Bend that knee

One guy's ongoing discussion with his left knee

Sunday, July 31, 2005

Listening for the horn

The hardest part when you head into the tunnel is wondering how long the tunnel is. The only decisions are really how fast to push as you go through. And finally, light. Is it the light at the end of the tunnel, or a train? :) Only way is the conductor wildly honking the horn - ya just hope it's loud enough that you can here. Or in my case, at least Steadman and the PT's are listening as well :)

Feeling pretty good today - probably because I took roxycodonen before therapy today with Zach. Lissa says it has street value. Helped the pain some, but not a lot on the flexion side. Started with the bike, did some wall slides, with the pain still hammering right below my kneecap where the fat pad and buras are. Did some patella mobs. Zach then had my legs hang over the side of the table like a 5 year old in a chair that's oo big for them. He slowly moved my leg back and forth, first up towards extention to about the middle of my range for a couple minutes, and then from the middle of my range into flexion. We then tried the ball roll with my feet on a exercise ball as he rolled it towards me, and then he just held my knee and slowly bent it. Hanging off the side of the edge again, he was able to bend it to around 93 degrees - it was 70 just lying there by itself. Certainly not as good as last week, but still above 90.

Hamstring stretches, some massaging of the back of the knee, and then prone hangs where he actually pulled my leg down a bit. He also was the first person here to apply overpressure directly over the knee. One hang pushing just below the knee and one just above, and he slightly bounced as well. He said this was instead of the JAS brace. Finished with 20 minutes of GameReady ice, which I was able to tolerate pretty easily. Checking my swelling, we're at 17 at knee cap, just under 17 inches 2 inches above, and 15.5 two inches below.

Slurpee count will probably decrease dramatically, as it's tough to hold a Slurpee with crutches. Maybe I'll find kind souls who will buy me Slurpees just like people buy underage kids beer.

Visit from Steady

Another couple sessions yesterday, with a little backwards movement. Had trouble with flexion and extension - I went back and forth between the bike and wall slides for almost an hour, since Luke was pretty busy in the morning, but couldn't get more than 90 degrees. Fairly tight with pain below above the medial part of my kneecap and I have stretching pain in one tendon on the back medial side of my knee. Steadman can by and sat down, and Luke shared we had regressed somewhat and were having trouble with the JAS brace. Steady push on my kneecap a bit and felt above my knee. Good new is my kneecap is still fairly mobile. We've backed off my program quite a bit over past couple days. In the morning and afternoon, bike, wall slides, patella mobs, and prone hangs (instead of the JAS brace) and then 20 minutes of ice. Even used a ice pad instead of the GameReady machine since the GameReady caused some extension pain in the tendon, potentially due to the weight of the brace.

Lunch was a pretty view - we rode the gondala to the top of Vail. Those thinks are quick - 1200 ft/minute - Vail is around 7500 ft and the top of the mountain is almost another mile up. Snow on the tops of various mountains. There was even a wedding up there. We considered moving our wedding to Vail but decided against it. Glad we did that together. Lissa had some pictures that I'll post whenever I get around to it.

Steadman said in the morning he'd inject my knee with cortisone on Monday, and depending on the results, perform an insufflation on Tuesday. That's where he injects water in my knee to create pressure that potentially breaks up the scar tissue, similar to water brushing away cobwebs. I'm glad he's taking a proactive approach rather a reactive one, "Let's wait a week to see if things get better..." Swelling is still more than desired at this point as well.

Luke suggested (actually, his words where "Talk me out of this") that I have one session today to insure I get some patella mobs in to keep that fluid. Plus, trying to generate motion is a good thing. He's headed to Chile with the US Ski team for the rest of my planned time here. Lissa left this morning as well. Hopefully she had a trip as safe as ET's.

For those of you on surplee count, none on Saturday.

Friday, July 29, 2005

Working for weekend

The days have mostly run together until now. Luke recommended that I take Sunday off. So now I'll track to Sunday! Overall today was better than the past couple days, but not yet back to the week after surgery. Luke also suggested I try a percoset before therapy in the afternoon; they taste like aspirin and work about the same. My pupils do get smaller, though.

Morning: Wall slides (to 100), bike, patella mobs, extension with move into 90 degree flexion, prone massage on the back of the knee. 20 knee raises off the edge of the table. I did manage to hang in the JAS brace for 30 minutes, although I was rolling my leg side to side to try and get some relief while I was enveloped. 20 minutes of GameReady and on to May Palace, Lissa's favorite eatery in the Valley, for lunch.

This afternoon was a bit of a break - Bike for 15, patella mobs, wall slides for 10 (probably 90ish), assisted ball roll. Stretching hamstring by putting leg in air, and then ankle raises with a foam roll under my knee. Tried a couple straight leg raises for kicks, with a little success. Ice. And then an icy Slurpee.

We're headed to Ti Amo, an Italian place we ate last week - really tasty. Lissa's folks are treating us 3 months before the wedding! It's getting closer...

Thursday, July 28, 2005

ing Aaooo-uuu-cchhh

Remember that scene in E.T? Where Elliot hurts his finger, says ouch, and then E.T repeats it? Today probably hurt more than that. Tough morning again - started with wall slides, hit the bike, did some patella mobs, stretched my hamstring while on my back, did some quad sets and then Steady stopped by while I was in the middle of a set. Share the JAS challenges from yesterday, and he said, "Keep working at it..." Walked back over a second or two later and asked if I was ready for him to sit on it. "Not yet - I'll let Luke try first." Tried the JAS again, but no real luck. Dirk finish up by massaging the back of my knee and then icing for 20 minutes. A short morning overall.

This afternoon went a little better, bike, mobs, wall slides (although pretty stiff, probably barely got to 100), and then I did a quad set with a sponge ball under my knee to provide some support. Did the hamstring stretch again. Actually managed to hang on for 20 minutes in the JAS brace - one spot on the back inside of my knee was driving me crazy. Dirk then massaged the back of my knee around that spot, spent some time on my superpatella (below the quad) and also stretched my IT band (runs along the outside of your leg)

He suggested that bike some tonight and showed Lissa how to do patella mobilizations as well. He also suggested I take pain medication while there. Different than suggested by Steadman and Rae, his assistant. Tough call, this one. I'll probably have some additional conversations before I try, becuase one of the risks of arthofobrosis is additional motion beyond a normal pain may cause additional generation of scar tissue. Just another in the long lines of decisions about the knee.

You may remember the other line in ET by ET with "ouch." When ET is leaving and Elliot is crying, ET points at Elliot's heart and says "ouch?". Lissa's leaving this weekend and that's certainly an ouch. I can certainly manage, though. She's pretty much put her life on hold a couple times since this injury to help me, and I love her very much. I'm a lucky guy - thanks for everything. Including the Coke-Cherry Slurpee this afternoon.

Wednesday, July 27, 2005

Let's EAT. And tomorrow. and probably the day after...

Ok, food just arrived. Let's inventory. Large Pizza we expected: check. Cheesesticks (fried mozzarella): yep. Lasagna and garlic bread: uh-huh. Garlic Cheese Bread: Oh yeah. Soup of some sort: bingo. Salads: whatever. Chocolate Cake: "Becca is great! She gives us Chocolate Cake!" [Bill Cosby reference]

So swing on by if you're hungry later tonight. Thanks again Becca!

Rough afternoon

Luke actually said he was going to take it easy on me this afternoon, and work mostly flexion since this morning was tough. Started with wall slides and hit 108, and then did some patella mobs, and the kneecap was pretty sore, and was at around 12. Hit the bike, and managed to get the setting down to 21, and then shifted further away and rode relatively smoothly for a bit. Then used the ball with my left foot on it and rolled myself into flexion easily.

Challenges continued when I got back into the Jobst boot. The air compression likely straighten my leg a bit, and that was pretty painful; Luke actually pulled it off after watching me grimace for a bit. "I'm all for pushing it, mate, but I'm not a masochist." We then did 20 minutes on GameReady, but without much compression. Didn't even try the JAS brace.

My leg was pretty bruised in a couple places, from all the work. Luke said I should only come once on Sunday (whohoo) and only do mobs and ice/CPM tonight to let it relax. We're been pushing it pretty hard over the last week, and it's probably started talking. Not too suprising to have a setback, it's always unknown what and when they might occur. We'll see how it goes. Besides, we stopped for another Slurpee.

My future sister-in-law (why is it in-law - did they think people won't acknowledge the family of their spouse, so they have to indicate it's by law?) sent us pizza tonight! Cheese as always for Lissa and green peppers and pineapples (why pineapples - not apples, don't grow on pine trees?) for me. Thanks Becca!

A tight morning

Headed into therapy earlier this morning so Lynne could sign the shirt. I also passed along an extra Jack ball. Hit the bike for 10 minutes and then some patella mobs. Pretty tight. 10 minutes of wall slides, hitting 110, so we're staying in that range. Lying in the prone position, Luke then gently bend my knee to a little beyond 90 and back down to extension, about 4-5 times. Flipped over and then did extension holds into 90 flexion 5 times. Then slide forward to the end of the table, and did ankle raises, 10, using the biofeeback machine. Then Luke, in some form of punishment, put his knee under my ankle and then had me hold a psuedo-straight leg raise. Ow. The JAS brace was REALLY tight today - lots of stress on the back of the knee, I could only wear it for 5 minutes, and then after a brake, another 10. We switched to a Jobst boot, a big blow up boot that helps compress the entire leg to push swelling out of the knee and then finished with 20 minutes of ice. Hung out another 20 minutes or so and then Steadman swung by and said 10-110 was good, and swelling is still expected at this point.

Luke and I had a longer conversation about swelling. he said it was really normal and wouldn't be surprised if I still had swelling 3 weeks out, since the medial release can cause some decent trama. This area likely drained to create swelling behind the knee and is potentially causing some extension restriction. Also, the soft tissue like tendons haven't been stretched to full extension for over a year, so reminding that tissue isn't not supposed to be at 10 degrees will take some time. The other area that has some pain is where a good chunk of scar tissue was removed, and the tissue is still rubbing again one another as it transitions through the range. Dirk also suggested that I spend some additional time on the bike while here at the condo.

Tuesday, July 26, 2005

A geek torch is passed

Well, a knee geek one anyway. Met Lynne in person today, one of the frequent posters on the knee internet board I read. She and I had similar injuries (both flag football) and similar ranges before surgery (20-70ish). Only difference is she was smarter and found Steadman after her second surgery quickly, whereas it took me 3 surgeries and a little longer. Good news is Dirk got her leg straight and flexion up to 125! Way to go Lynne!

She also officially passed the kneegeek torch as the latest knee geek to visit Steadman and on the way to good knees. Dirk even mentioned both our kneecaps were stuck really badly to start. It was cool to see someone who was in the same spot I am at one point and doing well, even though everyone is different, at least it's feasible. I laughed at her comment - "I was always jealous of everyone else's knees while I was in therapy here. I'm glad someone is finally jealous of my knee!" The shirts she made are AWESOME! Everyone should get one and I'll probably get some for Christmas presents later in the year. We plan to check tomorrow to see if we can put one in the Howard Head PT office, and then all future knee geeks can sign it. We're not all world class athletes, but Steadman and the PT folks treat us like we are. We figure we can have a 'signed jersey' there too! The three of us grabbed dinner - it's suprising how similar our injuries and progress are and hopefully I can follow the same path. Thanks Lynne, my fiance and I really appreciated the shirt and the thoughts. It was great to talk with someone face to face. We should plan a kneegeek convention or something.

After one week of therapy, things are decent, not good, not bad. My flexion is consistently at 112/113, after some warmup, only the part from 90-110 hurts. Extension probably starts around 15 and then is ten or less after PT. Dirk mentioned today that my whole knee is still tight. Hopefully the JAS brace will help that over time. The knee is still really stiff through any part of the range at this point, and I'm still concerned about the swelling and heat that are still around the knee. It's ironic - When the knee is so cold it hurts a little, I'm a little grateful since that means my knee isn't hot enough to "overcome" the ice! If the swelling will actually drop and then the range and fluidity will hopefully develop, I think we'll be good. If not, then I think we'll have problems. That's why I'm here for a month, so if it goes bad, Steadman is around to intervene if necessary. Tough to believe I've done over 40 hours of therapy since the surgery. Set up my first week of Aug with Dirk, Kim, and Zach.

As for today's activities, nothing new. Started on the bike in the morning for 15, did some patella mobs and then wall slides (only for a couple minutes, so only to a 100) Dirk then rotated my leg around the patella tendon area while sitting on my foot, to try and gain a little more flexion. He then put my upper leg at 90 and we were able to bend my knee to 109. A few more wall slides, although I didn't put it that hard. 5 minutes of quad sets and then straight leg raises (still couldn't get these off the ground). Stretch my hamstring by raisinng my leg to 90 and doing a quad set, and then Dirk massaged my knee in the prone hang position, using a gel that was a combination of arnica and something else. Inside tendon is still really tight, but he applied some downward pressure to help extension as well. 30 minutes of the JAS brace (which I backed off again) and then 20 on the GameReady.

Afternoon was much of the same, except we skipped the wall slides and the patella tendon rotation to focus on extension. Plus, we stopped for a Slurpee at 7-11.

Monday, July 25, 2005

Another double session

Started the morning with Dirk. The morning and afternoon were again pretty similar. Started with wall slides, and think I only got to 102. Hit the bike for about 15 minutes. Dirk indicated that we'd focus mostly on extension as long as the flexion was above a hundred or so. This is enough to go up and down stairs, although down might be a tight. He then pushed harder on patella mobs than any else. Dr. Steadman wandered by in scrubs about that time. "Don't go easy on him", with a grin. Dirk indicated that a problem area can be in the superpatella region, which is the fleshy area about an inch above the kneecap. It can scar and keep the kneecap from moving. He then did what I shall deem the "extension press", where he raised my leg to 90 degrees and then had me flex my quad for 10 seconds to try and get some additonal extension. Definitely tight. He then massaged the back of my knee for about 5 minutes while in a prone hang position. The inside tendon on the back of my knee was incredibly tight.

I think did some quad sets with my heel on a foam roll for 5 minutes (10 second hold, ten second rest), and then tried to do 5 and finish off with straight leg raise (3 sets). Then did bridges,but instead of bending my knees (which Dirk said increases the hamstring pressure), I did a normal bridge and rolled the ball away from me as I contracted my quad. 20 of these for 10 seconds each. At then end of all this, my knee was about 1 fingers width off the ground with some light overpressure and 2 without any pressure. Finished up with the JAS brace (and Dirk wrapped an ice pack around my knee at the same time) and Game ready.

Afternoon was similar. I started on the bike, 5 minutes, moved to patella mobs, and then wall slides. For the patella mobs, he pulled my leg off the table and had me lean back agains the wall, which helped relax the muscles and soft tissue a little. Wall slides were to 112 (Dirk thought that's actually what we got in the morning too). He mentioned my leg was pretty stiff. "In the running for worst in a while, eh?" Yep. Mentioned Steady's worst out of 10 comments. "When Steadman says it's bad, you know it's bad...". 5 minutes quad sets, 10 sec hold, then 5x10 sec with straight leg at end, 5 sets. I couldn't get the straight leg this time, though. Ball as before, 20 bridges with rollway for 10 seconds each, and then some additional massage in prone position on the back of the knee. He then did some additional stretching, first at 90 straight up with a quad set, then across my right leg - this one really stretched the muscles, and then out sideways to my left. 30 minutes of JAS with ice(which I had to back down again after 15) and 20 of Gameready.

Happy that I either didn't lose or regained the flexion in the afternoon. I'm still having difficulty moving through the range, but hopefully that will come.

Sunday, July 24, 2005

Bloody Sunday

Well, not really. Spent a couple session with Karen, who originally is from Indianapolis. Hoosieres are everywhere. Morning and afternoon sessions were pretty similar, ironic since I finished up in the morning we just had time to eat lunch before heading back for the afternoon session. Started with wall slides and bike (and then reversed the order of the two in the afternoon. Wall slides in the morning hit 112, good that I haven't gone backwards, bad that I haven't gone forwards. Did some patella mobilizations next in both sessions, and Steadman surprisingly appeared. Said hello, mentioned my patella still looked mobile (Karen mentioned less so in the vertical direction) and asked how the JAS brace was doing. I mentioned it was easier than the dynasplint and it was mostly stretching the back of my tissue; he mentioned again the reason he didn't do the lateral capsular release was becuase the tissue was already so tight.

Morning session did quad with biofeedback, 50 10 second holds. Afternoon was calf stretches with a band. Then bridges both morning and afternoon (put your feet on a ball and lift your behind like a drawbridge) 3o times. She added another that was tough. Do as above, but roll the ball with your feet towards your rear by bending your knees. That was pretty tough. Then she put pressure over my extended knee, slightly bending it more than it wanted to, almost bouncing it. Definitely stretched the tissue underneath the knee a little more, as my heel was on 1/2 moon of foam about 2 inches off the table. Followed that both times by holding my leg, raising it straight up, and then bending it downward at the knee. Ouch. And then our good friends JAS and GameReady. I actually racheted down the JAS setting (which has gone from 0 to 1 to 2 to 4 to 5.5, this morning) to around 5 during the last 5 minutes, and then left it there for the afternoon session.

She also had some running trail suggestions for Lissa. The knee seems straighter, albeit a little, and the lack of movement in the flexion is a little worrisome. I suspect it's partially becuase that range hasn't been used in so long, so it's really stiff, plus I still have a lot of swelling. Actually had a little fluid leak through one of my portals, but nothing serious. At the end of four days, things seem good, certainly better than before. Now need to get the swelling down and the range will hopefully develop...

Saturday, July 23, 2005

A lovely afternoon

Not much this afternoon. PT again with Luke, wall slides (got as low as 112), bike, which felt pretty fluid. Hyperextension / bend alternating, and then 20 quad sets plus 3 one minute holds with the quad. Hanging leg raise, 30 minutes in the JAS brace, and then no ice (think we forgot). Headed back to the condo for some time on the CPM and some pizza! Back at it tomorrow at 10:15. Finally got some rain here, about 30 minutes of decent showers, and we can see the thunder and hear the lightening (ah, reverse that). Holding onto the progress, and have a little soreness on the inside of the knee and a little brusing as well. Hitting 15 minutes of wall slides and patella mobs for dessert tonight.

Movin' along

Hit the first PT session of Saturday - Luke had me come in a little earlier to try and match Steady's time and that worked well. Worried about swelling since that's been a big problem, and he said that was normal for now. Also said the incision for the medial capsular release can help drain, although I haven't seen anything yet. He asked how the JAS brace was working, and I said I didn't have any significant pain, just stretching along the back of the knee. He said that was good, and he didn't do a lateral capsular release, holding that in reserve (I assume that means since the soft tissue wasn't loose enough to straighten, doing that wouldn't help. Once the tissue stretches, he could do that later if I wanted to all this again) He did press on my kneecap (not sure why, actually). He also mentioned that 10-113 is pretty good, much better than before, enough to live with, but that's "not where we want you". Depending on how things go on extension, either "we'll have that lady over there sit on your knee, Luke sit on your knee, or I'll sit on your knee". Overall, good to see him and get some feedback, but nothing significant to change the protocol.

As for exercises, a little slow this morning, started with wall slides, then to the bike, then to hyperextension/litte flexion. Put my heels on a small ball and lifted my behind, known as a bridge. Did 30 quad sets, sat in the JAS brace for 30 minutes (that was a little tight today, I actually backed it off about 20 minutes it, but it was more pressure than yesterday the entire time). And finished with elevated ice with the Gameready. Felt a little sore on the knee, but probably expected after this week.

Friday, July 22, 2005

the day after the day after

Summary: Two PT sessions today with Luke, great guy. Lots of knowledge about the knee. Goods news in the afternoon session I was at 113 and 10 (as usual, there's no way I could move between the two, but it's a start). Need to keep inching upwards and downwards and see where we get.

Morning session was with Luke, again with 15 minutes of wall slides. Did some assisted knee raises with my knee hanging out over the side of the bed - I was mostly raising it myself for the last set of the 2x10, but was having a little pain in the pateller tendon. Can't quite remember the order on these, but did a prone hang for about 5 or so and I pushed down with my other leg, received an 'overachiever' for that. We then did a little extension/flexion work, where Luke would place his left hand just below the patella tendon around my knee and gently lift up my heel with his right hand. Used a biofeedback machine to provide visual feedback on how strong I was flexing my quad muscle - it has a little indicator that raises and lowers as you squeeze the quad muscle. Got a little JAS (Joint Activation System) brace, which helps to both apply slight downward pressure while seemingly pulling your tissue away from your knee, so to not create additional tension on the knee. 20 minute of elevated ice on the GameReady machine, which pumps water at a constant 37 degrees around your leg and also compresses a little. At 2.5K, it does what it should do - keep my knee freakin' cold.

Subjectively, Luke mentioned that the patella is the key to the knee and that the joint was good; not really sure what he meant by the last statement, unless he meant it was only the tissue causing real problems, not the joint. Rae said hello again and we shared the Steady suplex where he pushed on my knee under anethesia. Rae wasn't sure about biking either, as Luke had asked me earlier.

Hit the afternoon session about 2 and headed straight to wall slides for 10 minutes or so. Hit 113 at the end of them. Evidently Luke had seen Steadman earlier to ask about me on the bike, and his response was the non-committal "if he has the range". So we were a go, and I pedaled forward and backwards on a recombant bike with little pain and little hip movement. Definitely a good step. After 10 minutes of that, hit the table again with the physioball, with Luke pushing on it back into flexion and out into extension, for a couple minutes. We then again did a little extension/flexion work, where Luke would place his left hand just below the patella tendon around my knee and gently lift up my heel with his right hand. After 20-30 seconds, he would gently bend my knee to maybe 50-60 degrees, and then repeat.

Patella mobs next and tendon mobilization next. Definitely tough to get straight enough to even move the patella coming from flexion. Luke had me lie on my back, which seemed to naturally help my mechanics. My tendon was moving pretty well, and I was having the hardest time with the up/down motion with the patella, which evidently is common, since that's where the scar tissue can form (Steady mentioned in the office visit that I had lots of scarring below the patella and a little above as well). Hit the prone hangs off the table for 10 minutes as well. We then used the biofeedback machine again, 2x25 with the quad, and then two one minute holds, keeping the monitor within the yellow, higher band. Then to the JAS brace for another 30 minutes, and 20 minutes of GameReady ice. Did I mention that thing is freakin' cold. Evidently, I startled a couple other younger patients who saw my knee. I'm still about the same level of pain but still have some significant swelling. Hopefully we can get that to drop soon. Forgot to ask Luke about exercises for tonight, so I'll do similar to last night and hit the CPM and ice.

the day after

After breakfast, headed to PT, and Kim came around to get me started. I started with wall slides, 15 minutes (put you leg against the wall while lying on your back and then let gravity help slide you leg down). Everyone hates wall slides - the goal is to slide as much as possible until you can't go further, and then use your good leg to push the bad one back up the wall. Repeat. Headed over to a table for some quad sets 3x15 (try to flex your quad muscle, which is difficult due to lack of extension and swelling). Assisted straight leg raises 3x10, and hamstring sets by pushing my heel into the ground, 3x10. Also did band stretches with a band around my toes and pulling on my foot to stretch the leg. Kim did some patella mobs (moving the kneecap to loosen it up and keep the scar tissue from forming and maintain flexibility) and then we did prone hangs and then finished with elevated ice. Had some significant bleeding from the drainage portal, but that's not unexpected.

Dr. Steadman came in around 11 and move around the room. For me, "Your knee was bad". How bad? "On a scale of 1-10, a 10." Not worst ever, but pretty bad? "Well, maybe a 9.5." About another surgery, he said he'd see how this one goes. He said to push through the pain (which after some clarification from Rae later really meant go to discomfort). If there was anything I couol do too much or too little of, he said to trust the PTs. As for a goal or what 'full ROM' meant on my sheet, he said it meant to push, he's not going to restrict me from a motion perspective.

The sheet had weight bearing in 1 week, but Steady said only touch down for 6 weeks. That's a long time to be on crutches, although I'd practiced that long before. He didn't do a capsular release on the medial (outside) of my knee, since he though the tendons and muscles were so tight, it probably wouldn't have helped. He said he always does the inside. Rae later mentioned, 'Oh you were the one who Dr. Steadman was putting an elbow to when I walked in.' I'm guessing he did that and realized the rest of the soft tissue was so tight, didn't do the outside. Main things to focus are the patella mobs and muscle contraction on the quad.

In the afternoon, we did much of the same, although added about 3 pounds on the prone hang. Managed to squeeze out 107 with the wall slides. That night, I managed to put my leg in the straight position for about 15 minutes and then did about 15 minutes of a combination of wall slides and seated assisted flexion raises. CPM and ice most of the night as well. Overall, the knee feels pretty stiff and sore. Seems like the swelling is restricting the motion and I have some pain that seems to be from one of the portals as well.

Sleepy, sleepy

Dee and Shirley managed the night shift on Wed night - just as awesome as everyone else. Made sure I didn't hurt myself when I headed out of the CPM and helped in so many little ways to make Lissa and I more comfortable. There were only 4 of us, probably all Steadman patients, that were there that evening, so they even had a chance to have an extra bed for Lissa. Lissa brought me back some Oreo cookies, and with some milk and vanilla ice cream, viola, a Oreo shake materialized. Quite tasty. I slept reasonably well, although I took a sleeping pill around 3 am since I kept waking up due to all the hydration. The entire time I was in the cold therapy and CPM as well.

Morning came quickly, and we were moving into the morning shift change, so slowly moved downstairs, waved at a couple of the other patients that were in surgery that night, and headed to get a little breakfast from MickeyD's.

Thursday, July 21, 2005

Wakey, wakey

So I awoke this time at 12:20, remember looking at the clock. Folks were doing various things, and I vagely remember Lissa coming in the room. After a bit, I sat up and moved over to a chair. I think both Jane and Michelle were helping me move around a bit with the crutches. I think that was around 2 or so that I moved to the chair. Jill, who came up from PT, started to walk through 5 different exercises (patela mobs, ankle pumps, quad sets, band stretch, and seating flexion raises) and Steadman stopped by with Dr. Stubbs. He said hi, and repeated the procedures, I think. I asked him if he had any quick thoughts, and he said again, "It was bad". Jill finished describing the exercises and then was enthralled by our Jack-in-the-Box antenna balls (there's a longer story there about how they were used in our engagement that I might post later sometime)

I had some ice chips, crackers and graham crackers and sat up in the chair. Jason came by with the CPM around 1:30, and set me up with that and someone else hooked up an autocold unit of some sort that didn't need ice, it wasn't a cooler, although I had one of those later. Jenner at one point ha to find my foot pulse becuase I'm good at hiding it. That's most of my afternoon. Really had no pain during this time. I was told not to put any weight on the leg, as I wouldn't feel any pain due to the femoral block. They also gave me an ani-biotic and tolurine?, an anti-inflammatory through the IV, and plugged another full bag of fluids for my third of the day right after surgery...

Surgery Day; awesome people hopefully produce awesome results

A long 36 hours, but seemingly good. Another quick summary before the avalance. Dr. Steadman said on a scale of 1 to 10, mine was probably a 10, "well, maybe a 9.5". He did an LOA, AIR, chrodioplasty, and a lateral capsular release. I came out of the surgery feeling much, much better than the previous ones. He got me to 5 and 120 on the table and was probably around 10 and 90 active at my first session this morning. I'm feather/toe touch only for 6 weeks (whoa!) to reduce scar tissue growth. Headed back for another session this afternoon. Overall, feeling cautiously optimistic. Everyone from Vail Valley Medical Center (hospital) to Steadman-Hawkins (surgery) to Howard Head rehab (PT) was awesome. I really wish I could remember all the names. Truly impressive.

The long version:

Crystal called last night - hospital at 7:30 am. Could've been 6 am, so got a little lucky there! Arrived first at Vail Valley Medical Center admissions on the first floor, got some paperwork, and headed upstairs. We notice they had Lissa's phone number wrong (not that she went anywhere!) Relaxed in the lobby for about 15 minutes and then Michelle brought us back to pre-op. Went through the normal stuff (why do I always have trouble tying up those gowns?), blood pressure, temperature. The didn't mentioned anything from the labs from Tuesday, so those must have passed. Popped a quick IV in my left hand and started the first bag of the day. Gave me a blanket when I got a little chilly as well - very attentive. Jack, must've drawn the short straw that day, as he got to shave my knee. The knee that didn't have NO written in large magic marker. Still on there at the moment, actually.

Hung out until around 10:00 am when Thaus ?, the anethesiologist and another nurse (Karin?) who started asking some general checklist questions. Lissa described the problems rousing from the earlier surgeries, where I woke up "hard" and they wouldn't let her back - I didn't know what that means, she said. Neither do I!, he said. I confirmed that I'd be under general during the surgery. He was describing a few more details when Steady stuck his head through the curtain with Dr. Stubbs, "Hi - wanted to remind you that we're going to potentially go behind your knee as well." Yep. "Ok, see you in a bit". Well, not really :) Thaus then walked afte him and said "Femoral block for this". Steady replied yes, thank goodness. They started the femoral block process, pricking my upper thigh after pressing for a vessel. He and the nurse started putting some other things on my upper thigh and at some point the doc asked if I was nervous, since I was shivvering. "A little, I replied." He asked if I had a femoral block before, and I said yes, but I thought I was already under general. "Probably not, actually. We need to awake to talk with us - let me know if you feel like you hit your funny bone in your arm or any other unusual sensation." After I replied in the negative, the doc then told the nurse to give 2 of something. The nurse then said "here comes the happy juice" to which I replied, well, I'm already pretty happy, so this should make me estatic." They had pulled Lissa out while they did this, and the last thing I remember is her giving me a kiss.

Funny thing about anethesia - I always expect it to be like Ah-nold in True Lies, where he gets the truth serum and his vision is all blurry and he's fighting for conciousness until finally dropping into sweet, peaceful slumber. Nope. For me (and most others I know), it's like a light switch. I'm awake, then I'm not. I remember talking with the anethesiologist during the first surgery and think I snoozed in mid-sentence.

Lissa actually saw Steady walk back through to his office while sitting in the waiting room. "Done already?" "Nope, still prepping him" was the reply. After the surgery, he then came out and told Lissa the procedures he had done, and the range he got. "It was bad".

Wednesday, July 20, 2005

Alex did GREAT!

Lissa here again...

Dr. Steadman poked his head into the waiting room around 11:45 this morning, and said that Alex came out of surgery just fine. He reported that "it was really bad", but that they had gotten down to 5-7 degrees of extension and over 120 in flexion. He stated they had to go into the inside of the back of his knee (thankfully using layman's terms for me), but did not do the other side. He said that there was a lot more they could have done, but they have learned that it's better not to do everything possible, because then there is a possibility of loosing ground.

About an hour later Jane, our post-op nurse brought me back to see the lovable patient, who she said had been cracking jokes since coming out of the anesthesia... yep, Alex was doing just fine :)

The folks here at the Vail Valley Surgery Center have been WONDERFUL and we feel so much more confident that we are truly on the road to recovery now.

Alex will certainly add more commentary tomorrow, after the two PT appointments scheduled for after his discharge. Thanks for all your support and happy thoughts!

- Lissa

Tuesday, July 19, 2005

Stations... but not the kind that we'll have at our Reception

Lissa here... Alex wanted me to add a synopsis of the final steps we went through on Tuesday for pre-op. Chrystal had us go through a series of "stations" to make sure we did everything required.

1. Met with the insurance coordinator
2. Met with the admitting department for the Vail Valley Surgery Center
3. Met with a pre-op nurse
4. Met with the admitting department for the hospital
5. Pre-op lab work

After that we went home and prepared for the next day, which was sure to be a busy one!

More in a bit...

The beginning takes the longest

At last, here we go. The summary: Dr. Steadman will be performing my surgery tomorrow morning. He indicated an 85% chance I would get better, with a 60% chance that another surgery would be needed. Extension of 5 and flexion of 120 would be very successful and that would be enough to bike and run, and then we'd go from there. Should be overnight outpatient, and pleased I was staying a month for PT. That's the bullet. Everything else below is just details, but heck, if you've read this far...

10:15 Arrive at the Vail Valley Medical center for Steadman-Hawkins clinic. Steadman's office is on the third floor. His seems to be the only clinic directly in the hospital. Walking towards his office is a little wacky - there are framed pictures of lots of sports folks, with signatures and notes written on them. Bruce Smith, the linebacker for the NY Giants, and Moses Alou were the main names that stuck out, but there are plenty of skiers and others. Check in was quick since I'd already faxed the basic info. Filled out a research form (pain is 1-10) for them to include me in their research stats. Also filled out anethesia paperwork since I was tenative for surgery.

10:35 Surprised that Andrea, one the nurses, came by so quickly near my appointed time. She asked me a few questions about my history, and wrote a few notes. Shared my newly-created binder with all my notes, and she asked for the post-op notes, and MRI notes, and I also gave her my update from Angela. She shuffled me down to x-ray for two more pictures, one from the back of the knee and one of my lower body. They had just installed a digital MRI system, so 2 minutes after my MRI, they had the 'digital films' displayed on the monitor in my room!

11:00 One of Steadman's fellows, Al Stubbs, entered. Nice guy (I think his bio is on Steadman's site). Asked about my history, and then proceeded to skim through my post-op and MRI reports; I pointed out that I had more range on the table during the MUA than the debridement two months later, and he wrote that down. He then checked my breathing. He then performed a neurological exam (Lissa knew that, not me) This was basically a quick game of SimonSays - follow my finger with your eyes, put your hands like this, thumbs like this, arms, elbows like this. It was pretty funny to watch, I suspect. He mostly listened this entire time. I'm guessing after some thought they probably aren't supposed to diagnose to much.

He then proceeded to do some flexion, extension and other stuff with my good leg and then switched to the left. Indicated my kneecap was definitely locked down and it had about 20-60 range with a little pain. I indicated that I had some other opinions as well and he asked what they said, and I quickly ran through the opinions of the other 4 doctors (Schoch, original OS - can't do much more; Kilbride, could remove tissue but no directly experience with artho and rehab; Burns, who said see Steadman, and Windler, who said wait a month). He asked where were staying and upon hearing Avon mentioned the PT facility in Beaver Creek instead of or addition to the one in Vail. He said Steadman likes people to stay a week, but if you can stay longer, that's great, becuase the PT's are available 365 days a year. [Lissa then mentioned how much Angela and Adam have done]

I asked about pain medication, and he mentioned aspirin and another anti-inflamatory for about a week after the surgery and other pain medication as needed, but seemed like taking pain meds specifically for PT was unlikely, although everyone is different. You're really trying to get everything you can under anethesia and then keep that once you're awake. He then said he's review the info and Steadman would stop by soon.

12:15 Steadman arrives. He's a big guy, probably 6' 4", with a deep voice. Definitely a grandfather figure. He also asked about the history, and I shared a little with him as well. He said it was a difficult case, and a normal OS would see this probably once every 5 years or so, whereas he sees them frequently. Based on the surgical techniques and rehab protocols, there's about an 85% chance of good improvement, and a 0.5% chance it will get worse. When things are this bad, sometimes more than one surgery is needed. He then proceeded to play with my knee for a bit. I asked him if he was able to determine what the problem was, and he said there was significant scarring between the patella and the tibia. The fat pad that normally is fluid and flexible had been scared with dense scar tissue. He said he'd remove that, as well as some tissue that might have formed above it. Depending on the extension after that procedure (a Lysis of adhension, LOA), he might consider, and would expect at this point, to also do an AIR and chonoicaplasty (sp?) on the back of the knee. The LOA would be arthoscopic but the c-plasty would be open - this would entail opening up the back of the knee and [doing something] to help the knee straighten. If my knee was at 10 degrees or lower, he wouldn't consider it, but becuase my knee has not been straight for so long it forgots how. He'd do this on the outside of the knee and potentially on the inside as well.

This would be a step-wise approach, so depending on the result of each step, the next may or may not be done, although he thought all might be needed at this point. The bone calcificaiton is not normally an issue, but we'd deal with it on a subsequent surgery. Yep, he said some require three surgeries or more, but another was possible based on where I was [of course, depending on what I wanted] It would be about 3-6 months down the line. He said it was flexible since we mentioned we have a wedding in a few months :)

He's from Sherman, Texas, where Austin College is, where Lissa went for a year, so they mentioned that. He also volunteered he's an Aggie, but I said that wasn't a reason to not move forward with the surgery. And that's the end of the office visit. Tune in later for the details on the pre-op steps!

Monday, July 18, 2005

Big Brother profiles

Out and about today. Hit the Wal-mart. They really are everywhere. I'm probably the only person who has ever purchased the 9/11 commision report and the latest Harry Potter book on the same day. Visited with Luke, the PT who I'll mostly be working with in Vail. Nice guy. The place doesn't seem as welcoming as Elite in Austin (shout out to Angela and Adam, without whom I'd probably still be on crutches), but we'll see. Plenty of equipment. Also picked up my schedule for twice daily PT after the surgery through August 1. We're headed to heard the symphony tonight at Beaver Creek, should be fun.

A lazy Sunday

A nice, relaxing day. Found the Starbucks, of course. Two within walking distance, although one is "one the other side of the tracks" - literally. Checked out the shops right below us (which includes a sushi place and toy shop). Continued my Harry Potter book count - currently at 5, with none of the owners under the age of 15. The over/under for the trip is twelve, let me know if you need some action now that the World Series of Poker is over. Pizza for lunch.

We spent most of the day driving around between the small cities in the Vail area. Beautiful scenry - a convertible here would be superb. Drove up into the mountains for some fantastic views before dinner. Lissa spent most of that ride looking at me and houses to her left, instead of the drop offs to her right.

Dinner in Beaver Creek at the Beaver Creek Chophouse; great seafood linguine that wasn't on the menu, but they couldn't quite get the filet migon to Lissa's liking. That's our big meal for the trip, since the rest of them will probably be inside our room. That's why we stopped by the grocery store earlier. Plenty of stuff in the kitchen now.

Saturday, July 16, 2005

Free wireless rocks

Yep. Three cheers for Vail/Eagle, with free wireless in the terminal. Flight into Vail would definitely be worth some pictures for posting if I was flying on the wing of the airline. I wasn't that dedicated for you, my reader, so you'll have to take it on faith. Which at this point, we're doing a lot of that already just for coming in the first place. Flight was also uneventful, even with about 15 kids who would easily qualify for the kiddie rides at Disney World. My mother, who was in charge of rental cars, was kind enough to rent four cars for our selection, so we took the intermediate which was upgraded. Vail airport feels like a ski lodge and has about 20 privatejets parked out front. Neither one of us is terribly hungry, but a "Bloomin' Onion from Outback is in our future. My fiance is dragging two checked bags that are only dwarfed by her muscular arms. Yes, of course she's looking over my shoulder at the moment.

The drive-in
Funniest moment so far: Lissa riding shotgun on the 75 mph I-6, as she sees a carcass on the side of the road "Aw, a dead kangaroo!....well..maybe not."

Our lovely abode
We love this little one bedroom spot. Great views from the bedroom and a little patio. DSL high-speed (and therefore wireless access). Outback Stakehouse and Sushi downstairs. About 15 minutes from the hospital. We even right next to the elevator, so no long hauls from car to front door when I'm on crutches. Not sure what else we really need!

Hanging at the Airport

Sitting at a pay by the minute terminal. Started typing at 1:34 secons, let's see how quick I am. We're gtting rid of all the bad larma on the way, as I was aying to Lissa that I shoud've kept my airline tmobile wireless internet plan, whch let's you access from the airport. "We shoudn't be there that long." bingo, Vail flight delayed by two hours. Not too bad hanging out though. Lissa said she wastn't hungry, then said she'd wait until 4 pm (at 3:15) to get some ice cream. She then returned at 3:20 with "icecream with Oreo's and other chocolately goo". I'm sue she'll correct me when she reads this. Hopefully, this will be the only thing that does goes as planned.
(signing off at 7:45 - I blame th keyboardfor my slowness...)

Friday, July 15, 2005

The prep

Packing. Boring. Last time I was out of Austin for a month was a business trip to China. Packed for Beijing for about two weeks. Ready to leave and give my stomach a rest, and the client asks, "How about Shanghai?" Two weeks later, my 30 day Visa is almost expired. Some days I would've welcomed the Chinese government removing me from their country. Actually, check that.

Leaving today aroud 1 pm central. Knee has been feeling decent over the past week, but certainly haven't tried to bend or straighten it in any way. Meandering around Vail should be a good way to spend my few mobile days before my world becomes repeats of Regis and Kelly and the Price is Right. Remember to spade and neuter your pets. How is that guy, Bob Barker, still around? Will there be a crazy game show host scandal like Letterman and Leno with Carson when Barker retires? Are there any hosts under 50 at this point?

A quick recap for those who haven't been playing along at home for the last year. I tore my ACL and sprained a couple other ligaments last April '04. In May, I had the ACL replaced, but was never able to gain much motion. Therefore, they did a manipulation under anethesia (MUA) in July. Basically, put you under, bend your knee to break up scar tissue. That didn't work well either, so a doc did a debridement in September - open up the knee and scrape away the scar tissue that is restricting the motion. Unfortunately, that didn't work either.

So we're headed to Vail to see a specialist in arthofibrosis (which is my problem, excessive generation of scar tissue). I can walk with a limp and don't have much pain, but can't get in a car or walk stairs easily. Plus, my chances of a first round selection in the NBA draft just bottomed out. Should be an enlightening adventure. Thanks for coming along.

Thursday, July 14, 2005

Get ready, get set - start here!

So we're about off to Vail. Just got off the phone with one of the physical therapists I'll be working with up there, Luke. Sounded like a great guy on the phone. Put me on his schedule, and said they'd have the CPM and cryo-cuff set up and ready to go for me after surgery. Eveything else seems ready to go! Even found someone to mow the lawn while I'm gone.

Welcome those who I sent an email recently. The earlier posts on the blog are pretty boring, but the interesting stuff should be next. We're headed to Vail for between 2 weeks and a month to bend this left knee of mine. Guy named Dr. Richard Steadman is a specialist in knees and specifically arthofibrosis (which has caused my knee to be less than perfect) so Lissa and I will be visiting him. We'll post updates of the surgery (on Wed the 20th), progress, and we'll probably deduce how to put some digitally snapped photos as well! Hope it will be interesting to some and informative to others.

Thanks for stopping by.

Tuesday, July 12, 2005

Walking to the starting gate

Been a slow couple days. Knee hasn't been bothering me too much, ROM still the same. My knee feels a little more tender on the outside but nothing major. All the travel arrangements are good to go. I'm still working through the details on some of the right after surgery stuff, like the CPM and estim and other goodies. Great thing by a fellow poster on the kneeguru site - she actually mentioned me to one of the PT's there, so that should make things a little better on the rehab side. Working with good people on that front will be critical to success!

Sunday, July 10, 2005

Quick post

Nothing major recently. Knee continues to be the same, a little sore and stiff after sitting, which creates some reasonable limping. Walked around a little more today than normal and felt stiff. Feel like I have all the plans for Vail other than car ready. Now must pack and prepared for everything. Talked with insurance on Friday - they only have information for the month of April for the PT and say they need more information. A definite bummer whenever paperwork is involved. Overall, in the home stretch now.

Thursday, July 07, 2005

More scheduling

Not much difference in pain or motion today. Haven't really done much either, though. A little walk for lunch. Did hear kindly from Laura, the original person from Steadman's insurance group. She unfortunately stated the hosiptal was out of network. Bummer. But she was going to look into a secondary network that the hospital and Steadman might be a part of - she actually had just received a letter about it yesterday, so we're a little ahead of the game on that one.

Also talked with Lynn with Vail Valley Sports Medicine - the PT folks. She was enjoyable to talk with, and indicated that I would be seeing Steadman the next day after surgery aound 9 am (depending on when he shows up!) I'd then do PT twice a day, once in the morning and once at night every day. Suggested that maybe after a couple weeks, I could drop down to once a day. Evidently the PT's work 4 ten hour shifts, so she tries to schedule the same person for the morning and afternoon and the same two people shifting back and fourth. Sometimes a third or fourth person slips in depending on scheduling and vacations. She even said she's try to pair me with Luke from Brisbane, who Heather M on the board said was good. Need to find the other person Heather mentioned and see if he's around too. She also said I could come in a couple days before to get my schedule and visit with folks. folks also take medication up there sometimes, so said that wasn't an issue, and they have a good cafeteria :)

Wednesday, July 06, 2005

Three from Vail

Most contact from Vail in a while. First call was from Ross at Vail realty. He had a 2 bedroom almost right next to Steadman-Hawkins. Since I've already booked in Beaver Creek, didn't explore too much. Second call was from someone in Steadman-Hawkins office talking about insurance. Looks like the tricky part is "reasonable and customary charges" my new lawyer phrase for the week. Code for a lysis of adhesion is 29884, the possibility that he might have to do other things is certainly there once he sees me and then again once he gets in the knee. The fact that one person had 8 different procedures certainly looms, but that's extreme!!!Steadman's probably a little higher than whatever the reasonable cost is - we'll see how the final numbers work out 3 or 6 months from now, but it certainly could be worse. She indicated hospital and physical therapy would be separate. Third was from RS physical therapy to set up appointments for after the surgery. Also called around to insure I can get all the medical records before I go. We'll see how things go.

Tuesday, July 05, 2005

Continued Slowness

Knee a little stiff but no significant pain. Called around to all the doctors and got my medical records and other X-rays this morning, so I'll make the drive sometime later this week to do pickups. Check on the condo - we're booked and good to go there. Didn't get the Oreo's last night, but the garage door is opening as I type this and it's entirely possible that Lissa pictured a bag tonight. Bingo! Oreo's galore! Later!

Monday, July 04, 2005


Really. Nothing today. Only sitting around. Might actually leave the house. 50/50 chance at the moment that we'll leave to get Oreo's and ice cream. 24 hours stores are bad for your health.

Sunday, July 03, 2005

Another slow day

And I'm completely good with that. Finally finished the fence outside in the back yard. Knee hasn't hurt me at all, but it's feeling pretty stiff right now. Took a small walk because I had to walk around the fence and a couple of neighbor' s houses. Tendons (at least that's what it felt like) seemed to be bunching while I walked and tried to straighten my leg. no really pain, just a weird feeling. Still looking at cars in Vail, unless I find a good buddy with an extra car in Vail, car will be pricey.

Alas, only two weeks until the trip!

Saturday, July 02, 2005

Grassy Knoll

Moved the yard this morning; knee feeling pretty good at the moment, although I didn't try bending it too much. Pretty hot this morning too. Cars are expensive in Vail! Can't find anything for a month less than 700 bucks. Heck, Denver's only two hours away, might even be worth it. Just checked google maps distance to Vail. Only 1,297 miles. But headed there in ny BMW isn't that's advisable and Lissa's manual would make for a long ride. It's only 3 turns though. Up to middle of OK, left towards Albuquerque, north to Denver, and West to Vail. Maybe not.

Friday, July 01, 2005

Another step

On the road to Vail. Crystal, Dr. Steadman's scheduling nurse, called today and reviewed my operation paperwork. Nothing too exciting, confirmed my operative information. Indicated that part of my stuff was in network and part of it was out of network. I mentioned that I hadn't been headed to therapy, and she didn't have any real suggestions on that. She did say I would stay overnight in the hospital (although I bet it's 23 hours) and that my surgery would probably be in the morning. She also said that I'd be headed to therapy twice a day, and asked how long I'd be staying. When I said a month, she said that would be great because I could go to therapy and I could see Steadman daily or as I needed after the surgery. Overall, nothing too unexpected, but certainly glad to hear some of her comments.

Knee felt ok today, but think I was limping a little more than normal.