Sunday, November 30, 2008

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...

Tuesday, November 25, 2008

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.

Saturday, November 22, 2008

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.