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.”
Showing posts with label screws. Show all posts
Showing posts with label screws. Show all posts
Saturday, April 9, 2011
Thursday, April 22, 2010
Welcome to the Bone Graft!
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.
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.
Subscribe to:
Posts (Atom)
