Sunday, January 27, 2013

And the 8th surgery is free!!

Well, so much for becoming the next Ultimate Fighting Champion.  I snapped my bone wedge, Joe Theisman-style.  I went back under the knife for the 7th time in my life.  Here’s what happened.
Back in May, the doctor removed the 2 screws from my tibial tubercle.  They were sticking out so badly you could read, “Craftsmen” through my shin.  While the bone hadn’t completely filled in the bone wedge area, it was solid enough.  The next 5 months were great.  I significantly upped my physical activity.  I hadn’t felt that good since before the initial ACI surgery.  I even ran a 5K in Maui (not an actual race, but the distance).  I also did some minimal jumping activity.  My vertical hadn’t reached LeBron James status, but I was hopping up and down off 18 inch platforms. All of a sudden, the next Olympics were in my sight.  Not sure which event, but I definitely felt Olympian. 
Over the holidays, I started taking Brazilian jiu-jitsu.  Absolutely loved it.  Fantastic workout.  Really enjoyed the grappling.  Like a physical chess match, only instead of taking somebody’s King, you tried to choke him out.  I considered building an Octagon in my backyard.
During class #4, we practiced basic guard escapes.  For the unfamiliar, “guard” occurs when the guy on the ground wraps his legs around the hips/back of the dude on top.  No homoerotic jokes, please.  Not that there’s anything wrong with that.  Anyway, keeping somebody in your “guard” – along with holding the collar of your opponent’s gi - prevents the top guy from standing up and raining down punches, etc., on the bottom guy.  Naturally, you also practice how to escape guard – i.e., how to stand up and break free from the bottom guy’s legs. 
Starting from a kneeling position inside my partner’s guard, I hopped up one leg at a time, first on my “bad” leg, slowly shimmying backward to shake off his legs.  As soon as I popped up, 2 loud cracking sounds erupted.  Pop.  Pop.  Like a pair of gunshots.  Those were the sounds of the bone wedge snapping off my tibia.  The only thing missing was Lawrence Taylor jumping up and down and screaming for the medical staff.
Of course, I’m super tough.  Definitely one of the baddest, 40-year old government lawyers around.  I shrugged off the broken bone and completed the rest of the class.  Only woosies let a broken tibia stop them, right?  I simply grappled around the injury, taking turns chucking my partner to the ground, and vice versa.  My performance was reminiscent of Jack Youngblood in the Super Bowl.
Later that night, I realized there was something seriously wrong with my leg.  I could barely walk.  A mammoth bruise engulfed my entire tibia.  The bone ballooned outward, like my shin was 4 months pregnant.   Oh, f*ck.
A visit to Dr. Scheinberg confirmed my fears.  The X-rays showed a crack along the entire edge of the bone wedge, and up-and-down the area vacated by one of the screws.  Because the bone didn’t fill in the last time, I knew this chasm wouldn’t fill in, either. 
Bone graft time!
I also mentioned to Scheiny my desire to “lessen” the osteotomy.  I felt the first one elevated my knee cap too much.  The knee felt fine, and I no longer needed to avoid pressure to permit the cloning process to heal.  He agreed. 
2 weeks later, I was back in surgery.  I earned platinum patient status the last time.  I got to bypass the waiting lines, and my room had the really soft pillows and extra warm blankets.  Huge perk. 
Scheiny ripped open the bone wedge, cleaned out the fibrous tissue and bone that remained in the underneath triangle area, then packed in a bunch of synthetic bone with various stimulants.  Before slapping down the top part of the wedge, he shaved it down a bitand buried 2 screws deep inside to attach the tibia and the wedge.  According to the nurses and reps in the room, he was very impressed with his work product.
I awoke about 90 minutes after being wheeled into the OR.  My brain probably had more CTE than Junior Seau’s.  Too soon?  Anyway, I couldn’t focus and felt extremely nauseous.  I nibbled on a few saltines and graham crackers, but struggled to chew them up.  I alternated between water and Sprite.  I remained in the recovery room for over an hour, unable to regain my strength.  Finally, I spewed out all those crackers-water-Sprite, unfortunately missing most of the portable bags and min-trash cans the nurses rushed in front of me.  Man, it felt just like that final tequila shot on your 21st birthday which sends your queasy stomach over the edge.  The curtain call for the night.
I felt slightly better when I finally arrived home, but I was still sweating anesthesia.  I napped intermittently, and nibbled on some more crackers.  Each time I arose from bed, a wave of pain flooded my leg, along with 10,000 paper cuts at the incision.  Imagine a microwave bag of popcorn, only with thumbtacks instead.  Around 9pm, I still felt nauseous.  We called in a script of Phenergan to counteract the nausea.  When Christina left to pick up my meds, I set a new puking record.  I almost wish my trash can had a measuring mark to see just how much I puked up.  But like a sinner who bears his soul during confession, I felt so much relief when that last quart of puke splattered inside the trash can.
The next day, I was a new man.  The leg still throbs every time I stand up, but I can walk gingerly on it.  I usually walk with 1 crutch.  I’m wearing the same knee brace I used 4 years ago.  Same crutches, too.  I even have the old ice cooler-knee brace thingie hooked up.  Can’t say those things bring back good memories. But this recovery is like a day at Disney compared to the ACI surgery. 
I will continue to use the crutches as needed.  The brace remains locked when I walk, but I can open it up other times.  Sleep hasn’t been a problem.  I stopped taking pain meds the day of the surgery.  Now, I just take a handful of Advil as needed.
I don’t know how long I have to wear the brace, or how long it needs to remain locked.  The major downer - it’s my driving leg, so I have to rely on Driving Miss Daisy to chauffeur me around.  My follow-up appointment is 2 weeks away.  I hope I’ll be allowed to open up the brace full-time after the visit.  Meanwhile, I’ll crank out a full array of leg lifts to strengthen the quad.  Man, I miss a rehab full of those leg lifts.
The good news?  The surgery should strengthen my leg.  Because the bone never completely filled in, my shin occasionally ached, and I never felt completely comfortable pushing off.  Now, my tibia is coated with super-strong bone material, kinda like Wolverine from the X-Men.  And by lowering the osteotomy, I should regain some knee flexion and quad strength.  It’ll take several months, but I should be better long-term.  Who knows? Maybe there’s still time for me to become the next Ultimate Fighter.          


Juris Doctorette said...

Hi, I found your blog on I'm having an ACI, TTO, and possibly DFO in March by Dr. Minas in Boston.

I haven't read through all of your blog yet but I noticed that you're an attorney. I am a public defender, so I was wondering about your rehab and how well you were able to work for the first month after big surgeries. I won't have a problem rescheduling court dates for a few months, but is it unreasonable to think that I might be able to write some motions while I'm at home recovering? Maybe after the first week or so? I just started my job and feel a bit lazy immediately getting a month off for surgery!

Thanks for the humorous posts about your knee - I've bookmarked your blog to go through and read it tonight!


Jim said...

Hey JD. It's been 4 years since the surgery, and I've kinda blocked out that part of my life. :-) But the first 2 weeks were really rough. I spent most of the time in a decent amount of pain and discomfort. And of course I spent 6-8 hours hooked up to the CPM machine, and it's pretty impossible to do any real work with your leg bending up and down. After that, I worked from home intermittently. I think you could crank out some motions in week 2-3, but I wouldn't expect being more than, say, 33% as productive as usual. As a PD, that means you'll be about 5% as useful as a normal person. Joke! Obviously, my surgery was 4+ years ago, so the recovery process has probably improved a bit. Plus, Minas is supposed to be the best. Hopefully you'll be further along than me. But I was pretty pooped just functioning daily and doing my PT during that first month, let alone managing a regular workload.

How'd you mess up your knee?

Keep me posted.

Unknown said...

Bummer. The non healing bone is something I fear... Hope you heal up well this time.

Can I hijack for a second and wave down Juris Doctorette? I'm having ACI with a DFO in March with Dr. Gomoll. Would LOVE LOVE LOVE someone else to chat with who is local and going thru similar at same time. Feel free to ping me, my email is on my blog... /commenthijack

Jim said...

No problem, Sarah. Glad my blog can help connect others. When I started writing the blog 4+ years ago, there wasn't a heckuva lot of info on ACIs. I tried to fill that void.

I wouldn't worry too much about the non-union/healing of the bone. Pretty rare. I was the unlucky 1%.

Debbie said...

Jim, thank you for your blog. I'm having an ACI on January 21, 2014 by Dr. Minas in Boston MA. Also with a tibial osteotomy. It will be my fifth knee surgery in 12 years. I also have to have a cadaver meniscus. I've been reading your blog and just started one myself. I really like the tips and humor in your blog.
In the end would you say the ACI was worth it?

Jim said...

Hey Debbie. Good luck with your surgery. It's tough to answer the "was it worth it?" question, because I had so many problems with the osteotomy part of the surgery. I definitely wish I didn't get the osteotomy. That procedure jacks up your gait permanently. You really won't be able to kneel normally ever. It's awkward and uncomfortable. Of course, my tibia didn't fully heal the first time, and I snapped the leg a 2nd time. Bad luck, I'm sure. The knee seems fine, though. I haven't had any issues since the surgery 5 years ago. ACI has undoubtedly improved since my operation, and Minas is supposed to be the best.
Good luck. Let me know if I can answer any questions along the way.

Unknown said...

Hi , I'm a newbie to knee surgery.I injured my knee 8 months ago and was misdiagnosed as a meniscus come to find out I have to have a tibial turbucle osteotomy procedure. I am absolutely petrified and don't have any info really yet about the recovery time or scar I will have.I am in nursing school and really can't take time off:( If anyone could help me by telling me your experience with this procedure I would be so grateful! Thank you

Jim said...

Hi Sarah. As my blog mentions, I'm not a big fan of the TTO. That's partly b/c my tibia never fully "filled in." But I also never fully appreciated how the TTO completely changes your gait. With the bone wedge and knee cap elevation, one of your legs won't bend the same way as the other. Plus, the TTO makes kneeling uncomfortable, at best. Granted, my TTO was part of a much larger surgery, so perhaps a standalone TTO won't be as dramatic. And that's also why I can't help you with the recovery timetable. Best of luck. Happy to answer any further questions if I can.


Someone give me that knee brace batman has said...

Hey Jim,

I stumbled across your blog as I was surfing the internet for some sort of idea of what I would experience after I have my ACI/TTT surgery in about two and a half weeks.

I'm a current college student and former D1 wrestler, "former" thanks to the knee (and shoulder but ahh well, not making any money wrestling post college anyway).

I was hoping to get back to my classes a week after surgery, but after reading through your posts and some other comments i'm beginning to doubt myself. I only have classes Tuesday and Thursday 9am - 2pm, do you think this is would be realistic goal? I'm sure none of my professors would have a problem with me taking a couple extra days, but finals are two weeks after the surgery and i wanted to gauge someone else's opinion who's been through the process before.

AND I know finals 2 weeks after surgery!? I tried to schedule the surgery earlier but couldn't get in until that date, and need to have this done before I start full time employment. Also, the finals won't be too extraordinarily hard i'm taking pretty much all free electives because for some reason my school thinks it's relevant if I take English literature through the 1800's as a finance major, and i'm pretty much finished all of my core classes.

Jim said...

Hey Former D1 Wrestler. Sorry that your career got cut short. My 13yr old quit wrestling after 8 years of martial arts (including some grappling) and wrestling. He was destined be a bad ass 103lb in high school. The first week or so after surgery is a complete mess. Even if you're in great shape with a high pain threshold, you're still gonna hate life. I wouldn't plan on heading to classes for at least 2 weeks. Studying for finals will be rough, but at least you'll have plenty of free time, even if half of the time you'll be in a maze of drugs.

I suggest you consider requesting some additional time to take your finals, if possible.

Good luck. Let me know how it goes.