,” Wheeler said. “Carl lifts her onto my lap and she gets some lettuce, banana or crackers. We have a routine together. It’s our chance to relax.”

About 10 days post-surgery, Wheeler realized something during their nightly sit.

“The pain had begun to affect my mental attitude. Being in pain all the time is tiring,” she said. “Then last week, I realized I was finally happy again. Every day goes a little more in the right direction. I’m excited to be happy again.”

About the author

Lindsey Reznicek is a communications specialist with UCHealth who is based in Steamboat Springs.