Jim's Bionic Knee

2+ Year Knee Update

2011-04-09T15:40:00.000-07:00

2 years, 3 months is a long time. Think about it. Ellin had yet to smash Tiger’s Escalade with a 9-iron. LeBron hadn’t taken his talents to South Beach. Obama thought he could “change” the country. And Snookie was a term of endearment, not a pudgy reality star.

I also had 2 holes in my kneecap and a perfectly healthy leg.

Obviously, a lot has changed since then.

So let’s begin with the obvious starting point. If I could do it all over again, would I still choose ACI? I honestly don’t know. Before going under the knife, my knee didn’t hurt THAT badly. I could sense it was about to take a turn for the worst, but it wasn’t there yet. Today, my knee doesn’t hurt at all, which is a good thing, obviously. On the flip side, the lack of pain pre-surgery also meant that I never experienced the unbridled joy of having a pain-free knee, post-surgery. So when I say my knee doesn’t hurt today, I say it with a shoulder shrug, not the fist pump of a guy who just birdied 18 to win the Masters.

Unfortunately, the surgery also produced some unexpected drawbacks, completely unrelated to my knee. I went in with one problem, and woke up with a brand-new one.
The osteotomy didn’t fully heal. My tibia remains “somewhat fractured.” (By the way, somewhat fractured is an actual medical term). While the bone didn’t fuse entirely, however, enough bits and pieces did to hold the leg together. Dr. Champine described my leg as a “poor welding job.”

Now, the screws were inserted to keep the leg intact, and the surgeon had warned me the area surrounding the screws would be sensitive. At the same time, I was assured they could be removed once the tibia fully healed, meaning I spent that first year or so biding my time until the leg healed enough to remove them.

Well, I can stop waiting; the leg never healed. So the million dollar question today for me is: Has the leg healed enough for the screws to be removed?

Champine says, “probably.” He believes – and his partner, Dr. Scheinberg, concurs – that since the leg has held up for 2+ years, it’s “probably” not going to fall apart now. Of course, patients really don’t like when doctors use the word, “probably.” I like to measure risk. Can I catch VD from that Vietnamese “masseuse”? Probably, so I’m not going to ask for the happy ending. Easy decision. So even though my current choice also involves screws, this one is a bit more complicated.

Ok, quick intermission from my knee situation:

Over Spring Break, we road-tripped to Chicago to see family. My parents still live in the same house in which I grew up. After spending the week at my childhood home, I’m not sure what seemed weirder: sleeping in my old bedroom with my wife, or the lack of Michael Jordan or Paulina Porizkova posters on the wall.

By the way, did you know Illinois leads country in vanity license plates? Even minivans have them. I actually saw a guy driving a minivan with “Peters 64” plates. Advertising that you own a minivan? I thought you were supposed to be ashamed of them.

Ok, back to my knee update:

Thus far, I’ve chosen the conservative approach and opted against undergoing the surgery to remove the screws. Maintaining the status quo. By all accounts, this surgery is minor. A few days on crutches. Not a big deal in the grand scheme of knee surgeries, so I don’t fear the recovery. But I don’t want to risk the consequences if it turns out that the screws really were holding my leg together. If so, I would need some sort of bone graft to shore up my shin. And THAT’S a big f*cking deal.

To give you an idea of what’s potentially at stake here, I have no “daily living” issues. I can walk just fine. No issues with stairs. I can bike and use the elliptical machines at the gym. I avoid impact exercises – running, squatting, jumping or explosive plyometrics – but otherwise no functional restrictions. I’m plenty capable of jogging around the soccer field with the kids, even cutting without too much difficulty during scrimmages with 9-year olds. In fairness, I’m a slow, 38-year old dad playing with third graders, and these kids aren’t Brazilian. I actually weigh a bit less than I did pre-surgery, and think I might even regain my 2-pack abs by summer if I keep up my current exercise routine. Overall, I’m pretty content.

On the other hand, the screws in my shin remain sensitive. I mean, really sensitive. A little tap on my shin will drop me to my knees quicker than a hooker looking for a quick $20. Um, not that I have any idea what the going rate is for those types of things….
Until lately, the screws weren’t too big of a deal; I could tolerate them. During recent workouts, however, some of the basic leg strengthening exercises – short arc leg extensions; shuttle leg presses; even hamstring curls – have started to stress the outside of my shin. And guess what? The mere sensation that metal screws might rip through your leg like Mr. Kool Aid bursting through that brick wall is not a good feeling.

Ok, time for the Second Intermission:

Just like a strong jawline or piercing blue eyes define somebody’s face, the random shops dotting the sides of the highways provide a glimpse of state’s personality. On my Spring Break road trip, I discovered that Missouri leads the country in adult video stores and firework stands, which says a lot about the Show Me state. In fact, sometimes there were 2 adult video stores next to each other at the same rest stop -- the porn version of McDonald's and Burger King. That made me wonder -- do truck drivers comparison shop at adult video stores? Do they broadcast over their CBs, “Breaker Breaker. This is Little Bear. The Bobby’s XXX in Joplin has a wider foot fetish selection than Soft Skins.” One of the adult video stores also advertised an adjacent "men's only spa," and even used a picture of a geisha. Why not just throw up a billboard that says, "Happy Endings Available"? And, oh yeah, the local Mizzou gas station is called, Kum and Go. I'm not kidding. And you can find them next to the adult video stores.

Ok, back to the blog:

While the screws have nothing to do with my knee, I can’t truly test my knee for fear of aggravating the screws. Perhaps if the osteotomy had healed, I would have a better appreciation for how well the ACI grafts worked. But the screws prevent me from playing, for example, competitive volleyball or taking jiu-jitsu lessons, which I envisioned as the true measuring stick of a successful surgery. And that’s disappointing. Grumble, grumble.

Here are some other observations:
• My quad remains a bit weak, and I really don’t ever see it gaining full strength. Not only do the screws limit certain exercises, but the osteotomy permanently altered my mechanics, making it difficult to isolate my quad and build up the “teardrop” muscle. You can only do so many straight leg raises.

• I still have a decent amount of crepitus, but no pain associated with any of the crunching. I planned on getting my knee scoped to clean up the crunching at the same time the screws were removed, but obviously that never happened.

• Every so often I experience a twinge of weakness on the inside of my knee. It’s more like a pinch, something that creates the sensation that my knee might give out. But the knee doesn’t. I’m not sure if there’s something slightly defective with my knee, or whether that’s caused by my lack of inner/outer thigh and hip strength.

So here’s where I am 2 years, 3 months after ACI. Part of me wants to tough it out by keeping the screws. I try to convince myself removing the screws just isn’t worth risking a bone graft and the attendant lengthy recovery. But man, my screws can be aggravated as easily as a sleep deprived new parent, and I wonder how much “quality of life” can be gained if they were taken out. I still haven’t made a decision, and probably won’t until my kids’ soccer seasons end next month.

Until then, I’d love to hear from others about their knee experiences, along with updates from other ACI patients who follow my blog. In addition, I welcome any ideas or suggestions on blog topics from my “readers.”

Disney

2011-03-05T16:03:00.000-08:00

Well, I figure it’s been long enough since my last blog post. Almost 8 months, in fact. Actually, I started writing this post over the Xmas holidays, but then I got busy lying to my kids that Santa really exists, and, before you know it, two more months slipped by. Wait, do you still believe in Santa? My bad. I guess I should’ve included a “Santa is fake” disclaimer.

I’ve passed a few milestones along the way, including the 2-year mark. I’m not really sure how to describe the past 2 years, other than to note the usual clichés: the recovery is a marathon, not a sprint; the surgery seems like it happened just yesterday; blah, blah. Eventually, I’ll post a 2-year update about my knee. And I promise I won’t wait another 8 months to do so.

But not today.

Instead, I’m going to share my recent Disney adventures. The Florida one, not the SoCal one.

Alright, let me get the usual Disney platitudes out of the way. Every story you hear about how Disney bends over backwards to accommodate visitors – especially kids – is dead-on. All of Disney’s employees were phenomenal – the hotel workers, ride operators, character helpers, the bus drivers. You name it. Even the cleaning people who didn’t speak English. Very friendly. And not fake-friendly. You know the type. The superficial syrupy-sounding people who deserve to be punched in the kidneys. These Disney people were genuine. I don’t know how they remain this friendly, day-in, day-out. After five minutes of kids tugging on my shirt, I’m pretty sure I would start playing Wack-A-Mole with anybody shorter than 3 feet tall. Honestly, I was most impressed with the girl portraying Jasmine. Not only was she smoking hot, but she never broke character, like an old school WWF wrestler. Well, except for the time when the creepy old man started groping her. That freaked out Jasmine, not to mention ruining the Disney experience for some family’s little Princess. Rough memory for a kid, right?

But I assume most Disney travelers know these tips. Therefore, this blog entry shares some observations that, perhaps, are news to you.

First, a random observation.

Disney’s bathrooms never ran out of paper towels. I’m pretty sure I visited every crapper in the park. No, I didn’t have diarrhea, just two little kids needing to piss constantly. Incredibly, there was never an empty paper towel dispenser. Never. I wonder if Disney employs a stable of Sherpas just to fetch paper towels.

Ok, now to my main observation. I’ve never seen so many f*cking fat people in one place in my life. Enough fatties to keep The Biggest Loser busy for 40 years. Holy lard asses, Batman.

Here’s another under-the-radar scoop about Disney – they lead the world in rascal scooters. All those fatties scoot around the park all day rather than trying to walk off the BonBons. Disney was like a giant bumper car park for very large people.

Now here’s the really annoying part. Call me crazy, but I thought rascals were only for non-ambulatory people. You know, the crippled; extreme elderly; or even the morbidly obese people who simply cannot walk on their own. Not at Disney. I lost count how many times some gump of sh*t scooted up to the entrance, parked their rascal, and walked onto the ride. Seriously? At first I thought Disney had some kind of magical healing power, like one of those Sunday morning revivalist churches where worshippers gets blessed, and hallelujah! they rise up and hop onto roller coasters. And get this -- these fat f*cks go straight to the front of the line!

Thankfully Disney’s “Fast Pass” limits the wait time for most rides. But picture this scene: you spend 45 minutes creeping along 2-3 feet every 15 seconds to ride Space Mountain. Like an Oasis in the middle of the Sahara, the final turnstiles appear on the horizon. You can sense Shang-ri-La. You inch closer, squeezing through the final set of gates, reaching the coveted “next rider” status. The moment of truth. Space Mountain, baby!

But as you prepare to board the coaster, you hear a wheezing puttering sound, like a 1970 Pinto desperately in need of a new muffler. “Hold on, folks,” says the ride operator. He’s smiling, of course, because all Disney employees smile more than the Joker. As you struggle to comprehend the last-second delay, the Blob dismounts from his rascal and steals your ride. Sure, it’s just 1 more ride to wait, but those 45 seconds feel more the 45 minutes you just spent in line. You want to enjoy the ride, but you’re kinda ticked about Tubby stealing your turn. And you can’t shake the fear that his 470lbs might’ve stressed Space Mountain’s brakes. Can this car handle those twists and turns? Will I go flying off the track? And why is this seat so God damn warm?

Anyway, the kids had a blast. A definite “must” vacation for families.

A Difference of Opinions

2010-07-23T20:53:00.000-07:00

The Summer of Bone Grafts is finally over. Or close to being over. At least I think it is. I might visit one more doctor, and I’ve got one more test to undergo. Anyway, I’ll treat this blog post like Lebron’s “Decision.” I’ll tantalize you with some background and details, string you along for a bit, and then announce my decision at the very end. Of course, unlike Lebron’s shameless hour-long special, you can simply scroll down now to learn my future plans. You won’t hurt my feelings if you do. I promise I won’t stick a shiv in your back like Lebron did to Cleveland fans.

4 doctors, 4 different opinions. Actually, it’s 5 different opinions, though I didn’t have a fully informed visit with Berman back in April. Let’s recap. Back in April, the CT scan revealed that my tibia hadn’t fully healed. Turgeon’s immediate reaction: I need a bone graft, and the bone is borrowed from the iliac crest (ie, my hip). He believed the screws would remain in place, packing the bone graft and putty around them. The next day, I sought Berman’s opinion on Turgeon’s advice. Berman generally concurred with Turgeon’s approach. The only real difference was that he would replace the existing screws with 2 “flat-head” screws so, hopefully, the new screws wouldn’t protrude through my shin like my current ones do.

Over the next 2 months, I educated myself about bone grafts. I also spent a week in Maui, which was much more fun than reading medical journals. Anyway, I learned that 10-20% of patients who donate bone from their iliac crest experience some type of long-term complication. I also learned that a synthetic substance – BMPs – has a success rate almost as high as using your own bone. And, of course, using BMPs means I would avoid having surgery on my hip, too.
Armed with this information, I met again with Turgeon. This visit was as productive as an Israeli-Palestinian peace meeting. By the time I walked out the door, Turgeon had a lower approval rating than George W. Bush did when he left office.

First, I asked Turgeon to explain the exact surgical procedure he would perform. He would borrow some bone from part of my iliac crest (he told me the specific area, but I’ve since forgotten where), mix it with BMPs, then pack it in around the screws. He wasn’t sure how much of the nonunion area would need to be “cleared out.” The nonunion’s not like an empty sack; there’s some bone and fibrous tissue there. He would keep the screws intact. He feared that yanking them out would weaken the existing bone, similar to how removal of a nail might cause a 2x4 to splinter. Turgeon also said he planned to shave down the existing bone wedge inserted to elevate the patella. Despite several follow-up questions, I never fully understood why he would shave down the bone wedge.

I then asked Turgeon about BMPs. He reacted like somebody farted in an elevator. He simply dismissed the use of BMPs out of hand. No response. No discussion. Nada. Zilch. When I mentioned that several medical journals documented that 10-20% of iliac crest patients suffer long-term problems, he got extremely defensive. He scoffed at my information, questioning the legitimacy of the reports. Um, I wasn’t exactly relying on a 1974 study from Zimbabwe. Rather, most of the articles came from various national orthopedic journals, and one of the studies was co-authored by 2 local surgeons, including the dean of the nearby medical school.

My initial thoughts? He didn’t appreciate me – a non-doctor – questioning his surgical advice. At one point, he grew so frustrated that he made the absurd comment that, “Well, none of my iliac crest patients has ever developed any problems.” Really? None of them? Ever? At that moment, I decided I could no longer trust his opinions.

He did note that I wasn’t likely to shatter my tibia performing normal activities, something I was seriously concerned about. But he warned me that if I fired my quads suddenly – like, say, I sprinted to prevent my child from wandering into incoming traffic – I might yank the screws out.

The visit ended, and Turgeon simply told me to let him know what I chose to do.

Because I entrusted this man 18 months ago with a surgery that would – and did – change my life, you can imagine how frustrating and disappointing this experience left me.

I next met with Alan Jones. I read an article Dr. Jones co-authored that compared the use of BMPs to iliac crest bone grafts. Jones specializes in trauma surgery. Most of his patients are car accident victims rushed to the emergency room after their legs got crushed. While he was careful to note that a patient’s own bone is the best source for a bone graft, he believed that BMPs mixed with cadaver bone produce comparable results, with, of course, the added benefit of not needing to cut my hip. Plus, using BMPs also reduces the time spent in surgery, another bonus. Based on his review of the CT scan, Jones was concerned there might have been some slippage with the screws and cautioned that I needed to repair the nonunion. Jones also noted that he was surprised that Turgeon performed a Maquet for the osteotomy. He didn’t go into details, but he said Maquets were rarely done these days. This was news to me. I was not aware he did a Maquet; Turgeon said he was going to perform a Fulkerson.

Next up was Bob Scheinburg at Texas Orthapedic Associates. My sister-n-law works with Dr. Scheinburg (along with the last surgeon I visited, Mike Champine), and spoke highly of him. Scheinburg specializes in microfractures. Bob was pretty laid back. No matter what I decided to do, Bob told me I likely would have long-term issues with my knee. Not surprisingly, as a microfracture guy, he was critical of ACI. He didn’t think the new cartilage formed was any better than that created after a microfracture. That I expected. What I didn’t expect was his criticism of the Maquet. He took great pains not to criticize a fellow surgeon, and I really didn’t want to play Monday Morning QB, so I simply noted that I couldn’t change what was done.

Scheinburg took his own x-rays. He doesn’t think I need to undergo the bone graft. He noted that enough bone and tissue had filled in to keep the tibia intact. He also pointed out that it’s been 18 months since the surgery, and my leg hasn’t suffered any setbacks. His bottom line advice – do nothing. He cautioned that undergoing a bone graft would basically “start the process all over,” and there were no guarantees my quality of life would improve. After all, the bone graft had nothing to do with my knee. He also thought the screws could be removed, and wondered if removing them might improve things.

Finally, I met with Champine, who works in the same practice as Scheinburg. Like his partner, Champine was critical of the Maquet. After prodding my leg, he noted that I was tender around the screws, but not where the nonunion existed. Champine recommended a more cautious approach. First, he didn’t believe I needed a bone graft, again noting to undergo one would re-start the healing and rehab process. He cautioned that I didn’t want to “constantly chase surgeries, undergoing one to fix a new problem, which might lead to further problems and more surgeries.” He also wondered if the screws could be removed. He suggested that perhaps I could have a cortisone shot (or some similar numbing injection) near the screw to see if that eliminated any pain/sensitivity in the leg. If so, then perhaps that would rule out the need to fix the nonunion area. He also suggested I undergo a particular bone scan to determine the amount of bone versus tissue surrounding the screws. If the screws were embedded in enough dense bone, he believed the screws could be removed. He also assured me that I couldn’t damage my leg doing normal activities.

So that brings us to the moment of truth. What will Jim do?

First, I’m getting a bone scan shortly. Unless something unexpected shows up on the bone scan, I’m not going to have a bone graft. I plan on seeing how the leg feels over the next few months. I might try a cortisone shot near the screws. If the cortisone shot suggests the sensitivity relates to the screws and not the union, and if the bone scan reveals enough bone has filled in, I’ll strongly consider having the screws removed.

Keep your fingers crossed. Lebron took his talents to South Beach, and screwed the Cavs in the process. My talents remain here in Dallas, but maybe I’ll remove my screws.

Bone Graft Intermission -- the World Cup

2010-06-25T19:42:00.000-07:00

I probably won’t have any updates on my bone graft for a few more weeks. I’m in the middle of meeting with 3 separate surgeons to discuss the pros/cons of using BMPs vs. borrowing bone from my hip. I already met with one, and he confirmed what my research suggested -- BMPs have a similar success rate as using bone from the iliac crest, with, of course, the added benefit of not needing to cut my hip. My new motto: why cut twice when once will do. The doctor also didn’t think there are any obstacles to using BMP on me. I’ll see what the next 2 surgeons have to say. I hope to make a final decision and schedule the surgery by the end of July.

Meanwhile, let me entertain you with my thoughts on soccer and the World Cup.

I love soccer. Growing up, I played competitive soccer. I’m also a big fan. I attended one of Pele’s matches for the Cosmos. I celebrated with the crazy Brazilians and Dutch after their classic ’94 World Cup quarterfinal match. I’ve been to the 200,000-person Maracana Stadium in Rio de Janeiro to catch a club match between heated rivals, Flamengo and Botafogo. And just like the circle of life, I coach my kids’ teams, just like my dad did for me.

Basically, I feel qualified – and comfortable – to say this: Soccer is NOT about to take off in the US.

People who insist otherwise are almost as annoying as those f*cking vuvuzelas. By the way, they’re horns, people! Calling them vuvuzelas doesn’t make them any cooler.

Anyway, I say this even after watching the US’s thrilling win over Algeria to advance to the knockout round. In my opinion, that game was just as exciting as Game 7 of the NBA Finals. After Donovan scored, I screamed so loudly that my dog sprinted around the living room looking for somebody to bite. But even this victory, and perhaps even if Team USA keeps advancing, won’t convert Americans into regular soccer watchers. Just ain’t happening.

And that’s ok. Let’s just embrace soccer as a niche sport, somewhere behind football, hoops, baseball and even hockey. Actually, it’s probably even less popular here than Mixed Martial Arts (the UFC).

Some soccer-lovers question why folks feel the need to point out soccer’s “place” in the American sports hierarchy, which they liken to soccer bashing. Simple. Many people, including soccer fans like me, are sick and tired of all the “American soccer has reached a tipping point” chatter. Dude, let’s just enjoy the current matches. I don’t need some false soccer prophet telling us that Americans are “finally ready” to love “futbol” as much as the rest of the world does. Loosely translated, they’re saying, “Hey hoosier. If these games weren’t exciting enough to keep you interested in soccer after the Cup, you’re an un-cultured caveman.” Yeah, that’s a good way to get people to jump onto the soccer bandwagon long-term. Thanks for ruining the moment, buddy.

Americans simply don’t want to follow this sport on a regular basis; soccer just doesn’t match up with “American sports.” I’m not trying to denigrate the game or the talent of soccer players (though most of them ARE douchebags), just making an observation.

First, the American culture will never accept soccer or soccer players. We’re a macho society. Guys who kick a ball? Pansies. Plus, Americans hate floppers, soccer players who agonize on the ground, insist on a stretcher to cart them off, and then immediately sprint back onto the field. It’s no coincidence a European – Vlade Divac – brought flopping to the NBA. But not even Paul Pierce getting carried off the court in the 2008 Finals compares to the worst soccer flopper. And don’t even get me started with the whining. Imagine Tim Duncan’s bug eyes on steroids for 90 minutes. Anyway, there’s a reason why every American movie features the star QB getting the girl, not the midfielder.

But our ambivalence with soccer goes beyond cultural objections. Soccer’s usually slow-paced; there’s not enough scoring; and the athletes aren’t nearly as spectacular as guys like Kobe or LeBron. Plus, Americans can’t stand sports in which playing for a tie is accepted. I’d rather get season tickets to the WNBA than suffer through some of these 0-0 draws.

And yet every four years during the World Cup, we hear the US is ready to embrace soccer. FINALLY! REALLY! We’re not kidding this time!

Well, guess what? It hasn’t happened. It didn’t happen when Pele played for the Cosmos. It didn’t happen after the US made the 1990 Cup. It didn’t happen after the US hosted the ‘94 Cup and advanced to the 2nd round. It didn’t happen in 2002 when the Yanks made a surprising run to the quarters. It didn’t happen when David Beckham joined the MLS. And it won’t happen after this World Cup, no matter how far the US advances. Please. Stop saying it’s gonna happen. You’re embarrassing yourself. For the past 20 years I’ve heard folks insist America was ready to embrace soccer. The boy didn’t even cry wolf that long.

Here’s my solution. Instead of demanding that we follow and discuss soccer like it’s a major sport, let’s treat it like a special event. That works, right? Let’s treat soccer more like the Olympics. There are lots of similarities, besides the every 4-year thing. Two years ago, I was mesmerized by Usain Bolt, and religiously followed Michael Phelps gunning for 8 gold medals, like I’m sure a lot of folks were. But am I going to follow track & field or swimming on a weekly basis? F*ck no. In fact, I don’t even want to see Michael Phelps hawking Subway right now. America should impose a rule requiring all swimmers to retreat to their aquariums 2 weeks after the Olympics.

Yet Americans dig these sports during the Olympics. The ratings are fantastic, as I expect the World Cup’s will be. Why? Because we watch them only every 4 years, capitalizing on the novelty factor. Combine that with jingoistic pride, and bingo, you’ve got gold.

Same with soccer. Every four years works. It’s infrequent enough to retain the novelty factor, and not often enough that Americans get tired displaying their patriotism. And we get to root against France. Never underestimate the value of booing the Frogs. That never gets old.

Personally, I think soccer’s best chance soccer of catching on here in the US has nothing to do with the actual game but with the changing demographics of the country. Most Americans will never give a sh*t about soccer, unless their kids are involved. But the fastest growing population segment? Hispanics. They’re immigrating here, and once they’re here they multiply like rabbits. And these people really, really like soccer, about as much as Texans love their guns. Of course, this influx of soccer fans won’t necessarily make US soccer more popular. Mexican-Americans – even those born and raised in the US – still tend to favor Mexico over the US. Hey, it’s better than nothing.

Soccer’s next best hope – a longshot, really – is the emergence of an American Pele. Some man-child who decides he doesn’t want to be the next LeBron but the next Pele. If an American somehow became the unquestioned world’s best player – a guy with dribbling skills that make Brazilians look pedestrian –Americans probably would rally around soccer. I call that the Tiger Woods effect. One guy is such a phenom that average folks tune in just to see what the big deal is. However, I can’t imagine a 6’5”, 235lb inner city kid choosing soccer over hoops or football anytime soon.

In the meantime, let’s enjoy the World Cup, and hope the US can make an unlikely run. But when the Cup ends, let me resume my normal sports obsessions (football training camp! Whoo hoo!) without a slew of “soccer is here to stay” articles. Just like the Olympic torch gets extinguished when the Games close, so too will American’s passion for soccer. But don’t worry, soccer lovers. In four years, there will be even more Americans waiting for the next Cup, including me.

Bone Graft Deliberations

2010-05-27T19:51:00.000-07:00

I’ve been radio silent for much longer than usual. Earlier this month, my wife and I spent some time in Maui without the kids. Good times. For a short time, at least, my knee/leg issues didn’t hover like a guillotine above my head. It was just blue skies, cocktails and sand between my toes. Now it’s back to the gallows, er, reality. Anyway, while I was bummed to read about some of your setbacks, it was still nice to hear from my “ACI friends.”

Ok, I’ve spent several weeks researching the bone graft options, probably more time than I spent researching the ACI. Yes, there are synthetic alternatives to the iliac crest, and I’m furiously educating myself about them. When my OS first told me I needed a bone graft from my hip, I asked about other options. He acknowledged others existed, but was adamant they didn’t compare. In fact, he seemed pretty dismissive of them. And it’s true – everything I’ve read since my visit described the iliac crest as the “gold standard.” My second opinion OS also said the hip was the best graft site, and I don’t recall him mentioning other bone graft options. Critically, both surgeons downplayed the negative side effects to my hip.

My research, however, suggests a far greater % of patients suffer drawbacks. Anywhere from 10-25% experiences some type of chronic hip pain or serious limitations. I’m not gonna lie. That scared the cr*p out of me. Now, most bone graft recipients are older and generally undergo the bone graft to fix their spine, or repair a leg mangled in some horrific car wreck. It’s fair to say these patients were likely in worst shape. On the other hand, the failure of my leg to heal the first time suggests I’ve got weak bones, meaning my hip’s probably brittle. In any event, I’m steadfastly opposed to borrowing bone from my hip unless absolutely necessary. I’m scared I could create a brand new set of problems if my hip gets cut.

I’ve learned there are 2 less-invasive options than borrowing bone from the iliac crest. The first involves BMP-7, a type of osteogenic putty. Turgeon mentioned mixing this or similar material with the iliac crest bone graft, but nixed the idea of using it alone. BMP can also be mixed with cadaver bone.

The second option appears to be even less invasive. It involves a bone marrow injection from the iliac crest. I still don’t completely understand this procedure, but it appears the surgeon draws the bone marrow from your hip, and then injects it into the area of tibial nonunion. No cutting involved. Obviously, this would be the preferred route, though I have the sneaking suspicion this procedure remains somewhat experimental or won’t be covered by insurance.
I don’t know whether the TTO or ACI eliminates me as a candidate for either option. No clue. And I’m still trying to pin down the success rates for the different options. Some of the medical journals I’ve read suggest success rates for the BMP bone graft – whether alone or combined with cadaver bone – are 5-10 points lower than the iliac crest bone graft. I haven’t located comparable numbers for the bone marrow option.

Assuming these numbers are accurate, a 10-point decreased success rate seems like an acceptable trade-off to avoid getting my hip cut.

While I sort out the bone graft options, I’ve scheduled a PT visit with the guy the 2nd opinion OS uses. My quad remains weak, even after 16+ months. I’m not sure why. Even though the nonunion in my leg probably limits how hard I can push things, I think an updated PT session might be helpful. Plus, I’ll get a third set of eyes to check out my knee. Even as I stare down another surgery, I remain hopeful that my knee might approach something close to normal if I can eventually build up my quad after I fix the tibial nonunion. I’m probably clinging to hope at this point, but still . . .

Two days after my PT session, I meet again with Turgeon. I plan to question him about the non-iliac crest options. Assuming he disfavors the bone marrow injection and the synthetic bone graft and/or lacks experience with these procedures, I’ll seek out another OS. The problem is that I probably need to get my knee scoped, too, though the knee scope can wait. I prefer to schedule both operations at the same time to avoid multiple surgeries and recoveries. But I only feel comfortable getting my knee scoped by guys familiar with ACI, which pretty much is limited to Turgeon and Berman.

I also want to get a sense for what it would take for my bone and screws to shatter inside my leg. A kick? Getting sacked by LT? Just bumping into the corner of the kitchen table? If I learn my tibia is a ticking time bomb waiting to shatter inside my leg, I’ll need to make a decision asap.

Welcome to the Bone Graft!

2010-04-22T19:34:00.000-07:00

This time the title sounds like something from a Guns ‘N Roses speed metal wannabe. Perhaps a ballad by Metallica? Unfortunately, it’s also the next surgery I’m scheduled to undergo.

A few weeks ago, I met with Dr. Turgeon and Dr. Berman on consecutive days. Both offered the same opinion: I need a bone graft. In fact, Berman had stated back in December that I needed a bone graft.

Here’s the deal. The space above my tibia created by the osteotomy didn’t fill in with bone as expected. The medical term is, “non-union of the bone.” Basically, the bone splintered off by the osteotomy now forms a wishbone with my tibia. The two Home Depot screws are the only thing keeping the bone from snapping off. If that space doesn’t get filled in, there’s a decent chance the tibia or screws might shatter or crack, leaving fragments of bone scattered throughout my leg. Quoting WebMd, that would be a really, really bad thing.

The solution is to borrow some bone from my iliac crest (part of the pelvis), mix it with some protein-rich putty, and pack it into the open space. Just like that.

Sounds straight-forward, yeah? It’s supposed to be. In theory, of course. So let’s hope the surgery works as it should.

Now the bad part.

For starters, I’ll spend the night in the hospital, unlike the ACI surgery. Deep breath. My hip will hurt like a mother-f*cker, just like Bo Jackson felt after a 260-pound monster piledrove his hip into the AstroTurf. Worse, the pain will be felt immediately, also unlike the ACI surgery. Back then, the femoral nerve block delayed the pain 1 ½ days. Not this time. I’ll wake up really sore, and, I’m sure, really pissed off. I’ll need to load up immediately on some good-old fashioned meds. That means the family drug store will be back open for business. Whoo hoo. Let’s hope I can stop at the vicodin. I really don’t watch to mess around with the serious stuff, like morphine. Selling it, sure. Consuming it, not so much. Just kidding. I don’t deal morphine. Only Hillbilly Heroin.

How long will this surgery put me on the DL? Turgeon and Berman gave slightly conflicting recovery timelines. I’ll be on crutches 2-6 weeks, and in a hinged brace (not the mongo immobilizer I wore after the ACI surgery) for 6-10 weeks. I should be full weight-bearing soon after the surgery. My workouts likely will be restricted for 3-6 months, at least until X-rays show the bone has healed. I’ll probably have to channel my inner Michael Phelps and use the pool to keep in shape. Not good times.

The surgery will be huge for 2 reasons. One, obviously, is the need to repair the TTO. Hopefully the bone graft will firm up the tibia, eliminating the ultra-sensitivity and my fear that a 4-year old soccer player might accidentally kick me in the shin and turn me into Joe Theisman.

Second, and more importantly, Turgeon is also going to scope my knee. That’s right. I’ll receive confirmation whether the ACI graft worked. That’s even scarier than the bone graft. While the scope is the more “minor” surgery, it’s actually more revealing. I’ll learn whether all the rehab, pain, and uncertainty was “worth it.”

Now, as much as I’d like to know whether the ACI surgery “worked,” I wouldn’t get scoped just to check out the graft site. However, I’ve got a fair amount of crepitus, particularly at full extension, suggesting overgrowth at the graft sites and possible scar tissue which need to get trimmed. Interestingly, Berman mentioned that scraping away the overgrowth might stimulate further growth of cartilage and hardening of the existing stuff. A nice side benefit to the unpleasant surgery.

On the other hand, it’s possible the crepitus indicates that the graft hasn’t filled in or the new hyaline cartilage hasn’t matured yet, which would not be a good thing. I’ve also occasionally experienced twinges of discomfort on the inside part of my knee, so I’ll learn whether my Holiday Inn-inspired diagnosis of a medial meniscus tear is correct. And these past few weeks I’ve suffered a few random pinpicks around my knee, which scares the bejesus outta me. Because of my osteotomy issues, it’s tough to pinpoint the exact location of these sensations. Sometimes they feel like they’re coming from the medial meniscus area; other times from the patella; and still others feel like they’re at the TTO site.

I don’t want to envision the possibility that my knee still has unresolved defects, but I need to mentally steel myself for that possibility. That would be a really crappy thing to hear after waking up from surgery. Unbelievably demoralizing.

Regardless of what the surgery reveals, I’m facing another lengthy recovery. I’ve learned that rehabbing is a lot like practicing sports. And sometimes the hardest part of sports training is working on your weaknesses. Nobody likes doing stuff they suck at, me included. This is especially true for kids. For example, the hardest thing for young soccer players to do is kick the ball with their non-dominant foot. The kids often resemble newborn giraffes struggling to walk after leaving the womb. Well, after the surgery, I’ll be forced to re-train all those obscure muscles in my leg that will have atrophied for the second time in the past 18 months. Let’s be honest here. I hated exercising my legs when I was healthy. I really hate lifting legs when all I can do are a bunch of functional leg lifts with no weight. I’m a guy. Guys have massive egos. We like to lift heavy weights. Me Jim. Strong! Guys pick up the biggest dumbbells we can find– even if lifting them causes a hernia – grunt loudly, and then drop the weights to make the loudest possible noise so folks, especially chicks, can see we just lifted something enormous. For some reason, we think this is impressive. It’s not, of course. But we’re dumb. We just can’t help it. And after checking out who witnessed our feats of strength, we flex a few times in the mirror. That’s right. Check out the guns, ladies.

But lifting your leg with no weight? Lame. Really lame.

I haven’t picked a surgery date yet. I still need to discuss a few things with Turgeon. Berman recommended replacing the existing screws with a new, flat-head screw that won’t protrude as much. I also want to learn more about what Turgeon would do if the cartilage hasn’t filled in or hasn’t matured. And I have a few more questions about the incision near my hip, like which side of my hip? Same side as my knee?

Anyway, this wasn’t what I was expecting when I decided to roll the dice on ACI surgery a little less than 2 years ago. I can only keep my hopes up that the knee will continue to improve over time, particularly if the bone graft fixes my osteotomy issues.

The Osteotomy Blues

2010-04-02T13:46:00.000-07:00

That title sounds like something B.B. King might sing about after visiting the ER. Ah, if only that were true. Well, I now know the source of most of my knee issues during the rehab. Or I should say, the source has now been confirmed.

A CT scan revealed that the bone graft from the osteotomy is not attached to my tibia. In medical terms, there’s non-union of the graft and the bone. The only reason the graft hasn’t floated away is because the two Home Depot screws are holding it together. Of course, these are the same screws that really ache and that I desperately want removed from my leg. Not surprisingly, this poses a major dilemma, which I’ll address in a moment.

Anyway, this discovery/confirmation explains my struggles to bend at the correct focal point; that my knee generally feels fine, but mechanically it functions differently, something I struggled to explain to folks, including Dr. T and Dr. Berman. I almost feel like the osteotomy defect has cheated me out a “true” ACI rehab experience. Ok, not really.

At least I know what’s wrong. And like the ending to the old G.I. Joe cartoons, “knowing is half the battle.”

So what does this mean? What’s next? Right now, I’m not sure. Presumably, I’ve got 3 choices: (1) do nothing, which means leaving in those f*cking screws and having an unattached bone wedge; (2) undergo a bone graft to fill in the “area of non-union” between my tibia and the wedge; or (3) see if the screws and the entire bone graft can be removed. None of these options is very good. All of them have drawbacks.

First, doing nothing means learning to live with the uncomfortable screws and a really sensitive shin. Plus, I can’t imagine having an unattached bone wedge inside my leg is a good thing.

Next, a bone graft means another major surgery. And several more painful months of recovery. And another several months of putting my life on hold. Not to mention there’s no guarantee the bone graft will work.

As for the final option, I have no clue whether it’s possible to remove the unattached bone wedge (along with the screws). In my non-medical mind, if it’s not attached, why not “take it out?” That seems logical, right? Besides, I don’t need the osteotomy anymore. The ACI graft has sufficiently matured, eliminating the need to alleviate the pounding absorbed by the patella. True, the osteotomy would alleviate pressure long-term, thus minimizing the risk that I’d re-injure my injury-prone patella. But since I don’t expect to play competitive sports anymore, I think the odds of a future injury are minimal.

Sometime soon I’ll discuss these options with Dr. T. And then I’ll seek out another opinion to be safe. Stay tuned.

14 Months

2010-03-07T14:19:00.000-08:00

Dallas has had an unseasonably long and cold winter. It actually snowed for 2 days in mid-February. I forgot how much snow sucks. Holy f*ck. It’s cold. Sh*t gets wet. Idiots drive too fast on icy roads.

On the other hand, kids have a blast when it snows. They get to pelt each other with snowballs. Mine built a wicked snow-woman.

But grown-ups can’t enjoy snow like kids. At least I can’t. See, I immediately succumb to my childish whims. Snowball fights rock. Who doesn’t enjoy throwing sh*t at other people? Good times. I start out lobbing a few snowballs at the kids. I playfully duck a few of their weak throws. But things spiral downhill quickly. While I’m goofing around with my 4-year old, my 8-yr old crushes the side of my head from 3 feet away. Oh, it’s on. My competitive instincts immediately kick in, and I transform from mild-mannered Bruce Banner into the Incredible Hulk. I need to win these snowball battles, even if I’m competing against people too short to ride Space Mountain. And I’m not content just cracking people. Nope. I want to inflict bodily harm. Before you know it, I start packing a bunch of baseball-sized WMDs into my snowballs. Acorns. Rocks. Anything to weigh down those puppies. This leads to a predictable chain reaction. Eventually I cripple one of my kids, my wife gets pissed off, and then I get no nookie for a few days. Not good times. Like I said, snow sucks.

Anyway, we finally had a decent day. Spring-like, even. Probably hovered around 60 degrees. I went biking. This was a completely different experience than my last outing. I rode around White Rock Lake and back home, about 16-18 miles total.

The knee felt good the entire time; it felt fine afterward, too. I even managed to push off my bum knee a number of times to “stand up” during my bike ride. There really aren’t any hills big enough that require riders to stand up, but, again, the competitive juices kicked in and I wanted to be able to stand up, so I kept practicing every 5-10 minutes. The first few times I tried to stand up, I was unable to complete the loop. It was a bit embarrassing. I stood up, did a half revolution, my right leg weakened, and then I got stuck at the top, forcing me to sit back down. I was playing Jack-in-the-Box on a mountain bike. It reminded me of my first efforts trying to ride the recumbent bike after my surgery, when I struggled to complete a full revolution. But halfway through my ride around White Rock I managed to “stand up” for 10-20 seconds at a time. Interestingly, I didn’t have to sit back down because the leg hurt, but because I was completely winded standing up for that short period of time.

I enjoyed my outing, but I don’t understand uber-cyclists. You know exactly the kind of people I’m talking about. The weekend warriors that wear yellow jerseys and spandex, ride in packs, and bark out instructions like they’re in the middle of some Tour de France team time trial. And you know what? Spandex is not a good look for most of these chubby riders. But I did ease into their world a few times during my ride.

Several times, I had the choice of whether to pass someone or draft behind them. Tough call. When you pass someone, you get to bark out, “on your left,” like one of those biking douchebags. And yeah, I felt like a dork, but, also, strangely superior; like sitting in first class on an airplane and watching people trudge back to coach. I paused briefly during the pass to savor the moment. I needed to make eye contact. I wanted them to acknowledge their master.

But sometimes I chose not to pass people. Instead I hovered a few feet behind them, drafting like a NASCAR driver. Drafting is a lot like stalking, actually. You just follow somebody, making them feel uncomfortable by remaining in their shadow. But when I wasn’t feeling creepy, I pretended I was at some Olympic Velodrome practicing my drafting skills. Of course, there’s really not a lot of wind resistance to avoid at my embarrassing speeds. But it did provide a pretty sweet view of some of the hotties on the trail. And those were the riders I didn’t mind stalking….

My next checkup is in 3 weeks. Not much has changed over the past month or so. I continue to increase my workouts. My gimpy knee still goes into convulsions during 1-legged squats, shuttle presses, and heel touches. The inside of my quad remains hollow. I struggle to perfect good “bending form.” But the knee continues to get a bit stronger. Baby steps.

I’m most anxious to learn how the tibia is healing. I want the screws removed, but I’m not sure how the leg will respond once their gone. Dr. Berman recommended undergoing a bone graft. That’s something I consider an absolute last resort. I have no desire to suffer through another major surgery and recovery. However, I need to learn the potential risks of having a “weakened tibia.” Does that mean the leg might break during normal activities? Would it complicate my knee recovery? Stay tuned.

Where Are They Now, Knee Edition

2010-02-08T15:22:00.000-08:00

I've always loved the “Where are They Now?” articles. It’s like catching up with a long-lost friend from junior high on Facebook. You also discover the answers to really important questions, like Which Biggest Loser winner got chunky again? Does Joanie still love Chachi? And, hey, whatever happened to Cousin Oliver? I always assumed he wound working on really cheap Indie films, bragging to everybody on set about the time he saw Marsha naked. Or maybe he dabbled in some fetish amateur porn like the creepy director in 8MM. God help us if Sam the Butcher played Machine in one of Oliver’s snuff films. Anyway, that’s why I love these articles.

Obviously, the status of my knee doesn’t quite drum up the same level of interest as Cousin Oliver’s career. But that won’t stop me from sharing. It’s been 6 weeks since my last update, and over 13 months since my ACI surgery, so I think it’s time for a “How is the Knee Now?” blog entry.

Alright, let’s start with the big picture. I don’t have any functioning limitations. I get around just fine. I don’t have any daily pain. And unless you analyzed my walking form like the Zapruder Film, you probably couldn’t even tell that I had knee surgery.

But the knee’s not 100%. My ultimate fighting career remains on-hold. Interestingly, different things bother me now than before I went under the knife, which both worries me and gives me hope. Let me explain.

Before ACI, the knee occasionally ached below the knee cap and behind my knee, near the spot where the knee bends and your calf ends. Now? Those spots are pain-free, though I haven’t “tested” myself with athletic activities. Of course, my previous occasional twinges of pain happened during normal activities; I didn’t need to play sports to trigger the discomfort.

Instead, the medial – or inside – area where the knee bends kinda sometimes bothers me when I push off; going up stairs sometimes causes a slight tweak. Nothing major, but it’s enough to make me “think” before pushing off, which serves as a constant reminder that the knee still lacks strength and stability. Going down stairs is no problem. I previously thought I might’ve torn my meniscus, but Dr. T and Dr. Berman disagreed. However, something still doesn’t feel right.

What does this mean? Strangely, it could be good news, because the ACI areas feel fine. And it’s also possible that my knee might return close to normal if this un-related problem goes away. At least that’s my hope.

So what might be causing the slight irritation on this new spot? Possibly the lack of muscle strength.

Right now, my entire quad and the surrounding muscles are still pretty squishy. The teardrop shape that usually forms between the quad and kneecap? Let’s just say my quad isn’t crying. I mean, the knee no longer looks like it belongs to a starving African child. But it seriously needs to bulk up, like a scrawny high school athlete getting ready to play college ball.

This is especially true for the inside muscles that run from my knee to my quad. That part of my leg looks like a crescent moon. Plus, the area immediately above my kneecap resembles the chin of an elderly person. Thankfully I don’t have 14 different folds or wrinkles there, but there’s a bunch of saggy skin present.

I’m hoping that, as the muscles continue to develop and strengthen the overall knee, the twinges of pain around the inside of my knee disappear. That’s what I’ll focus on over the next couple of months; to see if the pain decreases as the muscle grows.

Ok, here are some more knee thoughts:

I still have crunching sounds in my knee. But it only sounds like popcorn when I squat or extend my knee quickly. No pain.

Whenever I almost “hyper-extend” my knee – basically straighten it out a tad bit beyond straight – the knee pops. It’s the exact same sound my knee makes when I first wake up in the morning, or when I stand up after sitting for a long period of time. Again, no pain.

My hamstring is pretty soft. I’ve started doing various dead lifts. Unfortunately, the major exercise to strengthen hamstrings – hamstring curls – seems to hurt my shin.

I struggle to isolate my right quad because, during 2-legged exercises, my left leg over-compensates. It just can’t help itself. My left leg has always been the dominant leg, even before the surgery. I continue to do 1-legged exercises, mainly the shuttle press and calf raises, along with a variety of step-ups. Lately, I’ve been doing step-downs and holding the bottom position (almost like a 1-legged wall sit) for 20-30 seconds. That seems to be helping. Of course, my leg trembles freakishly like it’s going into epileptic shock.

The knee feels better immediately after I exercise, i.e., when the muscle is tight/tense, which suggests to my un-trained medical mind that the lack of muscle strength is causing the twinges of pain near the medial meniscus. Again, that’s what I hope is causing the problem.

Sometimes when I walk my right leg is a bit “stiffer” than usual; my knee fails to bend the same amount as my good leg. Insert your own pirate peg leg or Heisman Trophy pose joke here. I wasn’t creative enough to come up with one.

I’m unable to “fire” my calf muscles, but that’s not from a lack of strength; more of a function issue. Calf raises just don’t feel normal. I think it’s because of the osteotomy; that raising onto my toes tugs on the shin bone, which irritates the bejesus out of the screws.

Let’s see, what else? The area surrounding the screws in my osteotomy remains sensitive. It doesn’t hurt if left alone, but god forbid I accidentally crack my shin against the couch or one of the 4-year old girls on my soccer team kick me instead of the ball.

The area on the lateral (outside) of my osteotomy bone wedge remains numb. Some of the nerve/nerve endings got severed or damaged during the surgery, which was expected. No real issues, though.

Because of the bone wedge, I still struggle to bend normally, like I can’t find my “bending focal point.” Hard to explain.

There have been other changes to my body. Before the surgery, I functioned just fine on 5-6 hours of sleep. I settled into a nice routine. I’d put the kids to bed around 8, spend an hour or so catching up on personal stuff, before plowing through the latest DVDs or stuff on DVR until 11-ish. Then I’d wake up sometime between 4.30-5.30am to exercise. And I felt great.

Now? I need at least 8-9 hours of sleep. No matter how hard I try, I cannot wake up early enough to exercise in the morning unless I hit the sack by 8pm. And since that’s never going to happen, morning workouts remain part of my dreams.

On the positive side, I continue to slowly regain what I call, “athletic mobility.” I finally can perform basic athletic movements, like dribbling a soccer ball or basketball. My difficulties now are with that third step explosion, the steps taken after performing the initial move. I can move easily enough to demonstrate the actual move, but can’t continue the move with any speed. For example, I can showcase a cross-over dribble to get past the initial defender, but lack the strength/speed to continue the drive all the way to the hoop. Call it the old man Iverson, only even slower.

I haven’t tried running, but I think I’ll be able to soon. As I continue to re-build my quad, I think I’ll be able conquer the slight hitch that rears its ugly head when my pace quickens beyond a leisurely stroll. I doubt I’ll ever challenge the Kenyans, but I would like to move faster than the elderly. Or at least be able to dodge traffic if a car decides to play Frogger while I’m crossing the street. But all of this is contingent on the twinges of pain disappearing as my quad grows stronger. Fingers crossed.

2010 -- New Year, New Way to Think

2010-01-01T19:22:00.000-08:00

Full disclosure: this post is not about my knee, but about something bigger: our ability to think for ourselves.

As you welcome in the New Year with a fresh batch of recycled resolutions, I’d like to share the profound words of David Foster Wallace. Back in 2005, he spoke to the graduating class of Kenyon College. His speech was titled, “This is Water,” and it conveys Wallace’s struggles to define thinking and master empathy. His theme is captured in this little gem: “Think about it: There is no experience you’ve had that you were not at the absolute center of it.”

Wallace’s speech, I hope, causes you to re-consider how you view the world, or at least the small part of the world you inhabit. I hope it causes you to think before you speak; to seek information and form your own opinion, rather than follow the herd. Just like the mid-range jump shot, these attributes are a lost art.

In today’s partisan climate, people increasingly surround themselves with like-minded folks, especially the ones who are supposed to be “leaders.” Republicans only watch Fox; Democrats only watch MSNBC. Right-wingers listen to Rush Limbaugh; liberals follow Huffington Post. Issues are no longer debated. They’re not even spotted.

These days, you have to subscribe to multiple news sources just to get a (somewhat) complete picture. The media only reports stories with angles that reflect the viewpoints closest to their readers or reporters, failing to examine stories from all sides. It’s all about the angles. The source of your news says as much about you as your actual views. In fact, think about what your opinions would look like if you only listened to Bill O’Reilly or Keith Olbermann? While I realize they aren’t traditional newscasters, in today’s world most news is delivered this way. If your reaction to the mention of either of these guys is something like, “Man, that dude is so biased. Only a (liberal or conservative) would believe his cr*p.” Well, imagine how somebody with the polar opposite viewpoint reacted to that statement. Yup. They feel the exact same way about what you watch and read.

Here’s a challenge. Try watching one of those programs exclusively for 2 days, then switching to the other one. Just grit your teeth. Maybe half of the stories will be the same – the current health care vote, a bombing in the Middle East, etc. – except they’ll be covered from diametrically opposite angles. The other half of the program will address stories the other show doesn’t even mention. And yet people who watch just one of those shows are expected to get a complete picture of the issues? They’re supposed to debate things intelligently, let alone civilly? Um, yeah. Didn’t think so.

This dichotomy has trickled down to the local level, as our communities have become echo chambers, little cocoons of isolated thoughts and viewpoints. Neighborhood “for sale” signs should also include notices like, “Democrats only” or “Liberals need not apply.” Society has reached the point where “diversity” needs to be expanded beyond skin color or religion. Things don’t appear to be changing anytime soon. Remember last November when we were supposed to have moved beyond red states and blue states? Well, it looks like Obama’s ascendancy was a mirage, a temporary flash of hope. I can’t say I’m surprised, though I admit I had hoped things would change. But the venom spewed over the past decade wasn’t really about Bush, despite what was written for the past 8 years. George W. just happened to be an easy target, a caricature of ineptitude. The problem was how the rest of us debated stuff.

Fox holes used to be the last line of defense for the brave. Now? They’re refuges where folks willingly hunker down with sycophants. Who loses when people put on blinders and cannot have their views challenged? Everybody.

Which brings me to Wallace’s graduation speech. It’s not too late for society to become a bit more open-minded, a bit less hostile, and I think his words will help. For 2010, don’t just promise to lose weight or spend more time with your family, admirable goals. For the next 12 months, vow to step outside the box. To listen, before deciding. To contemplate, before reacting. To gather information, before offering a knee-jerk opinion. To try to see things from another perspective. You’ll be pleasantly surprised.

Happy New Year (and now I’ll step off my moral and philosophical soap box and return to knee updates.)

(Below are excerpts from Wallace’s speech; the full text can be found here. I highly recommend reading it) http://online.wsj.com/article/SB122178211966454607.html)

***

Thinking this way tends to be so easy and automatic it doesn't have to be a choice. Thinking this way is my natural default-setting. It's the automatic, unconscious way that I experience the boring, frustrating, crowded parts of adult life when I'm operating on the automatic, unconscious belief that I am the center of the world and that my immediate needs and feelings are what should determine the world's priorities. The thing is that there are obviously different ways to think about these kinds of situations. In this traffic, all these vehicles stuck and idling in my way: It's not impossible that some of these people in SUV's have been in horrible auto accidents in the past and now find driving so traumatic that their therapist has all but ordered them to get a huge, heavy SUV so they can feel safe enough to drive; or that the Hummer that just cut me off is maybe being driven by a father whose little child is hurt or sick in the seat next to him, and he's trying to rush to the hospital, and he's in a way bigger, more legitimate hurry than I am -- it is actually I who am in his way. Or I can choose to force myself to consider the likelihood that everyone else in the supermarket's checkout line is just as bored and frustrated as I am, and that some of these people probably have much harder, more tedious or painful lives than I do, overall.

Again, please don't think that I'm giving you moral advice, or that I'm saying you're "supposed to" think this way, or that anyone expects you to just automatically do it, because it's hard, it takes will and mental effort, and if you're like me, some days you won't be able to do it, or you just flat-out won't want to. But most days, if you're aware enough to give yourself a choice, you can choose to look differently at this fat, dead-eyed, over-made-lady who just screamed at her little child in the checkout line -- maybe she's not usually like this; maybe she's been up three straight nights holding the hand of her husband who's dying of bone cancer, or maybe this very lady is the low-wage clerk at the Motor Vehicles Dept. who just yesterday helped your spouse resolve a nightmarish red-tape problem through some small act of bureaucratic kindness. Of course, none of this is likely, but it's also not impossible -- it just depends on what you want to consider. If you're automatically sure that you know what reality is and who and what is really important -- if you want to operate on your default-setting -- then you, like me, will not consider possibilities that aren't pointless and annoying. But if you've really learned how to think, how to pay attention, then you will know you have other options. It will actually be within your power to experience a crowded, loud, slow, consumer-hell-type situation as not only meaningful but sacred, on fire with the same force that lit the stars -- compassion, love, the sub-surface unity of all things. Not that that mystical stuff's necessarily true: The only thing that's capital-T True is that you get to decide how you're going to try to see it. You get to consciously decide what has meaning and what doesn't. You get to decide what to worship...

***

And I submit that this is what the real, no-bull- value of your liberal-arts education is supposed to be about: How to keep from going through your comfortable, prosperous, respectable adult life dead, unconscious, a slave to your head and to your natural default-setting of being uniquely, completely, imperially alone, day in and day out.

***

And the world will not discourage you from operating on your default-settings, because the world of men and money and power hums along quite nicely on the fuel of fear and contempt and frustration and craving and the worship of self. Our own present culture has harnessed these forces in ways that have yielded extraordinary wealth and comfort and personal freedom. The freedom to be lords of our own tiny skull-sized kingdoms, alone at the center of all creation. This kind of freedom has much to recommend it. But of course there are all different kinds of freedom, and the kind that is most precious you will not hear much talked about in the great outside world of winning and achieving and displaying. The really important kind of freedom involves attention, and awareness, and discipline, and effort, and being able truly to care about other people and to sacrifice for them, over and over, in myriad petty little unsexy ways, every day. That is real freedom. The alternative is unconsciousness, the default-setting, the "rat race" -- the constant gnawing sense of having had and lost some infinite thing.

Two OS Visits

2009-12-23T18:27:00.000-08:00

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.

11-Month Update -- Setback

2009-12-08T20:40:00.000-08:00

I suffered my first real setback about 2-3 weeks ago. It might be a reoccurrence of an earlier problem. There’s a sharp twinge of pain on the inside part of my knee, right where the knee forms a “V” when it bends. I think this is what doctors call, “the joint line.” The pain appears to be below the patella, suggesting it’s unrelated to the ACI surgery (at least that’s what I hope). My symptoms are consistent with a medial meniscus tear. (I earned my M.D. at Google University). The 6-month MRI suggested I tore the posterior horn of my medial meniscus, which, I learned, is the most common place to tear cartilage. Turgeon thought the actual MRI pictures were inconclusive, and the 2nd MRI report didn’t note the meniscus tear. Then again, the MRI guys also thought they were looking for a torn ACL…

The pain prevented me from doing my knee exercises for a few weeks; the rehab kept aggravating the pain. That’s troubling. But what’s worse is that the pain started flaring up during normal activities. This is the first time I’ve ever experienced daily knee pain, and I’m seriously concerned. I never had constant pain before my surgery, and I’m worried that the surgery made my knee worse. The doubts about my decision to undergo ACI – the ones I tried to bury months ago – have re-emerged. I now think about my knee pretty much every time I walk or climb stairs. Over the past 2-3 days, the pain has disappeared, and I recently did some shuttle leg press with minimal bend and weight with no ill after-effects. Hopefully the pain is unrelated to the ACI repairs, hopefully the pain doesn’t suggest anything serious, but if it’s a meniscus tear, hopefully it can be fixed rather easily, or as easy as arthroscopic surgery can be. That’s a lot of hoping…

My next doctor’s appointment is this week. Hopefully (there’s that word again) I’ll get some insight into the cause of my knee pain, as well as a possible solution. I already scheduled an appointment with another ACI doctor for the following week. I want a second set of eyes to examine my knee, not just about the possible meniscus tear, but also to evaluate my progress from the ACI surgery.

The possible meniscus tear poses a new dilemma. I had wanted the OS to check out the status of my cloned cartilage and “clean up” any overgrowth at the same time he removed my screws, and I had planned on waiting until next year to have the screws removed. However, if I tore my meniscus I’ll probably need to get scoped fairly soon, which means I have to decide now whether to get the screws removed, too. Frankly, I don’t think I have a choice. I don’t want to undergo two separate surgeries and two separate recovery periods. I want to handle my rehabs at the same time, if possible, even if it’s earlier than I had planned. This will jack with stuff I had planned to do in 2010.

Anyway, I should have some interesting details to share next week after my two doctor’s visits.

Ok, because this latest posting is a bit morose, I decided to share my adventures dressing up as Santa 5 years ago. This story was re-worked from the original email I sent to some buddies. Enjoy.

I made 4 Santa visits. The first 3 stops were to little kids: 1 ½ - 3 years old. Those were fun trips, even the visit to the kid who was scared sh*tless of Santa. I read a few Xmas stories, gave them some gifts, and told corny North Pole jokes. Good times.

The last stop was a different story: a 7 yr-old boy and his 10-yr old sister. When I saw their ages on my checklist, I assumed the older sister no longer believed in Santa, but was just playing along so she didn’t ruin it for her brother. As it was, I was skeptical that the 7-yr old (first grader) still believed in Santa. Well, those were 15 of Santa’s most uncomfortable minutes.

I first made a couple of “I’m checking my naughty/nice list” jokes and then gave the kids the gifts their parents stashed outside. After they opened them, dead silence. Crickets chirping. I had no idea what to do. At one point, I almost asked their parents, “How ‘bout throwing Santa a bone here….” The kids didn’t seem real interested in listening to Xmas stories, and I’m not sure what the rules say about letting a 10-yr old girl sit on my lap. So I started asking them some dorky questions about school and what they like to do, the kind of questions aunts and uncles ask during family reunions. It turns out the boy is artsy. He bragged about the pot he made in art class and the poems he’s writing in English class. I almost asked if he painted the pot fuchsia. I immediately checked Santa’s rules for helping little kids come out of the closet. Not that there’s anything wrong with that.

Dealing with the daughter was equally nerve-racking. Very nice girl, but she was exceptionally quiet. I struggled to use her Hillary Duff CD gift as a conversation bridge. I even heard myself say, “Santa likes Hillary Duff, too. She’s a fine entertainer.” I was using Kramer’s “Mr. Movie Phone” voice, the episode in which he finally told the caller, “why don’t you just me the name of the movie…” Painful moments.

After a few pictures with Santa by the Xmas tree, I asked the kids if there’s anything else they wanted to ask Santa. The boy said, “You’re not the real Santa, are you? You’re just one of his helpers dressed up like Santa.” Totally out of the blue. Dad was videotaping the whole episode. I’m sure in a few years when they show that tape at their family reunion, some drunk cousin is gonna bust out, “Check out the look on Santa’s face!!” I was completely frozen. I desperately looked at the mom for some help, the second time that night I wanted the parents to throw Santa a bone. Thankfully, the mom said, “Santa, Brandon knows there are many Santa helpers.” So I picked up that train of thought and told the kids, “Yes. Santa’s really busy at the North Pole right now. There’s just no way he can check on ALL the kids in the world, so he asks helpers like me to visit certain kids to see if they’ve been naughty or nice. And after my visit here, I can safely report back that Brandon and Megan are nice kids, deserving of really neat gifts.” I think that answer helped avert disaster. If the kids didn’t buy it, I was ready to pull of my fake beard and say, “Look, kids. I’m just a gov’t worker, trying to make the world a better place.”

iPhone rant

2009-11-25T12:21:00.000-08:00

While I continue to play Monday Morning Knee Quarterback, I wanted to share a recent observation.

As I was leaving a Dallas Mavs game with my 7-year old son, I noticed a group of twenty-something guys and girls hanging around the main lobby area. The guys wore slacks and fitted, striped button-down shirts (I’m also pretty sure they leased BMWs, lived in 600-square foot apartments and racked up $30,000 in credit card debt, like most Dallas Chachis). The girls wore pant suits, so I don’t think they were hookers. Anyway, they looked like they were trying to figure out where to go next. Yet this group wasn’t laughing out loud or goofing around, the kind of behavior you’d expect from people this age. In fact, they didn’t seem to be having fun at all, or even socializing with each other. Something didn’t look right.

And then it hit me – all of them were texting. These people were more into their phones than their friends. At the risk of sounding like an old foagy – oh, these young whipper-snappers and their portable internets – what’s the point of going out with your friends if you’re not going to pay any attention to them? That makes no sense.

Like rats following the Pied Piper, one member of the group eventually signaled that it was time to leave, and everybody filed out of the arena. Of course, three-fourths of them continued pecking away on their phones, which made walking difficult. Actually, they looked like they were waddling. People probably thought they had dumped in their trousers. But seriously, I’m not sure what shocked me more: that people would ignore their friends like this, or that friends would tolerate this behavior? To paraphrase the immortal George Costanza, would it be so wrong of me to smack the iPhone out their hand? I say no.

Anyway, this scene reminded me of similar ones 10-15 years ago when cell phones first appeared. Back then, people spent the entire night talking on their cell phones, not to the friends they were out with. With the ubiquity of smart phones, I fear society is about to repeat this annoying behavior. Those who don’t learn from history are doomed to repeat it. I don’t think people had cell phones and texting in mind when they uttered this phrase, but it fits. So let’s take a little stroll back in time.

(Wait a second. Before I examine this troubling trend -- ubiquity. Impressed? Ever since I saw “ubiquitous” on my Word-A-Day Calendar three years ago, I have to use that word at least 3x/week. Even if I can’t pronounce it correctly. Ubiquitous).

Back in the ‘80s, cell phones were larger than Kim Kardashian’s ass. Seriously, have you seen non-airbrushed pictures of her rear end? It’s got more craters than the Moon’s Sea of Tranquility. (Thank you, thank you. I’ll be here all week.) Back then, cell phones were more flash than substance, just like Kardashian’s butt.

(Hold on a second. After I typed this blog post, I stumbled across a bunch of recent photos of Kardashian, including her Halloween “Princess Jasmine” costume. She looks lean and fantastic. The pictures didn’t show her booty, however. And with photo-shopping you can never tell how legit the pictures are. But I reserve the right to re-examine my previous comments about her rear…)

Gordon Gekko sat aboard his yacht and whispered into his cell phone, “Blue Horeshoe loves Andicott Steel.” (Maybe the scene didn’t play out EXACTLY like that, but this description works better for my blog post, and I’m not above bending the facts to fit my needs). Yuppies immediately sprinted from the movie theatre to buy their own phone, hoping to capture Gekko’s aura. Pretty soon, upscale clubs were full of douchebags walking around with suitcase-sized devices to their ears, pretending to be brokers. They really weren’t buying and selling stocks, of course. They just wanted people to think they were important. Their only accomplishment, however, was ignoring their companions. And looking like douchebags. Eventually the phones shrank in size (I don’t hold much hope for Kardashian’s butt) and cost, allowing the masses to buy cell phones, too. Poor manners were no longer limited to the sweater-vest and wine bar crowd.

Now, God forbid I morph into the Miss Manners of social etiquette, but proper usage of cell phones required a steep learning curve, made worse once people with IQs under 75 could afford them. At first, people talked non-stop on their cell phones, no matter where they were or whom they were with. Kids’ school functions. Restaurants. Sporting events. Who can forget the TV shots of people chirping away on the phone, oblivious to the game? But probably the worst experience, in my opinion, was grabbing a hung-over brunch at IHOP or Denny’s, and being forced to suffer through the cell phone conversation of a very loud redneck who just had to call Cooter and brag about the 5-point buck he just bagged, or the hot chick he just nailed who turned out to be his second-cousin. In my best Nancy Kerrigan voice, WHHHYYYY can’t I just eat my pancakes in quiet?

Folks didn’t care who they ignored or who they offended. Basically, they talked on their cell phones because they could and because they thought it made them look important. They were dead wrong; they just didn’t realize it. By using cell phones incessantly, the less affluent played catch-up with the douchebag-yuppies they openly mocked but secretly envied.

Let me share my cell phone epiphany. Back in the late 1990s I went to Happy Hour at a Tex-Mex place with a group of acquaintances. What can be happier than a Corona and chips/salsa? Nothing, I say. Well, I remember talking about sports and chicks – that’s pretty much the only thing guys talk about – and casually asked the guy a few seats down to pass the chips. I immediately resumed debating the virtues of Latinas vs. Asian women, truly the LeBron vs. Kobe debate of women. 5, 10 seconds elapsed before I realized the guy hadn’t passed the chips. I looked up and the bastard’s chatting away on his cell phone. I made eye-contact and gave him the look that says, “Hey buddy. Pass the chips already.” You know the look.

He appeared a bit dumfounded at my annoyance, and then he gave me a condescending look that says, “Um, can’t you see I’m a super-important guy on my cell phone?” You know that look, too. Then he spun around in his chair and turned his back to me. Apparently, a call in the middle of Happy Hour was so important that he couldn’t use his free hand to slide the chips down 3 feet.

15-20 minutes later – by this point I had calmed down enough such that I no longer wanted to dump the pico de gallo on him – I casually asked him who he was talking to (he didn’t realize that I was ticked off at him). He said, “Oh, a buddy got stuck working late and he was complaining about how he had to stick around until his boss left.” Somehow, speaking on a cell phone transformed this call into something so important that he couldn’t pass the f*cking chips and salsa. Bastard.

The common thread here? People ignored their companions. The phones gave them an inflated sense of self-importance. Their conversations – or, just the ability to hold a conversation – took precedence over the people standing next to them.

Grown-ups respond to new toys just like kids – they play with them non-stop until the novelty factor wears off. Just like Pac-man got old after the 12,063 time, cell phones did, too, and people eventually integrated them in a socially acceptable way. Everybody was much happier, especially the Verizon technicians who kept switching off cell phone towers because they thought it was funny to randomly drop calls. F*ckers.

Unfortunately, the smart phone crowd discarded the lessons learned during cell phone misuse. Maybe the current generation using smart phones never had to learn cell phone etiquette. Maybe people today just don’t care. Or maybe, just maybe, in the Facebook and Twitter era people like their friends a little bit less. Seriously, how many times have you looked across the table and saw a companion texting away instead of actually, you know, listening to what you were saying? If you’d rather text somebody else than talk with your companion, why go out with them in the first place? If your companion is so boring that you’d rather text somebody, just say so. You probably don't care about hurting his feelings.

(Exaggerated Al Gore sigh). Look, there are plenty of good reasons to text somebody or surf the web while out with others. I understand. Just don’t be one of those obnoxious pr*cks who texts while somebody else is talking to you.

And now I’ll step down from my soap box.

Two final thoughts: I’ve never read the Twilight books and don’t plan on seeing the movies. But the pasty Vampire guy? The James Dean lookalike? Robert Pattinson (I just looked up his name). He reminds me of those 90210 actors, guys who are 40 but play high schoolers. Except that without the sideburns and schlocky-ness, he seems creepy. If Pattinson ever appeared on 90210, he definitely would've date-raped Kelly. By the way, I loved watching 90210 and Melrose in college. I’d hit the bars immediately afterward with a happy face. Those shows always seemed to put me in a good mood. It's hard to top quarter beer nights after those shows.

And finally, Happy Thanksgiving. Remember, the mash potatoes make-or-break the meal…

10-Month Update

2009-11-07T07:45:00.000-08:00

Man, I never thought January and February would end. Shower seats. Toilet seat risers. 23 hours in bed. Sleepless nights. And now it’s November. You know what? I actually miss my toilet seat riser. Crapping that high is kind of empowering. Like driving an SUV. Alright, let’s check out how the knee’s doing today.

Walking around? No problem.

Stairs? Not completely normal, but no real issues. Sometimes I catch myself concentrating on my form, especially that first step.

Bending and squatting? Done cautiously, but capable. 1-legged squats are difficult once the knee bends beyond 60 degrees. At that point, the leg starts to quiver like a guy in the electric chair. The knee feels like it’s struggling to hold it together, like the First Wives Club at a Mathew McConaughey flick.

Surfing? Nope. Crossing my fingers I’ll be able to surf in Maui in May.

Lumberjacking? Not yet, but my chainsaw and flannel shirts are ready.

Kneeling and crawling? Difficult, but possible. It’s uncomfortable, not so much on the actual knee, but on the bone wedge when it brushes against the ground.

Running or jogging? No.

Pain? Not really, though I experience occasional twinges of discomfort on the inside part of my knee. The outside of my knee sometimes feels compressed, like an oversized object trying to squeeze through a smaller hole. (I’ve got several X-rated jokes ready to go, but decided to hold off). Also, the screws in my shin and the bone wedge from the osteotomy are sensitive.

10 months out, I still don’t know whether the surgery was “worth it.” It’s too early to tell. Keep in mind that my knee wasn’t in shambles at the time of the surgery, so I never experienced the debilitating moments some ACI patients suffered through. I decided to go under the knife before my knee rotted away. I’ll probably evaluate this decision every few months for the rest of my life. For my sanity, let’s hope I eventually reach the stage where I conclude the past 10 months – or however many months pass – was worth it.

MRI, Part II and a Little Road Rage

2009-10-29T09:48:00.000-07:00

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.

Celebrity Knee Surgery

2009-10-19T19:46:00.000-07:00

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...)

Sound Familiar? Slow and Steady . . .

2009-09-23T20:22:00.000-07:00

Not a lot has changed. I continue to slowly increase the amount of weight and reps on my leg presses, hamstring curls and step-ups. But I’m not sure if either really impacts the pace of my recovery. I mean, it does, obviously, because my quad needs to get stronger. But I don’t feel like these exercises will “fix” my knee. The knee just doesn’t feel normal, no matter how much weight I lift or how much stronger the leg gets. Don’t get me wrong -- the knee functions fine. I walk without issues, and go up and down stairs just fine. I just can’t “explode” off it, and can’t even imagine running at this point. For example, whenever I bend past a certain point, the knee starts to quiver, like a car engine struggling to start on a winter morning. Instead of gliding smoothly like a hinge should, the knee feels bulky, like a tennis ball rests between the patella and bone wedge. Maybe there’s a bunch of scar tissue there; maybe I still need to adjust to the osteotomy. Indeed, my shin gets irritated as much as, if not more than, my knee after a hard workout. But the knee doesn't feel right. Sometimes my knee issues remind me of those old school cartoons when somebody shuts down some massive industrial machine by shoving a rod into a spinning wheel. Hopefully, time will heal whatever is preventing my knee from becoming “normal.”

As for non-knee news, I’m a huge fan of the UFC (that’s ultimate fighting; you know, the sport where guys beat the crap out of each other inside a cage). I used to watch the first UFC shows on VCR tapes passed amongst friends back in college. And then I took a break from the sport, before getting hooked again when the reality show – The Ultimate Fighter – premiered back in 2005. The show rekindled my love of violence, and this time my wife got sucked in, too. And by sucked in, I mean, “all in.” I don’t do anything half-assed. Not only did I watch the TV show and the monthly UFC PPVs, but my wife and I plowed through all the old UFC shows we missed over the past decade. And once we finished watching those, we rented all of the fights from Pride, the UFC’s then-major competitor, based in Japan. All told, we must’ve watched 50 DVDs of fight cards. Good times.

The only thing missing was the chance to watch a card live. Usually, the fights are held in Vegas. Over the past few years, however, the UFC expanded and began holding shows across the country. On Saturday, Sept. 19, the UFC visited Dallas. We were there.

Several observations. First, the ratio of guys to girls was at least 300:1. And of the girls there, I think 70% of them were hookers, or were at least open to being rented for the night. Next, the ratio of graphic t-shirts to normal clothes was 743:1. I counted. The ethnicity of the show was striking. White males dominated, with a sprinkling of Hispanics. Also, there were probably more chicks there than African-Americans. But shockingly there was only 1 fight in the crowd. Unfortunately I couldn’t see it because the Jumbotron blocked my view.

The event was loud. I mean, really loud. Almost as loud as the Guns ‘N Roses-Metallica concert I went to back in 1993. The highlight, besides the fights, was the opening video montage before the PPV aired. The AAC darkened, and Baba O’Reilly by The Who started blaring. Then the scoreboard started showing knockout after knockout, along with flashing lights and smoke. I definitely wanted to kick somebody’s ass after it was over.

The fights were fairly entertaining. The last 7 fights – the 2 shown on Spike TV before the PPV and the 5 on the Main Card – all ended in KO or submissions, 5 in the first round. But it was the very first fight of the night that was most memorable. Two relative unknowns fought before most of the crowd had arrived. The stadium was probably 50% full, at best. Because it was so quiet, every leg kick – basically, a fighter uses his shin to kick a particular nerve near the other guy’s knee – echoed throughout the stadium. Holy f*ck. Those kicks pained me. To answer Maximus's question to the crowd in Gladiator, "Yes, I was entertained."

Hopefully the UFC returns to Dallas in the future. The event apparently did well financially. 17,000+ attended, and the event generated the 2nd most revenue ever at the AAC, behind only a Rolling Stones concert several years ago. Beer sales must've been through the roof, and the lines to buy t-shirts were 10-people deep throughout the night. And maybe by the time the UFC returns, my son will be old to come with us. He's a budding cage-fighter. In fact, I keep waiting for his school principal to inform me that he choked out some kid at recess. And honestly, when I get that call, part of me will be proud (assuming he choked out a bigger kid who was bullying people, of course).

Random Knee Thoughts, 8-Month Edition

2009-09-06T14:20:00.000-07:00

My kids are back at school, which is nice. I’m a huge fan of routines and schedules. Other than that, not a heckuva lot has changed over the past few weeks. Well, I am coaching my almost 4-year old daughter’s soccer team, the Rainbow Warriors. Within 3 minutes at practice, one of the girls either (a) has to go potty; (b) complains that’s she’s hot/tired; or (c) wants to know when she can play on the nearby playground. Coaching 3- and 4-year old girls is like herding cats. Rewarding, but sometimes it can be a major beating, too. Go Green Death. http://www.patriotledger.com/sports/x575725578/-Green-Death-coach-resigns

Back to my knee. Using the marathon analogy, I guess I’m at the 16-mile mark. I’ve made significant progress, but then I realize, “holy sh*t! I’ve still got 10 more miles to go. Not to mention that a pack of Kenyans just lapped me.” All kidding aside, the knee feels like it’s inching closer to normal. Baby steps, people. Baby steps.

Over the past few weeks, I’ve stepped up the intensity of my knee exercises. At this point in the rehab, it’s more of the same. Basically, I just increase the number of reps, weight and difficulty. For example, I now do 25 step-ups on a 2-foot high stool with 25 pound weights in each hand, a far cry from doings heel touches on top of a phonebook back when I started my rehab. The gimpy knee remains much weaker than my good one; my quad remains squishy. And pasty. No matter how hard I try to isolate my bad knee, the good knee instinctively compensates. On the step-ups, for instance, the help usually arrives in the form of a small “push” off the floor by the good leg before elevating atop the platform. Luckily, it’s almost impossible to cheat on certain leg exercises, such as the leg press and the nautilus, 1-legged squat machines.

The knee still makes little clicking and crunching noises when I walk. It pretty much has been since the surgery. But it doesn’t bother me. The back of my knee also “pops” frequently, especially whenever I wake up first thing in the morning, or after my leg extends from a hyper-extended position. Again, no pain, but these can’t be good things. The crepitus usually signals overgrowth of the cloned cartilage. While not ruling out overgrowth, my OS noted that the new porcelain sealants usually prevent overgrowth. We’ll see.

The area of my knee that may or may not have a torn meniscus kinda aches, but still hasn’t limited my activities or rehab. I’m hoping MRI, Part 2 will reveal the extent of the damage. In a perfect (surgical) world, my OS could fix the meniscus tear at the same time he removes my screws. I’m not sure whether that’s possible, or even advisable. Or even whether, if the meniscus is torn, that I should wait until Spring 2010 to get it fixed, which is presumably when the screws will be removed.

That’s about it. Pretty boring update, I know. But that’s what you get at 8 months. Meat and potatoes.

An Impromptu 32-Week Visit and Firsthand Exposure to the Health Care Reform Debate

2009-08-21T11:53:00.000-07:00

Last month I had an MRI of my gimpy knee. As I blogged about earlier, the MRI technician/specialist/whatever-his-title-is, thought he was checking for a torn ACL, not an ACI repair. Hey, mistakes happen, right? Well, he still wrote up a report. When I met with my surgeon last month, however, the report was not available. Instead, my surgeon told me he asked the MRI guy to re-do the report, which, I thought, meant focusing strictly on the ACI repair. Bad assumption, it turns out; more on that in a moment. Meanwhile, we reviewed the actual MRI pictures together, and Dr. T shared the good news that everything looked great. I still wanted the report, though. Dr. T said he would send me the revised report when it was available. He knows that, as a lawyer, I like written reports.

A few days after my appointment, I had yet to receive the “revised” MRI report. It turns out the guy never re-did his report. Instead, he simply noted on a separate cover sheet his mistaken assumption about my ACL. That’s it. Considering how much MRIs cost, that MRI probably wasn’t a good use of health care dollars. Consistent with today’s debate over health care reform, they’re not “my dollars” so, frankly, I’m not too concerned. Sad, but true.

Anyway, I still wanted a copy of the report. Even though it focused on my ACL, it nonetheless examined other parts of my knee, so that information would be helpful and I was anxious to review it. I finally received it about one week after my appointment.

Incredibly, the report failed to mention the ACI-repaired lesions on my patella and trochlear groove. At first, I thought this was yet another example of the technician’s incompetence. I don’t think it’s a stretch to say that the guy who mistakenly checked for a torn ACL would also miss a cloned graft, right?

Apparently not. When I finally reviewed the report with my surgeon, Dr. T told me he actually spoke with the MRI guy, who told him he was surprised to learn I had undergone a cartilage implant. When he examined the MRI, he simply didn’t notice any difference in the consistency between the “old” cartilage and the “cloned” cartilage. Now, I’m hesitant to do the Tiger Woods double fist pump because of the guy’s earlier screw-up. But it’s hard not to be pretty stoked.

(Speaking of Tiger, why didn’t the CBS golf announcers state the obvious at the PGA Championship: Tiger choked on those last few holes. Period. Even Michael Jordan missed potentially game-winning shots. It happens. Yeah, it sucks when your off day just happens to be during the final round of a major in a year in which you hadn’t won one. But there’s no shame in that. Hey, even the best f*ck up. Ok, back to my knee)

The MRI report, however, did identify some areas of concern, which I discussed with Turgeon. Incredibly, it said I had a torn meniscus on the medial side of my posterior horn.

What the f*ck?!?!

For the past 7 months, I haven’t been preparing for my UFC debut or even playing pickup hoops. Nope. I’ve spent my time on the couch or hobbling around an office with a bunch of government drones. My craziest activity has been riding a stationary bike – not exactly the kind of situation that leads to torn meniscuses, you know.

Before I share my conversation with Dr. T about the MRI report, let me explain a few things about a meniscus tear before friends and family freak out. First, this “tear” has nothing to do with the areas of my knee repaired by ACI. Totally unrelated (well, except for the fact that multiple knee surgeries surely have made my knee more prone to injury). Next, in the world of knee surgeries, a meniscus tear is pretty minor. Usually, a simple scope cures it. I’ve actually felt a slight twinge of pain in this particular spot for a few months. Nothing serious, though. The discomfort rarely lasts more than a brief moment, and doesn’t impact my daily functioning. I mean, I don’t want to downplay a meniscus tear. But I’m not overly concerned, other than how I could’ve possibly torn it during my recovery. I’m still shocked.

Despite what the report says, Dr. T isn’t convinced my meniscus is torn. During our initial review of the MRI pictures, I recall he noted some splotches on the MRI of some minor concern. I’m not sure he was pointing to the meniscus. But during our follow-up, he showed me the affected area. There was some “grayness” there, which apparently might be indicative of a possible tear. However, it wasn’t large or deep enough, in Dr. T’s mind, to say definitively, “Yes, it’s torn.” He said the only way to tell would be if he scoped my knee.

Of course, my response was a subtle, “No f*cking way.”

I only want him – or anybody – cutting me open if surgery is absolutely necessary. And it’s not necessary to “scope me” just to see if it’s torn.

So, as of now, I’ll just continue rehabbing as usual. Actually, Dr. T wants me to step things up to improve my quad strength. He reiterated that everything looks fantastic with my knee; he’s ecstatic how things turned out. Now it’s time to put Lou Ferrigno to shame with my workouts.

We also took another X-ray of the osteotomy, something we do at every visit. My screws and the bone wedge continue to irritate me. The screws bulge from my shin like the belly on a 9-month pregnant lady. You can read the Black-and-Decker label through my skin.

Things have gotten better, but I still feel like the osteotomy is holding me back, even more than the actual surgery. After reviewing the X-ray, Dr. T isn’t surprised. While the bone has filled in just, he says it’s continuing to harden, and thus the bone remains sensitive. Normally, the hardware can be removed at the 12-month mark, but in my case he suggests waiting several additional months to give the tibia extra time to heal.

Next up is another MRI in October, at the 10-month mark. Dr. T mentioned this time they’ll do a bunch of other stuff to specifically focus on the cartilage. My first thought? Uh, why didn’t they do this type of review the last time? Is there a particular reason to do another MRI only 3 months later? Again, because I’m not paying (I don’t have a co-pay for MRIs), I’m not complaining. The extra information can only benefit me. But this just seems symbolic of the current debate over health care waste. Maybe the additional test is just covering for the previous screw-up. I’m not sure. But part of me – that speck of a conscience buried far deep inside and which rarely surfaces – feels a bit uncomfortable being a party to possible wasteful spending.

And then I remember how often insurance companies screw over patients, and those concerns begin to fade away.

Passing the Beach Test

2009-08-18T14:26:00.000-07:00

I almost posted a mega blog entry, but decided to split it up into two postings. The original posting was dangerously approaching the length when reasonable people would say, “ok, no human should write that much about their knee.” Hopefully the 2nd posting will be ready within one week’s time. It will cover my 32-week appointment and review of the report from the MRI previously discussed. I know you’re anxiously awaiting it.

Alright, the Summer of Travels (and delayed blog entries) is officially over. Multiple trips to DC. A long journey to Stockholm. But neither trip compared to, or could prepare me for, my first family Griswold Adventure: we drove from Dallas to Pensacola, Florida. 2 kids. 2 portable DVD players. A box full of granola bars and Pepperidge Farm Goldfish. At least 17 “Are we there yets?” A packed SUV. 660 miles. 13 hours. Ah, the closeness and joys of family.

I was admittedly a bit nervous about how my knee would handle the beach, namely the unevenness of walking in the sand. In addition, I was concerned with my ability to remain steady when waves crashed into me, whether it was carrying my 4-year old daughter a few feet from the shoreline or wading into the deeper waters with my 7-year old son. The knee held up well. No issues whatsoever. Jim’s Knee 1 – Gulf of Mexico 0. Now, I’m not about to join the pro beach volleyball tour anytime soon; Karch Kiraly’s AVP record is safe. But only a few weeks ago, I wondered whether I would ever regain some semblance of athletics. Yet, at least for this trip, my knee actually felt “normal.” Maybe, just maybe, it even felt a little spry.

While the instability of my knee never strays far from my thoughts – I probably think about my knee probably every 10 seconds – after my first day I stopped worrying whether my gimpiness would prevent me from enjoying my vacation. That was a refreshing feeling. I can just picture my fellow ACI patients nodding approvingly. In fact, right now my immediate goal is that my knee reaches a certain level of comfort so I no longer think about it constantly. Pretty high bar, huh?

The lengthy drive didn’t crush my knee, either. I drove the entire way home, all 13 hours. Now, with kids, this wasn’t 13 hours straight. In fact, we probably stopped 3-4 times in the first 5 hours alone. You really can’t tell little kids to “hold it” or pee in an empty water bottle, especially a 4-year old girl. It’s just not happening.

My parents, on the other hand, were old school. The car never stopped, unless it needed gas. Maybe, just maybe, if I begged enough my dad would slow down the car to 55 mph and let me roll down the window and pee from the moving car. Of course, my dad first made sure the wind couldn’t blow back my urine into his prized Gran Torino.

I’m not medieval like them (just kidding, Mom and Dad. This trip gave me an increased appreciation of your parenting skills). Seriously, all the stops make the drive more bearable, and gave me plenty of chances to stretch my knee. Did you know that Hattiesburg, Mississippi has a phenomenal rest area? Top notch. They even offered free, freshly baked cookies. I highly recommend it.

Sweden Rocks! - 7 Month Update

2009-08-05T10:24:00.000-07:00

No, that’s not a typo. Nor am I Drew Carey, absentmindedly confusing the “mistake on the lake” with the “city by the water” (funny aside – I thought Stockholm was divided by a bunch of rivers; it’s actually dissected by the Baltic Sea). Speaking of Drew Carey, I never thought he was very funny, but I recently caught a glimpse of him on The Price is Right. Man, he’s fallen off the funny cliff. Paraphrasing the Dan Quayle debate insult, “I knew Bob Barker. And Drew Carey, you’re no Bob Barker.”

Anyway, I enjoyed a week of investigating in Stockholm, Sweden. Yup, that’s right. There’s securities fraud on every corner here, right next to the outdoor cafes. Corrupt Swedes.

Nah, I’m just kidding. The Swedes are good people. In fact, Uffe, some random 50-year old dude who sat next to me at the pub on Friday night bought me something called a Hoegarrden. It was more like a lunch bucket of beer than a mug. Coincidentally, it’s Gay Pride week here. There were probably 20,000 folks celebrating in the streets on Saturday afternoon. In fact, the loud clapping, whistling and continuous playing of the Village People interrupted my power nap. I don’t think Uffe was hitting on me. Not that there’s anything wrong with that. But he was at the pub with his wife. We did, however, swap phone numbers. You know, just in case I’m ever back in Stockholm or Uffe visits Dallas.

This was my first visit to Stockholm. A nice, relaxed, friendly city. Very clean and active. Everybody seems to either walk or bike places. And they take 3-hour lunches, usually at some outdoor café. I could get used to this lifestyle. In fact, in a perfect world, I’d spend my day sitting at one of these outdoor cafes with my laptop, cranking out blog updates and finishing the mystery novel I’ve been working on for the past 3 years. And then I’d hop onto my Mary Poppins bike and pedal home, tweeting my bell/horn whenever an idiotic tourist wandered into the biking lane. One more thing: I’ve never seen so many pregnant women in my life. And not just pregnant, but bursting at the belly, ready to pop, 9 months pregnant.

How does all of this apply to my knee? Well, let me tell you.

The Stockholm trip was the culmination of a busy summer of travel, hence the lengthy gap between blog postings. This was my third flight in the past 2 weeks (before Sweden, I had two overnight trips to DC). My knee held up just fine on the flights. While the DC trips are a beating, the Stockholm flight really sucks. We fly from Dallas – Chicago (2 hours) and then from Chicago – Stockholm (9 hours), not including the mad “dash” across O’Hare to make my connection (actually, it was more like an old person power walk). The knee got a bit stiffer than usual, but a few laps around the cabin loosened things up.

The knee also handled all the walking around Stockholm. I must’ve walked over 5 miles on at least 3 separate days, perhaps as much as 10 miles on one day, most of them on uneven cobblestone. No problems. I also went up and down plenty of steep steps. I did grip the railing, not because I needed to, but as a precaution. The knee still doesn’t feel “normal” going up and down steps. Actually, it’s fine going down, but heading up still feels abnormal. The strength just isn’t there. If I push off oddly, the knee lacks total stability. (It’s also possible I might’ve torn my meniscus, which, hopefully, is unrelated to the cartilage repaired by ACI. I’m waiting to hear back from the surgeon. Will post more when I get some answers). While the knee doesn’t hurt and I really wasn’t limited in what I could do – other than being unable to sprint across the street if a car came barreling through the intersection – the inability to move freely is frustrating. Again, the analogy of an athlete past his prime struggling to acknowledge his body’s limitations is the best way to describe my situation.

At this point in the rehab, I still struggle over whether the surgery was “worth it.” Unlike most other ACI patients, I wasn’t in daily agony, or unable to function properly. The knee occasionally suffered sharp pains, but I was generally able to perform basic athletic activities, though I couldn’t run or jump without extreme pain/difficulty. I opted for surgery because I was concerned that things were about to go downhill, and didn’t want to reach that abyss when it would be too late to repair my knee.

And that’s what makes my Monday Morning Quarterbacking over the surgery decision difficult. Yeah, I’m still worse off now than I was before the surgery. But it’s foolish to think my quality of life wasn’t about to experience a steep drop if I hadn’t gotten the surgery. Of course, part of me wonders whether I could’ve contained the pain/uncomfortableness by curtailing my activities, while still preserving my ability to perform simple athletic activities. Maybe that’s wishful thinking. I don’t know. Thinking about the “what ifs” really sucks.

I hope that my recovery progresses to the point where I function at least at the level I was at pre-surgery. If so, I’ll consider that a success, because, like I said, I suspect that things were about to get worse. Even at 7 months, it’s still too early to tell whether the ACI surgery “worked,” at least worked as I hoped it would. I feel like it’s election night and the polling places have just closed, but the race is still “too close to call.” In real life, unfortunately, I won’t know the results when I wake up the next morning…

Taken Down a Notch

2009-07-11T22:49:00.001-07:00

There's nothing like a 4-year old birthday swim party to remind you of your mortality.

First, I can't I'm posting a blog entry at 1am on Saturday night, but I'm still wide awake after watching UFC 100. Brock Lesnar is a very large dude. Real good times tonight.

Ok, back to the swim party. One of my daughter's fellow princesses celebrated her bday party at the community swimming pool. I dropped by after work. It was the usual scene -- tons of little kids splashing around the shallow end in the arms of moms and dads, while the older siblings cannonballed into deeper waters.

I relaxed in the shallow end with my daughter. Naturally, she wanted to practice swimming to me. Well, she really doesn't "practice," or at least it wouldn't look that way to folks without kids. But if you've got kids or have spent time at a pool with little ones, you've seen the scene. The munchkin hangs onto the edge of the pool, demands that you stand about 5 feet away, and then she launches herself into your arms. Now, if the parent remains where the child insisted they stand, there isn't enough distance to take a single swim stroke, let alone actually swim.

But crafty parents slowly drift away from the edge after their baby launches into the water, forcing them to take a few strokes before mom/dad rescue them from drowning. I don't think Parenting Magazine would approve. However, just like everybody knows about Code Reds even though they aren't written in the field manual, same goes for these swim tactics. I can see other parents nodding approvingly.

Once the child reaches you, they're either celebrating their swimming abilities, or they're coughing up 3 gallons of water. But they've definitely got the death grip on the parent.

After a few seconds, it's time to return to the pool's edge. And, for me, this is when the pain happened.

Olivia immediately shifted around in my arms until she was standing on my lap and facing the wall ready for the return trip. Basically, she planned to use my lap to springboard back to the side of the pool. I used appropriate caution to protect my knee as she positioned herself. What I didn't anticipate, however, were her legs flailing around. As she attempted to gain traction on my quads, her legs often slipped below my lap. Now they were in the danger zone. She didn't catch me in the nuts. But it was worse. Oh, much worse.

The backs of her heels cracked sharply into my shin, EXACTLY where the 2 screws hold together my tibia. Holy mother of God; that f*ckin' hurt, even worse than watching Bartman snatch that foul ball from Moises Alou.

Eventually Olivia planted herself on my lap and finished her return trek to the wall. Sadly, I didn't get a moment to grieve. As the tears trickled down my cheek, my daughter's much larger friend landed in my lap. This girl delivered a solid 4 or 5 mule kicks to my shin before I could heave her to the edge. Actually, my initial reaction was to club the girl and let the lifeguard deal with her carcass. But I'm pretty sure the moms would've given me the business if I clotheslined this girl. Don't be so surprised. These are the type of parents who get pissed when baby seals get clubbed. No sense of humor. So I gritted my teeth and screamed out for my wife to replace me in the water.

Ok. I don't support clubbing baby seals. That was just a joke. Harpooning them, yes.

Anyway, these little girls are ferocious. I have no doubt my daughter will kick the crap out of the first boy dumb enough to pull her hair.

In the meantime, add "swimming with little kids" to the list of things I absolutely cannot do at 6 months.

6-Month MRI Results

2009-07-07T07:58:00.000-07:00

Relief. Well, partial relief anyway. (More on that in a second.) My visit with Dr. T was punctuated by several high-fives, each as awkward as the ones between Tiger Woods and his caddie after a heroic birdie putt. Even though I didn’t hoist the Claret Jug during this appointment, I nonetheless received some good news.

The 6-month MRI showed that my graft is healing “beautifully,” to use Dr. T’s choice of words. The graft is completely filled in. First high-five. No overgrowth, fissures, cracks, or other deformities. Second high-five. Most importantly, the cloned cartilage appears to be bonding smoothly with the existing cartilage. Final high-five.

Unfortunately, we didn’t have an MRI report to review, so I’m hesitant to suggest that everything inside my bionic knee is “beautiful.” The MRI technician thought he was supposed to examine a potential “ACL” surgery, not ACI. He said my ACL looked great. Um, thanks? Since I’ve never torn my ACL, I guess that’s a good thing for the technician’s career prospects. I told Dr. T he should take credit for making my ACL look as good as new. Anyway, I’m supposed to get the correct report sometime this week. Hopefully Dr. T didn’t miss anything during his independent review of the films.

Dr. T was downright giddy, perhaps even happier than I was. He even called me his “poster child” for the ACI surgery. While I’m pretty stoked to learn that my knee’s healing as well as can be expected, I still worry whether my knee will ever become “normal” again. Plus, I’m hesitant to rejoice until I see the complete report. Now, I don’t want to be a wet blanket, ruining the good news like Gretchen Mol in Rounders. But the MRI doesn’t explain the random aches or clicking in my knee, nor does it answer why I’m still having difficulty bending/squatting on 1-leg. Hopefully, those issues are just part of the natural healing progression, as Dr. T seemed to think. In fact, after the final high-five Dr. T tempered his own enthusiasm, noting that ACI recovery isn’t a 10-K race, but a marathon. Well, if that’s true, hopefully I just passed the 13-mile marker ahead of a bunch of Kenyans, fully hydrated and without any cramps.

(Ok. If this was a newspaper column or magazine piece, this blog posting would’ve ended with that previous sentence’s beautiful wrap-up. Fitting and humorous. But screw my editor’s advice; I’ve still got a few more things to share).

6 months is probably a good time to mark my progress. Here’s what I can do:

• Walk for miles (and chew bubble-gum at the same time). On the treadmill, I’m now up to
3.5mph and can handle an incline of 6-8 with no problem. I can also shuffle sideways and walk backwards without tripping over my feet.

• Stationary bike at fairly high resistance. I’m getting a “real” bike sometime this month. I haven’t owned a bike since the early 1980s when I traded in my 300lb NY Giants dirt bike with the banana seat for a discounted, blue Sears 10-speed (my dad used to work at Sears).

• Moonwalk across the kitchen floor in my parachute pants

• Elliptical machine for 25-30 minutes at a fairly tame pace and incline

• Gently kick a soccer ball with my kids

Here’s what still gives me problems:

• 1-legged squats/bends beyond 45-60 degrees; 2 legged squats and wall sits are ok because I “cheat” a bit by placing more pressure on my good wheel

• Kneeling; crawling; kneeing evil-doers in the head with any amount of force

Here’s what I can’t do/haven’t even tried:

• Running

• Jumping

• Eat 68 Nathan’s hot dogs in 10 minutes (or even in 10 months)

6 months down; 6-12 more to go, I guess. I now embark on that vague recovery stage. I really don’t have any more major milestones or markers to pass, though 8 months (32 weeks) might be considered one. Everything’s now incremental advancements based on subjective feeling. I’ll continue to slowly increase the amount of weight or reps on various quad-building exercises. Once I gain sufficient strength – though I’m not sure what’s considered, “sufficient” – I’ll progress to rollerblading -- one of the pitstops between walking and running. I’ll probably piss in my pants the first time I do. Actually, Christina will probably be more nervous; maybe she’ll pee enough for both of us. After that, it’s just a matter of time (and Dr. T’s blessing) before I try more aggressive activities, like light jogging. That’s still at least 6 months away, but then again, I can’t believe it’s been six months since the surgery.

Almost 6 Months -- MRI pending

2009-06-29T07:44:00.001-07:00

I like coffee. I really do. That has nothing to do with my rehab; I just thought I’d share that.

It’s been an unusual past week, week and a half. I experienced some minor discomfort in my knee, the first time I’ve felt something other than the occasional swelling and soreness. I don’t want to overstate the discomfort, but it was a somewhat piercing pain, like a little pinprick on the medial side. This is where my lesions are, though not where I felt pain pre-surgery. Hopefully it’s nothing serious. It didn’t last more than a few moments, and only a handful of times. I think I over-did a cardio workout last week. At least I hope that’s all it was.

Perhaps emboldened by the somewhat normal state my knee seemed to achieve, I did a fairly moderate cardio workout. I spent 15 minutes on the elliptical, followed by 15 minutes on the bike, followed by another 15 minutes on the elliptical. No break in between exercises, with the entire time spent at a level only a notch or two below what I used to do pre-surgery. Too much, too soon? Perhaps. I’ve since backed off, returning to a gentler level on the elliptical. The “pain” has since disappeared.

Now, I don’t want to suggest that by calling my knee, “normal,” I’m close to returning to pre-surgery levels. God, no. By normal, I mean I can walk around without people gawking at me like I was John Merrick. I still lack any athletic prowess, and occasionally resort to the “old man shuffle,” as a friend described my movements at a recent baseball practice. And I don’t see myself cliff-diving in Acapulco anytime soon. But I’ve now reached the point that I feel dirty for parking in the handicap spots. Is that progress? Or just a sign that I’ve developed a guilty conscience?

My knee continues to click/catch at random moments, sometimes even making soft clicks while walking normally. No pain or discomfort, though. And if I walk slow enough, or focus on walking a certain way, my knee won’t click/catch. I still start each morning with a lovely “popping” sound when I finally exit my bed. That’s just my knee waking up in the morning. On the positive side, the back of my knee – popliteus tendon? – no longer aches or pops. Anyway, I’m hoping the MRI reveals the cause of these noises.

Ah, the MRI. I enjoyed the cold comfort of the human test tube on Monday morning, laying perfectly still for 35 minutes. Jack FM – the radio station without DJs – provided the in-flight entertainment. Amazingly, the films were ready immediately after the MRI, though it’ll take a day or so to prepare the actual report. I review the results with my surgeon on Wednesday, exactly 6 months after my surgery. No need to speculate what the MRI will show. I’ll update later.

I suffered an emotional setback recently. Not a death blow. More like Johnny sweeping Daniel-san’s leg. My knee’s healed sufficiently that I can kick the soccer ball in the backyard with my 7-yr old. Nothing sophisticated. Just some simple back-and-forth passing, using my good leg 95% of the time. I tried teaching my son a few dribbling moves, but quickly discovered I lack the lateral movement even to demonstrate them. I’ve got 1-step range, and that one step is R-E-A-L slow. Very depressing. I hope this is only a temporary limitation, but I’m pretty concerned it’s permanent. I never imagined I wouldn’t be able to physically assist my son’s sports development. That’s extraordinarily difficult to accept. Hopefully my mediocre athletic abilities return over the next 12 months as the cloned cartilage heals.

Tragedy is Comedy

2009-06-17T09:22:00.000-07:00

One of my favorite expressions compares tragedy and comedy. I’ve heard several versions used, but it goes something like this: “The difference between tragedy and comedy is 15 minutes.” The precise timeframe might vary, but the sentiment is that once you step away from something -- even something terrible -- you’ll be able to laugh about it. The trick, it seems, is being able to survive those first 15 minutes.

Now, I’m not sure 15 minutes is enough time to process a tragic event, just as I’m sure there are certain events that are never funny. I mean, I can’t imagine pounding Budweisers with a buddy 15 minutes after witnessing a fatal car crash, and then laughing about how far the dude’s body flew through the air.

But I understand the point behind this expression. To move beyond a tragedy, you need to create enough distance to de-personalize the situation; enough space that you’re able to laugh without offending or being offended.

That’s been a valuable lesson to learn during this recovery. (Yes, I realize there are plenty things worse than ACI knee surgery, but give me some leeway here). It sucked tremendously having my wife heave my crumpled, naked body onto a shower chair (without any chance for some shower nookie). And it sucked having to beg my wife to bolt down the toilet seat riser just so I could take a dump. Tremendous indignities. Some men have been permanently scarred by far less.

But you know what? Some of the sh*t ACI patients suffer through is pretty damn funny. Seriously. Being forced to poop on Nutty Professor-sized toilets? Freakin’ hysterical. Except, of course, when it happens to you. You just need enough time to remove yourself from that humiliating moment to recognize the humor. The sooner you do so, the easier the recovery will be.

On a completely separate topic, here’s a list of TV shows I’ve enjoyed through the power of Netflix. If you’re about to undergo ACI, I recommend picking up some of these DVDs to help pass the time during those first few days/weeks.

The Wire – “real” look at inner-city Baltimore, with each season focusing on a different aspect: drugs/cops, docks, politicians, schools and the newspaper industry. 5 seasons. Probably the best show, start-to-finish, I’ve ever watched. Lots of great characters; lots of plot lines. It might take a few episodes before you’re fully invested, but stick with it. You won’t be disappointed.

Extras – Ricky Gervais stars as movie extra who makes it big. 2 short seasons.

The Office – we’ve only watched the American version, but clever stuff.

Big Love – Polygamist family life. Season 1 was much better than Season 2, though we heard Season 3 is solid.

Arrested Development – smart person’s comedy. 3 seasons

Mad Men – sophisticated drama focusing on the 1950s NYC advertising world. Only 1 season available on disk right now.

Friday Night Lights – just started watching this high school football show, but so far it’s solid. 3 seasons

Curb Your Enthusiasm – uncomfortable humor at its finest. 6 seasons

Entourage – Hollywood star enjoys life with boyhood friends. The first season was excellent, but it steadily went downhill. Still, it's mindless entertainment. 5 seasons

Slow and Steady (hopefully) Wins the Race

2009-06-12T11:22:00.000-07:00

Another week, 2 more degrees of ROM. I'm gaining flexion on a timetable closer to a regular diet than the crash course Adkins -- I just keep adding a few degrees here and there. I'm now at 143 degrees, about 2 degrees shy of my good leg.

I went swimming for the first time. Not pool-walking; real swimming. A few weeks back, we set up the 20-foot round, 3-feet deep, above-ground pool. It sits right next to the camping trailer and the '75 Impala resting on concrete blocks. Real classy addition to our backyard. But the kids love it, so I can't complain.

Anyway, I actually swam the length of our pool a few times. My swim stroke can best be described as "painfully ugly." Well, assuming you can see my form past my blinding "office glare" tan. Truthfully, I can't call my swimming motion, a "stroke." That would be an insult to swim strokes; thrashing about is more accurate. But luckily it only takes me 2-3 "strokes" to cross my pool. Anything longer and I'd drown. No, wait. I'd just stand up. The pool's only 3 feet deep. Phew.

Similar to using the ellipitcal machine, swimming felt...odd. My leg felt more like a broken flipper, flopping precariously like a creaky door barely attached to the hinges. Not sure if that's my gimpy knee; the weak quad; or just my uncomfortableness with swimming. I doubt I'll swim regularly enough to give Michael Phelps a run for his money. But I do hope to get decent enough that the life guards won't have to rescue me. Or at least good enough to avoid having to wear my daughter's Strawberry Shortcake floaties.

Frustratingly Normal

2009-06-06T10:35:00.000-07:00

First things first. 141. That’s the number I’m slapping down. It’s got a mystic feel, like a 300 bowling game, or .400 batting average. No, it’s not my IQ (c’mon, don’t insult my genius with that piddling score). Rather, 141’s my new ROM. Breaking 140 is like shattering the flexion glass ceiling. It’s still 4 degrees shy of my good leg, but it falls comfortably within what’s considered full range of motion. Hopefully I’ll recapture those last 4 degrees, but I don’t feel like I’m missing anything if I don’t.

I experimented with a handful of new cardio exercises this week. Well, not new in the sense that I’ve never done them before; I just haven’t done them since my surgery. Some worked; some didn’t.

First, I fell in love all over again with my old friend the elliptical machine. Even before the surgery, I stopped running and rarely used the stair climber. Too much stress on my knees. The elliptical (some call it, Precor) became my primary source of cardio. Low impact, easy to use, and capable of various speed/intensity, the elliptical was a great way to sweat off 500 calories. This week, I set the machine at level 1 for both the height of the glide tracks and the resistance. Man, I felt like an 85-year Eskimo taking a leisurely stroll across the Tundra after chowing down on some penguin meat. The motion felt . . . strange. My knee didn’t hurt. I wasn’t tired. And my form was generally normal. But something didn’t feel quite right. The best way to describe it, I guess, was the sensation amputees report they feel from their missing limbs. Now, I’ve got all my appendages, so I really don’t know how that feels. This just seems to be the right description. Or at least the best I’m able to do. Anyway, I anticipate slowly increasing the level of difficulty on the elliptical, and finally being able to sweat off some of the extra poundage.

The treadmill proved far more difficult. For the past 2-3 weeks, I’ve steadily increased my pace and incline setting. Most recently, I cruised along at a 3.5mph clip at the 4-incline setting. After 20 minutes, I was glistening like a Southern Belle sunbathing on a glorious summer day. Glorious, that it, because she’s topless. Unless she’s really fat. In that case, put the Mumu back on, honey. Or scrape together a few yards of fabric to make one. Seriously. (Sorry, a sudden mean streak crept upon me. The kids were beating the crap out of each other. I’ll return to my jovial self shortly).

Ok, back to the treadmill without the boobie analogy. I tried lateral walking. Basically, that’s shuffling sideways, something middle-schoolers do at basketball practice. I slowed the treadmill down to 1.5mph, its slowest setting and took a couple of normal walking steps to acclimate myself before trying out the new motion. I didn’t think it was possible to move that slow. Sadly, even 1.5mph was too fast for my lateral walking. I simply couldn’t comfortably shuffle at that blistering pace. It felt like somebody was yanking out the rug beneath me.

The same thing happened when I tried to walk backwards, only this time I also resembled Elliot, you know, the really dorky 2nd grader with the coke-bottle glasses who always gets picked last at kickball? True, I simply couldn’t handle this speed at this point in my recovery, but I was also painfully uncoordinated, tripping over my feet and otherwise stumbling around, trying my best not to fly off the back of the treadmill. For somebody who used to dig 60 mph spikes, not being able to walk sideways or backwards was depressing. Taking the “glass is half-full” attitude, I’ve got a new athletic challenge. It’s just embarrassing that the “challenge” is something my 3-year old can do.

The past few weeks have been interesting. Several times I actually feel normal, forgetting the 2 screws and 13-inch scar decorating my knee. No pain. No limp. No uncomfortableness. I even handle stairs with minimal difficulty. But then I instinctively try to do something a bit beyond my limit – for example, trying to move 2 steps to catch an errant throw at my 7-year old’s baseball practice – and instantly my deficiencies snap me back to reality. I realize how limited I still am. Like an athlete past his prime. His mind knows what to do, but the body won’t cooperate. Actually, I’m way past my prime, so my body wouldn’t cooperate even if it wanted to. Nonetheless, I feel relatively decent about my long-term prognosis. Sure, I get beaten down plenty about the lost opportunities over the past 5 months and more than occasionally worry that I’ll be forced to embrace a lesser quality of life. But overall I remain hopeful I’ll regain full use of my knee. If so, expect a new Guinness record for backwards walking in 2010.

5 Months

2009-05-29T19:33:00.000-07:00

Wow. 5 months. I still remember lying awake at 3am in mid-January for something like 18 straight nights. Man, I watched a ton of crappy movies on TNT. But not Honey. Jessica Alba. Mmmm. She made many nights bearable.

Anyway, with my leg trapped in a clunky brace, I wondered whether I'd ever sleep through an entire night, let alone walk again. Now? Well, I'm still a tad bitter about my gimpiness, but I'm generally functional. Even my limp sometimes disappears. And I'm getting ready to try the elipitical machine for some desperately needed cardio. The recumbent bike just ain't cutting it. The 12 pounds lost immediately after the surgery returned. And these pounds I packed on aren't the type like those following an HGH cycle. These extra pounds kinda just hang on me like a cheap suit.

I'm down to 1 PT session/week. I'm heading to the gym about 5x/week, banging out most of the same exercises on my own. Plus I do tons of SLRs at home sitting on the couch every day. My right quad is still pretty squishy, but if you squint hard enough you can see the contour of some tiny muscles. Kinda like my abs when I was 12 years old.

I'm also trying to resume a normal workout schedule. Prior to the surgery, I used to head to the gym 2-3x during my lunch break at the office. These trips were in addition to the 2-3x each week I'd head to the gym in the morning. Though my somewhat chaotic work schedule isn't exactly cooperating, I'm close to recapturing that routine. And that's a good thing. My happiness is closely tied to maintaining a schedule. Just in time for summer.

20 1/2 Week Update -- OS Visit

2009-05-22T16:31:00.000-07:00

Actually, it’s been 143 days since my surgery. The ability to easily calculate the amount of time that’s elapsed is the biggest advantage of having surgery on New Year’s Eve, I guess.

I met with Dr. Turgeon Friday morning. My biggest question/concern was the crunching noises whenever I perform open chain exercises. The knee doesn’t hurt, thankfully, and I wanted to know whether I should continue performing these exercises despite the noises.

Dr. T said nope. He wants me to avoid open chain exercises for the next month. The graft is still healing, and he doesn’t want to risk damaging it. He didn’t seem overly concerned about the noises. He manipulated my knee a few times and noted the noises only happened at the initial contraction point when the patella and trochlear groove first bear weight. Actually, the knee really didn’t crunch during my visit today. Gotta hate it when the problem doesn’t occur the one time you want it to; that’s the Murphy’s Law of ACI surgery in action. On the plus side, the knee now barely clicks during full extension, and doesn’t click at all if I extend the leg at a glacial pace, an improvement over my last visit. Overall, this isn’t necessarily a positive sign, but it’s terrible, either.

I scheduled an MRI on June 29, with the follow-up visit on July 1. I’ll get an early Fourth of July present. Or lump of coal. I’m not sure what to expect from an MRI at the 6-month mark. It’s more like a mid-quarter progress report. The MRI really will reveal only bad information, like an incomplete graft, fissures or adhesions on the graft site, or excess scar tissue. Hopefully the MRI will indicate that the lesions are filled in, but it’s still too early to determine whether the cloned cartilage has adequately bonded with the existing stuff. That probably won’t happen until the 10-14 month mark, I believe, though sometimes you can tell at 8 months. And sometimes you really can’t tell unless the doctor actually scopes the knee. We’ll see. As much as I’m looking forward to seeing the inside of my bionicly repaired knee, that’s actually kinda perverse. If you think about it, the best case scenario is I learn things are on track, not that I’m healed. That’s the same kind of news I’ve heard for the past 20 ½ weeks. Basically, the MRI might not tell me anything new. Except now there’s a chance I might discover that something inside my knee is seriously jacked up. Not good times.

4 1/2 Month Update

2009-05-13T20:16:00.000-07:00

Nothing terribly new to report. The knee continues to feel better, and I’m slowly regaining what I consider, “basic functional use.” That doesn’t mean I’m back to normal. Far from it. But I’m able to walk without difficulty, and I’ve picked up enough speed to keep up with the elderly.

My limp is barely noticeable, but still present. The leg gives out randomly once or twice per day, usually for a nanosecond, and then I quickly recapture my normal walking form. Stairs remain problematic. I don’t have to avoid stairs, but I do need to handle them with care, especially going down. I’m just now heading up and down 1 step at a time, rather than planting both feet on a step before continuing, though I still occasionally do that. I also still use the handrail.

Here are some other highlights and lowlights at this point in the recovery:

• The most troubling part right now is the continued clicking, grinding, cracking, etc. during random exercises. Crepitus, I believe, is the technical term. No pain, fortunately. The hard part is determining whether to stop once the knee makes these noises. Dr. Petersen, the Swedish ACI pioneer who examined me last month, advised me to avoid doing knee extensions if it caused “clicking.” I know exactly what “clicking” feels like and can tailor my exercises appropriately. Some of the noises, however, isn’t clicking. It might just be harmless scar tissue breaking apart, or it might be a sign that the activity is aggravating the knee. The uncertainty sucks. I want to build up my quad strength, but I don’t want to jeopardize the healing process. This will be issue #1 to discuss with Turgeon next Friday.

• I started walking on the treadmill. Right now, I limit my speed to 3 – 3.5 mph, which is a pretty moderate walking pace, with the incline levels ranging between 0-3. Twenty minutes on the treadmill at this pace and incline won’t impress Bob and Jillian, but at least I can work up a minor sweat. But more importantly, it doesn’t cause any pain.

• I ride the recumbent bike at a moderate clip for about 30 minutes every day. I’m not going to break out the yellow jersey (actually only dorks wear one), but I manage a slight sweat. The biking and treadmill are my only forms of cardio. Hopefully I’ll be able try the elliptical soon. Meanwhile, I’ll continue biking, which is supposed to be the best rehab exercise for ACI patients.

• I still have some swelling in my knee, especially after I exercise or spend a significant amount of time on my feet. The knee’s no longer a grotesque cantaloupe, but it’s not pretty. Thankfully not as ugly as Hedu Turkoglu, though.

• Bending and squatting are still beyond me. I can handle wall sits, but maneuvers that require short bursts of pressure on the knee are off-limits. I started to add shallow lunges, but the knee crackles inconsistently, and I’m afraid to continue. Again, something I need to address with Turgeon.

• The back of my knee still pops softly after being in a locked position.

• I traveled to DC for a few days last week. TSA’s security measures concern me. The two Home Depot-sized screws in my leg didn’t set off the metal detectors. Hopefully terrorists would embed weapons inside body parts, but you never know. . .

• My passive flexion (meaning, on my own) is 130 degrees, and my active one (where Judy crunches my leg) measured 138 degrees today.

Week 17-18 Update

2009-04-27T11:44:00.000-07:00

I approached Friday’s PT session with renewed vigor. Dr. Petersen’s promising diagnosis provided the spark. Judy was pleased to hear the prognosis. I think she sees her hard work paying off, too. In any event, it was time to add some new rehab exercises.

After the usual entre of biking, stretching, leg raises and hamstring curls, Judy integrated a few new wrinkles. The first new exercise was actually an oldie – the wall-sit. For those unfamiliar with this exercise, picture somebody taking a crap standing up. And yes, the wall-sit feels about as good as it looks. Basically, in a wall-sit the patient places his back firmly against the wall, and slowly slides down until he’s in a seated position, and remains there until his quads start quaking uncontrollably. In my case, I wall-sat with my knees bent at a 45-degree angle; more of a stoop than a seated position. I remained in this precarious spot for 1 minute, pressing my palms together in front of my chest for balance and secret prayer. Surprisingly, the wall-sit really didn’t hurt. My quads, though weakened and much punier than they were before the surgery, are still pretty sturdy after years of volleyball and soccer. Of course, my left leg – the good one – over-compensated, bearing the brunt of the pressure. But my knee held up fine. No pain.

Next up was another traditional leg exercise – lunges. Lunges proved more difficult than the wall-sits. If you’ve never done a lunge – or watched an episode of The Biggest Loser – the patient steps forward until his lead leg is shaped like an upside-down L, while the back leg is almost kneeling on the floor. To protect my graft, I stopped my lunge forward far short of the expected 90 degrees. Lunges didn’t feel quite right. They didn’t hurt, but at times I sensed the surgically repaired knee was tantalizingly close to cracking, and rule #1 of rehab is stop if it hurts.

Judy kept things moving at a decent clip. I pounded out another set of 100 lateral heel touches, before cranking out a set of forward heel touches. At this point, my ass felt like it had a starring role in some porn movie called, “Backdoor Adventures.” Ok, that was nasty, but you get the point. For the first time in rehab, I had worked up a decent sweat.

We then broke out the balance board, called a BAPS. I have no idea what that acronym stands for, but those letters are written all over the board. It’s basically a circular slab resting atop a ball. With my gimpy foot planted in the middle of the board, I wobbled the board front and back, and side-to-side, before rotating the board circularly in both directions. The balancing exercises strengthen my ankle and corresponding muscles, as well as stabilize my knee. Eventually, I’ll perform my squats and heel touches on this machine to increase the difficulty level.

I had another PT session on Monday. This session wasn’t as productive. My knee just didn’t feel right. There was a crackling sound coming from above the patella – not where the graft site is located – while using the stair-stepper. The knee made similar noises during the 90- to 60-degree leg extensions. Previously, the clicking sounds occurred below the patella, and almost assuredly happened because the graft site was still hardening (I asked Lars Petersen about this). Again, the knee didn’t hurt, but I nonetheless stopped these exercises out of an abundance of caution. Judy didn’t seem overly concerned, but agreed with my decision to scale back for the moment. The rest of PT was without incident. Interestingly, the lunges didn't bother my knee. Perhaps I didn't lunge as far forward this time. Anyway, let’s hope these noises were just a one-time setback (though setback is too strong of a descriptor).

Examination by Dr. Lars Petersen

2009-04-23T21:43:00.000-07:00

Today was a “special treat.” Well, a special treat in the world of knee surgeries. Dr. Lars Petersen, the Swedish pioneer of ACI knee surgery, examined my knee. It was like the hand of God touched my knee.

Lars was in Dallas for a major knee surgery conference. I suggested he grab some Tex-Mex. (By the way, I can only imagine how exciting knee conferences are; hopefully more stimulating than law seminars). Anyway, Lars stopped by my surgeon’s office to check out my knee, as well as the knee of another ACI patient. According to Lars (and my surgeon), my knee seems to be healing ok. It’s tracking well and my flexion’s good. I’m still a few degrees short of full active extension, but neither doctor was concerned.

I pointed out the “clicking” noises my knee makes during the extension process, typically around the 45 degree mark. Lars nodded expectantly, as if my question was #1 on the list of FAQs. After manipulating my knee several times, Petersen explained that the cloned cells are still hardening. Because the graft site is pliable at this juncture, the cartilage has not yet formed a smooth surface. He used the analogy of something crashing over a step. I understood what he meant, but think I’ve got a better analogy.

Imagine a tire rolling slowly over a pothole. The tire dips into the hole, rolls across the crevasse, before smacking into the back edge of the hole. The tire then climbs up and out of the pothole, emerging back on the smooth paved surface. Well, when the bone/cartilage inside my knee passes over the site, it creates a slight indentation on the graft site, producing a clicking noise as it dips down and smacks against the existing, hardened cartilage. The clicking is supposed to end once the cloned cells mature to create a smooth surface area.

I also asked Lars about the knuckle-cracking sounds coming from the back of my knee. Typically, these sounds happen while walking, after my knee is fully extended or locked. Again, Lars manipulated my knee several ways. This time, he also squeezed certain spots along the top of my calf and the bottom of my hamstring. I don’t recall his precise explanation, but he concluded the patella tendon underneath my knee needed to be loosened up. Not only was the tightness causing the popping, that was probably a primary reason why I can't reach full active extension. I realize I’m not the knee expert, but this explanation didn’t seem as convincing as the one for the clicking sounds. Regardless, Lars said the popping noises were normal and nothing to be alarmed about. Easy for him to say.

Of course, I now want to know when (and how) we’ll determine whether the cloned cells are hardening. Turgeon says he’ll probably take an MRI of the knee in early July. That’s the 6-month mark. By that time, he should be able to gauge the cloning process. In other words, he'll be able to see if the cloned cells have filled the lesion. In the meantime, both surgeons gave me the obvious advice of staying away of rehab exercises that caused the clicking noises. They also suggested I rest my heel on a table and contract my quads to loosen up my patella tendon.

Both think I’m on the right path. Hopefully their intuition is correct.

Week 16 Update

2009-04-19T16:11:00.000-07:00

Phase 3 – the so-called, “Remodeling Phase,” which lasts from Months 3-8 – is full of highs and lows. For example, I’ll experience long stretches with no limping, and for the first time since the surgery my knee will actually feel almost normal. This false positive causes my mind to wander ahead, wondering when I’ll be able run and jump again. Like a bolt of lightning shattering a late-night silence, however, my knee will suddenly “give out,” severing those wishful thoughts and serving as a brutal reminder that, nope, my knee’s still jacked up.

During these moments, I often reflect on the various decisions I made and actions I took that resulted in my knee injuries. Nothing good comes from traveling down this path of “what ifs.” If you fixate too much on the past, not only will you drive yourself insane, you’ll also lose focus on the recovery ahead, which is the only time period you can control. I felt all grown-up when I finally realized this.

Right now, my biggest concern is the random crackling or clicking noises in my knee. The cracking and popping don’t hurt, and even seem to provide some relief. But the sounds are a bit un-nerving. I don’t know if they are an indication of over- or under-growth in the graft area, or whether I’m still bursting through scar tissues or adhesions, just part of the normal healing process.

I’m also concerned about my inability to “squat” on my bum knee past 30 degrees, the critical point at which the knee truly begins bearing weight. I realize that’s the major litmus test of my recovery, and I’m not yet to the point where I can even try full knee bends. In fact, full squats are probably a month away. However, I want (no, need) to figure out whether I’m on the right path. Likewise, I want to know if/when the OS plans to take an MRI of my knee to see how my cloned cartilage is healing. Frankly, the hardest part of the recovery now is not knowing whether the cloning magic worked.

My next OS appointment is Wednesday, and I hope to get some answers. Luckily for me, there’s also a major knee surgery conference in the area next week, and I understand that not only is the pioneer of ACI knee surgeries attending, he’s also stopping by my OS’s practice during my visit. Assuming this works out, I’ll get a free examination by the Michael Jordan of ACI.

3 1/2 month update

2009-04-13T13:27:00.000-07:00

Another PT visit, more pain. But most importantly, continued progress. I’m now at 135 degrees flexion, up from the 131 on Friday, which was up from 130 degrees last Monday. Apparently I haven’t hit the flexion wall yet. Yay me! 135 is at the bottom range of what’s considered “full ROM.” I don’t know if I’ll ever regain 100% flexion, but even if I don’t, those last 10 degrees shouldn’t prevent me from functioning normally. And who knows, maybe I'll eventually reach 145.

My extension, however, is a bit lacking. Full extension refers to the ability to keep the leg in a completely straight line in mid-air from a seated position. I’m 4 degrees short of full extension. Basically, my knee bends a tiny bit. That’s not terrible, but I should be at full extension by now. I believe I just need to improve my quad strength to reach full extension, but I’m not positive. I meet with my surgeon next Monday, and this is something we’ll cover.

The knee generally feels ok. Still no pains, though my knee gets tired if I remain standing for extended periods of time, get up and down repeatedly, or walk long distances (ie, 1 mile or so). The knee continues to “crack” or “pop” whenever my knee extends between 45 – 90 degrees, though not from 0 - 45. It doesn’t hurt, but the noise suggests there might be some overgrowth or undergrowth at the implant site. It’s still too early to tell. The cells, after all, continue to mature (harden) for 12-18 months. The back of my knee also seems to make a slight popping sound, like a pinkie knuckle cracking, each time my leg goes from completely straight to slightly bent. It doesn’t hurt, and I suspect (and hope) it’s just scar tissue breaking up. That also might be why I can’t reach full extension. Again, that’s another topic I’ll cover with the surgeon. Keep your fingers crossed...

A Moment in Time

2009-04-08T20:12:00.000-07:00

One of my favorite writers, Malcolm Gladwell, popularized the phrase, “the tipping point.” It refers to that exact moment when adding one more thing – person, object or event – instantaneously changes a situation. Picture an old-fashioned scale, with equally weighted objects, teetering perfectly still. And then something lands onto one side of the scale, changing things irrevocably.

There’s a reason people identify tipping points in hindsight, something I’ve learned first-hand during this rehab process. I constantly wonder, even daily, whether I’ve turned the corner. I analyze each PT accomplishment, each step taken without pain, each time I bend my knee without difficulty, searching (and hoping) for signs that my knee’s normal again. However, it’s nearly impossible to pinpoint, in real-time, the exact instant a situation changes. Did things really change? Or was it a temporary aberration, with the moment flittering away before slowly returning to the status quo? Unfortunately, blaring trumpets don't materialize to announce the arrival of a tipping point.

I realize I haven’t reached the tipping point in my recovery. Not even close. While my gait has steadily improved, I still walk with a slight limp (though I no longer use my pimp cane). I don’t have full ROM. I can’t push off my gimpy leg to stand up. And if I’ve been on my feet for awhile, my weakened leg sometimes “gives out,” a brutal reminder that my knee is far from healed. But back in January when I was peeing in plastic bottles and showering with my leg encased in plastic garbage bags, I never envisioned I’d reach this point. I know I’ve got a long way to go – at least 9 more months – but for the first time I think I can see the light at the end of the tunnel.

On a less serious note, my knee’s rounded because of the osteotomy. No pointy, bony knee cap juts out. When my leg’s bent, it resembles an amputee stump. Given the uselessness of my knee at times and the fact that the thickest part of my scar covers the 2 inches above my knee cap, that’s an apt comparison.

13 1/2 Week Update

2009-04-03T18:04:00.000-07:00

This week was full of mixed blessings. Work was exceptionally busy, thus hampering my at-home rehab (and, more importantly, my blogging). I didn’t make it to the gym, rode the exercise bike the bare minimum, and generally neglected my assortment of leg lifts and squats at home. Despite my inattentiveness, however, I made significant progress this week at PT. Shocking, huh?

At Monday’s session, my flexion improved slightly to 126 degrees. I also increased the number of reps for heel touches and single-leg squats. And I did them without the brace for the first time. Even better, my knee didn’t ache afterwards. I also began using Judy’s antiquated stair stepper, basically pumping away but never letting my knee bend further than 30 degrees. (That’s generally the point when the patella begins to bear weight, which I’m trying to minimize). This machine is straight out of a Suzanne Summers infomercial.

On Friday, I reached a new milestone – 130 degrees! Crossed a new threshold. Full flexion ranges from 135-150; it depends on your size and generally flexibility. My good knee can bend 145 degrees. I’ll gladly accept 140. Interestingly, I reached 130 without much assistance from Judy. Usually, she contorts my leg repeatedly, reducing me to tears, before she takes her measurement. This time, my knee “popped” during an abduction movement – from a seated position with my legs straight, I push outward and pull inward against Judy’s pressure. It sounded like somebody’s knuckle cracked. Although this loud sound freaked the bejesus outta Judy, it was only some excess scar tissue breaking apart. It didn’t hurt, and actually provided some relief. Somehow my knee was ready for Cirque du Soleil. Ok, that’s exaggerating things a bit, but you get the idea. Judy was surprised to see how much flexion my knee improved after the popping. Man, 130! And with no tears!

Reaching this target, of course, means karmas gonna demand some sort of setback. That’s how life works, right? Hopefully I won't get kicked by some angry 7-year old this weekend.

Finally, as my regular blog readers realized, this was the longest gap between posts – 8 days. My bad. That’s what happens when work gets in the way. Hopefully this was just an aberration. Another observation: it’s much harder now that it was 3 months ago to write funny material. Back in January when I was pissing in a urinal bottle? And pooping on a raised toilet seat? Like Frank Caliendo says, funny. Very funny. But increasing the number of reps on heel touches? Um, not so much. I never thought I'd be disappointed to leave behind a series of personal humiliations. To counter-balance the lack of embarrassing moments now I’m ambulatory again, I’ll try to weave in random, funny stuff from my world, even if it’s not directly related to my rehab. Hopefully it works. Definitely let me know.

12-Week Update

2009-03-26T20:16:00.000-07:00

Almost 3 months have passed. Lots of ups and downs. Lots of changes. Reminds me of that Beatles’ song, A Long and Winding Road. Anyway, it appears I’ve reached that point in my recovery where progress happens glacially. Instead of celebrating accomplishments like driving a car or ditching my crutches, I have to be content with 2 degree increases in my flexion. That’s like winning the World Series one week, and then trying to get excited about playing in the old man softball league.

The other downside, of course, is that material for my blog is diminishing. It’s tough to fill an entire post about graduating to 4-inch step-ups from 2-inch ones. But I’ll keep trying. I’ll probably transition to brief, bullet-point updates like this one. As always, I’m playing these developments by ear.

• The knee generally feels ok. People keep asking me if it “hurts.” Not really, though the knee gets tired and achy if I don’t rest or ice it regularly. The osteotomy, however, bothers me. The two screws in the tibia are visible when I wear shorts. Seriously, you can see slight bulges, like speed-bumps, on my shin. I don’t expect people to stare at my legs, but they kinda stand out like a third eye. The lateral side (ie, the outside part of my knee, not to be confused with the medial, or inside, part of my knee) sometimes feels like it’s stretched so tight that it’s gonna pop through the skin. I hope that doesn’t happen. It would be really weird if metal screws burst from my leg in the middle of the grocery store aisle. Clean-up in aisle four might be a bit embarrassing.

• 1-legged step-ups and 1-legged mini-squats (no deeper than 45 degrees) are killing me. It’s as much mental as physical. I’m convinced my knee will shatter if I bend any further. But I also have to remember not to push it. The knee is still healing.

• You know how your body twitches slightly during a morning yawn? Well, my gimpy leg convulses like it went into epileptic shock. Very freaky, and not in a good, freaky way like an insane stripper.

• My flexion continues to increase slowly. It reached 125 degrees on Wednesday. I hit 121-122 degrees with no problem, but Judy crunched my leg another 3 degrees. One of these days I’m gonna start crying. Or punch Judy in the face really hard. Not sure which.

Going Brace-less

2009-03-21T12:22:00.000-07:00

Ding dong, the brace is dead. Well, not completely. But the surgeon gave me the go-ahead to ditch the brace whenever I feel comfortable. Over the next week or so, I’ll begin weaning myself off the brace. I’ll wear the brace whenever I work out, or if there’s a chance 7-year olds could barrel into my knee, but I’ll slowly increase the amount of time I function brace-less.

Other than the approval to ditch the brace, the surgeon really didn’t note anything substantive with my knee at my last appointment. He was pleased with my flexion – now at 122 degrees; he noted the knee bent “normally”; he felt my quad strength was on track; and he thought the osteotomy was healing well, though he commented that the 2 screws were visible. I’m not sure how that may impact my eventual recovery. My knee also makes a “clicking” sound when it reaches about 60 degrees in extension, which concerns me. Turgeon, however, said the clicking is normal. As long as it doesn’t hurt or hinder my extension, he’s not concerned. It turns out my good knee clicks, too, though not as loud or as often.

On Thursday, I wore a suit to an office meeting with defense counsel. I completed the ensemble by wearing my black brace outside my pants and tennis shoes. Picture “Monet’s ‘The Man in the Flannel Suit’ meets Mad Max meets Larry David.” I’m pretty sure you’ll see this look in an upcoming GQ. I just hope fashion designers properly credit me.

There is some downside to ditching the brace, of course. I’ll no longer be allowed to wear track pants and tennis shoes to the office. Nothing says government worker like black Nike track pants, white Asic running shoes and a tucked-in polo shirt. I thought about by tattooing GS-14 onto my neck to transform this look into “government chic,” but decided that might be taking things a bit too far.

Without the brace, I’m also going to feel a bit uncomfortable parking in handicapped spots. I’ve discovered that thirty-somethings emerging from SUVs in handicapped spots generate puzzled – even irritated – looks from strangers. But this anger usually disappeared when they spotted my gigantic knee brace. In other words, the brace provided me cover to park there. I’m not ready to give up my prime sparking spot just because I no longer wear the brace. I’m still limping, and the knee gets sore if I walk extended distances. Plus, I like quoting Bob Ueker, “I must be in the front row,” every time we head to the mall or out to dinner.

Thursday was an unofficial American holiday – the start of March Madness. Personally, I think the government should trade Columbus Day for March Madness Day. That’s just me. For only the 2nd or 3rd time since 1995, I didn’t celebrate this holiday in Vegas or at a sports bar. Actually, I didn’t even watch the games or fill out a bracket. You know the saying, if a tree falls in a forest and there’s nobody around to hear it, does it make a sound? Well, if I’m not screaming at some scrub to hit his free throws at the end of a 30-point blowout because I need his team to cover 31 points, is March Madness really happening? Anyway, I hope the knee heals in time for next year’s March Madness, because I miss spending 12-hours straight in the Venetian lounge, surrounded by buddies, Amstel Lites, cocktail waitresses and betting slips…

A Quickie -- 10 1/2 Weeks Update

2009-03-16T12:10:00.000-07:00

I had planned on doing an update last week – at 9 ½ weeks – but I was busy with Kim Basinger. Buh-dum bum. Also note the double entendre in the title, “Quickie.” Heheheheh…I’m on a roll today.

After my flexion setback at last Monday’s PT session, I rebounded nicely on Friday. I hit 118 degrees with minimal effort. And then today (Monday), I hit 117 degrees completely on my own, and 120 with Judy’s assistance. Trust me -- those extra 3 degrees aren’t worth the agony. Anyway, I’m pretty much back on track, probably 5 or so degrees behind schedule, largely because of my slow-healing osteotomy. I consider myself within the margin of error.

I had stopped doing step-ups for a few days. My knee just didn’t feel right afterwards. No sharp pains, fortunately, and pain is always the guide. That’s gonna be my new bumper sticker – “Pain is my guide.” It’ll go right next to, “My kid beat up your honor roll kid.” I did heel touches today with no issues, so that’s a good sign. For heel touches, my gimpy leg rests atop a low-level aerobics bench (I moved up from the phonebook), and I “squat” 2-3 inches until my left heel touches the ground. Repeat 40x. Real good times.

The knee remains slightly swollen, though I can finally see the contours of the knee cap. The knee no longer looks like a watermelon; it looks more like a grapefruit. The outside part of the knee is still a bit numb. Neither the surgeon or Judy is concerned, however. Apparently some swelling is expected for months afterward. It also feels like there might be some minor fluid build-up below my knee. The surgeon thinks there’s not enough to aspirate, which he’d prefer to avoid under normal circumstances, but will keep an eye on it at future visits. He also said the potential fluid is outside the joint, which is a good thing.

My next appointment with the surgeon, coincidentally, is Wednesday. I’m trying not to get my hopes up, but I’m supposed to get the brace off. Keep your fingers crossed. Man, 11 weeks. That’s ¾ of a football season.

Recovery Thoughts and PT Woes

2009-03-11T14:11:00.000-07:00

At various points during my recovery, I’ve compared my situation to pregnancy, the elderly and newborns. Well, I’m going to add one more family analogy to the list.

Over the past 10 weeks, I’ve experienced several “firsts” -- accomplishments that made me feel like a proud papa: the first time I peed in the toilet, not the urinal bottle. My first shower, with and without the brace. My first steps without crutches. My first poop without the raised toilet seat. The first time I put on my own socks and shoes. My first shower standing up. Driving. The list goes on and on. Initially, I celebrated each “first” like I was Prince in 1999. But each successive accomplishment brought a less boisterous celebration. Now I no longer even notice, let alone cheer, my “firsts.”

And then it hit me – my experience is a lot like the second child syndrome, or the “Second Kid Shaft,” as I call it. The firstborn gets totally spoiled, right? His baby album is packed with mementos. Locks of hair from the first haircut. 12 rolls of film from the first birthday party. Designer pacifiers. The works. The second kid? Ehh, not so much. I vaguely remember saying, “Oh look. Kid #2 took her first steps. Great job, sweetie. Hey, isn’t Roadhouse on TNT now?” And that’s how I feel right now. I’m taking every new milestone for granted.

Ok, time to share my PT woes. Monday’s session was brutal. Two weeks ago Judy measured my knee flexion at 116 degrees, about where it needed to be. I asked Judy for another measurement on Monday so I could gauge my progress; I’m supposed to be at 120-125 degrees. My knee, however, wasn’t cooperating. It was stiff, like a creaky old man struggling to get off his rocker. I probably over-extended myself a bit on Sunday taking the kids to the playground and loading baseballs into the pitching machine. I wasn’t break-dancing or anything, but I did spend 2 hours straight on my feet, and perhaps that was enough.

Judy was determined to loosen up my knee. Her initial efforts, however, failed to produce the desired flexion. About 45 minutes into our session, she declared, “we’ll need to work on it some more after you finish your exercises. The flexion’s just not there, so it doesn’t make sense to measure it now.” Sounded like a good gameplan to me.

I plowed through the rest of my leg lifts and baby step-ups without incident, and then I hopped onto the bike for 10 minutes to loosen up again, before returning to the dreaded stretching table.

Judy’s expression announced her fierce determination to massage my knee to 120 degrees. Uh-oh. I felt like one of those captured Vietnam War soldiers in Missing in Action. In my middle school dreams, I was always Chuck Norris, delivering a roundhouse kick the prison camp warden. This time, however, I knew I was one of the wimpy privates groveling for mercy. I would’ve thrown the rest of my squadron under the bus if that meant saving my own skin. If you get stuck in a foxhole with me, we’re both screwed.

Prone on the table, Judy towered above me. She latched onto my ankle, slowly pushing it toward my body, gripping my thigh for increased leverage. Basically, my knee felt like an accordion. She gradually bent my leg further, until it reached a certain point where any further and I would’ve gone into shock. Unfortunately, that point wasn’t the desired 120+ degrees.

If Judy’s therapy room was the prisoner camp, this would’ve been the scene where I begged for mercy from the prison warden. Or asked Chuck to roundhouse kick Judy. Either one works. But Chuck wasn’t coming to my rescue. Instead, I was powerless as Judy tried to bust through my breaking point.

I learned something about pain, and I’m not talking about the “soreness” you get after a hard workout. This is real pain, the kind of pain that produces involuntary reactions. No matter how hard I tried, each time my knee reached a certain point I (a) lurched off the table, and (b) screamed out whatever word was on the tip of my tongue. Because I have a potty mouth, that normally meant some version of the f-bomb. Dropping f-bombs, of course, won’t endear me to Judy, and I really didn’t want to upset or offend her. After all, she was the one bending my surgically repaired knee. But despite my best breathing techniques and other Jedi-like relaxation exercises, I couldn’t control myself. It was kinda like Tourette’s Syndrome mixed with f-bombs. The obscenities were coming, rapidly and loudly.

Fortunately, I’m a relatively quick thinker. I realized that my word choice was involuntary – I’d blurt out whatever was on my mind at the precise moment the pain kicked in. So I decided to clear my mind of everything but the one word I’d scream out. I tried to pick something benign, like Dan Ackroyd did at the end of Ghostbusters. It didn’t work out exactly as planned, though the Stay Puff Marshmellow Man didn’t show up. Despite focusing intently on surfing and the ocean, I wound up screaming out various versions of the Lord’s name. They weren’t the best choices in front of a religious lady, but at least they didn’t rhyme with “brother-trucker.”

Despite Judy’s best efforts, my knee bent only 115 degrees, about where it was 2 weeks ago. Unfortunately, this was a “difficult” 115, unlike the relative ease with which I hit 116 the last time we measured. Ugh. Looks like I’ve got some more torture sessions in my future…

Good-bye to an Old Friend

2009-03-05T18:00:00.000-08:00

Ding dong, the CPM is dead! Or to tweak Al Pacino’s famous quote from Scarface, “Say good-bye to my little friend!” Real quick: have you ever seen an athlete’s or rapper’s house on MTV’s Cribz without a Scarface poster? Yeah, me neither.

Over the past 8 weeks, I spent more time with this machine than with my wife or kids. 6-8 hours/day. Brutal. I didn’t want to return the CPM; I wanted to blow it up. Anyway, I no longer needed the CPM once my knee reached a certain flexion. Here's a picture of my leg in the CPM.

My quest for normalcy continues to creep along. With Christina’s blessing, I graduated from Driver’s Ed and got my license last week. I’m back on the roads with no restrictions. So far, I haven’t run over any cats like my friend, Lori, did. I also started taking showers standing up. I’m much cleaner now. I kinda miss my shower seat, however. There’s something comforting about sitting down in the shower. Try it some time. I guess I’ve got something to look forward to when I hit 90.

I’m still wearing the knee brace. I meet again with my surgeon in 2 weeks. Hopefully it’ll come off. But as I’ve learned the hard way already, I’m not counting on it. I think my knee’s ready to handle it; I’m just waiting on the osteotomy to fully heal. Frankly, that’s a bit frustrating because I’ve got no control over how the bone heals. You can’t rehab a bone wedge.

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

2009-02-28T10:35:00.001-08:00

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.

The War on Drugs

2009-02-22T21:33:00.000-08:00

“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.

Random Update -- 7-Weeks

2009-02-20T14:23:00.000-08:00

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.

The Simple Things in Life

2009-02-16T13:38:00.000-08:00

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.

OS Follow-Up #3 -- Major Updates

2009-02-12T16:30:00.000-08:00

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.

Emergency Calls

2009-02-07T11:49:00.000-08:00

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.

Back at Work

2009-02-04T19:42:00.000-08:00

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.

One Month Update

2009-02-02T11:35:00.000-08:00

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.

Random Non-Knee Thoughts

2009-01-29T11:58:00.000-08:00

I haven’t had this much free time since I back-packed around Europe after the Bar Exam. Unfortunately, this past month hasn’t been nearly as fun, because, you know, this little knee surgery thing has gotten in the way. But I’ve still managed to fill my time with more than just SportsCenter, Tyra Banks and reality TV. This is probably the most informed I’ve ever been, having read more news articles and watched more news programming in the past 30 days than I have the previous 6 months combined. My gut might be growing from inactivity, but so is my brain. Along those lines, here two observations/rants on current events:

The stimulus bill, hypocrisy, and politicians. I’m not an economist, so I have no clue whether $800 billion of gov’t spending will lead us out of this recession or hurt our country in the long-term. However, I find it troubling that the same people who blast John Thain for spending $35,000 to renovate a toilet remain conspicuously silent when some Congressman tries to sneak a $50 million pet pork project into a job creation bill. Along those same lines, the Illinois governor gets indicted for soliciting campaign donations in exchange for a Senate appointment, yet the New York governor openly touts the fundraising potential of Caroline Kennedy if she got appointed Senator. I realize the situations aren’t exactly identical, but, in my opinion, only a fine line separates them. Likewise, I don’t see a heckuva lot of difference between the governors’ Senate bartering and Jack Abramhoff seeking quid pro quos for his lobbying efforts or President Clinton pardoning Marc Rich after Rich’s wife’s donated millions to the Clinton Foundation, other than some were a bit more brazen and specific about their demands. Oh, and some of them got caught on tape.

This isn’t a Republican or Democratic thing, but rather a politician thing. It gets annoying when one side grandstands about the other political party’s shortcomings, while conveniently glossing over similar misdeeds by their political colleagues. While the Republicans dominated Congress from 2000-2006, the Democrats bitched that the Republicans shut them out of the legislative process and repeatedly bemoaned the lack of “bi-partisan” negotiations. The Republicans responded that they won the elections and, hence, to the victors go the spoils, much like an athlete saying, “scoreboard.” Well, times have changed and now the Democrats control Congress. And whaddya know, the roles are reversed. This time, the Republicans are complaining about not being able to help draft the stimulus bill, while the Democrats are responding, “tough cookies. You had your chance, now it’s our turn,” ironically cloaking their strong-arm tactics under the guise of “Change.” The faces change, but the complaints remain the same. Instead of wasting time – and insulting the public’s intelligence – by playing the spin game, I just wish politicians would craft solutions, instead of blaming the other side for the country’s problems.

Donovan McNabb chokes again. I’ve long-believed that McNabb was an above-average QB who benefitted from a phenomenal defense and the lack of a dominant NFC team, like the Pats, Colts and Steelers have been in the AFC this decade. He was just good enough to get his team to the playoffs, but not nearly good enough to win a big game on his own. He’s way too erratic, and never seemed capable of rallying his team when it counted. Plus, he was the master of putting up big numbers in ugly performances, which helped disguise his shortcomings.

His performance against the Cards in the NFC Conference Game symbolized McChunky Soup’s career. Look at McNabb’s numbers: 28 of 47 for 375 yards, 3 TDs, 1 INT, and 31 rushing yards. You’d think he was all-world in this game. Think again. He stunk up the joint in the first half, putting Philly in a major hole. When his team got down big and the Cards started playing prevent defense, McNabb chalked up monster numbers as Philly caught up, just like he did in his lone Super Bowl appearance against the Pats. Actually, his Super Bowl stats are eerily similar to the ones he put up in the Cards’ game, both games Philly lost. Anyway, his deep ball to Kevin Curtis and the TD bomb to DeSean Jackson against Arizona were things of beauty, a prime example of what McNabb can do when he’s hot. But those are simply flashes of brilliance that McNabb can never sustain. When Philly got the ball back with less than 3 minutes to go, did anybody seriously think McNabb would lead Philly for the game-tying score? Of course not. He’s the anti-clutch. The A-Rod of football, except Donovan can’t match A-Rod’s regular season accomplishments. By consistently missing open WRs on that final drive and failing to lead the Eagles to a TD with the game on the line, McNabb once again proved he doesn’t belong in the top tier of QBs. Unlike the earlier playoff games against the Vikings and Giants, Philly’s defense couldn’t bail out McNabb this time. People credit McNabb for consistently leading the Eagles deep into the playoffs, but there’s a reason the Eagles are 1-5 in Conference Championships and Super Bowls under McNabb’s watch.

OS Follow-Up #2 -- The Letdown

2009-01-26T20:00:00.000-08:00

Man, what a roller coaster day. This morning, I had another PT session. Therapy went well. I performed all of my exercises with minimal difficulty, and exhibited greater control of my quadriceps. Judy was pleased with my overall leg strength. My hamstrings remain tight, but that probably won’t ever change unless I spend one month at a yoga retreat. Critically, I improved my free-standing flexion to 92 degrees, a 12-degree improvement from Thursday. This satisfies my goal for the week, and keeps me slightly ahead of my ROM schedule. At the end of therapy, I discovered that I was placing about 110 pounds of pressure on my right leg, which was just shy of where I’m supposed to be. I then practiced walking with just one crutch on my left side. No issues there. All in all, a promising session filled with progress.

Christina and I celebrated my successful PT by grabbing lunch at the NorthPark Corner Bakery. We arrived about 30 minutes before what we thought would be the lunch crowd rush, yet the place was dead. Actually, the entire mall was dead. Not sure if that’s just a Monday thing. Lunch was uneventful. I was able to rest my leg on the railing next to my chair, and enjoyed a relaxing sandwich with my wife without the kids. The restaurant (and mall) was still empty when we left 45 minutes later. I hope that’s not a sign that the economy is about to take another nosedive.

My momentary high quickly disappeared after my afternoon visit with Turgeon. At this visit, I had hoped that Turgeon would allow me to open the brace 0-30 degrees, at least when sleeping. That’s what we discussed at our last visit. He took two x-rays of my osteotomy. Since I tweaked the osteotomy on Day 2, I haven’t had any pain in the shin. The x-rays revealed the tibia break and the 2 implanted crews are healing just fine. However, Turgeon wants to “see more of the bone” on the tibia before he allows me to open the brace. He acknowledged the lack of pain confirms the bone is healing satisfactory, but emphasized he wants to be overly cautious, again reminding me that this is a marathon, not a sprint. Turgeon reiterated we’re only 4 weeks into the recovery. The first 6-12 weeks are the most important period, and he doesn’t want to risk me shattering the osteotomy and thus ruining the surgery. He did, however, approve the use of one crutch, and told me I could go crutch-less if I felt comfortable.

Unfortunately, I will remain locked in my brace at 0 degrees until my next visit in 16 days, meaning I’ve got another 2 weeks of sleepless nights and dead legs. I’m not gonna lie. The visit was demoralizing. If this were a chick flick, this would be the scene where I grab a spoon and a carton of ice cream, and watch sappy movies under a blanket by myself. Ok, it’s not that bad. But I’m still bummed out. I don’t mind wearing the brace. In fact, I’ll probably wear it longer than necessary as much for the mental comfort as the physical support the brace provides. However, I just want to be able to bend my knee like a normal person again. That’s not asking a lot. Feel free to leave plenty of pick-me-ups in the comments section. I promise to put down the Haagen-Daz to read them.

PT Session Recap

2009-01-23T07:18:00.000-08:00

I recently completed the equivalent of two-a-days, heading to PT on Wednesday and Thursday. Thursday started poorly, as I felt drained shortly before PT. I’m not sure why. I didn’t do much, other than heading outside for a little sun for the first time in awhile. But basking in 80-degree sunshine in a lounge chair for 10 minutes shouldn’t deplete a person’s energy. Can’t explain that one.

The PT session went well. I graduated to 2lb ankle weights, and the difference is telling. I’m almost embarrassed by my new muscles. Even extra large gym shorts can’t contain my legs.

I improved my free-standing flexion 3 degrees overnight, reaching 80 degrees. My thigh, however, suffered immensely to achieve this small gain. Dayna – one of Judy’s excellent assistants – was tasked with pinning my right thigh to the table while my gimpy knee dangled over the table edge, allowing Judy to slowly raise and lower the leg to measure my flexion. Apparently, my quads like to explode as my leg contracts, requiring Dayna to press down really hard to keep my knee immobile. Dayna might have a future as a grape crusher, as she generated enough pressure with her hands to make at least 4 bottles of wine. Her handprint remained on my thigh 24 hours later. Of course, she rightfully blames me for squirming too much (I did). Besides, the discomfort in my thigh was a welcome distraction from the soreness in my knee.

At the end of PT, I hopped onto the scale to measure how much weight I was placing on my bum wheel. I’m supposed to be at 50% of my body weight, and reach 75% before next week. For the first time since the surgery, I weighed myself. Wearing tennis shoes and workout attire, I was 152 pounds, a 6-10 pound drop from 3 weeks ago. That kind of weight loss probably would’ve kept me above the yellow line on The Biggest Loser. Of course, I also weigh less than most contestants’ elbows. Anyway, after pressing down on the scale with my right leg, I learned that I was averaging between 80-100 pounds of pressure. I need to reach 115 pounds soon. Pressing down that hard with a straight leg, however, feels unnatural. It contradicts everything you’re taught about avoiding knee injuries. Indeed, people frequently blow their knees by awkwardly landing straight-legged, snapping their ligaments like twigs. I realize that can’t (well, shouldn’t; never say can’t) happen with the brace locked, but it’s difficult to overcome those instincts. It’s just counter-intuitive. But that’s my new challenge for the next several days.

3-Week Update

2009-01-21T17:37:00.000-08:00

3 weeks down. 75 more to go. That’s how long it’ll take me to reach the 1 ½ year mark, when, hopefully, I’ll be 100% “normal” again. Well, I’ve never been considered, “normal,” but you know what I mean.

I had another PT session today. Things went fine. My free-standing flexion was 77 degrees. At this point, the goal was 75, so I’m slightly ahead of schedule. However, I was a bit disappointed. I just increased my CPM to 87 degrees today. Even though I understand my free-standing flexion will be less than my CPM number, I was hoping to hit 80 today. In any event, I’m supposed to be at 90 degrees free-standing by next Friday, which will be just over 4 weeks since the surgery. I also learned today that I won’t be able to start biking until the 6-week mark, regardless of when I reach 90 degrees, because of the osteotomy. Once again, my Tour de France dreams are on hold.

Judy manipulated my leg with the usual push and pulls, before adding a new wrinkle. For an extra layer of difficulty on my leg raises, she strapped on a massive, 1-lb ankle weight. Hoisting that 1-pound green boulder 3-6 inches off the trainer’s table generated a rare Hulk-like adrenaline rush. This must have been what Roger Clemens felt like after taking HGH. After cranking out 30 leg raises, I almost hopped off the table to flex in front of the mirror. But then I remembered I’m in no position to hop off anything or show off my guns.

Judy also removed the gauze bandaging on my knee, exposing the Franken-scar. The steri-strips still cover most of the incision, but the scar is gloriously prominent, especially when the knee rises in the CPM. It’s almost like the Franken-scar wants to smack me in the forehead. I can’t wait to show off the Franken-scar by wearing shorts on my next mall walk. I predict 3 people will pass out, and 2 will lose their lunch.

So far, there’s been no bruising on the shin or knee, and just a little swelling. I’ve rarely experienced pain in the knee, other than an occasional pinprick. The knee aches a bit first thing in the morning and after completion of my rehab exercises, but thankfully those are the only times. I do feel discomfort in my foot – the top part as well as the heel and ankle – because it remains flexed in the brace 24/7. I’ve been able to shower braceless every night without incident. Sleep remains elusive, though last night I almost made it through the entire night. I hope this marks the start of a new trend, but that’s doubtful. Oddly, I’m not tired despite getting no more than 2-3 hour bursts of sleep. Perhaps I should’ve been a stake-out guy instead of a lawyer. I wish I would’ve felt this good without regular sleep when my kids were newborns.

One final comment that’s completely un-related to my knee; something I’ve just gotta get off my chest. I watched most of the inauguration festivities yesterday. Like most Americans, I was moved by the historic moment, and it renewed my faith in our country. But what the fuck was Michele Obama wearing during the swearing-in ceremony? Did her “superstar designer” steal some shower curtains from the 1950’s? My 3-year old draws better-looking dresses, and she can’t stay between the lines yet. Michele would’ve better off wearing something from Zoolander.

It pained me to hear TV commentators rationalize the “beauty” of her dress as some kind of bold fashion statement. All I kept thinking was whether anybody would notice if somebody puked on her. Where was Mr. Blackstone when you really need him? Her dress was goony. Just say so. Speaking the truth about her dress doesn’t detract from the moment, but putting lipstick on a pig makes you look silly. Finally, the word “irony” doesn’t do justice to those who criticized car executives for flying on private jets to Congressional hearings, but then celebrated by throwing 10 ballroom functions. Ok, I’m done ranting.

Tips for ACI Patients

2009-01-19T11:19:00.000-08:00

I wanted to pass along some observations and lessons learned during these initial weeks to others who might be planning ACI knee surgery. In no particular order, here they are:

Stockpile tons of reading material and movies. For the first 7-10 days, you’ll likely spend most of the day in bed. To pass the time, I plowed through 2 books and tons of feature articles I had gathered in anticipation of the surgery. I also watched most of Season 1 of Mad Men, as well as a couple movies with Christina once I was able to move to the living room couch. I probably would’ve watched more movies if the portable DVD player hadn’t broken down.

Get married. I can’t imagine going through this experience without a spouse, or at least a very serious significant other. You’ll need someone to change ice packs, load ice into your ice machines, help you with your brace and the CPM, fix you dinner, and generally fetch all of your stuff. In the early days, you’ll also need help going to the bathroom, as well as showering. While a parent might love you unconditionally, I don’t think you want to pee or wash your private parts in front of Mom. You will quickly lose all dignity. Don’t fight it. Just make sure you have someone with whom you’re comfortable enough to let down your guard.

Get a laptop with WiFi. My laptop hasn’t left my bedside table since the surgery. I use it for everything, from surfing the web, to blogging about the surgery, to working part-time from home. Staying connected has been critical to maintaining my sanity.

Exercise and stretch before the surgery. Your body will suffer tremendously. It’s inevitable. But the recovery will be easier if you’re in decent shape beforehand. Plus, the intense rehab exercises won’t be as much of a shock to your body if you’re accustomed to working out hard. Looking back, I wish I had added some of the ACI rehab exercises to my normal workout routine before the surgery. I also wish I had spent more time improving my flexibility. My hamstring actually hurts worse than my knee.

Provide work with a realistic assessment of your work load and expected absence. I gave my bosses at least 4 months’ notice about my surgery and anticipated absence. I outlined the status of each of my cases, and all upcoming deadlines. We agreed which case I would hold onto, and which case (or task) needed to be transitioned to others. My office has been great about my situation. I told them I likely wouldn’t be in the office for at least 1 month, and possibly 6 weeks. Every patient recovers differently, of course. Some ACI patients have returned to work 2 weeks after their surgery. Even though I have a traditional “desk job,” there’s no way I could last an entire day at the office right now. My knee still occasionally aches and I get tired very easily. Also, I can’t drive, and can’t lug my workpapers back and forth between home and the office. Plus, there’s no way I could squeeze in the 6-8 hours daily I still need to spend in the CPM if I went to the office. My boss agreed to let me work from home as often as I’d like, as long as I send him a detailed summary of how many hours I worked and what I accomplished. I’ve also remained accessible via remote access email and cell phone.

Find a nearby PT with ACI experience before the surgery. This is an obvious point, but, after reading blogs by other ACI patients, it seems like some overlooked it. ACI is a highly specialized procedure, and success is dependent on the rehab. Find a PT who’s worked with plenty of ACI patients, especially one whose office is nearby. Right now, I go to PT twice/week for 1 hour per visit, and probably will continue to do so for several months. That’s a huge time commitment. Patients actually spend more time with the PT than the surgeon. Also, make sure the PT and the surgeon communicate regularly about your rehab progress.

Understand it’s a marathon, not a sprint. The first few days, perhaps weeks, after the surgery will really suck. I’m not kidding. There will be a few times when you are absolutely miserable. It’s human nature to question, even regret, the surgery while you’re wallowing in pain and self-pity. I know I did. But, like the overdone cliché, there is a light at the end of the tunnel. Better days are ahead. Remain resilient. Take some advice from the New Kids on the Block and Hang Tough. Good Lord. I can’t believe I just quoted the New Kids.

Develop a routine. Full disclosure: I’m a creature of habit. I like planning out my days. If I don’t, I forget to do stuff. Following a routine will help you get through the day and complete all the necessary home rehab. Patients spend 6-8 hours/day in the CPM, usually in 3 separate two-hour+ sessions, plus they spend another 15-30 minutes doing home PT. That basically wipes out your day. If you miss one of your CPM sessions, it’s difficult to make up those 2-3 hours. If you head back to work, it’s even more difficult to sneak in the required CPM time. Think about it. If you’re gone from the house from 8am – 6pm, you either have to wake up a few extra hours earlier than normal or you’re going to spend your entire evening in the CPM, leaving no time for the family. Plus, it’s taxing to spend more than 3 hours in the CPM.

Here’s a rough timeline of my normal day:

6–7 Wake up and eat breakfast

7-9:30 CPM

9:30-1 Relax, work, etc. Eat lunch.

1-3:30 CPM

3:30-5:30 Spend time with kids, work, relax. Eat dinner.

5:30-6 Playtime with kids.

6-8 CPM

8-8:30 Relax

8:30-9 PT exercises

9-10 Relax

10 Shower and sleep

Trust me. My day’s as boring as this timeline suggests. But at least I’m able to carve out enough time for the CPM and PT, which, at this point in the recovery, is critical.

Buy a shower seat and toilet seat riser with handles. As soon as you’re physically ready, you’ll want to shower. Your injured leg will quickly become engulfed with dead skin. It’s just nasty. However, you won’t be able to shower standing up. I bought a simple bench with a handle; that’s worked just fine. You’ll also want to keep your shampoo, etc. in a basket within reach of the bench. The toilet seat riser is also necessary, especially for women. I recommend getting one with handles, which make it easier to push off back to your feet. Plus, I plan on leaving the Cadillac on our guest crapper during all future parties. That should make for great conversation.

Don’t hesitate to call in favors from friends/family. You’re going to need help. Lots of help, especially if you have kids. You’ll need to arrange rides to school and sports practice. During those first few days, somebody will need to remain with you 24/7 in case you need assistance. If your spouse needs to run an errand or takes a deserved break, you’ll need a replacement adult to watch the kids. Guys hate asking for help. It’s genetic. It’s why we refuse to ask for directions, no matter how lost we are. Set aside your pride and ask for help. Don’t play hero. I learned most folks are more than willing to chip in. We’ve been fortunate, with several friends inviting our kids over for playdates, taking them to basketball practice, and bringing over dinner. You’ll have plenty of time to “make it up” after your knee heals.

Familiarize yourself with your insurance benefits. ACI is pricey. There are several cost components to the surgery. The cloning. The surgery center. Anaestesiologist. Surgeon fee. PT. The rental of the CPM and ice machines. Know how much insurance covers. Examine the exclusions provisions. Study the pre-certification and appeals process. Organize all communication and bills relating to the surgery. Save all EOBs. Document all contacts with your insurance carrier. Insurance companies make money by screwing people over. That’s their business model. Hopefully that won’t happen, but accepting this fact will provide a dose of realism. The surgery center initially asked for almost $9,000 before it would schedule the procedure. Luckily, I understood my coverage, refused to pay and directed her to the surgeon’s and Genzyme’s insurance liaisons. Perhaps this was a simple mistake by an unknowledgeable billing clerk, but a lesser-educated patient might’ve mistakenly paid the bill. And everybody knows how difficult it is to collect a refund once that money’s gone. The lesson: wait until all the bills arrive and insurance discounts have been applied before paying anything.

Physical Regression

2009-01-17T10:07:00.000-08:00

Before I begin, what the fuck happened to global warming? I don’t care if it’s January, it’s not supposed to be 25 degrees, ever, in Dallas, which, by the way, feels like -30 does to Chicagoans. Like most Americans, the cold weather is beating me down, and I can’t shake this nasty hacking cough and constant green snot. This isn’t helping my rehab.

17 days. That’s all it took to wipe out 4 months of solid exercise and healthy eating. The soulless combination of surgery and inactivity has inflicted serious damage to my body. Before the surgery, I wasn’t about to win any bodybuilding competitions, but I was in fairly decent shape. Now, the little bulging veins that once proudly rippled across my arms are gone, as are the 1- and 2-pack abs I developed. (The closest I got to a 6-pack was the Amstel in the fridge). My right quadriceps is flimsier than jello, to the point where the outside of my thigh is actually sunken in like a crackhead’s cheeks. In fact, my entire right leg looks homelier than an orphaned chicken. It’s shriveled up so much that the brace already is starting to slide off. The PT told me yesterday that my leg strength was “pathetic,” though that’s normal for folks at my stage. I haven’t stepped onto a scale, but I’ve probably lost 5-10 pounds, mainly because I lost all muscle definition in my upper and lower body. Plus, I eat less than a French super-model addicted to heroin. My body transformation is like the reverse Super Size Me.

To combat my Benjamin Button-like renovation, I resumed lifting weights today, in addition to my regular rehab exercises. I’m finally comfortable enough sitting up without putting any pressure on my outstretched gimpy leg. Using light dumbbells (10lbs), I did a variety of curls, military presses and delt raises. It’s not much, but hopefully it’ll stave off any further deterioration. This past week, I started taking regular showers again, and each glimpse at my new body humbles me. I’m just trying to hang on until the doctor clears me to resume normal exercise, which, unfortunately, probably won’t happen for at least another month. Once I reach 90 degrees flexion in my knee (I’m at 75 degrees now; hopefully I’ll hit 90 by the end of January), I’ll be able to start riding a stationary bike with no resistance. Nobody will mistake the biking I do for the Tour de France, but at least it's a form of cardio. At first, I’ll peddle for just a few minutes at a time, before slowly increasing the duration and eventually adding some resistance.

Around the 6-week mark, I also expect to ditch the brace and start water therapy. I’ll likely just walk the length of the pool, perhaps adding gentle straight-leg kicks to my routine. According to the rehab protocol, “the buoyancy of the water decreases the amount of weight-bearing forces” on the injured areas of the knee. Even before I hurt my knee, nobody ever confused my swimming prowess with Michael Phelps’s, so I’ll be curious to see how pathetic I’ll function in the water with my bum wheel. I might even wear floaties just to be safe.

Two Week Update

2009-01-15T08:39:00.000-08:00

It’s been 2 weeks since my ACI surgery. I can’t say time’s flown by, because there have been plenty of grueling moments to prolong most days. It also hasn’t helped that I’ve thrown 1 or 2 pity parties, temporarily cursing my decision to undergo this procedure. At the same time, the surgery feels like it happened ages ago, and, though I’ve got a long way to go, at least I know I’ve made some progress. In any event, remaining almost exclusively at home, spending most of the early days in bed, has jacked up my sense of time. Plus, I’ve been watching way too much Dora the Explorer, and that can’t be too good for my brain…

From a physical standpoint, I’m probably ahead of schedule. I realize it’s only been 2 weeks, but achieving these initial rehab goals has elevated my spirits. Trust me. I’ve been beaten down plenty of times, and I’m sure I’ll hit the wall at some point during rehab. However, having some accomplishments under my belt will facilitate my climb over those temporary obstacles. Wow. I’ve really embraced my inner philosopher. Call me SocrateJims. Or Homer Jim. No, wait, that’s too Simpsons-like. Let’s go with Aristotle Jim. Much better. Very regal-sounding.

I just started increasing my CPM again. I hit 75 degrees at the 1 ½ week mark, a relatively rapid rise. Because of the osteotomy, I’m supposed to remain at 75 until Week 3. Since today marks the start of week 3, I resumed my ROM increase. So far, the extra 5 degrees hasn’t felt any different. Indeed, the last 5 degrees of any target number are difficult. As the knee reaches the apex, the tension on the knee cap grows tighter than Joan Rivers’s face (as you can tell, I'm a big fan of face-lift jokes). Along the way, my knee’s “popped” several times. The popping didn’t hurt. To the contrary, it provided relief, much like you feel the moment after cracking your back first thing in the morning. I likely just worked through some adhesions, or scar tissue.

As I mentioned in earlier post, my OS left his practice group to open his own shop as of January 1st. Unfortunately, it was not a friendly split. Just like the practice of law isn’t strictly about providing legal advice, doctors also face business issues as well as dispensing medical advice. I don’t know the details of their split, and frankly I don’t care, except to the extent it impacts the quality of medical care I receive. Sadly, it did.

Turgeon’s old practice, Texas Sports Medicine and Orthopaedic Group, ignored 3 of my requests to transfer my medical files, as well as Turgeon’s request. Not only is this illegal and potentially exposes them to liability if something happens to my knee, it’s a stupid business decision. I’m a long-time patient of the practice group. The head doctor, Tarek Souryal, performed my shoulder surgery and evaluated my fractured vertebrae 14 years ago when I was still an SMU Law Student. Christina recently visited a different doctor within the practice to treat her wrist. Despite my long-standing relationship, the practice held my medical records hostage as part of its battle with Turgeon. My welfare, however, is not some bargaining chip to be leveraged. And it’s just fucking stupid to piss off a patient who also happens to be a lawyer. My personal legal skirmishes are legendary. Just ask the local dry cleaner who lost 7 custom-made shirts, and eventually had to cut me a check 10x greater than my initial settlement demand. There’s never been an idiot more deserving of his punishment.

On Wednesday, I stopped by the practice group to demand my records in-person. If they dicked me around, I was prepared to send them a nasty, “give me my records or suffer the consequences” letter. Although the office manager treated me coldly, she handed over my medical jacket, after charging me $25. Apparently, Texas law allows medical providers to charge patients a fee to retrieve and copy their medical records. While I think Dr. Souryal is a fantastic orthopedic surgeon, his group’s handling of this situation has poisoned my opinion of his practice.

My First Outing

2009-01-13T15:23:00.000-08:00

It was Road Trip time today. The first adventure for the bionic knee. Christina, Livi and I piled into Christina’s Sequoia for a trip to Northpark Mall. This was the first time I loaded myself into the Sequoia. Christina’s been driving her sister’s Subaru Impreza, which is much lower to the ground and thus easier to enter. But I deftly managed to yank on the “oh, shit” handles to pull myself up to the running boards, before butt-scooting across the back seat. Livi sat in the 3rd row. We conveniently found front-row parking at the mall, or, as a confused former colleague calls it, “porn star parking.” Don’t ask.

It was a pathetically short trip to the mall. I practiced placing 25% of my weight on my gimpy knee, which means octogenarians in walkers sped past me. I half-crutched, half-lumbered my way through Nordstrom’s and about 40 feet to the elevator. Totally wiped out. Livi grew frustrated waiting for my slow ass to catch up. After another 30 or so feet, I needed to rest on one of the wooden benches. I propped up my leg and struggled to gather my strength. 3-minute breather, I told myself. That’s all I need. I crutched another 30 feet before realizing I was done for the day. I felt like I had just finished one of those legendary workouts from the movie, “300.” And all I did was drag my gimpy knee a few hundred feet. Brutal.

The trip back to the car was deliberate and uneventful. Nobody plowed me over, and I didn’t face-plant at the mall. Feeling that exhausted was depressing, but I do feel a slight sense of accomplishment for making it out of the house. Baby steps. This is a marathon, no, an Ironman, and 13 days into the journey isn’t even a blip on the race course. At least that’s what I keep telling myself.

My First Follow-up with the OS

2009-01-13T09:06:00.000-08:00

Real quick. You might’ve noticed the new profile picture. I haven’t shaved since the surgery, almost 2 weeks ago. This is my “Rocky training in Siberia for the Drago fight” look. It makes me feel tougher. And like a hobo, all at the same time. Amazing, huh? We’ll see how long the beard lasts.

12 days after the surgery, I met with Turgeon for my first follow-up. He says the knee looks good. No swelling. No bruising. I’m a fast healer, I guess. I asked if the implanted cartilage cells were working. He shrugged. At this point, he said, there’s no way to tell. He joked about simply letting the black box inside my knee work its magic. I liked that expression, and added it to my profile description. Turgeon plucked out about 25 staples from my knee. In rapid fire motion, he started with the staples near my shin and worked his way up to the ones on my thigh. It didn’t really hurt. A few times, the staple didn’t come out smoothly and some of the skin surrounding the staple got ripped out, like somebody who gets a bit overaggressive removing stapled pages of paper and winds up tearing off the top corner. Next, Turgeon lathered iodine up-and-down the incision to sterilize the wound, making my leg felt like a baby back rib. He then placed a number of steri-strips across the leg. The knee looks nasty. Let’s hope the expression, “chicks dig scars,” is true.

I attached 2 photos of my knee after the staples were removed. In the first photo, sans steri-strips, the scar looks off-center. I think that's just the camera angle. At least that's what I'm hoping.

I meet again with Turgeon in 2 weeks. In the meantime, he wants me to start putting 25% weight on my bum wheel, slowly working my way up to 50%. This concept is referred to as Partial Weight Bearing (PWB, another acronym for you to remember). Either at that appointment or the next one, I think Turgeon will allow me to “open up” the brace a bit from its current 0 degree locked position, allowing me to bend the knee slightly. In perfect metaphorical fashion, opening up the brace will immediately open the door to an improved quality of life. Honestly, it really sucks spending the entire day with a peg leg entrapped in a massive black brace. It’s impossible to get comfortable in any position – laying down, sitting up, with my leg propped up on some pillows. You name it.

Sleep is difficult, at best. If I’m lucky, I manage a 3-4 hour block of sleep. Most times, I wake up every 2 hours, sometimes with my knee in discomfort, sometimes because I simply can’t find an acceptable sleeping position. I’m not used to sleeping flat on my back. Last night, for example, I couldn’t fall asleep despite getting some long overdue nookie. Like most guys, stick a fork in me after nookie; I’m done. Content. Relaxed. Ready to enjoy a solid 8-hours’ worth of sleep. But not last night. My hamstring throbbed uncontrollably, likely the result of some strenuous stretching by my PT that morning. She told me my hamstring got tighter over the weekend. Not sure how that happened, but it’s not a good sign. Anyway, after failing to loosen up my hamstring (note: never a fun thing to try at 11:30pm with a sleep-deprived wife), I alternated between whining and crutching around the bedroom. Neither worked. Finally, at 3am I decided to hop into the CPM machine. I hoped the CPM would alleviate the hamstring discomfort, and perhaps rock me to sleep. Well, the CPM went 1-for-2. My hamstring stopped throbbing, but I could never fall asleep, no matter how many times my leg rhythmically rose up-and-down. After an hour in the machine, I woke up Christina to turn it off. I also asked her to grab me a vicodin. Poor Christina. She’s suffering as bad as me. Thank god our pre-nup is iron-clad or she would’ve walked out days ago. I jostled around for another thirty minutes before finally finding a comfortable position. I slept for 90 minutes until the alarm woke me up. Luckily, I don’t have to be anywhere, so I fell back to sleep for another 90 minutes, finally grabbing my morning coffee at 8am.

More Ramblings

2009-01-10T15:01:00.000-08:00

• I had my second PT session. More leg bending and stretching. The PT also massaged my patella, which really weirds me out. Ever since I first hurt my knee back in high school, I get squeamish anytime somebody even brushes against my knee. I just do. In a few weeks, I’ll be expected to massage my own patella on a daily basis, something I’m dreading. The PT also performed a basic hamstring stretch. Pinning my left leg to the table, she slowly raised my straightened right leg as close to an L-shape as I could tolerate. Well, my hamstrings are tighter than Jerry Jones’s face. Even before my surgery I wasn’t flexible. I guess I should’ve taken yoga with Christina. Right now, I fear the hamstring stretches more than anything else during rehab. At the end of the session, my PT hooked me up an electro-shock stimulator. After wrapping my knee in cellophane and suffocating it in an ice pack, the stimulator sent a steady barrage of electric pricks and bolts to both sides of my knee for 15 minutes. It sounds very East German, and I wouldn’t be surprised to learn the SS used something similar. Luckily for me, I wasn’t being tortured.

• On Friday night, I got a change of scenery, moving from the bed to the living room couch so Christina and I could watch, Forgetting Sarah Marshall. Solid movie, though the guy’s excessive whining early in the movie initially made him unlikable. Plus, it didn’t help he was frontally naked in a few early scenes. Caught me totally off-guard. Movies should contain warnings about this. Thankfully, both the female stars – Mila Kunis and Kristen Bell – were extremely good-looking, Mila in particular.

• I spend 6-8 hours in the CPM machine every day. I’ve previously described the CPM as a motorized, oversizes knee bends that mechanically bends my knee. I made that description before I actually used the machine. The description remains accurate, but a better analogy would be a motorized, open-faced walking boot/cast with carpet lining. I usually use my CPM in bed. Christina lifts the machine (which isn’t exactly light) onto the bed, and slowly slides it forward until my foot rests flush against the walking boot/cast. Each day, I increase the ROM by 5 degrees. Today, I’m at 75 degrees, where I’ll remain until I see my OS on Monday. I need his clearance before going beyond 75 degrees. I can’t just turn on the machine and let the bending begin. I have to slowly work my way up to the final ROM number. I typically start at a ROM 5 degrees less than my target number, and increase it 2-3 degrees, until I reach my final ROM. It takes about 20 seconds for the CPM machine to rise 75 degrees, and another 20 seconds to descend. The first few knee bends are difficult. As my knee reaches its ROM apex, my body tenses despite my best efforts to remain relaxed, forcing a grimace during those final few degrees. After all, my knee is grinding its way through scar tissue, or whatever junk lingers inside my surgically repaired knee. After 30 or so minutes, my knee warms up. I eventually relax, seduced by the gentle swaying of the CPM, like my knee’s a baby in a rocking chair. Sometimes I read during CPM time; sometimes I nap. The other day, we took our CPM show on the road to the living room floor. Christina needed to do some PTA work on the desktop computer. Because the portable DVD player wasn’t working, I did my CPM on the floor in front of the living room TV. I watched 2 more episodes of Mad Men. Great show. Anyway, the floor is far less forgiving than my bed. While the bed “gives” a little when my knee lowers to 0 degrees, the floor holds steady. Consequently, my knee hyperextends fully. It’s like having a UFC fighter slap on a knee bar. And this discomfort doesn’t go away no matter how warmed up my knee gets. Not good times. I don’t think I’ll be doing my CPM on the floor anytime soon.

Random Musings

2009-01-09T07:12:00.000-08:00

I’ve got a couple of un-related things to share. Actually, they’re all related to my bum knee, but that’s pretty obvious at this point. I just can’t combine them in the same neat, packaged story as my previous posts, and alone they aren’t worthy of “feature” status as a stand-alone blog entry. But they’re still important enough (relatively, of course; “everything in life is relative” is one of my favorite expressions) that I wanted to share them.

• Fierce independence – On Thursday I continued my series of “firsts.” I got in and out of the bed on my own for the first time. I brushed my teeth in my own sink for the first time (previously Christina had brought a toothbrush and cup of water to bed). I used the grown-up potty for the first time (though I missed my urinal bottle, which is frightening). Later that day, I used the Cadillac of toilet seat risers for my first poop. I’m not sure which was odder – dumping on an elderly crapper without incident, or going 8 days between poops. And, drumroll please, I showered for the first time. Major adventure. I had to disrobe before crutching from the bed to the shower. There’s nothing more humiliating than naked crutching. We inserted a shower seat in the middle of the shower, held down by special adhesive bubbling. The seat is basically a white, plastic bench about as tall as a desk chair. There’s a red handle on the side furthest away from the shower head. I sat on the seat facing the shower door, with my left side closest to the shower head, using my right hand to grip the handle and leverage my bum knee. Getting into the shower was difficult. The doorway is fairly narrow, there’s a slight step up into the shower, and the shower seat is 1 foot away from the shower entrance. The placement alone is difficult to maneuver to, but then I’ve got to do it going sideways and backwards, on a potentially slippery surface, while keeping my right leg – which is encased in a multiple hefty bags to keep dry – elevated, and avoid banging it against things. This easily could be an Olympic sport. The shower itself was uneventful, though I felt bad for Christina because she had to sit just outside the shower, holding my right leg just off the ground. I did the best job possible. I still stink, but I’ll no longer turn heads. I figure I did no worse cleaning myself than little kids.

• Recurrence of shin pain. For the first time since Day 2, my osteotomy hurt. Perhaps the pain was a gentle reminder that I pushed myself too much during the day. Whatever the reason, I realized that life really sucks when your shin throbs uncontrollably.

• Home PT. With Christina’s help, I completed my first round of home exercises. After postponing the start of PT an hour or so because my shin hurt, we removed the knee brace on our own for the first time. Christina was more nervous handling my heavily bandaged knee than holding our oldest child as a newborn. We should’ve stuck on my leg a large “FRAGILE” sticker.

PT Session #1

2009-01-08T06:45:00.000-08:00

I accomplished a series of “firsts” today. First week post-surgery. First trip out of the house. First PT session. First time surfing one of those websites (ok, that one’s not true). And, first time seeing the Franken-Scar. That’s right – the PT removed all of the knee bandages, and I got a birds-eye peek at that monstrosity. Christina snapped a few shots on her cell phone, and those pictures are posted below. Christina and I agreed that the knee looks much worse on camera.

My PT is a 50-ish lady, Judy Holmes. My OS described her as the tough-loving type, though he said she always dishes the pain with a smile. Sadistic Judy might emerge over the next year, but I met a polite, polished, well-traveled woman who manipulated my knee while simultaneously sharing her German travel adventures. Christina, who lived in Germany for several years, remained with me during PT. Imagine the joys of hearing about Wurzburg, Neuschwanstein, and Stuttgard, or some other place I can’t pronounce or spell, while my knee is grinding through 14 layers of scar tissue. (Not that there’s anything wrong with German cities). At one point, I thought Judy got so engrossed in her conversation with Christina that she forgot about my gimpy knee. But then I remembered nobody could ignore my foul body odor. I haven’t showered since the surgery, exactly 1 week ago. I’ve had a couple of “baths” with baby wipes and hot towels, but trust me -- I need a full-fledged hosing; the kind of shower where you burn through two bottles of shampoo. We’re definitely throwing away every bed sheet used this past week. Today, I was so stinky (chorus: How stinky were you?). I was so stinky that I scared away the bums panhandling outside the PT building. Buh-dum-bum.

The PT session went well. My knee has little swelling and minimal bruising, all pretty shocking considering it’s only been 1 week since my knee endured a significant amount of trauma. Judy thought the knee is healing well. The scar, in all its glory, was a freaky sight to behold. The doctor can warn you about winding up with a 13-inch scar. But, with the staples still in, you can never be prepared for the sight of a metallic bolt snaking up from your shin to your lower thigh. My scar looked like miniature railway tracks. Or a zipper on a kid’s coat. Seriously, you could zip up my 3-year old with that thing.

Ok, here are 2 pictures of the scar, one showing it vertically, the other a horizontal angle. The yellow string running parallel to the scar below the knee is just leftover tape. In the horizontal picture, I think my leg looks creepy, like the leg of a really old man or something out of a morgue. My leg still has a solid tinge of yellow-orange iodine which clashes with my really pasty undersurface. I think that actually distorts the photo’s coloring a bit. I also think my leg looks weird shaved, even more so because it’s partially-shaved. In the vertical scar photo, you can see the hair growth on the top of my thigh. Anyway, enjoy the pictures. I’ll post another batch after Turgeon removes the staples.

Judy says my flexion and leg strength are greater than most people at 1 week out. (I asked her to put the gold-star on my brace). I’m currently at 60 degrees on the CPM. Today, she measured my flexion “free-standing” – which means bending the knee over the edge of the table on my own. I hit 55 degrees without effort. Judy says most people fall well short of their CPM number, especially early on, so she was pleased with my progress. She demonstrated a host of various ankle bends (with and without bands), leg raises, and side abductor moves, and gave me a list of 6 exercises to do each day on my own. I start my home therapy tomorrow. For the foreseeable future, I’m meeting Judy twice/week. And so the fun begins.

(Quick archiving/labeling note: From here forward, I plan to label my PT sessions by week, and probably note my OS visits by number. My first visit with Turgeon is on Monday. Each post will also contain a label for the post-op week number. This might help you search through postings or find an old one, assuming that’s possible. It will help me track the progress I’ve made)

The Chills

2009-01-06T11:17:00.000-08:00

Every morning or evening (sometimes both), I take a leisurely stroll around the bedroom. It’s kind of like mall walking, except that I’m on crutches and I don’t travel further than 20 yards. Plus, it takes about 10x as long to get ready for the walk and the subsequent “cool-down,” as it does to crutch around the room.

After 5 days, we’ve developed a pretty decent routine to get out of the bed. I sleep on the right side of the bed, closest to the door and the bathroom. When I roll out of bed (not literally, of course; that would hurt. Plus, I’m not 3 years old), I lead with my gimpy right knee.

First, Christina “clears the runway,” moving anything clogging up the area surrounding the bed. I slowly sit up completely erect. Christina gingerly places both hands under my right leg and, using my left leg as a propeller, I pivot my butt sideways until Christina guides the right leg to the edge of the bed. Sometimes we do this in one shot; sometimes it takes 2-3 slides/shuffles. Eventually I reach the edge of the side of the bed, with both feet dangling over. My right leg, however, is not allowed to touch the floor, or “bear weight.” The only time my right leg touches the floor is when I use my big toe for balance. Christina hands me both crutches, and, exploding off my left leg, I hoist myself up to my feet, keeping my crutches splayed at wider than normal angles for increased balance. I generally pause for a moment after standing up, to ensure I don’t immediately topple over with sudden dizziness. For normal, able-bodied folks, this process should take no more than 2 seconds; 3 tops. It takes me a little more than 2 minutes, and then another 30 seconds to recover before beginning my lap.

Standing up really isn’t that painful, so long as I avoid any odd tweaks to the knee. Or if Christina gets angry at me and drops my leg, which hasn’t happened. Yet. Standing up, however, releases all the pent-up blood flow that remained idle while I was flat on my back, creating a monotonous throbbing pain throughout my leg. Pain, I can handle. Even if my shin hurts, I simply find my happy place. Immediately. Like I’ve said before, the screws inserted during the osteotomy hurt the worst.

Once I regain the color to my face, it’s time to begin my leisurely crutching stroll. After gathering my composure, I slowly crutch my way left, down the side of the bed, squeezing my crutches between the edge of the bed post and the oversized green chair our neighbors gave us last year. Christina loves reading in this chair. From there, I continue my counter-clockwise movement to crutch along the foot of the bed, which stretches about 6 yards, or a good Adrian Peterson carry. I could turn left again back down the far side of the bed, but the alley there is a bit narrow and by this point I’m running out of gas.

It’s time to turn around. Looking like the talented hip-hop artist I secretly am, I pivot around 180 degrees on my left foot in 3 or 4 choreographed hops, until I’m facing the opposite direction. Actually, I’m really not that rhythmic, so this is when I fear falling down the most. I maneuver my way back to my starting point, with my butt resting on the side of the bed. Again, I take a few moments to recover from my strenuous outing. Phew, crutching back-and-forth across the bedroom really taxes the body. It’s my personal Ironman Challenge. I just don’t want to be the guy on the highlight shows who spasms across the finish line in complete darkness.

Normally, this activity is notable only for the times I tweak my knee or shin bone. Last night, however, was a different story. After I returned to my prone position on the bed, I suffered from a terrible case of the chills. My teeth chattered for 10 minutes, like one of those denture props given as gag gifts. The symptoms were so over-the-top that a stranger easily would’ve thought I was faking. I couldn’t stop shaking. My chest and legs convulsed uncontrollably. Even my bum knee shook, which frightened me, though it didn’t cause any pain. In some ways, it was kinda cute seeing my gimpy knee wiggle inside the mammoth knee brace, like watching a small child playfully struggle in the strong arms of a parent. For unknown reasons, I tried to picture my knee in a tuxedo t-shirt because, as Ricky Bobby said, a tuxedo t-shirt says “I want to be formal, but I’m here to party.” Like I said, drugs make people think of odd things. You can only imagine what the vicodin is doing to my already distorted mind.

My body just felt like it got pulled from the Artic. Not even the magical Tiger blanket Nanna gave me as a child could keep me warm. I mean, Tiger blanket cures all. Not this time.

Eventually the chills stopped, and life returned to normal. Well, as “normal” as ACI recovery can be. I guess my body finally exuded the yoga-esque calmness needed to end the shakes. A few minutes later I finished Disc 2 of Season One of Mad Men. Great show. Anyway, very odd way to end the day.

My first PT visit is tomorrow (Wednesday). I have no expectations, only that the actual therapy session will hurt, as will getting in and out of the car. So far, I’ve encountered no major difficulties with the CPM machine. I’ve steadily increased my ROM 5 degrees/day, as instructed, going from 30 degrees on the night of the surgery to 60 degrees today. In other words, I remain “on schedule” through week one of my anticipated 78-week rehab (1 ½ years) schedule.

The Surgery Hangover

2009-01-05T10:59:00.000-08:00

People historically spend New Year’s Eve under the influence, and then the following day they battle evil little gnomes playing ping-pong between their temples. My experience, frankly, wasn’t all that different. In fact, the evil gnomes inside my head kept me from blogging until Sunday night. Or maybe that really was Kathy Bates from Misery hovering over my blog and gimpy knee, declaring “I am your number one fan!” Drugs make you see weird shit, people.

But first, an important announcement. Over the past 4 days, I shattered Kobayashi’s world record for most Graham crackers consumed. I didn’t just break his record. I put up a number beyond the reach of even Joey Chestnut after a one-week fast. This was like Babe Ruth doubling the single season home run record in back-to-back years.

Ok, here’s the big picture -- the surgery went fine, at least as well as can be expected. The lesions were larger than they were during the scope, which was expected. I won’t know their exact size or particulars until my first follow-up appointment on Jan. 12. The OS did tell Christina in the waiting area that my knee was a mess. I’m a “knee-abuser,” he likes to say. I’m not sure if that’s his way of being funny or just his favorite adjective.

Anyway, here’s how the Dec. 31st surgery unfolded, as well as Jan. 1st, or what I like to call the single worst day of my life. The next few days kinda blended together, so I just summarized them collectively.

I arrived at the surgery center at 6am. A white cardboard box with a purple and green “Carticel” logo greeted me at the reception desk. Those were the vials of my knee cartilage. Somehow, I didn’t envision this process beginning with my cloned cells sitting in a non-descript box waiting to be checked in by a receptionist in desperate need of a second cup of coffee. Kinda took the sci-fi edge off the experience, you know? But at least I knew the surgical team wouldn’t be waiting around for the FedEx guy to show up.

This surgery got underway much faster than my scope did 6 weeks ago. The anesthesiologist walked me through the risks, etc., and began describing a femoral nerve block when the OS entered the room. Turgeon simply said, yes, you’re giving him the nerve block, told Christina to kiss me good-bye, and announced he was ready to go. All business. Turgeon had on his surgical game face.

During the last surgery, I remained awake as they wheeled me back into the OR. The anesthesiologist and I actually talked about the current economy and its impact on law firms before I went to sleep. Very sophisticated pre-op conversation. This time, I vaguely remember getting stuck with the needle used for the femoral nerve block, and I was out cold before we left the waiting room. The last thing I remembered before going under was how my left leg – the good leg – wouldn’t stop twitching. I don’t know why. Nerves, maybe? Buh-dum-bum. Thank you, thank you. I’ll be here all week.

The surgery lasted about 3 hours. I awoke in a haze of drugs and was unable to keep my eyes open for longer than 4 seconds. But I was able to cram down 2 packs of Graham crackers and a bottle of Sprite every 3 minutes. I was just starting my 4-minute mile pace. I thought the OR staff might leave a cloned hand in the bed next to me as a joke. I guess they don’t share my sense of humor.

At this point, I wasn’t in much pain. It turns out I just couldn’t feel any pain yet because the nerve block was still in effect. The pain – that sneaky bastard – was waiting until I left the hospital. It’s kinda like a car that stops rattling the second you arrive at the mechanic's shop. It’s not fixed; the car’s just playing coy. It was time to leave the safety of the surgery center for the very dangerous Casa de Etri.

FULL DISCLOSURE – TMI WARNING. I don’t get embarrassed, but the rest of the blog entry contains a smattering of Too Much Information. Fair warning.

We arrived home and our bedroom was set up like NORAD’s Command Center. Well, if NORAD had baby wipes and a plastic bottle urinal on a king-sized bed in the middle of the room. We did have walkie talkies, but they weren’t battle-field tested. Instead, they were the Walmart kind, designed for me to page Christina in the bedroom if I needed something. I surveyed the scene like an intrepid field general and quickly realized the next few weeks of recovery would provide a sneak preview of what Christina and I could expect when we’re 90, assuming she hasn’t traded me in for a younger cloned knee. Actually, now that I think about it, the army reference isn’t too far off. The evening before the surgery, I got the military haircut. I figured I wouldn’t be able to shower regularly, if at all, these first few weeks. The downside is that when I eventually emerge from hibernation with the shaved head and bandaged leg, I will look like an injured Gulf War veteran. That might lead to some awkward moments.

Since the surgery, I’ve spent 23 hours, 55 minutes of each day lying flat of my back. Incapable of performing even rudimentary functions, I now fully appreciate why the elderly quickly lose the will to live once their dignity goes. I can’t understate enough how totally useless I’ve been. Christina quite literally just had her 3rd baby, only I need more attention than the occasional breast-feeding and burping. Luckily for all involved, I haven’t needed a diaper change, but I’ll get to that shortly.

Let me state clearly that Christina has been a champ (she demanded that I acknowledge her assistance publicly). She’s easily the front-runner for 2009's Wife of the Year. I need Christina’s help to do anything. From propping me up so I can shovel down another batch of those record-setting Graham crackers, to loading me into the CPM machine for my 3 daily sessions, to replenishing the ice in my polar-care coolant. I can’t imagine going through this alone, or without somebody as unconditionally giving as Christina has been. For her handsome reward, I promise to get her some really swell hand lotion. Nothing says a combined, “thanks” and “I love you” more than the gift of hand lotion. Just kidding. The keys to the castle are yours; just remember we live in a gov’t-funded castle.

The first time I sat up in bed with Christina’s help, I turned whiter than a KKK rally. Since ghastly pale isn’t a good color for me, we agreed it would be wiser to use a urinal rather than battle excruciating pain every time I went potty. Honestly, I’m a bit disappointed I haven’t used the Cadillac of toilet seat risers just yet. I know you’re anxiously anticipating my first report. But the urinal has not been without its joys. One of the small pleasures I enjoy each day is using the walkie talkie to advise Christina that I have just gone potty, which is really just the polite way of telling her to empty my bed pan. I know she looks forward to those calls, too. One time, I must’ve taken too much glee because she “accidentally” failed to dry off the urinal, so I got a nice little treat the next time I peed. Women are evil, even those that provide unflappable care.

I was about to detail the moment the femoral nerve block wore off and I accidentally triggered the screws inserted during the oseteotomy by firing my quad muscles, but I won’t channel my inner-Stephen King to share the horrific details. I’ll just say it’s the worst pain I’ve ever felt, like a piping hot knife slowly slashing across your shin bone. The pain went away about 40 minutes later, after I called my OS and he berated me for being an idiot for tying to move my quads. Point taken, sir.

Ok, I think that’s enough to memorialize my surgical and immediate post-op experiences. They say each day the knee gets a little bit better, so, in my opinion, that first year can’t pass soon enough. Like Short Round famously said, “Hold on lady. We go for ride.”

Final Preparations

2008-12-29T19:59:00.000-08:00

With less than 2 days until D-Day, I’ve got Europe’s “Final Countdown” running through my head. Of course, Final Countdown brings mixed memories. The song reminds me of Arrested Development’s Gob performing magic tricks and making a high school mix tape – Final Countdown was the first song on Side A of the CasEtri. It’s a tough call which is more fitting of a knee surgery countdown.

I met with my OS this morning to go over the last-minute paperwork. Most of it was routine – hearing the standard admonition not to eat or drink after midnight; receiving a prescription for powerful narcotics; and signing a waiver acknowledging all the bad possible outcomes (always a personal favorite for lawyer-patients). I did, however, learn something new. My surgeon’s starting his own practice in 2009. He spent the first 20 or so years on his own before joining the current practice a number of years ago. He brought his own staff with him then, and all of them are leaving with him now. His new practice opens January 1st.

My first thought – Oh, shit. Will he still be on my insurance plan? This doesn’t impact the Dec. 31st surgery, but might impact the dozens of follow-up appointments. EOBs full of evil out-of-network charges instantly flashed before my eyes. But Turgeon says the insurance won’t change. He picked all of his insurance carriers and medical supply contacts prior to joining his current practice, and he’ll keep them when he opens his own office. At this point, BCBS still lists him as a “preferred provider” for 2009, but it also still shows his old address. As my father wisely counsels, it’s beyond my control so there’s no need to worry right now.

After leaving the doctor’s office, it was time to pick up some last-minute items. We went to Dougherty’s Pharmacy, which, fittingly, resembles a 1950’s Mom & Pop Dime Store. In fact, I think most of the shoppers in the store today could’ve been customers in the 50’s, too. Except for the cashier, Christina and I were the only folks younger than 350 years old. All of the store signs were written in 48-point font.

A tad bit embarrassed, I asked the cashier where the shower seats and, ahem, toiler seat risers were located. At first, I wanted to lie and tell him the items were for an elderly relative. No dice. I quickly gave myself away when I started “test-driving” the different toilet seat risers. I’m not kidding. I took a couple of mock poops before making my final selection.

The store offered 2 options: (1) the toilet seat shaped like a walker with a slender bowl-rim suspended in the middle, and (2) the oversized toilet cover that rises like a skyscraper 5 inches above the bowl. After hurriedly squatting back-and-forth between my toilet seat options like an antsy 4-year old, I settled on the oversized riser. Made by Nova, the heavily molded toilet seat provides luxurious comfort, as well as side handles that allow me to push off back to my feet. I consider it the Cadillac of raised toilet seats. I have a feeling I won’t want to give it up even after my knee heals. I know George Costanza wouldn’t. For my shower seat, I chose a basic white bench with a single red handle, completing our bathroom renovation. Unfortunately, Dougherty’s refused to throw in a free Driving Miss Daisy DVD.

Anyway, here's the bottom line:

Toilet seat riser -- $85.

Shower seat -- $55.

Geriatric purchase experience? Priceless.

Rehab is kinda like pregnancy

2008-12-21T18:44:00.000-08:00

No matter how much we empathize, husbands simply can’t grasp what their wives experience during pregnancy. Gaining 50 pounds? Perhaps. Craving bizarre food combos? Maybe. But it’s impossible for guys to understand what it feels like to have something kicking around inside our bellies. And no, that undercooked beef burrito we grabbed from Taco Bueno at 2am doesn’t count.

Rehab might be the closest we get. Both last about 1 year, and both are littered with time-stamped milestones, as patients are expected to reach certain targets at 8 weeks, 5 months, you name it. Of course, pregnancies chart the growth of a human being, like the formation of a baby’s lungs, while rehab tracks how many degrees a knee can bend. Subtle differences, to be sure.

At my last appointment, I received the ACI rehab protocol. Good lord. The Dallas Cowboys playbook isn’t this detailed. It breaks down my 52-week PT schedule into 4 broad “phases,” similar to pregnancy’s trimester approach. Um, my wife’s shaking her head right now. I think that’s her signal that the rehab-pregnancy comparison has gone too far. Time to stick with rehab.

Ok, the first part of the rehab is called, the “Protection Phase.” The goal is to protect the implanted cartilage cells, which rest precariously inside my knee like recently pored concrete. Most importantly, my knee must remain “non-weight bearing,” or NWB, during Phase 1.

As soon as I get home from surgery, rehab begins. I’m not kidding. There’s a rehab assignment for Day One. 6-8 hours after the surgery, I initiate Continuous Passive Motion (CPM) for 8-12 hours/day, something I’ll continue until my knee reaches a certain Range of Motion (ROM). Yes, I realize I’ve already used more acronyms than a CIA briefing. Hopefully I’ll use only 2-3 acronyms regularly. Most are fairly self-explanatory, but I’ll post an “Idiot’s Guide to ACI Acronyms,” just in case you need help.

For the first 6 weeks, my best friend is the CPM. The CPM is a motorized knee brace which mechanically bends my knee in slight increments. The automated movement helps cell growth, and also creates a smooth surface along the cartilage surface. I’m allowed to progress my ROM by 5-10 degrees/day, “as tolerated.” Wait, does this mean I have to stop the moment I yell out in pain? Can I scream twice? Can I chomp down on one of those horse bits to deflect the pain? My interpretation of “as tolerated” might be a little different than others. Anyway, I need to hit 120 degrees ROM by Week 6 before I graduate to Phase 2, which means I need to be able to bend the knee all the way backwards. When I’m not using the CPM, my knee remains locked in a brace at 0 degrees at all times, including during sleep. Because it’s my right knee, I can’t drive during Phase 1.

In my opinion, the rehab protocol omits critical tips, like, “If you wake up in extreme pain, pop 3 vicodin. Repeat every 15 minutes if pain persists,” and “Ring little bell when you can’t reach your book or laptop. If ignored, demand compliance from wife. When she tells you to fuck off, apologize, point to injured knee, and beg for sympathy.”

Some of the rehab is redundant. There are only so many ways to say, “Bend your knee a little bit further.” However, seeing the simple, incremental targets spread out over one year is finally driving home the difficult journey I’m about to embark on. Ok, that last sentence sounded really lame. Or like a contestant on The Bachelor. But this is definitely The. Most. Dramatic. Blog. Post. Ever. Well, at least until the next post. Stay tuned.

D-Day is approaching

2008-12-19T15:52:00.000-08:00

The surgery date has been set – 12-31-08. Yup. New Year’s Eve. Or as Christina likes to say, “Happy Knee Year!”

People keep asking me how I feel about the upcoming surgery. Remember Clubber Lang’s prediction in Rocky 3? Pain, said Mr. T. Before this surgery, I think the time I was most scared was when a bunch of seniors at my fraternity forced me to eat 3 whole jalapenos sober without a chaser. That was my punishment for being the Problem Pledge. I think this surgery will hurt much worse, though the vicodin should take away some of the sting. In some ways, I feel like the kid who fucked up and knows that momma’s waiting at home to whoop his ass. It’s time to face the music.

Some might suggest I’m being a bit selfish by scheduling the surgery on New Year’s Eve. Well, those people would be right. I am extremely selfish. I plan to milk my upcoming incapacity like an industrious farmer after 4 Red Bulls. But I didn’t screw up any special New Year’s plans. We weren’t heading to some swanky ballroom to sip champagne at midnight while being showered with confetti. Nor did we plan on hitting any 4am raves at secret warehouses.

Long gone are the days of paying $40 cover charges to drink unlimited 8oz plastic cups of beer and wine. Honestly, after having kids our New Year’s became pretty lame. These days, we watch the ball drop in Times Square, consider that close enough, and call it a night. I’m lucky if I’m still awake for some New Year’s nookie. Frankly, this year’s New Year’s Eve won’t be too different. Well, except for the nookie. I can handle the pain, but not the lack of nookie. It’ll be like sophomore year in high school all over again. Only without the acne, thank god. Anyway, this year I’ll watch the festivities with my SUV-sized knee draped over some pillows, bitching that the rabbit ears are obstructing the view on the ancient 13” TV in our bedroom. Part of me, however, is secretly excited about this New Year’s. I’ll be armed with a bottle of vicodin and a truckload of Ryan Seacrest jokes. That’s pretty tough to top. I’m pretty confident I’ll be giggling at midnight.

The decision to schedule the surgery on New Year’s Eve was strictly a timing and monetary one. Because of the lengthy rehab, I wanted to schedule the surgery as soon as possible. December 31st happened to be the first day the cloned cartilage cells would be available. Luckily, the surgery center and Dr. Turgeon were also available that day. Actually, it’s pretty good timing for everybody involved. The OR staff gets to stuff their pockets with all the leftover narcotics from my surgery before heading out to their New Year’s cocktail parties. And for me, having the surgery on the 31st brings the added bonus of lowering my surgical bill. I’ve already incurred a large chunk of health expenses this year. This surgery will put me well over my maximum out-of-pocket exposure. On January 1, that number starts over, so by sneaking in the surgery on the last day of the year, I’m saving a few dollars. Not only am I devishly handsome and gimpy, but I’m practical. It’s a wonderful combination that Christina can’t resist.

The DeNiro Effect

2008-12-14T19:11:00.000-08:00

Robert DeNiro is probably my favorite actor. Swayze and Van Damme are right up there, too. Unlike those other guys, however, DeNiro’s IMDB is full of quality movies. No matter the role, he’s always a bad ass, whether it’s a mob movie (Goodfellas, Godfather or Casino), action flick (Heat), or just a plain, great movie (Sleepers, Midnight Run or Meet the Parents).

Now, what does DeNiro have to do with my upcoming knee surgery? Well, DeNiro was a master at transforming his body for movies roles, and I’m about to experience my own transformation, though mine will be unintentional.

DeNiro’s greatest performance, I think, was in Raging Bull, the story about boxer Jake LaMotta which earned DeNiro an Oscar. In Raging Bull, DeNiro hit both ends of the weight spectrum, getting shredded to play the heavyweight champ in his prime, and then gaining 60 pounds to play the elderly Jake LaMotta.

I’m in the midst of my own roller coaster weight gain/loss. Thankfully, my swings aren’t as extreme as DeNiro’s. At least not yet. If I gained 60 pounds, I might be eligible for The Biggest Loser. I couldn’t handle that. Something about really large people in skivvies standing on oversized scales seems wrong. Or Dutch. That might be normal for them.

While weight gain might seem a bit trivial -- or vain -- considering the severity of the surgery, I’m legitimately worried about looking like a 70-year old Jake LaMotta next summer. I realize that once my knee heals I should be able to lose any weight gained, but for some reason I’m almost as worried about how fat I’m gonna get from inactivity as I am about the grueling rehab process. I don’t know why I feel that way. I just do. And yes, I recognize I sound like a 15-year old girl. But my blog readers deserve nothing less than my un-filtered emotions.

Since I re-injured my knee this summer, my weight’s swung 5-10 lbs several times. After first injuring my knee, I couldn’t exercise for a few weeks because the back of my knee swelled up like Barry Bonds’ noggin. Add 5 pounds. After the swelling subsided, I decided to have surgery, but postponed it for a few months. I decided to get in the best possible shape pre-surgery. Plus, I wanted to get my body “bikini-ready” for my October vacation to Maui. I realized most beachgoers would be staring at my wife, not me, but I still have pride. Besides, you never know when the paparazzi might be lurking.

Over the next 2 months, I ate extremely healthy. You know what? Eating right is 100x more important for getting in shape than lifting weights or doing cardio. Had I known that I never would’ve eaten all those chicken patties back in high school. I single-handedly kept Tyson’s in business. Anyway, 12 pounds disappeared. I didn’t win any bodybuilding competitions, but I trimmed up considerably. I joked that instead of 6-pack abs, I had a 2-pack. I’m not going to lie: In Maui, women swooned when I took off my shirt. I kept waiting for the shirtless beach photos to show up in The Enquirer, but no such luck.

I came back from vacation feeling bloated; that happens when you gorge on nothing but burgers, beer and ice cream for 1 week. Add 5 pounds. Unfortunately, I wasn’t able to drop those pounds right away. After we returned from Maui, I went out of town twice, and my eating and workout schedule always gets jacked up when I travel. And then it was time for Part One of the ACI surgery.

Arthroscopic surgery really isn’t that big of a deal. After all, pro football players routinely play a week or 2 after getting scoped. But I’m not a pro athlete. Frankly, I’m not even a true professional. I mean, I work for the government. Anyway, I hardly exercised for the next 3 weeks while my knee healed. Add 5 more pounds. But the great thing about eating right is that once you’ve done it, your body quickly recaptures the virtues of eating veggies and grilled chicken. It’s like riding a bike. After a week or 2 of eating right and exercising again, I’m back to my Maui weight, though my abs lost half of my 2-pack. I guess I’m sporting a 1-pack now.

I’ve got 3 or 4 weeks to reclaim that 1-pack. But I’m not stopping there. In fact, I plan on carrying over this attitude to rehab, and there’s nothing more hardcore than showing up for PT with your face painted. If I fail, I might be the first contestant on The Biggest Loser who’s “before” picture was half-red, half-black.

Still waiting. . .

2008-12-07T10:51:00.000-08:00

No surgery date yet. I joked that the cloning company, Genzyme, must be having a good year. It seems like every company is stuffing sales into year-end to make its numbers, yet my surgery likely will get pushed into 2009. I’ll welcome in the New Year, and then quickly accomplish everybody’s #1 resolution: getting a cloned knee.

On Friday, I met with my OS and Jimmie, a specialist from Genzyme. Jimmie was great. Part salesman, part trainer, he’s knowledgeable about the ACI surgery, having trained many orthopedic surgeons in this innovative procedure over the past decade. More importantly, Jimmie’s a terrific communicator. Before the OS arrived – by the way, why do doctors always keep you waiting for 40 minutes? – Jimmie and I spoke at length about the surgery and rehab. For each knee component, he used an analogy to enhance my understanding of the role each part of the knee played. He’s like a medical translator. This isn’t to diss Turgeon the Surgeon. Turgeon is personable, takes his time, and patiently answers all of my questions. He’s also regarded as one of the top ACI surgeons in the area, which, obviously, is kinda important. Sometimes, however, Turgeon forgets that I don’t speak medicalese, and Jimmie bridged that gap handily.

As a representative of Genzyme, one of Jimmie’s jobs was to review my medicals and confirm I’m a candidate for ACI. Jimmie quite bluntly told me, “Not everybody qualifies for ACI. Genzyme doesn’t want the wrong candidate who will screw up the company’s success rate.” Jimmie was like the anti-Chief Burrell, the Police Commissioner from The Wire who wanted to “juke the stats” to make Baltimore’s crime rate appear lower. I qualified as a “good candidate” for ACI. I’m not sure if that’s meant to be a compliment.

The 3 of us reviewed my MRI results and discussed the 2 lesions to be filled. The lesion on my patella is the smaller of the 2, but it’s trickier than the trochlear groove defect. Patella lesions historically have the worst ACI track record, largely because patellas absorb most of the pounding on a person’s knees. Moreover, the underlying injury often screws up knee alignment, which further increases stress on the knee. Over several years of trial-and-error (an expression that doesn’t comfort patients), surgeons discovered ACI implants in the patella were more successful when combined with a procedure to alleviate the stress on the patella. Jimmie said adding the second procedure improves the success rate by almost 20%. Usually, this means re-aligning the patella that got jostled during injury. In my case, however, my knee alignment is stable. Basically, my knee’s perfectly fine. Well, except for the 2 holes that shouldn’t be there.

Nonetheless, a similar procedure can still alleviate stress on my patella. During the ACI surgery, Turgeon will slightly raise my patella by a smidgeon (not a precise medical measurement). This doesn’t sound like a lot, but wait until you hear how doctors elevate the patella. In a procedure called a distal realignment (my particular version is called a Fulkerson), the surgeon breaks the edge of the tibia bone and re-connects the bone to the raised patella with a handful of screws. Yes, it’s supposed to be as painful as it sounds. Of everything that the knee suffers during the ACI surgery, this is supposed to hurt the most, though the pain generally subsides during the first 2 weeks. Of course, the screws will set off airport medical detectors for years to come...

Right now I’m waiting on final approval of the surgery from Blue Cross, Blue Shield, my insurance carrier. BCBS was at the forefront of coverage for ACI, and, according to Turgeon’s insurance liaison, covers ACI. Under my particular insurance plan, all surgeries are covered at 100%, minus $100 surgeon fee. Unfortunately, insurance carriers aren’t known as benevolent entities, even during the holiday times, and since ACI surgery costs $30,000 – new knee or new car? – I’m expecting some hassle over coverage. Don’t be surprised to see blog entries entitled, “BCBS is the devil.”

Once BCBS approves the surgery, Genzyme will produce 4 vials of my cartilage cells. Each vial contains 12 million cells. Turgeon doesn’t think he’ll need 48 million cells to fill my defects. I’m hopeful I’ll be able to take the leftovers home in a “To Go” vial. You know, just in case I need a few million cartilage cells some day.

Pre-Op Preparations

2008-11-30T13:21:00.000-08:00

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...

Knee Injuries (yes, plural)

2008-11-25T08:02:00.000-08:00

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.

The Beginning

2008-11-22T18:13:00.000-08:00

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.