Two OS Visits

Before I describe my recent OS visits – yes, plural; seeing two surgeons reminds me of that “famous” JCVD quote and movie trailer line: “There are two of them. Double the Van Dammage” – I wanted to share my bike riding adventures. A few weeks ago, I bought a friend’s old mountain bike. Other than a few bike outings on vacation, I haven’t ridden one since my sophomore year in high school; i.e., when I got my driver’s license and no longer needed a bike for transportation.

First, it really blows biking outdoors in the cold. And by cold, I mean anything under 50 degrees. The wind whipped my face worse than Vic Morrow cracked Kunta Kinte (not sure why that analogy popped into my head; it just did.) Pedaling faster to get home quicker just makes things worse. Yeah, I realize I’m a moron. But at the time, that logic made sense. Also, I’m a sh*tty bike rider. Just brutal. I need bumpers on the side of the trail, like those bowling lanes for little kids.

Bikes have changed dramatically from the ones I rode as a kid. My first bike was a New York Giants dirt bike bought at Sears (my dad got a steep work discount). With a massive banana seat and tires fatter than contestants from the Biggest Loser, that thing outweighed a tank. I remember getting trapped underneath the bike after a wreck, unable to lift that beast off me. Too bad they didn't make the LifeCall for that thing. You know, I've fallen and I can't get up? Anyway, I’m pretty sure the Army now uses its frame for body armor in Iraq.

Remember being fearless on your bike as a kid? It was like the Dukes of Hazard on two wheels. We would rocket over creeks off homemade ramps and launch ourselves down outdoor stairways. Now? I avoided even the 2cm crack in the middle of the paved trail. That twig smaller than my 4-year old’s foot? Too big to ride over. Yes, age and injuries have transformed me into a mega-p*ssy. It’s gotten so bad that just watching the X-Games freaks me out.

Ok. I met with 2 surgeons last week. I had my regularly scheduled check-up with Turgeon on Friday, and then I met with a new OS just to get a fresh set of eyes to check out my knee. For the most part, their evaluations were similar. Here’s what each had to say.

When I met with Turgeon, my big concern – other than the usual, how is the knee healing – was the twinge of pain on the inside part of my knee. As I blogged about earlier, my google-educated diagnosis suggested a possible medial meniscus tear.

Turgeon doesn’t think my meniscus is torn. He didn’t rule it out, but after performing a variety of bends and twists he doesn’t think there’s anything seriously wrong. He also thought the knee looked pretty good, and suggested it was time to step up my activities. He told me to start pushing the envelope and scale back if my knee starts to hurt. In fact, he told me – gulp – that it was ok to start jogging, though I need to use baby-steps. For instance, he told me to slowly increase my treadmill walking until the pace reached a point where I had to start a slow jog. He suggested I maintain the jogging pace for short periods – 10, 20, 30 seconds – before reverting back to my walking speed.

Turgeon, however, is a bit concerned with how the osteotomy is healing. The x-rays reveal the bone hasn’t filled in yet. He wants to keep the screws in my shin until July. Normally, he removes the hardware between 12-18 months. In my case, if the bone had looked ok, he would remove the screws now because they’re protruding. But he wants to keep them in for a bit longer.

But the main takeaway is that the knee looks and feels solid. The crepitus is normal. I’ve got full range of motion and full extension. No pain in the ACI-repaired areas. I need to build up my quad strength, however, which should come with time and after some more intense rehab. That will be the challenge with pushing things – how far can I go without aggravating the knee?

He told me that as I push the knee, I’ll also learn whether the meniscus is torn. He cautioned that the MRI – last taken 2 months before I started feeling the pain – is an imperfect tool to detect meniscus tears. If the pain persists, he mentioned undergoing an MR arthrogram. Basically, the doctor sticks a needle into my knee and injects some type of dye. The fluid then seeps into the knee joint and shows any “contrasts,” or possible tears, etc. The pictures might also reveal any deformities with the ACI graft. This procedure is not without risks, however. A number of lawsuits allege that one of the substances in the dye – gadolinium – causes a number of harmful side effects. Plus, sticking a needle into your knee joint can’t be enjoyable. Unless you’re Bubbles, I guess.

Turgeon didn't suggest I get MR arthrogram. He knows I’m an information junkie, and wanted to share this possibility now so I can educate myself in advance. Of course, I hope the pain goes away, making the possibility of further testing a moot point.

Turgeon also told me that he’ll probably check out the graft site when he removes the screws. He could clean up any overgrowth or remove extra scar tissue, though, at this point, he doesn’t think that’ll be necessary. He used a bioglide sealant – not periosteum – to cover the graft, which has a better track record; less than 5% of patients with bioglide sealants experience overgrowth.

The following Tuesday I met with Dr. Joseph Berman in Arlington, Texas, about 30 minutes away from my house. Berman, I think, does the most ACIs in DFW, and works out of a specialized facility; it was even larger than Turgeon’s old offices at the Texas Sports Medicine Group. I brought all of Turgeon’s visitation notes and the two surgical reports, as well as both MRI pictures and the technician reports. I felt like a fledgling author delivering a rough draft of his novel to a publisher. Berman took his own x-rays while I was there.

I was very impressed with Berman and his staff. I sensed he felt a tad uncomfortable serving as a second opinion, not wanting to play Monday Morning QB-surgeon and question Turgeon’s actions. However, I think he realized that I was a pretty-educated patient and had a number of specific questions for him to answer, which made his job a bit easier.

Like Turgeon, Berman did not think I tore my meniscus. So much for my google MD. Also like Turgeon, he thinks my recovery is going well. He suggested that the pain on the inside part of my knee, along with the quivering sensation my knee experiences when doing single-leg squats, might be from my lack of core strength. My right quad is still noticeably smaller and weaker than my good leg. Berman thinks that with continued rehab my knee will strengthen and some of these issues will disappear. Berman does not suggest I start jogging yet. He told me he counsels ACI patients to wait 14-16 months before attempting impact activities. But he says biking, even mountain biking, is fine.

Like Turgeon, Berman is concerned with my osteotomy, though he offers a dramatically different solution. He would remove the screws now and do a bone graft to fill in the tibia. If the bone hasn’t filled in by now, he says, it probably won’t. A bone graft is a pretty serious – and painful – procedure, and the recovery lasts 3+ months.

We also spoke, somewhat at length, about the ACI process in general. He told me that the Israeli surgeon who pioneered MACI is a friend of his. I informed Berman of the CBS Today feature piece on Dara Torres’s ACI knee surgery (in my earlier post, “Celebrity Knee Surgery,” I noted that the press release announcing her surgery was vaguely worded; it didn’t specify which procedure Dara was having. I speculated it was ACI, and it turns out that's what she had.) If I was Berman, I would find a way to turn Dara’s very public ACI surgery into a marketing effort, assuming that’s ethical. It’s like rainmaking for doctors. Anyway, here’s a link to the CBS story on Torres:

http://www.cbsnews.com/stories/2009/12/14/earlyshow/health/main5977298.shtml

I also told Berman about my blog, and gave him the link. Not sure if he’ll check it out, or if he’ll enjoy my sense of humor. I also spoke with one of his nurses about my blog and my recovery experiences. I had mentioned I had swapped messages with one of Berman’s recent ACI patients (and blog follower), Char. Hopefully the info I passed along helps.

So, where do things stand now? Interestingly, the pain on the inside part of my knee has disappeared over the past few weeks. The leg actually feels ok right now, though I still think something’s amiss with my meniscus. I’ll probably try speed walking, and might even progress to a point where I jog a few steps. But I plan on waiting at least another month or so before I begin jogging. I also plan on regularly doing weighted leg raises again -- something I stopped doing -- especially the ones lying sideways to build up my abductor and adductor muscles. I think that might be the best and least painful way to build up my inner quad strength. And I wonder if the increased strength might eliminate the meniscus pain.

I next meet with Turgeon around Spring Break, unless the pain in my inner knee re-appears. We take x-rays every visit, and, if the bone does not appear to be healing, I’ll ask Turgeon’s opinion on how to address the problem. I want to avoid a bone graft, if possible. I really don’t want to endure another crippling surgery, especially now that I’m somewhat normal again.

In the meantime, happy holidays.