MRI, Part II and a Little Road Rage

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.

Random Knee Thoughts, 8-Month Edition

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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