Post Op 1

After 6 days, I had a day full of medical visits with a bit work tossed in the middle. The day started with my first post-op appointment. I was looking forward to it as it was my first chance to get the full story on what happened and an explanation of the pictures I have been staring at for the past few days. So what was really done? The fat pad (I think anterior?) was inflamed and removed. Scary but true, I also got a CD with a video of it being cut and ripped out (ouch). The fiber near the attachment site was trimmed. If you look at the circular probe in the pictures, it turns like a drill and appears to have roto-rottered the loose fibers away. The cartilage in my knee was soft; however, this could be genetic and didn't appear to be arthritic. The cartilage doesn't appear to be worn down or show any other signs of degradation. My ACL and MCL look great. Finally, the star of my procedure, a Topaz device was utilized to coblated/removed with radio frequency radiation--death by radio, several small holes in my patellar tendon near the attachment site of the inferior pole.

Once again, the concept behind the operation is to remove some of the damaged area and stimulate the tendon to grown again in a controlled healthy way. The general message was everything looked good and was healing.

My recovery program got a little more structure. I was told I could lose the crutches after 7 days. I will still need a brace for another two weeks but no crutches is great news. I can start swimming when the stitches disappeared. He guessed it would be another 7 to 10 days. The hidden good news is that I can start getting the area wet in another day. Until now, I took a few sponge baths, not fun, and more recently used some Nathan Power Shower wipes--way better, to get clean. I can't wait for a shower. Back to the rehab plan. When I return to the pool, it will be with my feet tied and a pull buoy. No kicking for 12 weeks. I was told, to delay getting on the bike another 3 weeks, 4 weeks total. On the bright side, I can bend my knee as much as I can as long as I don't but weight on it. My PT gal temporary took that freedom away later in the day. She suggested it would be best if I let her move it and I only stay get happy with my brace.

As for pain, it's not too bad. I still have a lot of tightness in my quad and my knee doesn't have anywhere near a full range of motion, up to 90 degrees after a little help. I was told my quad hurt because I was lifting my leg with it more and adding stress to it. Of course, combine that with some operation stress and you get sore quads. My biggest problem is actually keeping the brace all the way up on my leg. My quads are too dang skinny to fill out the top of the brace. Come on, why can't we use something big like my butt as a reference point. Nope, they use my skinny quads and I have to take the Velcro all the way to the side of the brace and not the designed point. Think of having to make your hole in a belt to get it to fit.

Later at work, we had a health screening. Other than being the guy hobbling around on crutches all went well. I have a good cholesterol level, blood pressure, sugar level etc.... Now if my knee heals life would be perfect!

To finish off the trifecta of medical fun, I had my second PT appointment. We discussed the full rehab process and started a lot of basic movements. It feels great to have my leg out of the brace and moving. Ok, I am not moving it but to have someone moving it is nice. I did a few simple leg strengthening exercises but all with a straight leg to keep the pressure off my knee. Simple rotations, lifts on different angles etc... Then we worked a little bit on using one crutch. I am not transferring weight to my right, injured leg. After a few reminders, I was doing better. I have to admit, I am still really nervous to put any stress on my right leg. I just don't have any confidence in it. I should trust the brace but easy to say and hard to do after a night of screaming in pain. Oh well, that's all from me.

Operation Day

So the operation happen a couple days ago and my goal is to document the process and my post operation experience so that others can learn from my experience.

The procedure was outpatient and I was scheduled to arrive in the morning. The facility was only a mile away from I live so I decided to walk. I knew it would be the last time I could walk for a few weeks so why not. I arrived with plenty of time to spare and relaxed in the waiting room. After a short wait, I was called back, filled-out some papers, and got dressed for the operation. On the bright side, I didn't get one of those thin gowns. Instead, they had these insulated ones with an attachment for and air hose to help stay warm.

After a short period of time, my doctor and anesthesiologist stopped by and I knew it about to be show time. I walked into the operating room and I was out pretty quickly.

I awoke about 90 min later in the post op room and was told my ride would be here soon and that everything went well. Sure enough, within a few minutes, my ride was there and I changed and was loaded into a car for the way home. Seeing as I didn't know what the next few days would hold, my friend volunteered for me to stay at their place and mentioned they would help out if I needed anything.

For the first few hours I felt great. Ok, I was walking with crutches and with a big leg brace but everything felt not too bad. I was told to move around and then hold my leg up. I did both throughout the night but in general was thinking this isn't going to be too bad. Well, I was a bit to optimistic.

After dinner, I felt a little bit of pain and started to take my pain meds, Norco. I took two and new I was going to take a sleeping pill in a couple hours and that would knock me out for the night. I made it up the stairs to my room, took an ambient and then read a few pages as I anticipated falling asleep soon. The entire process started around 10 and by 10:30 PM. I was hoping to fall asleep. I tried but just could get comfortable. My doctor mentioned I could take the brace off when I sleep if that helped so I tried that and couldn't get comfortable. Even worse, now my knee was starting to really hurt! I spent the next 2 hours changing positions and putting my brace off and on in hopes of getting comfortable and falling asleep. Unfortunately, it wasn't happening. I took two more pain pills and hoped they would kick in and kill the pain. No such luck. By 1AM I was screaming in pain into my pillow and hoping/praying anything would change. It didn't.

In my desperation, I thought I needed ice and maybe that would be the silver bullet. When I started down the stairs, my friend say me and innocently asked, "do you need some help?" I said, "Yes." I was truly suffering and hadn't anticipated it. I We made it down stairs, she gabbed some ice and helped me get onto the couch.

After seeing all the pain I was in, she called the doctor to ask for help. He said he couldn't do much because increasing my meds required special triplicate forms and it just wasn't going to happen. He did ask where the pain was and said the pain being all around my knee was from swelling and I had to get it down or the pain wouldn't stop. We prompted my leg up with 5 pillows and then placed ice everywhere. My friend was honest with me and told want I needed to hear. The pain will lessen but not anytime soon and you are just going to have to deal with it. Let's turn on the TV and it will help to pass time.

Somehow, when we turned on the TV, it was on Comedy Central and was showing a preview for Jackass in 3D. It brought a smile to my face. The pain returned but I knew I just had to find a way to make it through the next few hours. I told my friend to go back to bed because there was nothing she could do. If anything happened, I would wake her up and she could help. A few minutes later, she brought over a piece of bread to eat with the next pain pill and walked upstairs to go to sleep.

I spent the rest of the night, watching bad TV and wishing I could get some sleep. By 3 AM the pain had decreased enough for me to get a few minutes of sleep, 15 min, and then I would awake in pain. I repeated that a few times and by 5 was able to extend to 30 minutes before waking up.

The next morning came and she came down I was doing better. The blood had left my foot and the swelling as going down and my body was adjusting to the pain. It still hurt but it was not the screaming pain of the night before. We talked for a bit and it passed time before she took-off for work.

I called the doctor and got my medication increased. I still couldn't sleep more than 30 min and it was getting old. They doubled the pain killer and after a couple doses I was able to sleep for up to 60 min before the pain took over. By that evening, I was doing better but felt really bad between the lack of sleep and pain. After dinner, I stayed downstairs this night and had keep my leg elevated almost all day to reduce the swelling. To heck with the nurse telling me to move around, I needed the pain to go away.

The second night was infinitely better. I was able to sleep in 60 min segments all night long. I would only be awake for 15 to 20 min and then I was back asleep. The human body is an amazing thing. By morning I felt great! OK, the pain was present but after some sleep the world looked much better.

It was Friday and I was scheduled for physical therapy. I made it to my PT place. I was a little late but not too bad. The therapist was a little surprised I was there two days post operation but I was. After a few strengthening exercises, I underwent some electrostim and I was set to go home.

We stopped at Rubio's on the way home hoping a burrito would cure everything. It tasted great going down. However, the stronger meds had killed my stomach. After 3 hrs it was still sitting in my stomach and it come out. Not good! I ate soup and some yogurt that evening and couldn't even hold it done. I hate pain meds. They didn't help me when the pain was bad and now they had totalled fried my gut. On the bright side, I sleep great Fri night....I will get some images up soon so have patience...

a bad Right Knee

A couple weeks after I finished Ironman, Kona, I started feeling some minor pains around me kneecap. I was just coming off a nice break and wanted to get going for the upcoming 2010 season. I went to the weight room and when I tried to do leg extensions with my right leg I could barely lift the bar! I stayed away from running and went to my primary care physician who diagnosed it as runner's knee. I took anti-inflammatory drugs for 4 weeks and stayed off it but it just never felt right.
I stayed away from running until Jan and after a week new something was wrong and went to a specialist. I got an MRI that found a 5% tear of my patellar tendon. My doctor gave me a cortisone shot and said I would be fine if I would take a month off running and take it easy. I did but it didn't heal much. I never noticed and difference and was tired of waiting around. I returned to training and spent the full 2010 season trying to make up for lost training time. It never happened.
On the way back from a work trip, my knee was pounding in pain after sitting in a plane for several hours. I was really for a change and went to a different specialist, Dr. Daniel Keefe. Keep in mind, I could run/ride/swim with little to no pain but I couldn't stay seated for more than 30 minutes without pain.
Dr Keefe looked at my MRI and discussed several treatment options. I had already tried 2 months of physical therapy, 3 months of Graston therapy, gone to two chiropractors, one ART person and was working with the Wolf Studio. I felt confident I had exhausted all non-surgical options. He agreed. He suggested a new procedure call Topaz microabblation. I had never heard of it so I looked into it. The operation involves opening up the knee and burning a series of small holes in the tendon near the damaged region. The idea being destroy the damaged area and then stimulate new tendon growth in the holey region under post-op conditions.
I found a pretty high success rate for tennis elbow so I agreed to give it a shot. Yes a patellar tendon is different but from what I can tell my injury is rare. Most people either completely tear it off or have tendonitis. A partial tear is less common. I was informed to think about it because the small tear I have shouldn't effect my triathlon ability but I knew it was affecting my quality of life so I scheduled the procedure to occur 3 days after my last race of the year, Austin 70.3