Hamstring harvesting

Doesn't sound that appealing? My doc thinks it's the way to go. He says the cadaver grafts are popular in the Bay Area but he's not very keen on them, says the joint may be more likely to react (this is the kind of thing where 'reaction' is generally synonymous with 'bad reaction,' I imagine), says cadaver grafts have been heavily marketed (because the procedure is more expensive?) and it's all fun and games until there's a "bad batch" of tissue and the doctor has to call all the patients and say, oops...or whatever the doctor says in that situation. He said the recovery from having a bit of hamstring relocated is not such a big deal. He said the total process from surgery to 100% green light is about six months. He said I need to do physical therapy to get my full range of motion back before the surgery (which confirmed what I'd heard already). I will call the PT's office tomorrow to schedule my first appointment.

He showed me a video about the procedure. I'm going to do some checking on YouTube to see if I can find something like it to link here in the future. I was impressed that when he looked at my MRI images he sounded like he knew what he was looking at..."See, these are your meniscii...they look just fine...there's the posterior cruciate ligament [which I could see]...there's the ACL [which I couldn't really see, maybe if it weren't torn asunder I could have seen it better]?"

I felt like he spent a decent amount of time talking to me and answering my questions about why he doesn't favor the cadaver graft procedure, though I was a little surprised to hear him say, "well it's from a dead guy!" in a tone that sounded like he was kind of grossed out by the idea. Before he looked at my x-rays or the MRI he asked me what happened in some detail, making me feel that my own experience of the event was potentially of some clinical importance, then he looked at the film / MRI images, then we watched the movie. Two small incisions, knee is filled up with water for better viewing, old trashed ACL is snipped out, tissue is "harvested" from hamstring tendon [gotta love that word, "harvesting," in the context of body parts], it is neatly folded in half and sewn together at the ends, holes are drilled in the leg bones and they thread in the new ligament and pin it in place. Oh and of course this all happens while I'm sleeping.

After the movie, he looked at my knee for awhile, bending it this way and that, but not in any ways that hurt, which kind of surprised me. The last time I saw an orthopedist about ten years ago, in an attempt to divine what was causing my knees to go click...click...click with every step when I walk or run sometimes, the doctor seemed to delight in causing discomfort. Oh, does this hurt? Oh, it still hurts when I do the same thing again? How about this time? Still hurts, does it? [All we ever found out was that it hurt when he did that.]

One bit of news I liked was that I can have the surgery AFTER my bike ride down the Oregon coast in September. Should get home from the around the 8th, surgery is tentatively scheduled for the 11th or 13th. Meanwhile I'll be fitted for a sports brace and get going with PT. Feeling a lot more hopeful that the way my knee currently feels is not at all what I'll be stuck with until the surgery.

Hope floats

Haven't used the little condo swimming pool much. It's a tad over-chlorinated and often there are people in there, and I haven't been a much of a socialize-at-the-pool person. However, it is a place I can walk to and it's shallower and warmer (and possibly cleaner thanks to the chlorine) than the big creek pool in the park. Decided to give it a try and see if my knee would allow for swimming right now. I have been depressed by my sudden new lack of exercise since "the Pop." And, even though I hadn't yet quite mastered the art and science of tackling, the idea that I will have to wait almost a year before I can have another (legal, consensual) try at knocking the snot out of somebody is also depressing.

Anyway, got in our pool and immediately realized that this injury could be, oddly, the best thing that ever happened for my triathlon. Not that I've quite decided to be happy about it, but I see that it could have some benefit. I can't even cheat with a frog kick right now which is what I always do if I'm feeling lazy or tired. Flutter kick is the only motion both legs can accommodate. I can dolphin kick a little bit if squeeze my knees together and use the left leg to stabilize the right. And there ain't nothin' wrong with my arms. I didn't stay in very long, but it felt SO good, I cried with my goggles on. [Somewhat defeats the purpose of goggles.] I wonder if there is some sort of amphibious brace I could wear. Maybe a neoprene wrap would help. I need a little bit of motion control...a couple times my leg went in a direction that made kind of unpleasant clicking and grinding noises in my knee.

I will see Dr. Komas in 6 days. Since the last post he has received high praise from people I've talked to who have seen him. That's a relief. Talking with teammates who have had ACL reconstruction, it looks like I might be getting a piece of somebody's achilles tendon in my knee. Somebody who didn't need it any more. Maybe in the Illiad when mighty [and sulky] Achilles met his downfall with the shot to his heel, it's not so much that he actually, literally died, he was just so bummed out by not being able to fight the Trojans any more that he wasted away on the couch. If he'd had a swimming pool in his campground and a good orthopedic surgeon the story would have been much different.

is he out of his mind?

Here are some pictures of torn ACLs that are a little easier to follow than my real images were.

Made an appointment with an orthopedic / sports medicine doc today (who is in my PPO network, unlike the one to whom Immediate Care referred me). A little worried that I don't know anything about him, and a lot frustrated that the earliest appointment was two weeks away. The receptionist told me he couldn't give me any advice about what I should / shouldn't be doing until he sees me. In two weeks. Why don't I call the doctor at Immediate Care and ask him, she suggested. Oh yeah, that guy who thought I just had a sprain. For lack of other options I called him (thinking maybe he can suggest some good exercises, etc.) and his well-thought-out advice was "I see you have a complete tear. Wear the immobilizer and use crutches and don't put any weight on it." You've got to be kidding me. I live AND work on the second floors of buildings without elevators for one thing. I was feeling proud of how much better I'm climbing stairs today. OK, it was the most conservative possible advice, but it was dumb. I'll be careful, but I haven't read anything that says you can't walk around just fine with a torn ACL. Two weeks of the "immobilizer" is B.S. I think if it were necessary our team doctor (an orthopedic surgeon) would have said something when I showed up to watch Saturday's game wearing only my ace bandage (in addition to other clothing appropriate for the situation). He read my MRI report and said, "Oh, it's just the ACL. The MCL issue can be treated non-operatively. ACLs must be to him something akin to what 30-day termination of tenancy notices are to me. Our coach who is a physical therapist (and who previously tore her ACL playing football) noticed I was holding my cane in the wrong hand and showed me the correct way to do it. (Bellabell's comment on the last post hinted that it isn't completely intuitive--I didn't realize I was doing it wrong.)

Maybe I'll ride my bike to the appointment in two weeks to protest how long it took to get the appointment. If I can find a suitable hinged brace, Mom.

Magnetic resonance

I can identify some of the structures in these images but I wouldn't have been able to look at them and say ah, yes,

complete tear anterior cruciate ligament. Associated bone bruise lateral femoral condyle and posterior lateral tibial plateau. Menisci intact [Yay, that's good, right? Intact menisci are the best kind]. Soft tissue edematous changes in association with large knee effusion. There may be a partial tear of the medial collateral ligament.

There were numerous other pictures. This series was the "sagittal proton density fat suppressed" scan. All the findings in the report may not be visible in this particular series but it was a bit of work capturing the images. Had to use Virtual PC to read the disk from the MRI office that came with its own special medical industry viewing software...not the JPGs I'm used to working with. Virtual PC runs...very...slowly...on my Mac. So eventually I had the screen with these images open in Virtual PC, I took a "picture" of the screen (not with a camera--it's a feature of Virtual PC of which I now see the usefulness), got it back on to my regular Mac OS desktop, opened Adobe Photoshop, changed it into a JPG file, and voilà!

One o' these things is not like the other...

Yes, I know far, far worse things have happened / are happening in the world. I listened to NPR on the way home from work tonight re: armor piercing explosives and unfriendly Iraqi police. A man in an electric wheelchair scooted by as I hobbled across the street to an ATM. So I have asymmetrical knees right now. No big whoop. At least there's two of 'em. Still, I'm managing to feel terribly inconvenienced by it all. Perhaps I took unrestrained mobility a tiny bit for granted.

The [mostly] walking wounded

I wish there were some exciting visuals to go with this post. I wonder if there's some way to get a color copy of my right knee MRI when it's done sometime this week...be it normal or...Abby Normal. I took a hit in the Santa Rosa game yesterday at the start of the 3rd quarter (we were kicking off, I was running down to meet the ball carrier and somebody else met me first). Can't wait to see the game film because I don't really know what happened with my knee, felt like it buckled or did something untoward, then when I stood up again it felt like it popped back into the right place. Or that it popped somewhere. Tried to walk it off. Played a couple more plays and we were back on offense, I think, and I was lined up in my left side tight end spot and got knocked down in the crowd, was trying to stand up again and somebody told me to sit down and rest for a minute. Come to think of it, that seemed like not a bad idea, so I did. Then our team doctor came over and helped me walk off the field. Wiggled right knee this way & that way and compared it to the left knee, and thought the sore unstable one was too wiggly. Didn't hurt all that much. I'd always thought if I tore something it would really smart. Dr. Dotson said if it was a torn ACL (which he thought it might be but hoped he was wrong) it would likely swell up like a grapefruit by the next morning so he wrapped it and I popped a few "vitamin I" (thanks J.M. for introducing me to that term), iced it for the rest of the game and off and on throughout the evening. Woke up this morning and it didn't seem swollen at all, but as the day has progressed it's looking fatter. The doctor at the clinic back home here in Chico didn't think it was all that wiggly; he thought maybe it's just sprained. Wrote Diagnosis: Sprained Knee on my chart so it must be true. MRI Tuesday. Either way it looks like I won't be playing next week. Crap.

I went to Rite Aid and got a cane. Nothing fancy or hand-crafted but more befitting my...je ne sais quoi...than crutches.

Oh. The other thing I've not been mentioning here. It's not the elephant in the room so much as the whole house. C is hunting for apartments in SF, having secured employment there. Please think good thoughts and / or prayers, as you are inclined, for her successful housing hunt and peace of mind. And save a few for Lefty too. It's a hard change.