Writing takes a while - 5 days from Surgery to departure

Well, here goes. After almost three weeks, I figured I'd finally write down all the excitement of the second surgery. Looking at my notebook, we'll see how far I get...hop in the wayback machine and we'll head with Mr. Peabody and Sherman back to August 9th...

August 9th
Headed into therapy with Kristen this morning. Steady came down a little after 10:30 and walked over to the table while doing wall slides. He had me straighen the knee and felt the back of my knee and generally around it. "Yes, I think we should give you some light anethesia tomorrow and the put fluid in, and then put in the scope if we don't like the results." His gut feeling was I had scar tissue regrowth, "We can't make it worse, but it should help". Not exactly what you want to here when you have problems with scar tissue. This was the first time he mentioned the possibility of going back in with the scope, although we had been discussing the insufflation for about a week or so since I started to have problems with the flexion.

Finished up the morning session with the typical bike, wall slides, patella mobilizations, quad sets, attempted straight leg raisees, hamstring stretches, and then ice. Passed on the JAS brace.

I headed up to the office and ducked in the back entrance. Rae actually put me in Steadman's office becuase she didn't have a room. This guy has more signed stuff that anyone I had ever seen. I took some poor cell phone pics that I'll try to upload at some point, but for example. A signed picture by Gerald Ford in the Oval, a Bruce Smith football, a collection of random arabic soccer stuff, including a trophy that had a camel on it, a picture on the broncos sideline. On his desk was a million papers, and among some other things, a model of a knee, and a sign that said "a cluttered desk is the sign of a genius mind".

He came in for a couple more comments, and I asked if maybe we didn't get it all the first time, and he said, "oh no, we got it all, this is certainly new growth. It loves it in there." I had asked about predisone, and he said give it a week if we did the scope and probably right away if not." I said I wanted to give it everything we've got.

Bounced me to an actual room after that, and I waited. Christal came in a couple times, and I guess they needed a dr to actually review with me what was going to happen 'cause Dr. Cabrerra finally came in to discuss the procedure and get some notes. We're going to try an insufflation in the joint capsule, and scope if needed. He said they'd probably use the same portals, but they ended up making new ones. He said Steadman would again do the surgery, asked about my history, and marked me at about 20-60 on the range [I suck when it's cold]

Cristal then had me sign some paperwork, and called down to have them put this surgery on the same tape as the other one (20 bucks saved, whohoo and it even came on DVD. Not that fun to watch though). She actually indicated that Steadman always does the surgery and the fellows watch, but from a few other folks seems like sometimes fellows actually do the surgery...

To insurance with Paula: She had already pre-authed it with Aetna, and didn't take a payment upfront since the insufflation is a few hundred but the scope would be a couple thousand. That was nice. Christal should be able to help with letter of medical necessity for PT.

Headed to the surgery check-in - they actually couldn't find my file at first, so I started to fill out all the paperwork, but then finally tracked it down. The pre-screening stuff was much shorter, and Richard, the same guy who shaved my knee the first time was there. The temperature things are wicked - they run it from your forehead to your ear and 'bam! - temperature done. None of this under the tongue junk. Down to hospital and then over for blood and urine.

Headed back over to Crystal for the normal 'let's go through the checkpoints' again. I wanted to ask about the roxy (ok if you need it until midnight, but I didn't take any), PT in the afternoon was ok, but I ended up not going) . Indicated I wanted to stay overnight no matter if he did the scope or not, and found there was no charge for the CPM - sure wasn't going to lug mine from the condo! They weren't sure at first, but ended up needing the lab work since I might have the scope and they couldn't re-use from 3 weeks ago.

In one of those improbably concidenses, I ran into two people from Austin that I knew! A mother daughter pair who the daughter had surgery with Steadman almost 6 months ago and did some PT with Angela. The mom was one that had given me some information about Steadman, which mentally started down the road. They were there for a follow up and to do the 'sport test' which Steadman requires before releasing someone back to competitive sports. It was definitely nice to see an old face.

Random act of silliness this evening. Needed to do some thing to relax/not think about the surgery, I bought 12 boxes of cereal to get the UPC symbols to send off for 4 cases of Disney 'Wobblers' for Kellogg's. We still haven't received them as of end of August. Bummer.

Cristal called to say my surgery was at 8:30, I believe...

August 10th
Headed into the hospital to check-in on the first floor. "Bentley? Oh yeah, Bentley." People you don't want recognizing you on sight unless they are personal friends: Hospital employees, school principals, firemen, and the Secret Service [guys, it's not a secret anymore....]

Headed upstairs to check-in and waited about a 1/2 hour. Steadman walked out to talk with another group in the waiting area after a surgery, and as he walked by, said "Kinda boring out here, huh?". Yes.

Brought me back, and I recognized many similar faces [nurses/doctors also in the 'don't recognize category]. Katie "Weren't you just here?". Why yes, and it was such a lovely time I thought I'd visit again...I had my Purdue shirt on, and some said they also went to Purdue. She also happened to stay in the exact dorm, Shreve, I did the first two years. Wacky. "Did you streak?" - referring to the '"Nude Olympics where people run around naked in the quad in the middle of another dorm on the first snow". My reply "Nope, but I might do it in here if I can't tie the back of the gown again..." After hooking me up to everything, they shaved the knee, removed the steri-strips but left the sutures in.

Ready the local Vail Daily for a while, 10M for the most expensive house. "Perfect for corporate retreats, this 14BD/13.5 bath has..." - why did they decide one bath only needed to be a 1/2?. Someone walked in and asked "Is Dr. Steadman here?" to looks of 'who the heck are you and why are you asking'. "He's in surgery." "Oh, he wanted Dr. X to fix his back". That's not quite what you want to hear....they also had the date of my last surgery on the patient wrist ID. oops. Had a little trouble finding a vein in my right wrist as well, so they did the back of the hand.

Anethesiologt arrived and asked if I wanted a general or epidural. Easy choice. Awake for this, no thanks. Although when she said "I won't go into the whole spiel then", I wondered if she preferred that one. She also mentioned I have big tonsils. And then I was out.

And then I woke up. Not quite as quick, and took a little longer to actually feel ok, but near the evening, things were ok. Jill came by for PT around 2 or 3, i think. She did some over pressure, ankle pulls with a towel to try a straight leg raise. Said she was liking extension. Steadman stopped by with a couple of his crew, and said it was a good thing we went back in. Still thought there was a long of soft tissue restrictions. He also said some other stuf, but I can't read my handwriting. Dirk swung by a little later as well - very cool of him. He also liked the extension, although my flexion was painful. He caught Steadman in his office to ask if I could go to 0-90 on the CPM, and Steady agreed.

Ali and Shirley, the same Australian gal who was there the first night. Around 7:30 pm I was going 0-to 90 with a little soreness, about a 2 on the scale. Dinner at 7ish, and a little walk on the crutches around 9 with a turkey sandwich afterwards. Didn't take any roxy, but did a percoset. In the CPM all night, woke up around 4 - actually checkd email and tried to straight the leg with some exercises. Little pain in the morning and sat it a chair for a while with the knee propped straight. They let me go without anyone with me, since I was looking so good. "Hey Alex, stop by socially sometime. You don't have to have surgery to say hi..." The ceiling was actually leaking a bit in some places - they were wondering if they were going to open that morning, although they did from what I heard.

August 11
Headed down and had breakfast in the cafeteria, and then to PT. Dirk got me started around 9 - Rae gave me the same debrief as before (although I mentioned I had sutures whereas she thought I had dissolvable ones). Dr. Atticus, one of Steadman's fellows, also came down. He was prepping the other OR (evidently Steadman bounces back and forth between two rooms over the day). Said at one point, Steady looked up like he couldn't believe the tissue growth. Got me to about 115 and 10 or 15 on the table, and that my knee looked straighter right then than on the table in the OR. Said you only needed from 110 to 10 to go up and down stairs easily.

Steady arrived. When asked, said I should stay as long as I can "You can see the benefit of staying". We might do a medrol pack in a week. Also echoed that it looked better at that moment that in surgery. He wasn't able to get anything with just the manipulation "so it's a good thing we were ready to go it". Were you suprised? "Nothing surprises me anymore...but sommtimes knees test me...a challenge even for me, and I've seen more of these than anyone in the world." Said my knee was in the upper 1% of the problem children...

Therapy was light, with biking, patella mobes, overpressure and quad sets. In the afternoon, Dirk recomended the same schedule, but said how long I stay had more to do with how much I trust me PT's at home. Biked for 20, 93 degrees on the wall slides, various manual things by Megan, and 30 minutes on the jas brace.

August 12, Friday
Morning: Bike, manual work, quad sets and overpressure, and JAS brace. Afternoon: Slides to 90 with pain, bike, manual work (warm knee), quad sets, hamstring stretches, and JAS brace.

August 13, Saturday
Found out my boss was let go yesterday; have to return to give a presentation on Wed. Steady said a quick hello - reconfirmed partial weight bearing, maybe think of the medrol pack. Said it looks better and said they'd set me up in Austin when told him I was leaving on Tuesday.

Bike, wall slides, JAS brace (then measured at 7 with overpressure), quad sets, hanging off the edge of table, flexion to 90. With significant overpressure, pushed down to 1 degree, and then iced. Afternoon I have only bike, wall slides and JAS brace written down.

August 14, Sunday
Bike, wall slides, quad sets, JAS brace (0-1) right after mobs. Massaging back of knee and heard a pop, as did Kim (who worked with me on Sat too). Ball flexion, bridges and hamstring. 20 minutes of GameReady. Kim also suggested I work on terminal knee extensions as well.

Monday, August 15th
I left Rae a message letting her know I was leaving a little quicker than normal and headed in for morning therapy with Dirk. Bike, wall slides to 80ish, mobs, quad sets, hamstring stretch, JAS for 10 and then another 5 minutes due to pain. 20 minutes GameReady.

I was late coming back in the afternoon becuase I had to ship some things and I was really tired. Rae was actually looking for me - she evidently got my voice mail. Headed upstairs and snuck in the back door from Cristal - once again, back to Steady's office. Gotta figure out how to get those pictures off! Steady walked in again [still not sure if he was warned or not this time either, seemed like not ;)

He reiternated that he was glad he went back in. Touched the knee a bit and stressed patella mobs again. Said there was lots of scar tissue both times. I shared that Sat/Sun we had 15 degrees of differentce between active and passive. Glad Kim was aggresive and said the difference was due to the lack of mobility in the soft ttssue - the tissue wants to be at 30 degrees (maybe a bit much). Remembered, surprisingly, that Burns had recommended me, and said I should keep seeing him in Austin. Goal is to get above a 100; back in 6-8 weeks if so. I assume he was thinking faster if I wasn't there, but that might be tough to do! Other than the PT's up here, there's nothing else he would do if I stayed.

Said I could call Rae with updates, or email, and I could even have Rae set up a phone call if I had more questions. Amazing (of course, I actually have to try it :) Headed back and said thanks to Laura, the insurance coordinator, and then Rae found me. Gave me a generic letter about the importance of PT for the insurance, but I think I'll need a little more than that. Said to also stay in touch with Dirk. "He's good at following up and keeping us informed." Dirk said the same thing when I went downstairs, "Rae and Steady sometimes forget, and I can ping them..."

And that's the last time at PT and Steady's office.

Tuesday, August 15
Alarm at 5:45, snooze until 6:05, out the door at 6:45. Drove the 30 minutes or so to the airport. Enjoyed the scenary for the last time. As I turned into the airport drive, heard a 'ping'! Fuel light appears. And I pre-paid for the full tank of gas! Awesome! Pulled up curbside and did the curb check-in. Guy there suggested I park closer than the normal drop-off point, which is a quarter mile away. That would've sucked. Grabbed my backpack and x-rays and hobbled in myself on crutches. Right inside was a couple wheelchairs and someone came out quickly to help; she zipped me through security to the gate.

On the way, she mentioned I had two choices for getting up the stairs to the plane. Crutch the equivalent of 3 flights of stairs, or let 3 big guys carry me up in a special chair. Looking out the window in the sprinkling rain, I chose number 2. But I got lucky - they were able to get a contraption that automatically raised me up to the door. But it got stuck 1/2 up, with a nice drizzle. "Yeah, too bad, somebody ripped off the canopy last week..." Thanks.

Flight to Dallas fine. Flight to Austin fine. Landing in Austin. Priceless. It was very nice to be home.

a quick update

A quick update for me. I'm going to try and transcribe my notes from the second surgery and rehab, etc, but it's been tiresome since the return home. Right now, I'm pretty close to where I was before surgery, about 15-70 cold. Bad news is the flexion barely gets to 80-85 in therapy on the bike or otherwise. Still having some trouble keeping any extension or moving from flexion into extension. Good news my extension can get to the table pretty quickly, down below 10. Hopefully, I'm reshaping some tissue.My PT at home who I trust very much, said my hamstring and the overall feel of the tissue are much better. I'm in Pt twice week (instead of twice a day!) I'm still trying to focus on riding my recumbent bike and using the JAS brace at home, but it's a tough road when I really am not seeing any changes day to day/week to week. I've been afraid I've plateaued really quickly. When Steadman said after my second surgery "well, you know, some knees are challenges, tests, even for me, and I've seen more of these that anyone in the world", it can't be good. :-) Any small fear that "it was all in my head or I wasn't doing enough" certainly was eliminated!

Lynn, one of the fellow patients of Steadman, mentioned in a quick note a good deal of her progress was made almost 2 months out. That defintely helps the mental. Sure would help the "why the heck did I do this?" thoughts that float around on occasion. Vail sure was nice, though :) Hopefully, I can get back to a more regular posting, although it will probably won't be daily. Thanks again for reading.

Last Slurpee in Vail

Alex's Tip for the Week: If you get a candy twizler slurpee straw, don't bite off the top. You'll end up with a sticky straw that is obstainate and persistent in it's inability to provide you with the delicious slushee, frozen goodness that your mouth so eagerly wants, nay, desires.

An interesting month in Vail, with a fairly rapid roller coaster ride. Reminds me of two a days before school was in session in high school. Everything was a bit of a blur. Everyone here has been fantastic, from dr to PTs. Called Rae, Dr. Steadman's clincal assistant this morning to let her know I was leaving a day early, and she plunked me in Steadman's office at about 5 pm and he spent 5 minutes or so chatting with me. Being a regular probably helps :)

As for the result of my month, reminds me of my time canoeing one weekend during my internship in Cincy. After an hour or so, one of the canoes upriver from mine was stuck along the side of the river in some brush. I hopped over the side and started to briskly stroke upriver. After 30 seconds, I look up, and notice my canoe. Then the two guys laughing crazily in my canoe. Becuase my canoe is exactly the same distance from me as when I started. Becuase I haven't moved. Well, I had probaby moved forward a bit, and back, and then forward again, but it sure didn't feel like I moved much. So if you ask me how my knee is, and the reply is "Swimmingly", you'll know. I'm not tired from swimming yet, and I'm not ready to get back in the boat.

I have an appointment with Angela and Adam at Elite (rock on!) Thursday, so we'll see how the flight and a day at work treats me. Thanks to everyone who has posted comments or send emails over the last month - that has meant a lot. I'll keep posting once I'm back in Austin and will try to write my notes from the last surgery and few days for posterity, although it might take a few days.

they pull you back in....

Yup, another surgery this morning. Doc indicated he'd do an insufflation and maybe a scope, and a scope it was. Got 120 and 'almost flat' on the table, and seems to be hanging in ok - have the CPM at 90 and 0 although it doesn't really go to zero. Feeling good, gonna have some ice cream after I finish this post. I have a bunch of notes from yesterday and today but it's mentally exhausting sometimes to post the marathon days like yesterday and today so I'll probably hold off until I get to the condo tomorrow afternoon.

And I love Lissa very much.

Two funny things:
Waiting room, before I'm called back in the moring. Steadman, winks at me on his way to talk to a husband about the surgery he finished. Walks by, smiles, shakes my hand and says, "Kinda boring out here, huh?"

Anethesologist. checking me out. "Open wide. Gee, what big tonsils you have."

And then there was the nurse who asked me if I streaked. How's that for a teaser?

Steadman Steps In

(Lissa posting for Alex today)

Dr. Steadman said during his appointment on Tuesday that surgery might do some good, so this morning he did an insufflation, manipulation and scope of Alex's knee.

Alex is recovering in the hospital tonight, under the watchful eye of the wonderful staff at the Vail Valley Surgical Center. He'll do the same routine as his last surgery tomorrow, with physical therapy after being "kicked out" while the surgical center gets ready for their Thursday patients. He'll post more later with details of what he heard from Steadman and his staff about the surgery.

Thanks again to everyone who has been following along and wishing Alex well!

Straighter....

8 degrees at rest, 4 degrees with a quad set. A good day. Flexion still 80 or so with some pain. Rae said hello and indicated Steady would see me tomorrow in PT and then upstairs. My read is we'll do the insufflation. Hopefully that will assist a little on the extension and a good amount on the flexion, and then hang on for the ride afterwards. Another patient, another Alex actually, volunteered to give me a ride (or his mom) afterwards, so one less thing to worry about. Almost all the pain on the extension side today was a 3 or lower.

Not many details today - both morning and afternoon hit the bike/wall slides for 10 apiece, and then Megan spent most of the rest of the session pushing, pulling, massaging and quad setting my knee. Went from 3 fingers to about 1 after the manual stuff, and then to a 1/4 inch above the table after the JAS - hit about 6/7 setting both times without much pain. 20 minutes of GameReady both times.

Relaxing Sunday morning

Mentally, it's nice to have another one session day. Zack started with the usual, 5 minutes of bike and wall slides. Even he commented it was tight as he started the patella mobs. Quad sets, prone massage on the back of the knee. Dangled my knees off the side of the table and he gently tried to push my ankle under the table - about 82 max. With me on my back and grabbing the back of my leg, we were able to get 90 degrees of flexion with a small amount of pain. Overpressure slightly next, and then measured - my knee was at 12 extension with no help, and I could push it down to about 8. 30 minutes on the JAS - started at setting 3 and dialed it up to 6 over the 30 minutes. Since we were icing while in the JAS, Zach said GameReady might be too much (overicing can evidently caused swelling instead of reducing, but the threshold is pliable) so called it a day. My shortest session ever, at 1.5 hours.

And then my folks and I got a Slurpee, since my mother had never seen one. Unsurprisingly, she wasn't impressed.

the light reappears

Well, yesterday the light nearly extinguished. Today, might have found some oxygen (well, it might just be the roxycotin :) Extension was down to 4 after the JAS brace and a little overpressure. Flexion was back to 90 on the wall slides. Steadman stopped in and said my extension was looking better than before the injection, but sharing yesterday's 67 [too bad that's not a golf score], he said he'd see me Tuesday and then consider an manipulation and insufflation on Wednesday. Good or bad news? Hard to say, but if that's what's needed to move the knee along, then it's an easy choice.

I think I've tried to condition myself with the JAS brace - Lissa can probably tell you the technical term, but in addition to associating the JAS with pain, I've also read the Harry Potter book solely during the times I'm in the brace (or in the GameReady). Maybe that's conditioning myself to not have a much pain due to focus on something that is not painful? And does that mean that I associate Harry Potter with pain or pain with Harry Potter? Hmmm. Maybe I should rethink that.

Details
Bike, wall slides, mobs, and quad sets. Steadman was down talking to another patient, and then left. Feared slightly he wasn't returning, but he did [Kim didn't even mention me - thought for a bit she might have prompted him, but he continues to demonstrate why he's a great person, not just a great doctor]. When I asked, he said he wasn't ready to sit on it yet. Pushed on the leg and the kneecap as he normally does - good patella mobility, and extension better than before the injection. Shared that pain was in tendon and medial regions. Said as above, and glad to hear I had an office appointment on Tues for a follow-up. Kim mentioned that not many folks have manipulations/insufflations with Steadman, but I continue to demonstrate that I'm special.

8 lb weight with prone hangs, and then ankle raises, bridges 3x15 with peanut, and then hamstring rolls. JAS at 5 setting, and then 20 minutes of GameReady.

Afternoon
Bike, wall slides (to 90 degrees, woohoo). Quad sets, bridges with peanut and hamstring rolls, mobilizations, hamstring stretches with band, JAS at 6 with decent pain on tendon, and GameReady for 20.

Not so good Friday

Tough day today. Lots of pain and loss of flexion. Of course, I did try the entire day without any pain medication to see if the meds were really having an impact. Hopefully, the answer is yes, and tomorrow will at least be more pleasant. Worked with Kim today - interestingly, she was the first person who asked if any particular exercise was really helping. Unfortunately, I couldn't point to one that made a big difference! The manual stretching seemed to help the extension side, but nothing seemed to help flexion - pain still behind the knee on the medial tendon area and the good 'ol MCL area on the medial side of the kneecap. Whereas early on, the first pain was about a 3-4 and I could push through a little, these days the flexion pain immediately jumps to a 6-7 and pushing much further is more difficult.

Hit the bike and wall slides in the morning - both were extremely tight; I haven't had the bike below setting 29 (used to work down to 24) for a couple days. Wall slides wasn't close to 90. Did some patella mobs, manual stretching, and prone massages. The back of my tendon was screaming anytime Kim massaged it. Tried a prone hang with and additional 8 lb weight for about 5 minutes - not bad until near the end. We measured my extension at 10 degrees - not bad all things considered, that was just with me hanging out. Bridges with the peanut, and then hamstring rolls (put legs up on peanut and pull back with hamstrings to bend knees). Then did ankle raises with my legs dangling off the edge of the table for 5 minutes. A flexion measurement here was 67 degrees. Ouch.

JAS for 30 minutes at a 6-7 setting. To match, the pain was about a 6 - it was probably the highest pain I've had but still managed to stay in the brace. good news: After all that, Kim hammered on my leg with overpressure to straighten, and it was at 4 degrees. GameReady for 20 to close...

Afternoon
No meds in the afternoon as well to see where we were. Bike and wall slides to stasrt, prone massage + some pressure on the heel to straighten the knee while prone. Quad sets for 5 minutes. Ankle raises again, with a flexion at 72. Ouch again. Patella mobs, bridges and hamstring with the peanut, and then used a strap for calf and hamstring stretches.

Didn't do much in the evening - tired, so did some quad sets and mobs while in the CPM and icing at night.

Backed off on the JAS, to 3-4, and then 20 minutes of GameReady.

No procedure yet

Nothing too exciting today. Steadman did a drive-by for his Thursday visit, and said to keep working on getting the knee straight. It's hard to not want more sage advice from the oracle, but in some ways, there's nothing to say but keep working. Still focusing almost solely on extension. Morning and afternoon sessions were similar to the past couple days - bike, mobes, general strtching, quad sets with overpressure. I didn't seem quite a tired or quite as painful as yesterday - hopefully that's a trend. Tried 15 minutes of quad sets with electrical stimluation this morning. Still couldn't pull out a straight leg raise at the end. 20 x10 seconds of ball bridges. 30 minutes on the JAS at 7 and then ice.

Afternoon. Overslept. Just conked out in between sessions - yesterday they caught me with the Harry Potter book open, my head tilted up and eyes and head wobbling. Happened at a therapy session back in Austin, and I'm glad neither group put my hand in warm water. Hit the bike when I finally made it, mobs, prone knee massage, 5 minutes of quad sets, and a little stretching, then GameReady. I actually started with the JAS right after the bike and before everything else - I was pleased that then leg still stretched quite a bit. I didn't put it back in the CPM after the morning session, though, so I cheated a little.

But I forgot to take my drugs and the pain (5 hours after taking them in the morning) was not bad at all. Hope that trend continues as well!

Oh, and my folks decided to fly in - after going round about coming out for the potential procedure, they found some decent tickets and decided to visit for the weekend. They are like the two word entry for Earth in the Hitchhiker's Guide to the Galaxy: Mostly Harmless.

Back again

Decent day today. Extension looks good, with about 30 minute of reasonably light stretching and moving my kneecap aggresively, we can get my knee to within about a finger's width of the table (of course, the table has a little give on the heel as well). Biking is somewhat smooth on a recumbent bike, which doesn't require as much flexion as a normal upright back. Challenge will be to maintain extension once I leave therapy, and continue gains in flexion. Steadman should be in PT tomorrow, so we'll see what he thinks about insufflation.

Details
Morning and afternoon were really similar. Dirk had a student, Megan, working with him today who I had met before, so she did some of the hands on stuff today. Pretty much the same results, which also is a little encouraging. Bike, wall slides (still painful right below kneecap and on medial side of knee). Patella mobs and then a variety of stretches. Quad sets with overpressure - Megan said I should try to push more with my knee, to drive it into the table. I could feel something pop in my thigh, so hopefully that mental change will give some more extension and push though some scar tissue, if it's there. Stretched my calf and hamstring with a band, and then did a 5 minute quad set and tried a straight leg raise, but still needed assistance. Ball bridges for 20x10 sec each. JAS was almost to the max, at 6.5, and still felt some stretching back in the tendon behind the medial part once again. 20 minute of ice.

Afternoon was nearly the same, but added a massage to the back of my knee after the patella mobs. Maybe I'll get some pictures up - Dirk snapped one of my knee yesterday that was pretty flat...

Good day.

Good day, mostly. Focused mostly on extension today, and had the JAS brace at the highest setting yet for an entire 1/2 hour without much pain. Dirk's good - I usually go from 3 fingers under my knee to about 1 finger after 15-20 minutes of stretching and massage. Challenge is to keep that same range outside of therapy and move from that deep extension into flexion faster that the current rate of 1 degree per minute....most of the pain is behind then knee in deep extension and running up the side of my thigh and right around the medial side of the kneecap. About the same places as before the surgery.

Saw Steadman in PT. Told him the bike was smoother last night and seems looser. He seems to have decided against the insufflation for the moment and indicated he wants to see me every Tues/Thurs in therapy. If it does occur, he did say I could drive home afterwards. Rae said general or local is case-by-case decision by the OS/anethesiologist for this procedure. Three other people (Dirk, Rae, and Jennifer - another person from the internet boards) mentioned today that he can change direction quickly. Multiple stories of people seeing him in the morning in PT and in surgery the next day. Generally a good thing, though, since you don't want to taint the patient in PT via an anticipation surgery. Jennifer has a completely different problem that me, but we commiserated briefly.

Overall, seem to slowly be improving - now sure how much of the pain is masked by the roxycotin before each session, but there's not much in extension. Through a combination of good OS, PT's and Slurpees (FRAWG today), we can make it.

Details
Swelling last night was 16.75 in on the kneecap, 16.5 (2.5 in above), and 15.25 (2.5 in below). This hasn't reduced much recently, so will continue to be a concern. Started this morning with mobs, skipping the bike and wall slides. Started with foam under my thigh, then no foam, then off the table on his leg - he'd raise his leg to get a little bit of extension as he did this. We then did 10 quad sets for 10 seconds while he applied overpressure right below the knee. Flipped over and he massaged the back of my knee, and then pressed down on it some to get some extension. Surprisingly, none of this hurt much at all. "First time in over a year someone massaging my knee felt like a massage!" He then stretched my knee again while lying on my back.

5 minutes of quad sets, and then attempted straight leg raises again. The quad sets felt much better than a few days ago. Added bridges, 20 x 10 seconds each, contracting the quad each time. Stretched the hamstring, raising my leg in the air while lying on my back.

30 minutes in JAS - started at 3.5 and then bounced it up to 5! GameReady for 20.

Afternoon was almost exactly the same. Started on the bike for about 10 - on 29, managed to get the left to work almost exactly like the right, no 'hip hiking'. Didn't do the ball bridges in the afternoon. Started the JAS at the same place I finished in the morning, at 5, and bounced it up to 6.5, the best so far. Wow. Maybe it's the magic of the Harry Potter book, which I started reading today during my afternoon hour of JAS + GameReady. Whatever the reason, we'll continue it! Bike, wall slides, and then quad sets and hamstring to try and get back into extension tonight. If the flexion stuff doesn't seem to bad today, I'll be jumping (on the inside) for joy....

The good, the bad, and the ugly

It not quite as overused as "Twas a dark and stormy night" but probably close. The ugly - man, my knee is ugly. Old scars, new incisions, brusies from the surgery and from PT. It's probably as weathered as Clint Eastwood's face. The bad - had the injection today, and we're considering the insufflation. I have also named my knee Sam. The good - hit nearly 5 degrees near the end of PT today, and even managed 30 minutes in the JAS brace. And I think Steadman's office has wireless. And a Coke Slurpee! Some things aren't as hard as you think once you try them. Feeling decent, and somewhat optimistic due to that extension numbers today. Dirk says since I'm here for 2 weeks, he's confident he can get my knee to lay on the table - although he recognized that each day it wouldn't stay there, it might get closer each time.

Should find out more from Steadman about the insufflation in PT tomorrow. A parent may fly out if I'm under general, we'll see. Unless anyone reading happens to be hanging out in Vail and wants to give me a lift home (that's not the only reason they're coming, of course) Ironically, a little more good news, the bike tonight in the condo was reasonably smooth - much less painful than any other time today. I also finished the 9/11 commission report, so it might be time to switch to Harry Potter. We'll see if we can work some magic this week...

The Morning
Hit PT this morning at 10:15. Started on the bike, and let Dirk know that Steady said Saturday he wanted to give me a shot today. Dirk ran upstairs and talked with Rae, the physician's assistant, and after some patella mobs and tight wall slides, Rae came down and brought me upstairs to a room. Steady arrived in between surgeries, and asked how it was feeling. "Still pretty tight, about the same as Saturday." "No surprise there -" with a smile. He pressed on my kneecap as always, and I showed him my pain was just below the kneecap, on the inside of my knee (to the right of the kneecap from my view) and behind the knee on inside if in extension. He recommend 5 cc of lyticane (sp) ]for pain] and 5 cc of ketalog (sp) [for the inflammation]. Back to surgery for him.

Dr. Atticus?, one of the surgeons in his fellowship, actually administered the shot. "Boy, I was just reading your chart - sounds like you've had a long haul.." (I just smile at that type of comment these days - it's regularity is almost comical) Right below the incision that was on the outside of my knee. He said the location of the injection isn't that important, since it all gets in the joint. They swabbed it, hit it with some sort of liquid ice to numb it, and then injected pretty deep into the knee - he actually had me sit with my legs over the edge of the table. This guy played pro football and mentioned he's had about 6 surgeries "or so" on his knees for a variety of things - "That always was less painful for me". "Nice to have a doc that can easily identify!" [it was for me too] Right after the injection, he slowly moved my knee from about 20 to 70 to work the fluid into the joint. Rae then indicated Steady said I could head back to PT for mobility stuff only, and also mentioned he wanted to see me tomorrow in PT and Thursday as well - insufflation might occur on Friday. While waiting for her, I move my leg up and down and heard a pop! And then another! Heard a few more through the day, so hopefully there are some changes going on in there.

Back to PT, a little more mobs, bike, and wall slides for the next hour or so. My knee felt looser, but it didn't really translate into much more motion. I didn't feel as much pain below the kneecap, but still had pain on the medial part of the knee. Dirk said my kneecap felt maybe 10-20 precent looser, and then didn't ice since I didn't work the knee to much and the fluid could distribute.

That's why I came here - Steadman saw me on a Saturday, wanted an injection. I showed up Monday and in just over an hour (with no one other than Steadman in his office aware he said this on Saturday) had a brief visit with Steadman and an injection. Proactive, Proactive, Proactive.

The afternoon
Hello, roxycotin. The bike, 30 wall slides to 93 degrees, patella mobilization. I asked Dirk was was right below the knee, and there are three tendons that meet right next to the patella tendon and then spray through the medial part of the knee right up to the quad muscle. Two of those (the two closest to the knee) he said are used for the hamstring ACL replacement. That's what I had, and my medial pain seemed to be in the area he pointed. Wondering if the remain tendon might be causing some of my problems.

He then proceeded to do a variety of stretches to my knee - tibia rotation and plenty of others - I had some pain but only at the apex of the stretches. He then massaged the back of my knee while in the prone position, and then pressed on my heel to straighten - he seemed surprised that I didn't complain too much. We then did something that really helped Lynne - a quad set but with him pushing on my tibia with overpressure. This seemed to really help - he could see my knee drop from about 3 finger widths to 2 finger widths after completion.

"Let's hammer some quad sets." "I appreciate the fact you said 'us'" :) 5 minutes with my heel about 2 inches off the table on a 1/2 foam roll, and attempted the 1 minute then straight leg raise after that. Hamstring stretches on my back, and then 30 minutes of tolerable JAS at a 4 setting! 20 minutes of GameReady on moderate pressure. Good news is the extension pain was almost all in the soft tissue in the back of the knee, and it wasn't limited to the one medial tendon like a couple days ago. Hopefully, we've moved past that and are on to new, exciting pain!

If you've read this far, thanks. It either means the above was riveting, or more likely, you care a lot. Either way, muchos gracias.