Thursday, October 29, 2009

MRI, Part II and a Little Road Rage

A lot has happened over the past few weeks. Not with my knee, of course. More same old, same old there. But I do have a new update to share – my 2nd MRI. I’ve also got a classic car accident story. Minor fender bender; nobody got hurt. The lady who hit me, however, sped off. Don’t worry, I channeled my inner Bo and Luke Duke and chased her down. More on that later. In the meantime, grab a Coke and a snack, and settle in for a mammoth, 3,000-word entry to make up for my sporadic postings.

This was my 2nd MRI. The first one took place at the 6-month mark, and the technician wrote up a report focusing on my perfectly intact ACL, not my ACI. F’ing moron. Excuse me – Dr. F’ing Moron. I can’t believe that guy is a legit doctor. He probably got an on-line diploma from The University of Phoenix. That’s a pock mark against MDs.

Anyway, fast-forward three months. As I blogged about earlier, I felt kinda dirty when my OS ordered another MRI so soon after the last one. From my non-expert opinion, it didn’t seem as though it was justified. Nothing new had happened to my knee over the past 3 months. But since the MRI cost me $0, I wasn’t complaining.

Well, it turned out to be a complete waste of time. Maybe that’s karma’s response to health care waste. Of course, I’m not too concerned about adding a few thousand dollars of wasteful medical spending to our current gazillion dollar deficit; I’m only concerned about wasting my time. Unfortunately, I will never get back the 30 or so minutes spent lying inside a metallic tube, struggling to hear crappy music over a ton of static. Not even the free cookie the diagnostic center offers made the trip worthwhile.

A week after the MRI, I reviewed the results with my OS. You know how sometimes you walk into a doctor’s office and the morose vibe swallows the room? Cranky and sickly people hovering about? Maybe a few injured old people? Man, hurt old folks are the worst. Anyway, you can almost sense that any news delivered won’t be good.

That’s how I felt walking into Dr. T’s office. During every visit, I exchange brief pleasantries with Dr. T before my examination, usually in the waiting lobby or on the brief walk to the patient room. This time was no different, except Dr. T was distracted. Very distracted. I barely got a nod. He also seemed rushed, perhaps even a bit irritated.

When Dr. T entered my room, his speech was rapid, his attention diverted. He even grumbled a bit. His demeanor reminded me of a blackjack gambler who excitedly doubles-down on an 11 against a dealer’s 6, only to watch the dealer miraculously pull out a 21. Worst, as the gambler slumps away with up his last 3 chips, the dealer cheerfully wishes you good luck, when she's really being condescending. Frankly, I think the gambler would be justified in shoving an automatic shuffler down the dealer’s throat. Ok, that’s a bit violent. I wouldn’t do that, even after my 14th Vodka Cranberry, my personal favorite Vegas drink. I admit this drink is a bit girly, but it’s decent-tasting, doesn’t leave me bloated (which 14 beers would do, assuming I didn’t barf after my 8th one), and usually I don’t wake up the next morning thinking I’m in Kabul. Ok, back to my doctor’s visit.

Dr. T’s attitude was strikingly different from my last visit when we rejoiced over the results from the MRI at the 6-month mark. At that visit, Dr. T dished out high-fives as frequently as Amy Winehouse pops pills. Of course, I’m taking Dr. T’s word that my MRI looked good. The garbled grid of images always confuses me. I can’t tell if I’m looking at my knee from the right or left side, top or bottom. Hell, it could a sonogram and I wouldn’t know the difference.

I didn’t learn anything new from MRI #2. It basically said everything looked exactly the same as it did 3 months ago. The lazy MRI technician probably wanted to write, “ditto.”

There was one interesting piece of information. Unlike the previous report, this one did not identify any meniscus tear. Apparently it magically healed over the past 3 months. I have no explanation how. Oh, wait, that’s not true. The logical explanation is that the MRI technician is an effing moron. The second report noted “increased signal” in both the medial and lateral meniscus. There was no edema (basically, swelling) or any defects noted. Indeed, the articular cartilage “appears well-preserved.” The MRI revealed some cartilage thinning along the lateral patella facet. There was no mention of the trochlear groove, the other spot fixed.

Frankly, I expected Dr. T to be generally happy with this report. From my perspective, it confirmed the earlier, “good results” from the previous MRI that led to all those awkward high-fives. But he was nonchalant, even dismissive. Even after I prodded him about how the graft looked, he simply said everything looks fine. I got nothing from him. Nothing.

Dr. T’s mood wasn’t the only aspect of the visit that bothered me. He also gave me conflicting advice. At the last visit, he said he wouldn’t take out the screws from the osteotomy until 15-18 months because the tibia was healing slowly. This time, he said he’d take them out before year-end. He didn’t explain what had changed.

Also at the last visit, Dr. T encouraged me to ramp up my quad-strengthening activities. Specifically, he told me to start doing step-ups, slowly increasing the amount of reps, height of the platform, and the weight in each hand as my leg got stronger. Well, I took his advice. Yet, instead of congratulating me when I told him I had progressed to 2-foot step-ups with 20lb dumbbells, he chastised me for being too aggressive, and warned me that I was placing too much force on my patella-femoral joint. Huh? I was dumbfounded. After I listed all of the exercises I had been doing, Dr. T told me to focus on the shuttle leg press. This was the first time I left my appointment discouraged not by the progress of my knee, but by my OS.

So, how does my knee feel now? Tough to say. The knee goes through odd stages. It continues to click and pop occasionally. Sometimes it sounds like little people are celebrating July 4th inside my knee; other times those little people are cracking their knuckles. But no matter how hard they’re partying, the little clicks and crackles don’t hurt or otherwise bother me. On the flip side, there are plenty of extended periods when my knee settles into a perfect groove and gives the illusion of being 100%. These are the moments when I think that I might return to pre-surgery activity levels in 6-9 months. Wishful thinking? Maybe. But to quote Obama’s campaign promises, these positive thoughts give me, “hope I can believe in.”

Right now, my biggest concern – besides getting the screws out – is the random twinges of pain on the medial side of my knee, which I previously thought might have been a torn meniscus. I’m not sure what causes this discomfort, and it’s difficult to pinpoint the exact spot. It kinda feels like bone-on-bone rubbing, but it also feels like the inner quad muscles might be weaker, thereby increasing stress on that spot. It doesn’t seem directly related to the ACI, but who knows. It only bothers me when I push myself during my leg exercises. While I’m hesitant to get scoped again, I might allow Dr. T to examine my knee when he removes the screws. It’s possible there’s a slight tear. It’s also possible that the clicking signals over-growth of the graft, which Dr. T could scrape that away. Or the clicking could mean the graft needs to harden some more, which I understand can continue for up to 2-3 years, especially for patella ACIs. If he scoped my knee, I’d also find out whether the graft worked. The MRI is an imperfect view of the ACI. The only way to be certain is via a scope. I’m just as hesitant to find out about the graft as I am to get scoped. It would be crushing to learn that the graft failed.

Let’s see….I’m slightly more capable on the sports field. I can now move laterally well enough to retrieve errant soccer passes from my kids, and the knee can handle demonstrating some dribbling moves. Mind you, I won’t be confused with Ronaldinho. I can just do more than I could a few months ago. At times I feel like I should try running and playing sports, but I know that’s neither wise nor practical.

Of course, that didn’t stop me from “practicing” running again. And by practice, I mean I took 3-4 steps to mimic the form of running. In some ways, I resembled a track runner practicing his starts. But not really. Track guys work on exploding out of the blocks. I’m just trying to see if my knee will cycle through the correct running mechanics, even in slow motion. No such luck. I couldn’t shake that hitch in my right leg when I tried to run. No matter how hard I tried, the knee just wouldn’t cooperate. I felt like Dinah from The Biggest Loser trying to hop up onto that 6 inch platform. She couldn’t overcome that mental hurdle of hoisting her sizeable self onto the platform, no matter how many times she tried. And when I continually failed to jog, my only solace was that, unlike Dinah, I haven’t ballooned to 300 pounds. I know I tell my kids it’s not right to make yourself feel better at the expense of others, but like Tom Cruise said in Risky Business, “Sometimes you just gotta say, what the f*ck.” And damn it, I’m a grown-up. So sometimes in my injured state, I need to take comfort any way I can, even it’s mocking fat people who can’t jump. (Sigh). Ok, that’s wrong and I realize karma will definitely take revenge. But I needed to vent for a moment. I’m done now. I take back my teasing of Dinah.

Long-time blog reader and frequent commenter, Jen, recommended running in the pool to help overcome these mental (and physical) hurdles. That’s a good suggestion. I haven’t been in the pool since the weather changed. We finally disassembled our trailer park, above-ground pool a few weeks ago. My backyard now has a sweet, UFO-looking brown patch of dirt. So if I plan on jogging in water, I’ll need to do it at 24-Hour Fitness, which isn't a problem. I went pool-walking there a handful of times early in my recovery. But going swimming in the winter – even a mild one like Dallas’s – is extremely un-appealing. I’m definitely concerned with shrinkage. But like Dinah eventually leapt onto that platform, I, too, can splash around an indoor pool when it’s 50 degrees outside.

Ok, if you’re interested in reading only about my knee, stop now. Otherwise, enjoy my car accident story.

Leaving the 24-Hour Fitness parking lot, I pulled out to the far left turn lane. It was a red light, and there were about 3-4 cars waiting ahead of me. I drive a Toyota 4Runner. As Jack FM was telling its listeners the radio station plays what it wants, the reverse lights of the beat-up, green mini-van 5 feet in front of me popped on. My initial thought, was, “huh? That’s strange.” And then the mini-van slowly rolled backwards. I immediately screamed out, “hey moron!! Stop!!” Too late. Pop. She tagged me.

When I stepped out of my car to inspect the damage, I wasn’t too worried; only 5 feet separated the two cars. The driver and passenger of the mini-van emerged at the same time. The driver was a 5 foot-tall, 200 pound Hispanic lady. She could’ve been 60 or 35 years old. No clue. The passenger appeared to be her daughter. She was slightly taller, and slighter less chubby. Like her mom, her age was vague. Maybe 40, maybe 20. Neither spoke English. Great.

She immediately started blabbering and gesturing at my car, and then pointing at her car. She then started yelling at me in Spanish. I speak conversational Spanish, enough to realize that she blamed me for her backing into my car. I was annoyed when she hit my car, but now I was irate that she faulted me for her incompetence.

I immediately told her to shut the f*ck up, you just hit my car. In Spanish. She quieted down. I was very impressed with myself. She was shocked a white boy like me spoke Spanish. Of course, she now expected me to speak Spanish well enough to understand every word she said. Not good.

I started examining my front bumper and noticed a decent-sized scratch. Nothing serious. The scratch, however, did not appear to be in a spot where her car hit me. Hmm. Before I could finish my inspection, I noticed the driver started acting suspicious, pacing a bit anxiously, like she was nervous. I wondered, (1) does she have insurance, and (2) is she an illegal alien? As I started searching other spots along my bumper, I told her we needed to exchange insurance information. Again, in Spanish. My high school Spanish teacher would’ve been proud. Muy bien, Jaime. The driver nodded, and both ladies retreated to the mini-van. I likewise left to get my insurance card from my glove compartment.

And then I heard the mini-van’s ignition start. Holy sh*t. The bitch was gonna bolt! I quickly shuffled – remember, I can’t run – to the driver’s side window and started banging on it. She opened the window and motioned ahead, suggesting we should move our cars out of the turn lane – we were on a pretty busy street – and onto a side street. Or so I thought that’s what she meant.

I returned to my car and the mini-van pulled away. Another car cut in front of me. The mini-van made the left turn onto the access road (that’s a feeder road that runs parallel to the highway). And then she was off to the races. Mother-f*cker gunned it. She had about a 20-yard headstart on me. The access road was empty. It was time to transform my 4Runner into the General Lee.

I floored it. The odometer showed 75mph. I jammed on my horn for the 4th or 5th time. I eventually caught her. As I pulled alongside her, I rolled down my window and started screaming at them to pull over. In English. I can’t speak Spanish in the middle of road rage. She sped up. Pffft. She didn’t realize I watched every episode of Dukes of Hazard as a kid. She wasn’t getting away.

I pulled ahead of her again, and then immediately slowed down, forcing her to do the same. I then let her get ahead of me and tailed her. After a few switcheroos, I think she realized she wasn’t escaping and the mini-van finally pulled into the parking lot of a local grocery store. Before exiting my car, I took a few calming breaths. Maybe I even thought of the hot chicks doing Namaste Yoga on the Fitness Channel. That seemed to work, and I reminded myself there was no need to wage war on an elderly Mexican lady.

But when I asked her why sped away, she started rambling incoherently, pointing at me, then my car, and then her car. By now, I had reached the limits of my Spanish. For some reason, the driver grabbed some random Hispanic lady walking to a nearby parked car. I think she hoped this woman could translate for us. I’m not sure. But the driver also borrowed this woman’s cell phone. Odd. The other lady didn’t speak English much better. However, all three of them understood me when I accused the driver of telling a “mentira,” or lie, about pulling over. I think I successfully shamed her. At least she stopped acting belligerent.

I finally had a moment to inspect my bumper. After tempers cooled down, I told the lady I simply wanted a few minutes to see if there was any damage to my car. That’s it. I asked her to get her car insurance. The side of my front bumper had a fresh scratch, but, like I said, it couldn’t have happened from direct contact from the mini-van. It appeared the bumper flexed upon contact, and this "scratch" could be rubbed out. There were also a handful of little scratches around the license plate area where she had hit me. Nothing serious.

She eventually returned from the mini-van, but with no paperwork. She then told me she didn’t have insurance and again tried to blame me for the accident. Her temper flared, though this time I sensed it had more to do with frustration than anger. At that point, I said, F*ck it and called 911. I calmly reported the accident, emphasizing that nobody was hurt and the only reason I called was because the other driver tried to leave the scene. I minimized my role in chasing her down. The dispatcher said an officer was on his way.

The driver finally calmed down. She offered me $50, but insisted that I not call the “Policia.” I appreciated her offer, but told her I already called the cops. Besides, I told her I didn’t want any money unless there was actual damage to my bumper. She immediately huddled with the other passenger.

Shockingly, the cops arrived 2-3 minutes later. I only hope they’re this prompt if there’s a real emergency. I noticed the passenger immediately walked 200 yards away to a neighboring Denny’s. Officer Friendly (note: not his real name) was a white guy in his late 20s. Nice guy, as it turned out. I calmly explained the situation, though I left out the Dukes of Hazard references. Officer Friendly then called HQ to get a Spanish-speaker on the phone to get the driver’s side of the story.

I ultimately decided that any damage was inconsequential. Yeah, she probably caused a few small scratches, but the bumper already had plenty of little dings. When the cop asked if I wanted to file a report, I declined. So did the driver. Interestingly, the cop told me the driver had car insurance. I’m not sure why she lied to me.

When Officer Friendly left, the passenger returned. I think she was an illegal, or had a record, perhaps an outstanding warrant. The driver again asked if I wanted $50, though she conditioned her offer on me not calling the police. She was thoroughly confused. I declined her money, and reminded her that if she hadn’t fled the scene of the accident, I never would’ve called the cops. All I wanted was a chance to inspect my bumper.

I ended our conversation with a line from one of those early morning ABC Family Shows – Senora, lying and running from trouble only gets you into more trouble. That, and selling meth.

I’m not sure the lady understood me, but I no longer cared.

Monday, October 19, 2009

Celebrity Knee Surgery

Man, it’s been way too long since my last update. To make up for my absence, I was working on a mega-blog post. Ultimately, I decided to break things up. Hopefully, the next post won’t take 3 weeks.

Ok, let’s start with some celebrity knee surgery news. And no, I haven’t spent the past few weeks playing paparazzi. Or stalking Brittney Spears or Lindsay Lohan. Nor do I plan on turning this blog into some sort of National Enquirer meets knees. But this is relevant to my postings, and it's the first time the specifics of a knee operation have made major news.

Olympic Swimmer and Buffest 40+-year old Mom in the World, Dara Torres, is having knee surgery, possibly ACI (Hey Dara, if you’re reading this, leave me a comment). The press release announcing her surgery was a bit confusing. It’s almost like her press team purposely picked the least knowledgeable person on their staff to issue the release. Is she having ACI or some sort of OATS procedure?

Here’s the release (I’ve deleted the non-pertinent parts):

Dara Torres overcame staggering odds to make the U.S. Olympic swim team in her 40s. Now, an even bigger challenge awaits.

Torres' arthritic left knee is damaged worse than she thought, requiring a radical, reconstructive procedure that will leave her with a recovery of 12 to 18 months. But she told The Associated Press on Thursday she's not giving up on the London Games.

The operation -- tibial tubercle osteotomy -- will be performed Oct. 20 in Boston. Torres' shin will be broken and shifted to create more room for cartilage to grow around her kneecap.

She already had the first step in the procedure a couple of weeks ago, when cartilage was removed from a nonweight-bearing area around her anterior cruciate ligament so it can be transplanted to the area around her kneecap during the next operation.

"This is really going be new experience for me," Torres said. "It's a little unnerving. I was seriously freaked out when I read the literature."

Torres had shoulder surgery after the games and looked forward to competing fully healthy, only to suffer from increasing pain in her left knee. She made the team for the world championships but was clearly not at full strength. She was unable to do much lower-body training in the months leading to Rome because all the cartilage around her knee had worn out, leaving her with bone rubbing against bone.

"There are times when my knee just swells up like a balloon," she said. "When I'm going up and down stairs, I have to hold on to the railing. It's very tough."

After the surgery, Torres won't be able to return to her home in Florida for about five days. Then, she'll be on crutches for six to eight weeks. The first tentative steps in her rehab will be hooked to a special machine that limits the range of motion in her knee.

While she already was looking forward to a break from swimming, she's concerned that other forms of training -- such as biking -- will be off limits until her knee gets stronger.

"I don't know what freaks me out more: having my knee fixed like this or the actual recovery time where I won't be able to train," Torres said.

"I'm ready to get it done and move on," she said. "I just want to have some normality in my life. I want to be able to walk up and down the stairs without being in pain."

While the release mentions a transplant of cartilage, thus suggesting OATS and not ACI, it also pegs the recovery time at 12-18 months, which sounds more like ACI. Indeed, recovery from OATS procedures usually is much quicker, more like 6-9 months.

Anyway, a couple things about this release caught my attention. First, it describes the procedure as “radical.” I realize ACI or OATS-type knee surgeries are a big deal. Believe me, I do. I’ve been living with it for 9+ months. But it’s not like they’re growing a second head here, or trying to install gills on Dara. Hmm. Actually, that might work out to her advantage. Maybe they’ll stick in some extra white blood cells to help her swimming, just like Lance Armstrong used to do in the Pyrenees Mountains to win all those Tour de Frances. (I know, I know. Lance is great. LiveStrong! He never doped. And neither did Roger Clemens or Barry Bonds. And OJ couldn’t have killed those people since the glove didn’t fit. Riiiggghht). Calling this surgery, “radical,” doesn’t exactly inspire confidence in my ability as a mere mortal to recover. I realize Torres's PR team needs to set the bar high in case she's not able to return 100%. But still. Radical? That’s the knee surgery equivalent of fear mongering.

Next, the press release makes it seem like the “tibial tubercle osteotomy” is the main course. It’s not. The osteotomy is a side dish. An important one, sure, like the mash potatoes at Thanksgiving. But the ACI or OATS transfer is the turkey here. Yet there’s no real focus on the actual cartilage transfer (if it’s OATS) or cloning (if it’s ACI), only a brief mention of the transplant and some vague reference to creating more room for the knee cartilage to grow.

Since the release says her surgery is in Boston, I assume her surgeon is Tom Minas. I’m sure Minas performs all sorts of knee operations, but he’s widely considered the top US ACI surgeon, suggesting she’s having ACI. And Torres is spending 5 days either at the hospital or near the actual surgery site, something ACI patients do. Not me, of course. I was home in time for Oprah.

The release does nail her initial recovery period. She’ll spend the first 2 months or so on crutches and hooked up to my old friend, the CPM. But the most shocking omission? The release doesn’t mention the type of toiler seat riser Dara bought. Maybe she’s planning on announcing her choice on Twitter.

Anyway, Torres, like most rich athletes, will have many advantages. The best surgeon. The best rehab facilities. The best trainers. Plus, she’s a world-class athlete in amazing shape. And she’s a swimmer, which just happens to be the best possible recovery activity. I’m rooting for her to fully recover. Or pose for Playboy after getting a boob job. Call it the Girls of Failed Knee Surgeries. Ok, that's tacky. But I needed an ending to this post, and that's all I could think of. (Ed. note -- I just realized why the Playboy comment popped into my head. The last swimmer who "crossed over" to a certain degree, like Torres has, was Amanda Beard, and she posed for Playboy. Um, not that I ever saw her photos...)