Final Preparations

With less than 2 days until D-Day, I’ve got Europe’s “Final Countdown” running through my head. Of course, Final Countdown brings mixed memories. The song reminds me of Arrested Development’s Gob performing magic tricks and making a high school mix tape – Final Countdown was the first song on Side A of the CasEtri. It’s a tough call which is more fitting of a knee surgery countdown.

I met with my OS this morning to go over the last-minute paperwork. Most of it was routine – hearing the standard admonition not to eat or drink after midnight; receiving a prescription for powerful narcotics; and signing a waiver acknowledging all the bad possible outcomes (always a personal favorite for lawyer-patients). I did, however, learn something new. My surgeon’s starting his own practice in 2009. He spent the first 20 or so years on his own before joining the current practice a number of years ago. He brought his own staff with him then, and all of them are leaving with him now. His new practice opens January 1st.

My first thought – Oh, shit. Will he still be on my insurance plan? This doesn’t impact the Dec. 31st surgery, but might impact the dozens of follow-up appointments. EOBs full of evil out-of-network charges instantly flashed before my eyes. But Turgeon says the insurance won’t change. He picked all of his insurance carriers and medical supply contacts prior to joining his current practice, and he’ll keep them when he opens his own office. At this point, BCBS still lists him as a “preferred provider” for 2009, but it also still shows his old address. As my father wisely counsels, it’s beyond my control so there’s no need to worry right now.

After leaving the doctor’s office, it was time to pick up some last-minute items. We went to Dougherty’s Pharmacy, which, fittingly, resembles a 1950’s Mom & Pop Dime Store. In fact, I think most of the shoppers in the store today could’ve been customers in the 50’s, too. Except for the cashier, Christina and I were the only folks younger than 350 years old. All of the store signs were written in 48-point font.

A tad bit embarrassed, I asked the cashier where the shower seats and, ahem, toiler seat risers were located. At first, I wanted to lie and tell him the items were for an elderly relative. No dice. I quickly gave myself away when I started “test-driving” the different toilet seat risers. I’m not kidding. I took a couple of mock poops before making my final selection.

The store offered 2 options: (1) the toilet seat shaped like a walker with a slender bowl-rim suspended in the middle, and (2) the oversized toilet cover that rises like a skyscraper 5 inches above the bowl. After hurriedly squatting back-and-forth between my toilet seat options like an antsy 4-year old, I settled on the oversized riser. Made by Nova, the heavily molded toilet seat provides luxurious comfort, as well as side handles that allow me to push off back to my feet. I consider it the Cadillac of raised toilet seats. I have a feeling I won’t want to give it up even after my knee heals. I know George Costanza wouldn’t. For my shower seat, I chose a basic white bench with a single red handle, completing our bathroom renovation. Unfortunately, Dougherty’s refused to throw in a free Driving Miss Daisy DVD.

Anyway, here's the bottom line:

Toilet seat riser -- $85.

Shower seat -- $55.

Geriatric purchase experience? Priceless.

Rehab is kinda like pregnancy

No matter how much we empathize, husbands simply can’t grasp what their wives experience during pregnancy. Gaining 50 pounds? Perhaps. Craving bizarre food combos? Maybe. But it’s impossible for guys to understand what it feels like to have something kicking around inside our bellies. And no, that undercooked beef burrito we grabbed from Taco Bueno at 2am doesn’t count.

Rehab might be the closest we get. Both last about 1 year, and both are littered with time-stamped milestones, as patients are expected to reach certain targets at 8 weeks, 5 months, you name it. Of course, pregnancies chart the growth of a human being, like the formation of a baby’s lungs, while rehab tracks how many degrees a knee can bend. Subtle differences, to be sure.

At my last appointment, I received the ACI rehab protocol. Good lord. The Dallas Cowboys playbook isn’t this detailed. It breaks down my 52-week PT schedule into 4 broad “phases,” similar to pregnancy’s trimester approach. Um, my wife’s shaking her head right now. I think that’s her signal that the rehab-pregnancy comparison has gone too far. Time to stick with rehab.

Ok, the first part of the rehab is called, the “Protection Phase.” The goal is to protect the implanted cartilage cells, which rest precariously inside my knee like recently pored concrete. Most importantly, my knee must remain “non-weight bearing,” or NWB, during Phase 1.

As soon as I get home from surgery, rehab begins. I’m not kidding. There’s a rehab assignment for Day One. 6-8 hours after the surgery, I initiate Continuous Passive Motion (CPM) for 8-12 hours/day, something I’ll continue until my knee reaches a certain Range of Motion (ROM). Yes, I realize I’ve already used more acronyms than a CIA briefing. Hopefully I’ll use only 2-3 acronyms regularly. Most are fairly self-explanatory, but I’ll post an “Idiot’s Guide to ACI Acronyms,” just in case you need help.

For the first 6 weeks, my best friend is the CPM. The CPM is a motorized knee brace which mechanically bends my knee in slight increments. The automated movement helps cell growth, and also creates a smooth surface along the cartilage surface. I’m allowed to progress my ROM by 5-10 degrees/day, “as tolerated.” Wait, does this mean I have to stop the moment I yell out in pain? Can I scream twice? Can I chomp down on one of those horse bits to deflect the pain? My interpretation of “as tolerated” might be a little different than others. Anyway, I need to hit 120 degrees ROM by Week 6 before I graduate to Phase 2, which means I need to be able to bend the knee all the way backwards. When I’m not using the CPM, my knee remains locked in a brace at 0 degrees at all times, including during sleep. Because it’s my right knee, I can’t drive during Phase 1.

In my opinion, the rehab protocol omits critical tips, like, “If you wake up in extreme pain, pop 3 vicodin. Repeat every 15 minutes if pain persists,” and “Ring little bell when you can’t reach your book or laptop. If ignored, demand compliance from wife. When she tells you to fuck off, apologize, point to injured knee, and beg for sympathy.”

Some of the rehab is redundant. There are only so many ways to say, “Bend your knee a little bit further.” However, seeing the simple, incremental targets spread out over one year is finally driving home the difficult journey I’m about to embark on. Ok, that last sentence sounded really lame. Or like a contestant on The Bachelor. But this is definitely The. Most. Dramatic. Blog. Post. Ever. Well, at least until the next post. Stay tuned.

D-Day is approaching

The surgery date has been set – 12-31-08. Yup. New Year’s Eve. Or as Christina likes to say, “Happy Knee Year!”

People keep asking me how I feel about the upcoming surgery. Remember Clubber Lang’s prediction in Rocky 3? Pain, said Mr. T. Before this surgery, I think the time I was most scared was when a bunch of seniors at my fraternity forced me to eat 3 whole jalapenos sober without a chaser. That was my punishment for being the Problem Pledge. I think this surgery will hurt much worse, though the vicodin should take away some of the sting. In some ways, I feel like the kid who fucked up and knows that momma’s waiting at home to whoop his ass. It’s time to face the music.

Some might suggest I’m being a bit selfish by scheduling the surgery on New Year’s Eve. Well, those people would be right. I am extremely selfish. I plan to milk my upcoming incapacity like an industrious farmer after 4 Red Bulls. But I didn’t screw up any special New Year’s plans. We weren’t heading to some swanky ballroom to sip champagne at midnight while being showered with confetti. Nor did we plan on hitting any 4am raves at secret warehouses.

Long gone are the days of paying $40 cover charges to drink unlimited 8oz plastic cups of beer and wine. Honestly, after having kids our New Year’s became pretty lame. These days, we watch the ball drop in Times Square, consider that close enough, and call it a night. I’m lucky if I’m still awake for some New Year’s nookie. Frankly, this year’s New Year’s Eve won’t be too different. Well, except for the nookie. I can handle the pain, but not the lack of nookie. It’ll be like sophomore year in high school all over again. Only without the acne, thank god. Anyway, this year I’ll watch the festivities with my SUV-sized knee draped over some pillows, bitching that the rabbit ears are obstructing the view on the ancient 13” TV in our bedroom. Part of me, however, is secretly excited about this New Year’s. I’ll be armed with a bottle of vicodin and a truckload of Ryan Seacrest jokes. That’s pretty tough to top. I’m pretty confident I’ll be giggling at midnight.

The decision to schedule the surgery on New Year’s Eve was strictly a timing and monetary one. Because of the lengthy rehab, I wanted to schedule the surgery as soon as possible. December 31st happened to be the first day the cloned cartilage cells would be available. Luckily, the surgery center and Dr. Turgeon were also available that day. Actually, it’s pretty good timing for everybody involved. The OR staff gets to stuff their pockets with all the leftover narcotics from my surgery before heading out to their New Year’s cocktail parties. And for me, having the surgery on the 31st brings the added bonus of lowering my surgical bill. I’ve already incurred a large chunk of health expenses this year. This surgery will put me well over my maximum out-of-pocket exposure. On January 1, that number starts over, so by sneaking in the surgery on the last day of the year, I’m saving a few dollars. Not only am I devishly handsome and gimpy, but I’m practical. It’s a wonderful combination that Christina can’t resist.

The DeNiro Effect

Robert DeNiro is probably my favorite actor. Swayze and Van Damme are right up there, too. Unlike those other guys, however, DeNiro’s IMDB is full of quality movies. No matter the role, he’s always a bad ass, whether it’s a mob movie (Goodfellas, Godfather or Casino), action flick (Heat), or just a plain, great movie (Sleepers, Midnight Run or Meet the Parents).

Now, what does DeNiro have to do with my upcoming knee surgery? Well, DeNiro was a master at transforming his body for movies roles, and I’m about to experience my own transformation, though mine will be unintentional.

DeNiro’s greatest performance, I think, was in Raging Bull, the story about boxer Jake LaMotta which earned DeNiro an Oscar. In Raging Bull, DeNiro hit both ends of the weight spectrum, getting shredded to play the heavyweight champ in his prime, and then gaining 60 pounds to play the elderly Jake LaMotta.

I’m in the midst of my own roller coaster weight gain/loss. Thankfully, my swings aren’t as extreme as DeNiro’s. At least not yet. If I gained 60 pounds, I might be eligible for The Biggest Loser. I couldn’t handle that. Something about really large people in skivvies standing on oversized scales seems wrong. Or Dutch. That might be normal for them.

While weight gain might seem a bit trivial -- or vain -- considering the severity of the surgery, I’m legitimately worried about looking like a 70-year old Jake LaMotta next summer. I realize that once my knee heals I should be able to lose any weight gained, but for some reason I’m almost as worried about how fat I’m gonna get from inactivity as I am about the grueling rehab process. I don’t know why I feel that way. I just do. And yes, I recognize I sound like a 15-year old girl. But my blog readers deserve nothing less than my un-filtered emotions.

Since I re-injured my knee this summer, my weight’s swung 5-10 lbs several times. After first injuring my knee, I couldn’t exercise for a few weeks because the back of my knee swelled up like Barry Bonds’ noggin. Add 5 pounds. After the swelling subsided, I decided to have surgery, but postponed it for a few months. I decided to get in the best possible shape pre-surgery. Plus, I wanted to get my body “bikini-ready” for my October vacation to Maui. I realized most beachgoers would be staring at my wife, not me, but I still have pride. Besides, you never know when the paparazzi might be lurking.

Over the next 2 months, I ate extremely healthy. You know what? Eating right is 100x more important for getting in shape than lifting weights or doing cardio. Had I known that I never would’ve eaten all those chicken patties back in high school. I single-handedly kept Tyson’s in business. Anyway, 12 pounds disappeared. I didn’t win any bodybuilding competitions, but I trimmed up considerably. I joked that instead of 6-pack abs, I had a 2-pack. I’m not going to lie: In Maui, women swooned when I took off my shirt. I kept waiting for the shirtless beach photos to show up in The Enquirer, but no such luck.

I came back from vacation feeling bloated; that happens when you gorge on nothing but burgers, beer and ice cream for 1 week. Add 5 pounds. Unfortunately, I wasn’t able to drop those pounds right away. After we returned from Maui, I went out of town twice, and my eating and workout schedule always gets jacked up when I travel. And then it was time for Part One of the ACI surgery.

Arthroscopic surgery really isn’t that big of a deal. After all, pro football players routinely play a week or 2 after getting scoped. But I’m not a pro athlete. Frankly, I’m not even a true professional. I mean, I work for the government. Anyway, I hardly exercised for the next 3 weeks while my knee healed. Add 5 more pounds. But the great thing about eating right is that once you’ve done it, your body quickly recaptures the virtues of eating veggies and grilled chicken. It’s like riding a bike. After a week or 2 of eating right and exercising again, I’m back to my Maui weight, though my abs lost half of my 2-pack. I guess I’m sporting a 1-pack now.

I’ve got 3 or 4 weeks to reclaim that 1-pack. But I’m not stopping there. In fact, I plan on carrying over this attitude to rehab, and there’s nothing more hardcore than showing up for PT with your face painted. If I fail, I might be the first contestant on The Biggest Loser who’s “before” picture was half-red, half-black.

Still waiting. . .

No surgery date yet. I joked that the cloning company, Genzyme, must be having a good year. It seems like every company is stuffing sales into year-end to make its numbers, yet my surgery likely will get pushed into 2009. I’ll welcome in the New Year, and then quickly accomplish everybody’s #1 resolution: getting a cloned knee.

On Friday, I met with my OS and Jimmie, a specialist from Genzyme. Jimmie was great. Part salesman, part trainer, he’s knowledgeable about the ACI surgery, having trained many orthopedic surgeons in this innovative procedure over the past decade. More importantly, Jimmie’s a terrific communicator. Before the OS arrived – by the way, why do doctors always keep you waiting for 40 minutes? – Jimmie and I spoke at length about the surgery and rehab. For each knee component, he used an analogy to enhance my understanding of the role each part of the knee played. He’s like a medical translator. This isn’t to diss Turgeon the Surgeon. Turgeon is personable, takes his time, and patiently answers all of my questions. He’s also regarded as one of the top ACI surgeons in the area, which, obviously, is kinda important. Sometimes, however, Turgeon forgets that I don’t speak medicalese, and Jimmie bridged that gap handily.

As a representative of Genzyme, one of Jimmie’s jobs was to review my medicals and confirm I’m a candidate for ACI. Jimmie quite bluntly told me, “Not everybody qualifies for ACI. Genzyme doesn’t want the wrong candidate who will screw up the company’s success rate.” Jimmie was like the anti-Chief Burrell, the Police Commissioner from The Wire who wanted to “juke the stats” to make Baltimore’s crime rate appear lower. I qualified as a “good candidate” for ACI. I’m not sure if that’s meant to be a compliment.

The 3 of us reviewed my MRI results and discussed the 2 lesions to be filled. The lesion on my patella is the smaller of the 2, but it’s trickier than the trochlear groove defect. Patella lesions historically have the worst ACI track record, largely because patellas absorb most of the pounding on a person’s knees. Moreover, the underlying injury often screws up knee alignment, which further increases stress on the knee. Over several years of trial-and-error (an expression that doesn’t comfort patients), surgeons discovered ACI implants in the patella were more successful when combined with a procedure to alleviate the stress on the patella. Jimmie said adding the second procedure improves the success rate by almost 20%. Usually, this means re-aligning the patella that got jostled during injury. In my case, however, my knee alignment is stable. Basically, my knee’s perfectly fine. Well, except for the 2 holes that shouldn’t be there.

Nonetheless, a similar procedure can still alleviate stress on my patella. During the ACI surgery, Turgeon will slightly raise my patella by a smidgeon (not a precise medical measurement). This doesn’t sound like a lot, but wait until you hear how doctors elevate the patella. In a procedure called a distal realignment (my particular version is called a Fulkerson), the surgeon breaks the edge of the tibia bone and re-connects the bone to the raised patella with a handful of screws. Yes, it’s supposed to be as painful as it sounds. Of everything that the knee suffers during the ACI surgery, this is supposed to hurt the most, though the pain generally subsides during the first 2 weeks. Of course, the screws will set off airport medical detectors for years to come...

Right now I’m waiting on final approval of the surgery from Blue Cross, Blue Shield, my insurance carrier. BCBS was at the forefront of coverage for ACI, and, according to Turgeon’s insurance liaison, covers ACI. Under my particular insurance plan, all surgeries are covered at 100%, minus $100 surgeon fee. Unfortunately, insurance carriers aren’t known as benevolent entities, even during the holiday times, and since ACI surgery costs $30,000 – new knee or new car? – I’m expecting some hassle over coverage. Don’t be surprised to see blog entries entitled, “BCBS is the devil.”

Once BCBS approves the surgery, Genzyme will produce 4 vials of my cartilage cells. Each vial contains 12 million cells. Turgeon doesn’t think he’ll need 48 million cells to fill my defects. I’m hopeful I’ll be able to take the leftovers home in a “To Go” vial. You know, just in case I need a few million cartilage cells some day.

Pre-Op Preparations

Surgery #2 -- aka, the really painful one -- hasn't been scheduled yet. I've been assigned a rep from the cloning factory (sounds like a role in an Arnold Schwarzeneggar movie), and I have another follow-up appointment with my OS on Friday. By then, I’ll hopefully know when the cartilage cells will be ready and we’ll pick a surgery date. Once that happens, I’ll probably start some kind of D-Day Countdown on the blog. Maybe I’ll figure out how to post one of those T-Minus clocks NASA uses for the shuttle launch.

Meanwhile, I’m quickly grasping how drastically this surgery will change my life, especially in the short-term. It’s been just over 2 weeks since the “minor” arthroscopic surgery to harvest the cartilage cells, and my knee is close to 70%. I’m still limping, but I can walk without pain.

Many things, however, remain difficult, including several really simple, daily functions you take for granted. Let's just say it's not easy going potty with a leg you can't bend. I learned this the hard way when I got some sort of stomach bug after Thanksgiving. I spent most of Friday night in the bathroom. Not good times. I was just “thankful” I didn’t puke it up. My knee couldn’t handle praying to the porcelain god. Anyway, I might need one of those medical alert bracelets in case I get stuck on the toilet.

To minimize bathroom difficulties, it's recommended that ACI patients buy a toilet seat riser and shower seat. Neither is covered by insurance. I never thought I’d have to spend the cash left-over in my flex-spending account on these items. I’ll probably be the only shopper under 90 in Wal-mart asking about toiler seat risers. Of course, my recently deceased grandfather had both of these items, and I don’t think any of his heirs claimed them. I wonder what UPS would've said if I tried to ship home a toilet seat riser. Hmm...

Knee Injuries (yes, plural)

This is my 3rd knee operation. Well, actually it’s the 4th one, if you count the 2-part ACI procedure separately. You’d think I’m an NFL offensive lineman. But I’m not. In fact, I’m not even a large person. At my size (5’ 8”, 160 lbs, as of today), my best shot at professional sports was probably hockey. Unfortunately, I can’t skate, so I probably wouldn’t have done too well. Oddly, in college I played club volleyball, which isn’t exactly known to favor short people.

My first knee injury happened almost 20 years ago playing pick-up basketball. Somebody on the other team intercepted a lazy pass and streaked the other way for a breakaway lay-up. I had exactly a zero percent chance of catching them, but, damn my Midwestern pride, I tried anyway. I didn’t get very far; maybe 3 steps. I slipped on the blacktop, violently hurling my right knee inwardly to form an inverse, “L.” Because people can’t run when one of their feet is 2 feet above and parallel to the ground, my knee bounced off the pavement twice, each thud producing a sickening crack. That was my meniscus shattering. My ACL and MCL apparently got “stretched,” too. You’d think I’d know for certain what happened because those are important ligaments, right? Well, you’d be wrong.

I got stuck with a doctor who often read X-rays upside down. Dr. Smarty Pants (not his real name) “apparently” didn’t realize a person’s legs are below their torso. Try to picture how helpless I felt right before the anesthesia kicked in, as this guy hovered above me, with access to a bunch of really sharp objects and license to use them on my knee. Now I know how people felt during the Inquisition.

I awoke minus a meniscus. Dr. S. Pants told me my ACL and MCL were damaged, but he didn’t “fix” them because he thought they might heal on their own. He didn’t explain how that would happen, of course. Eventually, my knee returned to normal strength, although it would buckle at random moments, probably because my knee was still waiting to be magically healed.

Fast-forward 13 years. I grew up playing soccer. I later incorporated my soccer skills into my volleyball game, digging balls with my feet. I thought that was being innovative. My coaches and teammates disagreed. They thought I was being lazy, since, technically, I could’ve dug those balls with my arms if I dove for them. They would’ve been right, but laziness is a really hard habit to break. My soccer skills turned out to be a curse, not a blessing.

During a volleyball game, the ball deflected off the top of the tape, changing directions rapidly. Rather than diving for the falling ball like my I should’ve, I decided to dig it with my foot. After planting my right foot, I tried to change directions with the ball. That’s when my knee buckled. Somehow I was still able to kick the ball up in the air with my left foot – yay, me! – but saving the point really wasn’t worth the price of shattering my knee cartilage.

I visited Dr. Clueless (again, not his real name) at Baylor. Clueless had lots of pictures of famous athlete-patients on his walls. In hindsight, I would’ve preferred my old buddy, Dr. Smarty Pants.

Heading into the surgery, Clueless told me I’d awake as good as new. Back then, I couldn’t google his advice, or stay at a Holiday Inn, so I had no clue what he was going to do to my knee.

After the surgery, I diligently following the prescribed rehab plan – I even ran into Shawn Bradley at one therapy session; he’s really tall. My knee, however, still didn’t work like it did before the injury. I mentioned this to Dr. Clueless. He replied, “Of course your knee doesn’t work as good. You’ll have problems the rest of your life. The knee cap is unstable.” I wish I had my crutches with me during this visit. I would’ve made one of Clueless’s knees unstable.

I later learned that Clueless simply scraped away the cartilage near the defect. While smoothing out the cartilage allowed me to walk relatively pain-free, it created a gap where my knee and leg bone meet. Gaps aren’t supposed to be there. This particular gap prevented me from “exploding” off my knee – ie, no running or jumping. At age 30, I could live with that; I just wanted to make sure I could run around with my kids. Nonetheless, I wasn’t happy with Dr. Clueless.

6 years later, I injured my knee for the third time. I was helping coach a 12-year old girl’s club volleyball team. One night, I stuck around after practice to help the girls practice their spiking and blocking. Normally, I wear a neoprene knee brace whenever I do anything remotely athletic. I didn’t wear one this time. After only a handful of jumps, the back of my knee swelled up. I later learned that not only did Dr. Clueless fail to make my knee “as good as new,” his surgical genius actually made my knee more susceptible to further injury. Dr. Pants wasn't looking so bad anymore.

And now I'm getting ready for another surgery. I can only hope Dr. Pants and Dr. Clueless invested heavily in Enron; that'll comfort me during my year-long rehab.

The Beginning

I'm about to be cloned. Not all of me, though I wouldn't mind having an extra set of hands. Just my knee. Or, more specifically, the cartilage inside my knee. This blog will chronicle my experience. Let me explain.

I'm about to undergo a knee operation called, Autologous Chondrocyte Implantation, or ACI. It's actually a 2-part procedure. On November 14, 2008, I finished step one. The good doctor examined my knee arthroscopically to gauge the extent of the damage. Once he determined it was pretty bad (note: not really a medical term), the doctor harvested some cartilage cells for re-growth. Harvested is such a cool word; it conjures up images of sci-fi movies with aliens capturing humans to eat them later. Alright, I digress. The doctor basically scraped off some cartilage and sent it to a special lab to re-grow the cartilage. This process lasts about one month, and then it's time for step two.

When the cloned cartilage is ready, I head back to the surgery center. Once again, I'll make small talk with the OR Nurses, hope the anaestesiologist didn't arrive straight from a 3-day bender, and get my knee ripped open. While the first operation is performed arthroscopically, the second one is the real deal. It's called an arthrotomy, which is a fancy way of saying the patient wakes up with one of those Frankenstein scars stretching vertically across the knee. By the way, I wish I would've studied Latin in high school. Sure, Spanish helped me with the ladies growing up (Mexican chicks dig my Sabado Gigante impersonation), but knowing Latin would've made it easier to understand what exactly was happening to my knee.

Back to the surgery. After ripping open my knee, the doctor glues the cloned cartilage to the "defects" - also called lesions -- in my knee. In my case, I have two lesions: a 10x14mm defect on the medial facet of the patella, and a 12x15x15mm defect on the medial trochlear groove, which extended down to the intercondylar notch. The damage went almost down to the subchondral bone. Now, I have zero clue what the hell I just typed really means. I just copied what the operative report said. But I know knees aren't supposed to have these kind of defects. And it's never a good thing when bones get exposed. Just ask Joe Theisman.

Right now, I'm waiting to see if the lab had any problems cloning my cartilage. While I obviously want them to grow as much of that stuff as they can, part of me secretly hopes the lab says, "Sorry, sir, it was impossible to clone somebody as perfect as you." I don't think that'll happen, but a man's gotta dream, right? Once I hear from the lab, I'll meet again with my OR (that's code for operating surgeon) to schedule surgery #2. And then I'll start getting physically and mentally ready for the operation.

This blog will chronicle my surgical exploits and the grueling rehab that's expected to last at least the next year, and likely will continue into the following year, too. In Chinese parlance, 2009 will be The Year of the Rehab. The blog will also give me a creative outlet to vent, especially when I run out of Hillbilly Heroin to dull the pain.