A Christmas Getaway

Today I woke up thinking about the fact that surgery is now just over two weeks away.  That idea just blows me away.  As the day nears...Melissa and I decided that it would be good to get away for a little Christmas Escape...without the kids!!!

So we traveled 30 minutes away and just lounged around and enjoyed each other's undivided attention for a couple of days.  Here are some of my thoughts coming out of our time together with perspective of surgery just a few weeks away:

• Shopping has become even more agonizing than ever before, due to the knee issues.  At least now, I have a good excuse.
• My wife amazes me time and again.  I appreciate her support and encouragement.  She has been by my side through a lot of injuries and now the biggest physical challenge is just around the corner.  I wouldn't want anyone else by my side as I prepare to walk through this surgery.
•  I really like chocolate fondue!
•  The knee seems to be getting worse.  After a little pampering (a couples massage) and just a little shopping...it is time to get the feet up for a while.  Not only that...I didn't think I would hurt so bad the next morning.
• I am really ready to move forward...let's get the surgery over so that productive pain...therapy can begin.
• The Wii we bought for Christmas has been a hidden joy.  It has allowed me to be active while not really being active.  It also helps take the mind off of the knee.  Which at this point is nice blessing.
• It has been more difficult than I ever expected to keep weight off.  I joked before that I exercised so that I could eat.  I am seeing that that statement was more true than I thought.  For the first time I actually have to watch my daily calorie intake.

17 days...

Final Approval

Late last night, while participating in my fantasy basketball draft, I received an email that my final approval for the procedure and the hospital stay has been approved.  What that means we are officially a GO!

Now Genzyme, the Carticel company, will begin cloning my cells.  In just a few weeks 50 million stem cells will show up ready to be injected into my knee (not at my house- at the hospital).  I am secretly hoping that the procedure will only take 48 million.  I wonder of they give you a doggy bag to take home the left-overs?  You just never know when you will need 2 million stem cells.  With my recent medical "luck" they will get most of the way through the procedure and realize that they actually needed 55 million.

Just a few more weeks left.

Counting the weeks

Hard to believe that I am now less than 4 weeks away from my surgery date.  I find that everyday I am waking up thinking about the procedure and counting the days.  However, there are a few things that I am trying to take care of in preparation for the big day.

1) Date night...Next week my wife and I are dropping off the kids with the grandparents so we can get out of town for a couple of days.  It will be nice to get away and do some fun things before being laid up for a while.

2) I am really trying to get as strong as I possibly can right now.  Knowing the toll of what my leg will go through I want to make sure it is as flexible and as strong as I can get it.  However, that is proving to be more difficult than expected...because of the pain.  My two main exercises are straight leg lifts and walking up to my pain limit.

3) I am also trying to get my upper body as strong as I can get it.  Knowing that I will have to pick my body up for several months and use crutches as well is good motivation.

That's all for now.

Osteotomy

One part of the procedure recently discussed was to perform an osteotomy along with the ACI procedure.  Now I do know that there are many different types of osteotomies and I am not exactly sure what type of osteotomy I will undergo.

What is an osteotomy?  Basically, an osteotomy is a surgical procedure where the bone is cut to allow a reshaping or a realignment of the bones around a joint. The good news is that my knee alignement is good. However, the reason to perform this procedure is to change the weight distribution in my knee joint.

I am hoping that we are looking at a Fulkerson osteotomy and nothing more invasive.  The Fulkerson is done to reduce the load on the patella.  The downside of a Fulkerson is that I would no longer be able to kneel.  I guess I will have to learn how to pray standing up.

Here is a x-ray of what a Fulkerson Osteotomy looks like.

Looks like fun doesn't???  Just one more thing to look forward to in January.  As I know more I will update you on what I find out and what procedure they decide to perform.  In all, I am not too worried about all of it.  I know it is going to hurt but that kind of comes with the territory!

Carticel Implantation

What is carticel?  


This term is used often for a patient getting readying to undergo ACI.  CARTICEL is a biologic product used to repair articular cartilage injuries in adults who have not responded to a prior arthroscopic or other surgical repair procedure. It uses your body's own cultured cells to form new hyaline-like cartilage in your knee following a surgical procedure called autologous chrondrocyte implantation (ACI). CARTICEL is the name of the cells that are grown from the samples (or biopsy) taken from your knee. When implanted into a cartilage injury, these cells can form new hyaline-like cartilage.

CARTICEL is the first biologic product to repair articular cartilage injuries in the knee. In 1997, it became the only FDA-approved autologous cultured chondrocyte product on the market in the United States. CARTICEL is a product of Genzyme, a company with more than a decade of experience in developing and manufacturing autologous cell therapy products. (Taken from the Carticel website)

How is CARTICEL manufactured?  Here is a quick step by step look at what it takes to clone my knee.  Pretty SCI-FI stuff.

1. A patient's cartilage is harvested by the surgeon and sent to the Genzyme manufacturing facility.
2. The biopsies are processed to isolate chondrocytes from surrounding matrix.
3. Each patient lot is maintained under strict quality control procedures.
4. After primary culturing, patient cells are cryopreserved until an order is placed. This offers flexibility for patients and surgeons to schedule implantation.
5. Once an order is received, the patient's cryopreserved cells are expanded.
6. Two to three days before surgery, CARTICEL vials are released and shipped to the surgeon.

In all it is a pretty interesting process.  If you are interested in knowing more about CARTICEL...take a quick spin around their website: CARTICEL

There are some pretty interesting video spots on the procedure as well.

Random Update

It has been a joy to spend the last 48 hours with my little daughter.  My wife's grandmother died this week and she, along with my son, traveled out to California to attend the funeral.  That left my 13 month old and me to hang out for a couple of days.

One of the things that my daughter loves to do is to go for walks.  Especially, during the Christmas light season.  However, long walks and a bad knee don't necessarily go together well.  O'well...the walk always wins out in this scenario.

Yesterday, we walked about 1.5 miles and today we walked about the same.  Tonight, as I write this I am feeling the pain.  In some ways I can't wait to get on with the surgery and knowing that the pain will be "productive pain."  Nevertheless, I know the procedure is quite extensive and will be more difficult that I presently understand.

Only 5 more weeks to go!!!

Like yogurt?

I have been doing some extra reading on what to expect after the surgery, when it comes to the actual recovery time.  Here is an interesting description of what is actually going on in the healing process and how long it takes the new cells to do their thing.

Implantation Stages:
- After 1 week...like water
- After 3 months...like yogurt
- After 6 months...like pizza dough
- After 9 months...like the cheese that goes on the pizza dough
- After 12 months...like rubber

I guess that is why crutches are a must.

Prepartions

Today I have been battling through quite a lot of pain.  Sunday's are harder on me than most days due to the extended time on my feet.  However, the day has been full of great conversations and that always keeps you going.

At six weeks out I am beginning to put a list together of items that will help my life be a little easier post surgery.  Two previous knee surgeries help the process, but I have never been down as long as I will this time.  Here are some of the things I am looking at getting:

- Shower seat...yes it will be a little difficult to get this part of the daily routine done.
- Baby wipes (helpful having a baby in the house for this one)
- Toilet Risers...you have to think of everything
- Movie list
- New Wii games
- Reading list
- Buzz Cut...will make life a little easier
- Leg Lifter
- New Shorts and sweat pants
- Comfortable/flexible ice packs
- Small back pack to carry things around the house

And I am sure there will be more to come.  Let me know if anything else comes to mind that might help the rehab.  (Movie suggestions, book suggestions, game suggestions, rehab items, etc.)  Love to hear from you.

Famous ACI

Dara Torres, a popular USA Olympic swimmer, recently went under the knife for ACI surgery. Here is a great look at her story.

Got my crutches

You know things are a little weird for you when you find yourself excited to get new crutches.  Yesterday evening I pulled up to the house to find a nice box sitting at my front door...New Crutches.  Now these aren't your average crutches- these are Smart Crutches.  You can order and read more about them here: Smart Crutch

This is what my Smart Crutches look like...

These crutches are CAMO...in other words...crutches for the real man.  These are a nice upgrade from the standard silver/armpit crutches.  These fit the entire forearm and pivot to different angles allowing your arms and hands to get some rest every now and then.  In a funny way, I am looking forward to my new fashion statement come January.

I will blog more at a later time on how well I like them. But for now, it is practice time.  Furthermore, I need to put a little thought into what I am going to wear with these new crutches...I don't want to clash.

Here We Go!!!

Who knew how special today would really be?  Today I am preparing for the idea, that I am going to be cloned this month.  That's right!  I am going to be cloned- at least some of me.  Actually...if I am more specific only the stem cells from my knee cartilage are being cloned.


Let me do a little explaining...


This blog is being created to chronicle my journey and to help others who are facing similar circumstances.  I am about to undergo a knee operation called Autologous Chondrocyte Implantation, or ACI.  You can read more about the actual procedure here.


On August 1, 2011 I completed the first stage of the process.  What happened was over the years my left knee has started to deteriorate to a large degree.  In June 2005, I tore my ACL playing basketball when a large ogre of a man fell and rolled into my left knee.  The injury left me with no ACL and two tears in my meniscus.  Not fun...but not the end of the world.  My doctor went in and "fixed" the issues and created for me a new ACL using part of my patella tendon in August of 2005.  For the most part I was fixed and participated in fairly normal activity...though I had a nagging phobia of playing basketball.


In October 2010, the same knee was re-injured by a different ogre who attempted to tackle me while playing flag football.  The result of this injury was a small tear in the cartilage.  After attempting to go through life as normal as I could- the final straw that broke the camel's back came in June 2011 while bowling.  Yes, and I know what you are thinking...bowling is a vicious sport.


On August 1, 2011 we scheduled an Arthroscopic Chondroplasty to inspect the knee, to clean it out, and to perform a possible micro-fracture of the knee.  However, that wasn't to be the case.  What was found in the knee pretty much left the surgeon speechless...what was found were multiple, large lesions (or defects of the cartilage).


Medically speaking:
- Grade IV lesion measuring anterior to posterior 4cm x 2cm medal lateral and medial femoral condyle.
- Lateral femoral condyle lesion measuring 3cm x 3cm, uncontained in its lateral-most edge (note: uncontained is a bad thing)
- 3cm anterior posterior x 2.5cm medial to lateral trochlear lesion
- 1.5cm x 1.5cm lesion of the patella central


In laymen's terms...I have one jacked up knee.  To be even clearer...today I went to visit the surgeon who will be doing the operation for the first time and his first two words after looking at my surgery pictures were "Holy Crap!" (would have been even better if he put BATMAN at the end of that)


Anyways, during the Aug. 1st surgery my doctor realized that my knee was really bad and that I was a prime candidate for ACI- so he went ahead and biopsied my cartilage stem cells.  Right now...part of me is in Massachusetts getting ready to be replicated.  I know it sounds like something out of an old alien movie...but it is true.


When the cloned cartilage cells are ready, I will head back into surgery...January 16, 2012 to be more precise.  While the first operation is performed arthroscopically, the second one is the real deal. It's called an arthrotomy, which is a fancy way of saying the patient wakes up with one of those Frankenstein scars stretching vertically across the knee (about 12 inches in length).  Now after they get done ripping my knee open they will work to relocate my fibula, my knee cap, and "patch" the large lesions with tissue, and then inject my harvested stem cells underneath the patches just created.  Right now we are just waiting for my cells to reproduce and to head into surgery.  


What is being predicted is that I will need to spend 2-3 nights in the hospital, 10-12 weeks on crutches (non-weight bearing), and 18 months in rehab...all in hopes that I get 10 more years out of my knee before I need a total knee replacement.


This blog is intended to chronicle my adventure through surgery and the grueling rehab.  Furthermore, the blog will give me a creative way to deal with my boredom and pain.