Age-appropriate activities

I had a checkup with my knee surgeon today. He has a good reputation for his work, and is not unpleasant, though his affect is...warmly robotic. However, today he greeted me with a hearty handshake and asked what I'd been doing (with my knee, I reckoned he meant). I described my activities thus: "Well, I went for a 30-mile bike ride yesterday...I've been doing some weights at the gym...I've started jogging a little (described the jog 3 minutes / walk 2 minutes routine that I might kick up to a total of 15 minutes this week)..." and he seemed fairly impressed. Got a little raise of the eyebrows even.

He said, "let's see, you're 4 months out? If you were on an accelerated program you could go back to full activity now, but I'd rather you waited two more months...are you going to play football?" I said no, I wasn't. Then he said "it is probably best if you stick with the age-appropriate activities if you want to extend the lifespan of your joints and your ability to participate in athletics as long as possible. Women are much more prone to this type of injury." Okay, I know all that, but age appropriate? What exactly does that mean? He hasn't met the elder half of my football team, I guess. But I realize that in NFL years I would probably be about 62.5. Maybe that's one of the reasons I love Brett Favre. He's older than I am.

Then he did his usual knee bending and pushing to see how much sideways movement there was in my knee, and seemed nearly...dare I say...delighted? with whatever he found. "Oh! That's Super!" he said. "I'm going to cut you loose, unless you have any trouble," he said. He shook my hand again and headed for the door. So I don't need to go back. I'm glad we ended on a such a happy note.

Week 6 Multimedia Update

Here is one of the clearer drawings I've seen of where the ACL is and what it looks like.

And HERE is the newly installed right ACL of the author, as it appeared six weeks ago Thursday. That shiny pulled-taffy looking bit in the middle.

On the sidebar you'll notice the green Gcast box. I posted a couple updates on the way back to work from the doctor's office today.

Doc says my range of motion looks really good. As you'll hear in my cellphone podcast though, weeks 6 - 12 are actually the weakest time for my ACL graft, even though the rest of me is starting to feel much better like we all ought to be out riding a bicycle soon. What was once a tendon gets somehow changed, by virtue of its relocation and careful reading of its job description, into a ligament. But right now it's at that point where it's tendon personality has been sort of worn down and its ligament personality hasn't been well established yet. So I have to be a bit cautious for six more weeks.

Run, Forrest, Run!

I'm definitely not running right now. Still walking pretty slowly with assorted props. I'm already more than a bit weary of wearing this brace. The novelty of it has worn off and I'm feeling a bit like poor little Forrest Gump. (Special thanks to somebody who recently suggested there was a resemblance, too.) My goal for the coming week is to be able to unlock (i.e. bend) the brace when I walk. I'm not supposed to do that yet, nor does it feel like I should. My leg muscles can't quite hold me steady. Before my second physical therapy session last week I was lamenting the sudden dramatic loss of muscle strength in my right quad and hamstring. Amazing how quick it goes. But then the PT gave me quite a boost in pointing out that, unlike many people a week out of knee surgery, I actually have visible muscle tone (at least in my quad--my hamstring muscle currently just sort of flops, but it's then it's been through a lot). He also said I'm on or ahead of schedule with my range of motion.

So the moral of the story, if anybody reading this is anticipating knee surgery, is: get on your bike and ride. As much as you can. Up the biggest hills you can manage (understanding that not everybody has a 'Karla'). I don't think I realized how helpful it would turn out to be. Not just good fun exercise.

I made it through a whole day yesterday without any Norco. Before that I was down to half a pill every 24 hours. Looks like I can manage alright with just Vitamin I and ice at this point. Good progress. I also have a fridge and freezer loaded with ready-to-eat food. Mom left me with a big pot of chili frozen into meal-sized portions, which I'm enjoying for lunch with my Sunday football today, and my friend H left a lasagna I'm going to bake for dinner...wanna come over?

Going to work tomorrow. Don't know if I'll stay the whole day but I'm ready to give it a try. Our office manager will pick me up bright and early at 8:30.

vice / vise

Oops. The aforementioned "vice clamp" would be something that helps one get a firm grip on ones addictions, perhaps. A rather secure coffee mug holder, for example. I think I really meant vise.

On the related subject of the bruise(s) my physical therapist says they show up downstream from the trauma site...that I could even end up with bruises on my foot from having knee surgery. Sure enough, there are some. Physical therapy felt pretty good. We took off the brace and I tried to let gravity bend my leg to 90 degrees dangling off the edge of a table. Felt sort of good to bend, and sort of not. All my pre-surgery biking definitely paid off. The PT and the assistants commented on how good my quadricep strength is considering we're four days after surgery. I can unlock the brace for sitting around so that I can get more bending practice, but it has to be locked at zero (straight) to walk on it.

The Yes leg, unwrapped

Looking at these photos might not be everyone's idea of a good time...there is some dried blood in them...but hopefully your sense of morbid curiosity is just a little stronger than your aversion. Weren't you just on the edge of your seat, along with me, waiting for the 72-hour point where I could undo the straps and roll up the ace bandage and peel back the gauze? Either way, here's what it looks like.

We'll start with the bruise that's coming up on my shin. The Yes Bruise, if you will. My mother suggested maybe they stuck my leg in a vice clamp to hold it still. Perhaps the Dr. built some dovetail joints for his cabinetry or tied a fly or two while he was at it.

Next we have the knee itself. On Wednesday I'll ask for a map / legend to the various incisions. There is one more tiny one not shown a few inches below the spot in the lower right of the photo (or a few inches above the spot, rather, as the human body is typically oriented feet = down, head = up). I think the total number then is five. The one at the top of the picture (lowest on my knee) is a couple inches long. I dabbed each one with some neosporin, put new clean squares of gauze over everything, and wrapped it again.

fall fashions

The view from the sofa.

The small tube is for my cold pack -- it connects to a little cooler full of icewater that I use to recharge it when it warms up.

And for the latest in weatherproofing accessories, we secured this attractive trash bag with duct tape. Actually the weather outside today was lovely but I was eager to take a shower and this is how the nurses said to do it. The silver duct tape cuff at the ankle was a nice accent (the photo doesn't quite do it justice).

The Yes leg

The nurse wrote "Yes" on my leg at around 7:00 a.m. yesterday and commented that it was the current standard in the industry because a big "X" was thought to have negative connotations. I think other things are written on my knee but I don't get to unwrap it for awhile to read it.

While Dr. K was poking around in there he found a small meniscus tear, which he fixed, and he cleaned up a bit of messy cartilage behind my kneecap. Appears that I had a little runner's knee going on. A little arthritis. My whole leg was numb yesterday and I felt pretty good. Since it thawed out overnight it rather hurts but I've been very conscientious with my pain management schedule. And I have some fabulous German chocolate cake. I'm hanging out with my mom. Life is really pretty good.

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.