Saturday, February 28, 2009

OS Follow-Up #3 -- 8-Week Update and Other Developments

Some good news, some “ehh” news. Or to be more philosophical, two steps forward, one step backwards. Seems like the story of my recovery.

Ok, the good news first. The surgeon says the knee looks good. I’m on track with my recovery. Flexion’s good (at least 116 degrees). Leg strength is good. The patella’s a bit tight, but the rest of the area around the knee feels fine. The swelling is minimal, and the knee hasn’t gotten swollen after any activities. I got a good report, apparently, from my PT. I say “apparently” because I didn’t see the actual report. But I don’t think Turgeon would make that up. That would be a dick move by a doctor. Anyway, at that point of my visit I was thinking to myself, “Man, this is sounding good.” Turgeon even announced he was ready to open the knee brace to 90 degrees, and noted I was close to ditching the brace.

But then Turgeon pressed down pretty hard on the top of the osteotomy, right below the kneecap where the bone wedge was inserted. I winced. He took another x-ray and determined it still needed to heal further before he was ready to let go of the reins. Instead of rocketing to 90 degrees, he scaled back to 60 degrees, a modest 10 degree increase, though I remained free to increase it 10 degrees/week. That wasn’t the killer. It appears I’m still on track to ditch the brace at the next visit. However, Turgeon told me he wanted to see me back in 3 or 4 weeks, not our usual 2-week interval. Whoa, big fella. Why the extra week? That sucks. So, it turns out I’ll be wearing the brace at least one more week than anticipated. Everything’s fine, but, man, 11 weeks in a brace. Some people switch cars faster than that. And, of course, there’s no guarantee the brace comes off at the next visit. As my New Jersey friends would say, oy vey.

I stepped up things this week in PT, which brought mixed blessings. I’m happy that my recovery is progressing sufficiently that I’m capable of doing more, but somewhat skittish about how my knee handles the increased workload. I added some very minor 1-legged “squats” and step-ups to my usual routine of isometric leg raises. I put quotes around “squats” because my stooping was imperceptible to the naked eye. They don’t make protractors small enough to measure how far I squatted. I still made the requisite grunting and facial expressions of gym meatheads hoisting 600 pounds, but I really looked more like an old person squeezing out a big turd. Sorry for that visual. It was the first thing that came to mind.

The step-ups were even more humbling. Normally, you see folks stepping onto benches 2- and 3- feet high, often holding dumbbells in each hand. Not me. I placed my right leg atop a phone book – yes, a phone book. Remember the Yellow Pages before the internet? – and slowly lowered my left leg a whopping 1 ½ inches to the floor until my heel touched down. Repeat 25 times. And this tired out my leg. Please hug me the next time you see me.

I also waded into the pool for the first time. After a decent 25-minute workout lifting weights – I’m actually proud to report I’m slowly regaining my strength – I cooled down with some pool walking.

24 Hour Fitness offers three, 25-meter swimming lanes. Actually, I’m guessing they’re 25 meters long. I’ve never swum before, and I don’t do the Metric System.

Each lane is about 2-arms’ lengths wide, with a line down the middle creating 2 mini-lanes within a lane. When I arrived, 4 serious swimmers occupied the pool. One of the girls actually wore a New Zealand swim cap. I notice things like this. I also noticed her ridiculous body when she got out of the pool. I tried to disguise my ogling from Christina (who had accompanied me) by commenting on the aerodynamic texture of her swimsuit. I don’t think I fooled her.

Anyway, after removing my brace I dangled my legs over the edge of a pool lane used by a Serious Swimmer. If you’ve seen swimmers at the gym, you’ll understand what I’m talking about. I’m not knocking them. All of the Serious Swimmers seemed far more friendly than the typical gym-goer. In fact, after seeing my predicament, Serious Swimmer simply nodded to me during one of his flip-turns and moved over to the far half of the swim lane. When have you have ever seen a meathead offer to share any of the 15 dummbells he hogged?

I slowly lowered myself into the pool, landing on my good leg. My gimpy leg touched down a moment later, as I gingerly placed weight onto right leg for the first time in 8 weeks without the aid of a brace. I realized the water’s buoyancy would alleviate the stress placed on my knee, but part of me still feared that it would buckle underwater. Didn’t happen. After a few steps to gather my balance, I glided down the length of the pool. As the water levels rose from 3 feet to 4 ½ feet, the resistance increased and I was forced to concentrate a bit more to walk normally. Yes, I needed to concentrate just to walk normally. Humbling, I know. The pool actually is 5 feet deep at the far end, but I stopped at the 4 ½ foot marker, about 15 feet, er, I mean 5 meters from the wall. Touching the far wall and turning around seemed inappropriate. I wasn’t walking fast enough to justify simulating a normal race. Plus I was wearing floaties on my arms. You know, just in case.

I walked up-and-down the swim lane about 5 times, getting lapped repeatedly by Serious Swimmer. Show off. I made sure the water got real choppy every time he passed me.

Pool-walking actually felt good, even if I felt dorky with my slow motion pace. It eliminated, or at least, severely reduced, my normal limp. Now that I can drive, I plan on pool-walking more often.

Surprisingly, getting out of the pool wasn’t tricky. With my back to the wall and palms pressing down, I lifted myself out of the water, basically doing an exercise called, a dip. I immediately swung my legs over the wall onto a pre-positioned towel. It took a little longer than normal to dry off because I was seated the entire time, but I managed to avoid injuring myself. The only unusual thing was how the chlorine turned my scar a freakish purple. Other than the plum-colored knee, I thought things worked out well.

Sunday, February 22, 2009

The War on Drugs

“Just say no!”

– Nancy Reagan

Because I’ll never have a debilitating addiction and uplifting recovery to chronicle (well, unless I pull a James Frey), the Pulitzer is probably beyond my reach. So here’s my stab at the next closest thing: the “struggle” to wean myself off painkillers. James Earle Jones agreed to provide the voice-over to this introduction to lend some seriousness to the blog post.

With Green Day’s “Time of Your Life” (aka the Seinfeld finale song) in the background (the Foo Fighters’ “Best of You” is on-deck), envision me seated in front of the fireplace, a blue-and-grey sweater covering an un-tucked white dress shirt atop dark brown corduroy slacks, stroking a not-so-well-kept beard, with an earnest gaze some might mistake as forlornness, sharing heartfelt thoughts to a living room gathering of my devoted Jim’s Bionic Knee audience. And yes, I realized I just described the stereotypical “hip” male college English professor at a coffee shop poetry reading, minus the tweed jacket and secret stash of marijuana, of course. Don’t think any less of me. I’m just trying to set the right tone for this blog entry.

(Real quick: Mom/Dad, don’t worry. This is just material for my blog. I have as much as chance of becoming a vicodin addict as I do winning the NBA Slam Dunk Contest).

To me, drugs are necessary evils. People can tolerate only so much pain. Without drugs, injured people can’t function properly, and instead would spend their days screaming like inmates at an insane asylum. If I didn’t take drugs that first week after surgery, I’m pretty sure I would’ve called my kids all sorts of parentally incorrect names. Can you imagine the lifetime of emotional scars inflicted upon my children if, drug-free, I had screamed, “Hey dumbass! Nobody fucks with Daddy’s nap time!” Yeah, me neither.

The dangers of using drugs to manage pain, of course, are well-known – they lead to addiction. Think Brett Favre. Or perhaps prostitution in Malaysia, but I don’t want to go there. Besides, I don’t like Asian food.

There’s always going to be some level of pain during any surgical recovery, so patients have a ready justification. Ouch! My knee hurts. Hand me that vicodin and a glass of water, please. But at some point people must ask, does the pain hurt that bad? Do I really need the pills? There’s a thin line between necessity and dependence.

People can’t remain on drugs forever, however. Well, at least those who don’t want to live like Bubbles from The Wire. It’s not good for the body or the mind, and the further down the road of numbness folks travel, the tougher it becomes for them to stop the journey. And, as I learned, before you can slay the vicodin dragon, you’ve first got to make the pain tap out. Realistically, there was almost no chance I would get addicted to the painkillers, yet the fear of addiction accompanied every pill I swallowed.

(Alrighty now. How’s that for some seriousness? Ok. Back to the story.)

During the scope to harvest my cartilage for cloning, I took one 7.5mg vicodin right before leaving the surgery center. I also might’ve taken half of a pill later that night to help me sleep, more as a pre-caution than anything. I didn’t want to wake up in the middle of the night randomly screaming vulgarities like the chef at Larry David’s restaurant. I might wake up the kids, after all, and then Christina would really make sure I was in pain.

Luckily, my knee didn’t hurt after the scope, so I never had a continued need (or excuse, depending on your perspective) for meds. The second surgery, however, posed a different challenge. The difference in severity between the two procedures is impossible to overstate. It’s like the difference between Major League Baseball and Little League. I knew beforehand my leg was going to hurt. Badly. Before going under the knife the second time, I read several diaries by recovering ACI patients. Lots of them were X-games athlete-types or ex-military, and they readily confessed to extreme amounts of pain. One former marine passed out the first time he tried to get out of bed. A member of the Green Berets, I am not. I’m relatively athletic, but let’s just say there’s a reason I’ve never entered a Tough Man competition.

For the second surgery, my surgeon prescribed a more powerful vicodin, 10mg. I could take two pills every 4-6 hours. On day one, I was like clockwork. As it turns out I really didn’t need any pills that first day, because the femoral nerve block prevented all pain until the following morning. Of course, I didn’t know when the nerve block would end, and I wanted to “stay ahead” of the pain.

Day 2 arrived with a vengeance. Not only did the nerve block wear off, but it was the first time I “felt” the pain. The first twangs are the most difficult to handle, because the body has yet to assimilate the pain. Every sensation is new, and thus heightened. I eventually learned that pain is largely a matter of controlling expectations. Once you experience the pain, you know what to expect, and therefore can adjust your tolerance levels accordingly. If managed correctly, each burst of pain should hurt a little less than the previous one. The trick, of course, is to control the pain before it overwhelms you.

Throughout the initial onslaught of pain, I struggled to last 4 hours between pills, sometimes taking half of a pill at the 2- or 3-hour mark to tide me over. I failed to settle into a pain management rhythm on my second day, and Day 3 brought more of the same. That’s when I tweaked my osteotomy, prompting a panicked call to my doctor. That also gave me a small dose of what prisoners of war experience; I would’ve broken within seconds.

The vicodin failed to provide any meaningful pain relief. I could feel myself getting loopy at times, sort of like suffering a minor concussion. But my knee never stopped aching. I decided to upgrade to the varsity painkiller. Morphine. I think that’s what helped the Asian tricycle rider in Revenge of the Nerds complete the obstacle course.

Christina picked up my morphine prescription. Apparently it’s easier to navigate customs at a Third World country than it is get morphine. Christina had to sign multiple forms at the doctor’s office, and again at the lone pharmacy that carried the drug before receiving the morphine. It wouldn’t surprise me if I pledged my knee as collateral. Between the morphine and vicodin, the street value of our medicine chest reached five figures.

The morphine, surprisingly, didn’t provide any additional relief, though the fog around my brain thickened. Even while resting in bed, I felt like I was on that amusement park ride where the room spins around before the floor drops out. At that point, I mistakenly thought the meds would eliminate all pain, not just dull it to manageable levels. It took 3 full days after the surgery before I established a comfort level with the pain. Finally, the pain no longer dictated how I spent the day. Well, I still spent most my day in bed, but you know what I mean. Though I was somewhat unsure whether the morphine helped, I quickly decided to ditch the highly addictive drug. Besides, morphine gave me a massive headache. This was the moment I realized I could never hack it as a junkie.

After 1 day on morphine, I transitioned back to vicodin. The change caused no noticeable difference in pain management. My pain levels actually decreased, mainly because more days had passed since the surgery, and my tolerance had grown. The next step was to slowly decrease my vicodin usage. I was determined not to lose any more brain cells.

For the next few days, I cut back on my normal dosage, from 2 pills to 1 ½, and from every 4-5 hours to every 5-6 hours. I also stopped taking my 2 or 3am dose so Christina could sleep through the night. The reduced dosage generally worked just fine. However, as I became more “mobile,” I increased the strain on my knee/shin a bit more, thereby upping the pain and making it difficult to wait 6 hours between pills. Ironically, the more freedom I exercised, the greater the pressure to remain dependent on the vicodin. Nonetheless, I gritted through the extra pain. To me, it was a worthy tradeoff for the opportunity to feel “more normal.”

The baby steps to wean myself off painkillers slowly grew further apart. Soon, I lasted 8 hours between meds, and decreased the dosage to 1 pill. Not long after that, I stopped taking any pills during the day. I took only one vicodin first thing in the morning, and another right before bedtime. I didn’t want to play hero, but as my buddy PK once joked, “my body is a temple,” and I don’t want to pollute the temple with unnecessary foreign substances. Well, not unless I wanted to preserve my right to feign ignorance after a positive drug test.

Eventually, I stopped taking vicodin when I woke up, though I still took 1 pill before I went to bed. In other words, two weeks after the surgery I was down to 1 pill/day, and only as a sleep aid. I rationalized I couldn’t afford to reject anything that helped me sleep. Unfortunately, I discovered the nighttime vicodin didn’t help, either. I certainly became groggy about 30 minutes after taking the pill, which allowed me to settle into a relaxed stupor. But I continued to wake up 3-4 hours after I went to bed. After a few days, I stopped taking the vicodin before bedtime. I still failed to get more than a few hours of sleep at a time, but at least I could enjoy the 3am Ginsu Knife infomercials with a clear head.

And here I am, 7 weeks after surgery. I’m officially drug-free, victorious in my battle against vicodin. Or as alcoholic might measure his days, I’ve been sober for 4 weeks, 5 weeks if you don’t count the vicodin nightcaps. I’m even strong enough to stare down the vicodin in the cabinet without being tempted. To paraphrase Vince Vaughn from Swingers, “Jim’s the big winner! Jim’s the big winner!”

Thank you, Nancy Reagan. I couldn’t have done it without you.

Friday, February 20, 2009

Random Update -- 7-Weeks

Lately, nothing earth-shattering has happened. But that doesn’t mean I haven’t made any progress. I’m still piling up accomplishments; they’re just of the baby-step variety. For example, I’ve continued to increase my knee flexion (I hit 110+ degrees last week); I’m walking without crutches around the house; I’ve returned to work 2x/week; I regularly go out for dinner and attend my son’s sports functions without a second thought; and I’m even getting ready to drive again.

My return to the roads will be a bit like having a driver’s permit. I first have to convince Christina that I’m capable of driving; she’s like the Driver’s Ed teacher. She wants to see me drive around the neighborhood a few times before permitting me to drive on my own. She even wants to install a brake on the passenger side of the car. Insert your own manhood joke here. Anyway, once I get the green light, the next step will be to slowly increase the distance I drive. I’ll start with trips to the gym so I can ride the exercise bike, and perhaps pool walk, on my own schedule. Assuming I don’t wreck, I’ll eventually start driving around town, before hopping on the highway, and eventually driving myself to the office.

I didn’t exactly “enjoy” returning to work two weeks ago, though the change of scenery was nice. And I did miss the regular interaction with my co-workers, even if most of them are boring lawyers. Shocking, I know. (To my colleagues reading this blog, I’m just kidding. I love each of you.) The toughest part about heading back to work was waking up an hour earlier than usual, and showering in the morning again. Because I still needed Christina’s help, she also had to wake up an hour earlier. Talk about crank-eeee.

I’m pretty sure my outfit violated the office dress code. My brace doesn’t fit underneath normal pants, so I’m forced to wear warm-up track pants, with button-up snaps on the sides. I also wore my tennis shoes for comfort and stability reasons. A solid-colored sweater completed my ensemble. It was definitely a sweet look for a government worker.

Big announcement – On Monday, I plan on posting a lengthy "feature article" about my recovery, something worthy of The New Yorker. At least I think so.

Monday, February 16, 2009

The Simple Things in Life

The expression, “sometimes it’s the little things that matter most,” is particularly true when it comes to recovering from ACI surgery. After spending most of the initial recovery period completely dependent on others, I savored the chance to do normal stuff on my own again. Over the past week, I accomplished several things functioning adults might snicker at, but to me rank right up there with the birth of my children. Ok, that’s a bit of an exaggeration, but I am extremely proud of what I did this past week.

• For the first time in 6 ½ weeks, I actually walked without crutches. I only made it a few steps, but it felt great to walk on my own. My knee tired quickly, and remains somewhat unstable, so I need to keep the crutches nearby. But I hope to be walking on my own within the next week, once I regain a little more quad strength. However, I’ll likely have to use the crutches again, at least for a few days, once the brace comes off in 3 weeks. Patients apparently struggle with their balance while adjusting to life without the brace. At that point, I really won’t care about any balance issues; I’ll just be stoked to be out of the brace.

• I put on my own socks and sneakers. Yup, you read that right. Now that I can bend my knee, I can dress myself. I’m starting to feel like a grown-up again.

• I went to the gym for the first time this year. I rode the exercise bike for about 20 minutes, and then did my leg raises in the stretching area. I was only there for 30 minutes, but it felt nice to be back at the gym. I’m a creature of habit, so regular trips to the gym should help me regain some of the normalcy I lost during my recovery.

• I showered by myself. I still need Christina’s help getting the brace back on afterwards, but I no longer need her to remain outside the shower to help out. It would’ve been more fun if she could’ve joined me inside the shower, but the shower chair isn’t sturdy enough for two people. Heheheheh…

Finally, some quick political commentary. Obama’s crew made the talk show rounds this weekend, trumpeting the success of the “bi-partisan” stimulus bill. Really? Convincing 3 Senators and 0, repeat, zero, Congressman now counts as bi-partisan? Frankly, I'm no economic genius, soI have no insight on whether the Republican suggestions should've been included in the bill. I was just disappointed to see Obama’s team adopt the Baghdad Bob spin playbook. Please, Obama, stop peddling this “bi-partisan” crap to the public. You’re supposed to be better than this. Just state the facts, your best argument, and move on. Claiming 3/200 Republican votes counts as “bi-partisan” is sure-fire way to damage your credibility. Remember, when you insist on spinning something not even Hollywood PR folks can do with a straight face, all that trust built up over the past 2 years will disappear faster than Rush Limbaugh’s OxyContin pills.

Thursday, February 12, 2009

OS Follow-Up #3 -- Major Updates

It’s been 6 weeks since my surgery. This marks my first milestone -- the possible end of Phase 1, the “protection phase.” At this point, patients must satisfy several rehab goals before graduating to Phase 2 and beginning more strenuous therapy. I met with my surgeon on Wednesday to measure my progress.

As I’ve blogged about before, Dr. T is playing things conservatively. I assume that’s driven as much by his style as the osteotomy. At the 4-week mark, Turgeon informed me I would not be allowed to open the brace until the 6-week mark (which is 2 weeks later than usual) to give the osteotomy some extra time to heal, guaranteeing that my Phase 1 would last a little bit longer. That’s not terribly unusual, but I’ve been an overachiever all my life. I’m “one of those people,” so, as you’d expect, falling behind schedule is killing me, even if it’s not my “fault.”

During our visit, he x-rayed the osteotomy again and was pleased with how the shin was healing. Consequently, he allowed me to “open up the brace” – basically, bending the brace below the knee – up to 30 degrees. That might not seem like a lot, but it’ll significantly improve my level of comfort. With the brace bent, I’m now capable of sitting somewhat normally in a chair or car. It’s far from perfect – the leg can’t bend perpendicularly off the edge of the seat – but at least my leg can dangle a little bit instead of jutting outward like a missile. Opening the brace also unleashed a tidal wave of relief for the back of my knee. This immediate sensation is similar, I imagine, to the relief experienced by a woman who finally removes her corset after a 6-hour dinner party, or perhaps by an American Idol contestant who learns she advanced to the next round. I still have to sleep with the brace locked, which sucks. I haven’t slept longer than 3 hours in a single stretch since the surgery. But I figure that’s why God created coffee, right?

Dr. T also told me I could begin riding the stationary bike and walking in a pool. That’s also huge. My PT believes biking will help me gain those last degrees of flexion in my knee. Last week, I hit around 100 degrees passive flexion, and I need to reach 115 to advance to Phase 2. Other ACI patients have sworn by the benefits of pool walking. Frankly, I’m afraid of slipping in the pool area, not to mention being shirtless in public. I might wait another week for the leg to heal. That’ll also give me some time to finish my first HGH cycle so I can build up my pecs again. The swelling on the knee, while still noticeable, has gone down, and Turgeon said it looks fine.

Interestingly, Dr. T asked me to do a straight leg raise (SLR, for those at home) during the visit. I was a bit confused because SLRs have been off-limits while the osteotomy healed. In fact, raising my leg on Day 2 – essentially a modified SLR – triggered the pain that led to my panicked emergency call. Anyway, maybe Dr. T was confused, or maybe he just wanted to see my legendary quads in action, but I cranked out several SLRs for his amusement.

In my opinion, it was a successful visit. The conservative approach means I’ll be in the brace longer than most, but I’ve satisfied all of the Phase 1 goals, except the critical 115 degrees of flexion. Dr. T told me I can open the brace another 10 degrees next week. As soon as I get comfortable walking with the bent knee, I’m allowed to ditch the crutch(es). I don’t see that happening anytime soon. I still lack confidence in my knee’s ability to support my weight. Plus, the knee gets tired quickly. I see Dr. T again in 2 weeks. He anticipates allowing me to open the brace even further, before ultimately removing the brace for good 2 weeks after that meeting, or 4 weeks from today.

I had a PT session a few hours after my OS appointment, and shared the good news with Judy. She was especially ecstatic about me being allowed to bike. Judy’s a big believer in the bike. I also told her we could add SLRs to our sessions. Whoo hoo. Fun times ahead.

This was probably the toughest, most rewarding, humbling, and exhilarating PT session. Perhaps emboldened by Dr. T’s assessment, Judy tortured my leg. After the usual assortment of leg raises, I flipped onto my stomach for some passive hamstring curls. Good lord, this freakin’ hurt. Oddly, my knee never ached. Instead, my quad felt like it got severed from my leg. Judy repeatedly bent my knee perpendicularly. Each time it hit 90 degrees, my quad stiffened. It was tighter than Bar Refaeli’s ass. Normally Judy manipulates the leg a handful of times. With that in mind (apparently that’s a required quote before somebody reveals their vote on The Biggest Loser), I typically mentally prepare myself for 10-20 seconds of pain. This time, however, the pain continued. And continued, as she bent my leg 2-3 dozen times. I swore it lasted 20 minutes, but really it was closer to 2. Not good times.

After a few more leg raises and some stretches, we hit the recumbent bike. It took a moment to hop my good leg over the bike into the pedals, before hoisting my gimpy leg (sans brace) into the other pedal. Judy cautioned me to take it slow. There were no expectations. This was just another way to improve flexion. As my bum leg slipped under the pedal cover, I was acutely aware that this was the first time my leg was truly exposed to the “real world.” I was about to actually “use” my leg for the first time in 2009. I slowly pedaled forward until my right knee reached the apex, then it cinched up and I could not complete the revolution. Judy told me to slowly pedal backwards. With my left leg now in control, I reversed field easily until my right knee again hit its apex. And again it wouldn’t budge. I started to laugh. I couldn’t pedal a bike. Good lord, the mighty have fallen.

Undeterred, I began pedaling forward again. I got a bit closer to completing the loop, but the tightness in my knee and a healthy dose of fear stopped me. Judy re-assured me that it was okay if I couldn’t pedal all the way around. For some reason, this made me think of a woman telling their man, “It’s ok. That happens to every guy.” Of course, nobody’s ever said that to me before.

And then a minor miracle happened. On the backward pedal, I felt a few layers of scar tissue loosen and I made it all the way around. A reverse revolution! Success!! The scar tissue didn’t pop, it just gurgled a bit, providing some relief. I was in business.

Now I was determined to complete a forward revolution. On my first try after the reverse pedaling, I got stuck again. As I reversed course this time, I completed the backward revolution fairly easily. And then, jackpot. By shifting my hips slightly to my left, I was able to pedal all the way around going forward. And then another one. And another. Gosh darn it – I was biking. Pretty soon I didn’t even need to lift my hip or even slow down. Judy patted me on the back, and told me to bike for 8 more minutes.

On the next revolution, red lights flickered on the bike. Apparently, I picked up enough speed to trigger the computer. I was booking now. Judy, however, immediately shot down my newfound confidence, telling me I wouldn’t be able to sustain enough speed to keep the computer going. And she was right. As I decelerated through the down-pedal, the bike’s computer shut off. Power down. Judy gave me a “don’t worry about it, little camper” pat, and started to leave the biking area.

At that moment, I channeled my inner-Michael Jordan competitive fire and transformed Judy’s harmless observation into a massive sleight. Adrenaline surged through my blood more ferociously than a Lance Armstrong climbing attack in the Alps (except I don't have Lance’s EPO, of course). And then the computer flickered, and it stayed on. Judy had made it just a few steps when I coughed mischievously, “ahem. Oh, Judy, the computer’s working now.” Judy gave me a sly smile, like she had purposely challenged me. She then set the bike program for Level 1, and I happily finished my 8 minutes. Tour de France, here I come. Next up, the pool.

Saturday, February 7, 2009

Emergency Calls

ACI is a major surgery. Significant trauma to the knee. Very intense rehab. Lots of variables impacting recovery. The road to success is an intertwined partnership amongst the surgeon, PT and me. Everybody plays a critical role. Dr. T explained all of these points before the surgery, and he repeats them at every follow-up visit. To emphasize his commitment, Dr. T gave me his personal cell phone and instructed me to call him, at any hour, if I encounter any problems. Over the past 5 ½ weeks, I’ve called him 3 times.

My first panicked phone call to Dr. T was on Day 2 when I tweaked my osteotomy. There really wasn’t anything he could do, other than tell me I screwed up by flexing my quads. I think his precise medical diagnosis was, “you’re a moron. I told you not to lift your leg on your own.” Lesson learned.

I called Dr. T again last week when I developed some sort of upper respiratory infection. My throat got extremely sore, and the lymph nodes on my right side ballooned. Normally, that’s not a big deal. With the rapid and extreme changes in weather, everybody in Dallas gets sick this time of year. Unfortunately, I’m not “allowed” to get sick. I’ve got 2 metal screws inside my leg. In medical terms, they are foreign substances in the body. If an infection reaches the screws, I could be in big trouble. When I informed Dr. T of my situation on Saturday evening, he immediately called in a Z-pack prescription. Bang. A few days later, infection gone. Disaster averted.

About a week and a half ago, I noticed what appeared to be a small, ball-shaped scab near the top of my scar. Nothing alarming. But then last night I started pecking at the “scab.” After a little bit of prodding, the scab miraculously uncoiled, revealing a 1-2 cm piece of string. Holy crap! A piece of string was growing out of my skin! It was like Jack and the Beanstalk on Jim’s thigh.

The part of the string protruding from the skin had a slight tinge of blood. I immediately stopped playing with the string and called my sister-n-law, who’s a nurse. With the clinical detachedness common to medical professionals, she quickly observed that the string was an outgrown suture. She even noted the specific type of suture, based on the type of stitching and material. She told me it wasn’t totally uncommon for a suture to poke through, but it was something I needed to address immediately. The opening was a “portal” for bacteria, she said, and it needed to be closed. I doused the suture with Neosporin, before covering the wound with 4 band aids. The following morning (Saturday), I made my third call to Dr. T. He asked if I could meet him at his office in 30 minutes. We loaded up the kids and road-tripped to the surgeon’s office.

I was a bit nervous. I’ve never had a piece of string growing out of my body before. I bet you haven't, either. But it turned out not to be a big deal (well, at least as of now). Dr. T sterilized a clamp and scissors and simply snipped the suture, leaving a microscopic hole. That was it. The rest of the suture apparently dissolved underneath the skin. Dr. T lathered some Neosporin (or similar substance) over the hole, and patched me up with a band-aid. 30 seconds later, we packed the kids back into the car for the ride home.

I hope there aren’t any more emergencies. Or if there are, they aren’t serious. But it’s nice to know I can count on Dr. T.

Wednesday, February 4, 2009

Back at Work

5 weeks. That’s how long I have been away from the office. When people are gone that long, they normally call it a sabbatical. Folks typically use that time away to travel, finish the great American novel or build orphanages in Nicaragua. Or they dry out in drug rehab, though hopefully not in Nicaragua. They might wake up in a bathtub missing a kidney. Sadly, I accomplished none of those admirable tasks, though I still have both of my kidneys.

Anyway, all good and not-so-good things must end, and I returned to the J-O-B on Tuesday. A co-worker was kind enough to chauffeur me to the office. While it’s demoralizing to rely on others for transportation, I enjoyed having company during the 45-minute commute. Before my surgery, I loaded up my iPod with various sports-related podcasts to help pass the time. Or I made fun of other drivers on the road. I think conversation with others is more stimulating.

My first day back was pretty uneventful. I’m still on crutches, and probably will be for another month. Most of the essentials were packed in a backpack, the same one I’ve taken on every road trip since law school. Lots of sentimental value in this JanSport. Anyway, I brought my lunch (I didn’t think I’d be able to eat out), a few work papers and an icepack and towel. I planned on icing the knee twice during the day, and again on the ride home.

I arrived at work a little before 8am, about 15-30 minutes before the office fills up. I spent part of that initial quiet period getting re-acclimated to my office. Ok, that lasted about 30 seconds. Nothing’s changed. Papers were still scattered across my desk. Several boxes of documents still littered the floor. And pictures of my kids still occupied the edge of my desk and the wallspace above my computer. Home away from home.

I brought my office laptop home after the surgery, and I’ve been using it since then to work part-time. The office IT person kindly installed a temporary desktop in my office so I didn’t have to lug my laptop back-and-forth while on crutches. Much appreciated.

Like most returns after a long absence, I spent a good chunk of my day catching up with concerned colleagues, who alternated between checking on the status of my knee and teasing me about my gimpiness. Nice to be surrounded again by those who care. Eventually, the pleasantries ended and it was time to actually work. (Major pause.) Or just surf the internet and pretend to work. Just kidding.

My life at home the past 5 weeks hasn’t been that different than a regular day at the office. Neither is very taxing. At the office, I spend most of my day plugging away on the computer, occasionally flipping through documents. While home, I spent about 5 hours in the CPM during work hours, simultaneously plugging away on the laptop or reviewing work documents. Tomatoes, toe-mah-toes, right?

For some reason, just being at the office wiped me out. Maybe it was the extra crutching to the printer, or my inability to find a comfortable way to prop my leg atop some boxes. Maybe all those GS-14s sucked the energy out of me. I’m not sure. But I started clock-watching at 4pm. I haven’t done that since my days at Sizzler. I miss the Sizzler sundae bar and boxes of wine.

I almost fell asleep several times during the drive home, despite having a frigid ice pack 3 inches from my groin. That’s when I realized I wouldn’t be “up” for nookie that night (hohoho). I felt somewhat guilty after I arrived home. I scarfed down dinner and spent only a few moments with the kids before heading to the bedroom while Christina readied them for bed. I would’ve liked to spend more time with the kids, but I was cashed out. Plus, I needed to cram in as much time in the CPM as I could. That’s the downside of returning to the office. From start to finish, work consumes about 13 hours of the day, making it impossible to spend the requisite 6-8 hours in the CPM. I didn’t settle into the CPM until almost 8pm, leaving me, realistically, about 2-3 hours of CPM time. Of course, I was able to enjoy The Biggest Loser while getting something of a workout.

Hopefully I’ll re-adjust to office life quickly. A 2-day conference and federal holiday over the next two weeks will allow me to ease back into things. Meanwhile, I’ll continue to work from home a few days/week while going to PT so I don’t overdo things. The transition from full-time patient to full-time worker who still needs to rehab diligently should be interesting.

Monday, February 2, 2009

One Month Update

February 1st. For most people, yesterday was notable because of the Super Bowl. That was true at our house as well. We loaded up on chips, salsa and beer. I expected my 7-year old to switch allegiances between the Steelers and Cardinals as deftly as a politician changes his position to suit his immediate needs. The over/under for flip-flops was 3, but to his credit my son stuck with Arizona throughout the game. By the way, great game. But I’m still shocked they didn’t review Warner’s fumble to end the game. I’ve seen a dozen replays, and I’m still not sure if it was a fumble or incomplete pass. Think how cool it would’ve been if the Super Bowl ended on a Hail Mary…

Anyway, yesterday also marked the 1-month anniversary of my surgery. I think now’s a good time to “commemorate” this passing of time, noting how much things have changed, and how much more work I still have ahead of me.

On a scale of 1-to-10, with 1 being “no worries” and 10 being “life sucks,” the first week after surgery was an 8. Week 2 was probably a 6 or 7, with weeks 3 and 4 drifting into a manageable 3 or 4. After spending my first 7-10 days almost exclusively in bed, peeing into plastic bottles and not showering, my life today is like a Southwest Airlines commercial – I’m free to move about the cabin. I’m still in the locked knee brace, but I’m capable of crutching around the house, even heading out to dinner and to attend my son’s sporting events. I’ve even begun scooting around with just one crutch; this is like the young person’s cane. Using one crutch is supposed to help with my gait. I’m not sure if it does, but as a practical matter, it frees up my right hand to carry stuff. I no longer have to beg Christina to do everything for me, which means I’m only indebted to her for, like, 4 years now. I shower every day, though I still need Christina’s help, and I shower at night like a little kid. I’m not 100% clean, but I’m no longer the stinky kid in class.

My knee remains somewhat swollen, though I’ve luckily avoided bruising. I have no clue what it’s supposed to look like at this point, but I’ve been told it’s healing just fine. The scar no longer looks gruesome, which is really shocking. I always thought it would be my third eye. Once my leg hair grows back – right now my knee cap has some peachfuzz stubble, just like Bruce Willis’s haircut – the scar will blend in enough such that only those staring at my knee will notice it.

I hit my first minor PT roadbump today. Judy didn’t measure my flexion, but noted it was no better, and perhaps slightly worse, than it was last week. Normally I use the CPM machine before my PT session, but not this time. It looks like I need the CPM to warm up my knee enough to hit my flexion goals.

My knee’s not the only body part that’s changed significantly. After shaving my head the night before the surgery, my hair has finally grown back. People won’t mistake me for a Gulf War veteran anymore. I’m 5-10 pounds lighter, down to 152 pounds, but that’s not really a good thing. I lost most of the muscle tone earned through exercise and dedicated dieting over the 4 months before surgery. Luckily, muscles have great memory, and some of my definition has returned after I began some light dumbbell lifting. But it’ll be awhile before my body’s normal again.

I plan on returning to the office on Tuesday, 5 weeks after my last appearance. I have been working part-time from home, burning through weeks of sick and vacation leave when I’m either too tired or too lazy to actually work. I still can’t drive, so I’m relying on a co-worker to chauffeur me to the office. Thankfully, I’m now able to squeeze my leg into the front seat. I really didn’t want to pull a Driving Miss Daisy and spend 45 minutes sprawled across my colleague’s back seat. If I make through the day without incident, I’ll probably head into the office twice/week on my non-PT days.

One month down. A long way to go. But the hardest part (hopefully) is behind me.