5 Year Update on the Knee

Five years! In many ways it is hard to believe that it has been just over 5 years ago that life began to change. It has been just over two years from my last knee surgery. I am so thankful that my knee doesn't look like this any more.

After gaining some weight and being tired of sitting around,  I decided it was time to see what the knee could handle and I signed up to join Orange Theory Fitness. Orange Theory is a high interval training class/routine that pushes you through the paces by filling an hour workout with cardio, rowing, body weight and dumbbell exercises. Now being actively going to OTF for the past year, I have to say that I love it.

The year at OTF has helped me regain balance, muscle tone in my left leg, and helped me get back into shape. It hasn't all been easy. I still have to modify certain exercises knowing that lateral movements, jumping, and running make my knee angry; but I think I have improved my vertical leap from 2 inches to about 4 inches. However, with the aid of the trainers and paying attention to what my body is saying, I get through a rigorous workout 4 and 5 times a week. And in many of those workouts I am now able to perform squats and lunges. Who knew???

Where am I at now? Overall, I feel pretty good. I still deal with some pain from time to time. My knee clicks every time I walk across the room. Which is both physically and audibly annoying, but nothing that concerns me too much at the moment. When straightening the knee from a bent position there is still a fair amount of grinding taking place. The good news is the knee isn't swelling and when there is pain, it is manageable. The goal is to get down the road another two years before we consider doing a total knee replacement. I think...that is doable. But one thing I have learned is that when it comes to knee stuff it can turn in an instant.

Melissa and I really appreciate the support from friends and family we have received over the years. I plan to continue to workout regularly and I am even thinking of doing one more bike race in February of 2018, for old times sake. The goal being to go have a good time and not to compete for the podium. Let's see if the leg will continue to cooperate.

I will continue to update the blog when there is something interesting to write about. Thanks again.

Bringing in the New Year

Well...it happened- another surgery.  Right before the parties got started to usher in the new year, I was hanging out with the medical staff that was getting my leg prepped for another surgery.  Here is the run down of how we got there and what happened.

After the latest diagnosis of having SONK and then finally hearing some positive signs that the SONK was showing signs of reversing, my wife and I decided we needed a break.  So we decided to play the "ignorance is bliss" card for while and just live life the best that we could and not worry about the knee until something happened that caused us to have the necessary conversation.  In plain English, we stopped going to the doctor for a while.

And honestly, that provided a little over a year of fun and manageable activity.  However, this past fall things began to change again.  I flew to India for two weeks and after arriving home, I wanted to spend sometime helping my 4 year old learn to ride her bike.  It only took about two minutes of walking behind her bike holding the seat for my knee to get really angry.  It actually took me out of commission for a couple of days on top of making me very grumpy.  That is when we decided it was time to see the doc again.

During the appointment and routine evaluation it was confirmed that most of my current knee issues are probably a result of my knee cap.  Therefore, it was suggested to perform a chondroplasty to go in and clean up the knee and to see if the knee cap could be helped out at all.  Following the suggestion of our surgeon, we decided to move forward and to schedule surgery for December 31.

What we found is that the ACI surgery took fairly well.  There seemed to be a good amount of new cartilage that had regenerated and still looked healthy.  However, the knee cap was "trashed."  My doctor did his best to clean it up and tried to get it tracking a little better, but honestly time will tell if it is working.  It was mentioned that I might need an artificial knee cap if this surgery doesn't do the trick.  So I have some educating to do when it come to artificial patellas.

As of right now - I am still in recovery mode.  I am walking without assistance but not winning any races. There is still some swelling on the joint along with bruising.  Because of the swelling, it really is too early to tell the final outcome of the surgery.  As the swelling goes down I am hopeful that this will be the last surgery for the near future.  I know there are more surgeries in the future but hopefully further down the road.

I will continue to update the blog with the latest happenings and progress coming out of the this latest procedure.  I appreciate everyone's support and pray for those that are going through similar challenges.

Two Year Update

Hard to believe it, but it has been two years since surgery.  In some ways the recovery process, the long days laying in bed, and even the intensity of the pain seem like distant memories.  The process coming out of ACI surgery is an ultra-marathon...not a sprint.

I am sure you might be wondering what the latest news is concerning the knee...so here are some observations followed by what life is looking like today:

• My quad strength is still limited.  I really don't think the quad will fully come back.  I have gone through several sessions of dry needling to help with pain management and to get the muscles firing correctly.  The goal is that this will help the muscle to continue to heal and strengthen. More on the dry needling in a moment.
• I still have a lot of grinding in the knee.  Every step I take you can actually hear the knee snap, crackle, and pop.  Though I have an orchestra living in my knee, the grinding doesn't seem to be causing any pain.  It just serves as a constant reminder that more surgeries are coming.
• Standing for a long time gets tiring and painful. My knee still doesn't like the times I have to be on my feet for an extended amount of time.  It does help me get out of shopping, so I guess there is a bonus to it.
• Still no running or jumping in my routine.  The best I can do is a slow awkward trot around the yard when playing with my kids.  You know its bad when your three year old daughter can outrun you.  
• The osteonecrosis seems to be a thing of the past.  At least that is how it is feeling.  I haven't had another MRI since the last one in May.  I am playing the "ignorance is bless" card when it comes to the knee and MRI scheduling.
• I continue to ride the road bike a few times a week.  It has helped level out my weight and at least gives me a little relief from the demands of the day.  However, riding on the road has gotten boring.  I finally decided to buy a mountain bike a few weeks ago to vary it up.  My wife and I came to an agreement that I would ride once a week and that it would be a bike with gears. Mountain biking does bring some discomfort to the knee but the rolling over boulders has a way of easing that discomfort.  I know this time is limited, so I wanted to do some riding in the mountains while I still have a little ability to do so.  I don't ride like I used to but at least I am out there doing something.

So...that is where I am at two years after ACI surgery.  I love hearing your feedback and questions and please let me know if there is a certain topic you would like me to cover.  Any suggestions are welcome.

Positive News

Finally...got some better news this week.  After the last MRI, I had the chance to sit down with my doctor on Thursday.  Immediately, he walked in and proclaimed, "I have good news."

The good news we heard is that the bone is now showing signs of vascularization...in other words, blood was beginning to flow back into the areas affected by the osteonecrosis.  This is what we wanted to hear.

What does that mean?  First, I no longer have to walk with a cane.  Secondly, the overall process of healing will take around 6 months.  Thus, we will have another MRI in 6 months to confirm the bone has healed completely.  Until then, I have to continue to use my unloader brace for the next 6 months, but only when I know I am going to be on my feet for an extended amount of time.  The great thing is I can begin introducing some activity back into my life.  I was encouraged to walk around the block and to ride my bike.  YEP, I can ride my bike again but I did have some specific guard rails...no hill climbing and no racing.

I am looking forward to spending time on the bike again.

I am still dealing with some pain in the knee.  I am hoping that some of this is still a symptom of the osteonecrosis and the fact that my muscles and tendons are overloaded.  I started to do some basic physical therapy to help rebuild the muscles and even ordered some orthotics to help with my overall alignement.  Can't wait to see where things go.

I will continue to report any new progress and tell you how the therapy and the orthotics do for my overall progress.

I am Evolving

Just a few days ago I had my follow-up appointment with my doctor.  I wish I had more to say at this point.  The exact wording on the MRI results were that my SONK lesion is "evolving."  Evolving???  What does that mean?

All of a sudden all the jokes of me being the missing link are beginning to make more sense.

Basically, my understanding is that the SONK is changing.  It hasn't gotten progressively worse which is a good thing.  However, before we start dancing through the streets naked...it is still there and by no means hasn't disappeared.  Where do we go from here?  Actually nowhere...yet.  Doc said that he wants me to keep living life as we have for the past 30 days for another six weeks.  At that point he wants to do another MRI to re-evaluate the knee.  I think after the next MRI I will officially be glowing.

Waiting seems to be the word of the moment.  If I am honest, my patience is beginning to wear thin.  I am tired of sitting around, walking with a cane, and living in constant pain.  We are now approaching the two year mark from when things went really bad with the knee.  My wife and I are ready for answers and that seems to be our constant prayer right now.  My doctor really acts like we need to outlast the SONK- so he can move forward with the osteochondral allograft procedure (Bone and Cartilage Transplant).  Which I am not super excited about doing.  I feel like we have looked at and tried the conservative approach and now we are ready to try some "not so conservative" approaches when it comes to the knee...which would be something artificial.

I guess we will know more in 6 weeks.  At least that is what we are hoping for!

MRI #2

Yesterday, I finally made it in to have my second 3T-MRI of the year.  I just wanted to update any progress in moving forward and this is one simple, and yet, big step forward.  My follow-up appointment with the doctor will be in one week.  At that point, I hope to have lots to share.

SONK

Today, I learned a new term related to the knee - SONK.  Before I get to what SONK is and how it relates to me, let me briefly update what has taken place the last few weeks.

Over the past few weeks following the initial MRI results I have visited or have been in touch with five different orthopedic doctors concerning my case.  Which led me to my sixth doctor that I visited yesterday.  Why so many?  It has been hard to get both a solid perspective of what the next step should be and to find someone that seemed ready to dive into my case (or had the expertise to dive in).

The first words that doc #6 had to say when he walked in the room was, "Lee, you have one challenging knee."  After stating what I took as obvious...lol...he began to ask questions about the last year, we talked through the last few surgical reports, and then he did some pushing and moving of the knee.  Coming out of that appointment we decided to schedule a scope of the knee to get eyes on what is really going on inside...with two possible plans of action based on what we found: 1) Osteochondral allograft or 2) Artificial fix.

Melissa and I left feeling like we had a plan of action that both of us were very comfortable in exploring.  Then the phone rang.  Dr. #6 was on the other end of the phone.  He began to explain that he decided to dive into my MRI a little more and so he called his favorite radiologist to give an opinion on my films and together they came to a conclusion that I might have a SONK lesion.  You can click on the link below to read into the detail of what a SONK lesion is.

SONK Lesion or (Spontaneous Osteonecrosis of the Knee)

What does this mean and where do we go from here?  Basically our plan of action at this point is that my doc told me to put the unloader brace back on, walk with a cane, and to take it easy.  There is a small chance that the damage to the knee (what seems to be a SONK lesion) could reverse itself if given to rest (if it is small).  However, to do a scope of my knee could cause my SONK lesion to get worse if indeed that is what it is.

From here the plan is to rest the knee for a month, at that time we will do another 3T-MRI of my knee and compare the images to my January MRI.  If the area they are concerned about doesn't change or worsens...it is a SONK lesion.  We haven't talked in detail at this point what we will do if indeed this turns out to be a SONK lesion...but from my research the only options seem to be a unicompartmental knee replacement or a TKR.

It is hard to explain the emotions of the current journey.  I feel more numb to it all at this point...probably because I feel I have moved into survival mode or I am just tired of facing the emotions of the problem.  At least, at this point, it looks like we will have more answers in a month.  In the meantime, I am rocking my new Walgreens cane.

MRI follow-up

Monday afternoon I had the privilege of sitting in the MRI machine for 45 minutes as I they did a cartilage map of my knee.  Today we got the results.

The results were that the ACI procedure done a year ago, yesterday, didn't fully take.  The lesion on the outside of my knee looks good but the other lesions (the larger ones) didn't work.  Hearing that news was both good and bad.  It was good in that it meant that I wasn't crazy.  Bad...well I think you get the bad side of it.  Hard to believe that we went through all the pain, craziness, time, money, etc. to be no closer to fixing the knee.  Where do we go from here?

That is a good question.  A question that we hoped would be answered today but what we found out...my knee is seriously jacked up and there aren't any real good alternatives.  Here are the current three options on the table as discussed with my doctor today:

1) Do ACI surgery all-over hoping this time the odds fall in our favor

2) Try another procedure called: Osteochondral allografts.  What is this?  This procedure involves the transplantation of a piece of articular cartilage and attached subchondral bone to a damaged region of the articular surface of a joint.  Basically transplanting cadaver material into my damaged knee parts with the hopes it works.  (Probability of this working is around 50%)

3) or Knee resurfacing.  A procedure in which a metal plate is placed in the damaged area of the knee. better alternative than a total knee replacement in that it allows me to keep all of my ligaments and tendons in tact.

*A total knee replacement is still not a good option due to my age.

At this point you might be wondering what our game plan is?  We are not 100% sure if I am honest.  We are going to seek an audience with a couple of specialist in the Osteochondral Allograft procedure to get their perspectives of my knee and whether or not this is a good option for me.  One of those doctors is here in Phoenix and the other in San Diego.

There are still a lot of decision to be made and a lot of information to gather.  More blogging to come...

ONE YEAR!!!

Yesterday I went in for my one year check-up.  And yes, it was two weeks early, but who's counting.  I was a little nervous going in not really sure where I stood and if the doctor would be happy with my overall progress.

As the Doc came in his first words to me were, "Was it worth it?"

That alone gives you a basic understanding of how difficult the surgery and the recovery are for this procedure.

After a brief five minute conversation it became clear that I haven't been progressing the way that I should.  Some of the basic things that helped us reach that conclusion were:

- I was still having pain with any extended walking or standing
- I still have moments of swelling (specifically a real large knee this past weekend after working in the garage for a couple of hours)
- No real maneuverability while playing with the kids in the backyard. (Doc suggested I should be able to jog around and play soccer with the kids without any setbacks)

All of this to say... the last year and a half and two surgeries hasn't put me any closer to my goal of being semi-active again.  At this point of the blog you might be wondering what the next step is from here.

The first step from here is to go and get a 3T MRI (an advanced MRI test) to see exactly what the status of my knee is.  Based on the results of that MRI we will move forward.  What does it mean to move forward?  If I am honest I really don't know.  What we discussed before the ACI surgery was that if this procedure didn't work the only real place to go would be a total knee replacement.  I just cannot imagine having to go through a total knee replacement at my age.  However, I also cannot imagine living with my current knee issues for an extended amount of time.

Emotionally the last few days have been a little difficult to digest.  Knowing that the last surgery, pain, time, family and financial stresses didn't accomplish what we were hoping for is hard to swallow.  I can liken it to running a marathon only to find out at 26.2 miles you ran the wrong direction and now you have to run back.  I don't know exactly what the next year will bring.  But what it seems is endurance will be the key to 2013 just as it was in 2012.

Obviously there is more to come.

11 Months and counting

There really isn't a whole lot to report at this time.  My routine is still fairly limited in what I do and can't do. Two weeks ago I spent about 4 days wrestling with some serious pain in the knee.  I have no idea where this pain came from but it sent my mind wandering for sometime.  Did the surgery work?  When will my next surgery be?  You kind of get the point.

Last week, I actually paid someone to come and put my front yard in.  The movement and the rigors of having to move rock, lay irrigation lines, etc. is still to much for me to overcome.  Not only did I have to rely on another guy to put my yard in...I had to rely on my wife to hang the Christmas lights.  With the ongoing knee problems over the years I think she has hung lights more often than not.  I hope one day to get back to normal activity when it comes to what I can do around the house.

This past month has been nice being able to get out on the bike.  Not only has it helped me physically it has helped me emotionally too.  Don't worry...I am not riding a lot of miles.  I am averaging about 40-45 miles a week.  I did go out for a slow 20 miler the other day.  It was nice to get moving but I did live in pain for the next 24 hours.  The muscles around the knee are still weak, which I think adds to the pain issue when I do something.

I still find it hard to stand for long periods of time.  If I keep moving I can make it a little longer.  I am looking forward to my one year follow-up in January.  There will be lots more to share at that time - I am sure.

Half-way mark

9 months down...that means that I am now officially half-way through the recovery process.  That is crazy in many respects.  First, that I am now 9 months post surgery.  Secondly, that I have 9 more months to go until I am out of the recovery process.

Here are some of my recent updates on the knee and the overall recovery phase:

• Two weeks ago we left for a family vacation.  We flew to Florida and did the whole Disney World thing.  We had a great time with the family but as you can expect...the knee wasn't going to take a full day walking around the park and definitely wouldn't take multiple days at Disney.  Therefore, we did it in a wheelchair.  It got old staying in a wheelchair the whole time but the plus side was we didn't have to wait in line for anything.
• While in Florida we also hit the beach.  That proved to be more difficult than I first thought.  Walking on a slope beach and wading around in the ocean was challenging and painful.  I left my unloader brace on the entire time and had to take numerous breaks from walking and playing with the kids.  At least I got some good sun when taking a break.
• Swimming is going well.  I am still hitting the pool three times a week.  Still if I kick too hard or move a little funny in the water the knee lets me know.  It is nice to do something.
• Today I dropped my bike off to get ready to ride.  Come November 1st I am cleared to start peddling around outside on my bike.  I can't wait...as this is one of my favorite past-times.  It will be nice to be on a bike again but it will be hard to ride slow.
• Overall, the past few days the knee has been feeling a little better.  I would call it another break through in the overall healing.  This past weekend we moved into our new house and that demanded a lot physically and the knee did much better than expected.  I can't wait to hear in January the doctors report on my overall progress.

Here is to keeping up the routine.  At least the routine will get a little change come November 1.

8 Month Update

8 months out...hard to believe it.  I can remember thinking that first week of post surgery what it would be like to be 6, 8, and 12 months down the road to recovery.  The knee is looking good and I even have a little definition in the leg muscles.  Let me clarify...definition is relative and not from lifting weights.  Mainly any tone I have in the leg is from leg lifts, mild walking, and pure luck.  For those that are curious here are a few of the most recent pictures of the knee.

If you can make out the scar from all that hair...you will see that the scar is looking pretty good.  The swelling has gone down nicely.  I still have a little swelling on the knee but nothing too alarming.

Here are the quick bullet points on the knee and my current activity level.

• Overall, not too much pain anymore.  However, my knee aches badly if I am on my feet too much, walk too far, or when I get done swimming.
• That's right...I took my doctors advise and for the time being, I am a swimmer.  I go to the local pool and swim 30 minutes a day, three times a week.
• Swimming is boring, but it gives me something I can do and the good news- it is making my arms look buffer. : )
• The fall has been difficult emotionally.  I really miss playing with the kids outside and biking.  I am actually coaching my sons soccer team this fall.  Something I always dreamed of doing but I thought I would be able to run and demonstrate the drills needed done.  Let's just say that's not happening.  Thus, I am very thankful for my assistant coach.
• Brace...I am still stuck in my brace during the day.  Last month I had taken it off while in the house and was walking across the living room when all of a sudden that knee buckled and gave out.  As you can imagine I went down with a thud and spent the rest of the night icing.  Not a great experience and I am tired of wearing the brace.  And it is beginning to stink.
• I have spent a lot of my time reading other blogs on the surgery and from what I can tell I am one of the most restricted patients.  That can be frustrating but I am working really hard to follow the doctors advice.  Still no elliptical, cycling, and nothing that even resembles running.  Playing this one by the book!
• I can't wait for November when I finally get the green light to do some light bike riding on the street.  
• Next month we are making a trip with the family to Disney World.  This will be an adventure for everyone.  I will be sure to post how the trip goes and pictures.  

6 Month Update

Wow...six months down and out!  I can't believe that it has already been six months from the time my leg got filleted.  I had a follow up appointment this week with my original orthopedic - remember my surgeon dropped me because of insurance challenges.  Any how...not a whole lot of new information from the doctor.

Actually the entire appointment consisted of dialoguing about the knee and how it feels.  There was no physical examination.  He reminded me that we really won't know how things are really working and progressing until we hit the year mark.  For that reason, all doctor appointments have been pushed to January.

Here are some things to note about where I am at and things I am looking forward to:

• No outdoor biking yet.  Actually, I was told I really need to hold off the biking until November and even then it needs to be something I ease into.  NO RACING.  So until then...it is more time on the trainer with no resistance.
• The knee still has some swelling in it.  I asked the doc if I should head to PT to help with the swelling or strengthening the muscles around the joint and he quickly said not yet.  The knee and my patches are still vulnerable and it is better to play this one safe than to try to push through and make something happen.
• The lack of exercise is about to kill me.  I realized that this is the longest I have been out of commission since I started playing sports at 5.  It is for sure an adjustment period.  At least with my ACL surgery I could do some small things and was able to get on a bike regularly by 6 months.
• We are still living in our temporary space until our house gets finished.  This space is great but it does have stairs.  And incase you were wondering...stairs are not my friend.  I still have to take them slowly using my good leg to get me up and down.  It can be painful if I move too fast or happen to step wrongly as I go up or down.  I try to limit my trips and often need to rely on my son or wife to help me get something if I forget to grab something.
• The unloader brace is actually wearing out somewhat.  I sometimes wonder if I should have pushed for a custom brace.   Maybe it would have lasted a little longer.  I still have another 4 months of wearing the brace.  At that length of time I hope there is something left.

Still a long road ahead.  Everyday that goes by is one more day closer to normal living.  This weekend we are going water skiing as a family and I know it will be very hard to hang out in the boat as everyone else gets to be pulled around the lake.  Part of the healing process I guess.

4 months and counting

I can't believe that it has now been more than 4 months sense the surgery.  Things continue to move at a snail pace.  I find myself longing to get back to some normal physical activity.  Riding the stationary bike at 14 mph just isn't cutting it and I am tired of adjusting my eating for the lack of exercise.

The past week I did go and buy a new bike in hopes of riding it soon.  I had to ask the bike shop to keep it on the shelf until September.  Otherwise the temptation to ride would be too great...as I am still not allowed to ride outside until the fall.  Below are some basic things to note:

- The knee is still swollen.  I wonder how long it will take until I can see my knee cap again?

- The past week I have had some moments of sharp pain.  Those moments bring enough pain that it leaves me gasping for air and causes me to lose focus on whatever I was doing.  The pan doesn't last very long but it is intense when it happens.  The weird thing I haven't been able to figure out what is triggering the moments.

- My left quad muscle is still squishy...really squishy.  But, if you look hard enough and turn your head in to the right place you can make out some contour of my small muscles.  At this point I take anything I can get.

- My limp is barely noticeable, but still present. The leg gives out randomly once or twice per day, usually for a nanosecond, and then I quickly recapture my normal walking form.

- Stairs remain problematic. I don’t have to avoid stairs, but I do need to handle them with care, especially going down.

- My ROM is still good.  However, deep bending or squatting are still beyond me.

Another DOC visit

Another week...another doctor visit.  At just over 14 weeks post-op...I am feeling good and I was really looking forward to talking with Dr. Tarlow to see my latest progress and to ask some big questions.  Teh appointment was quick and full of exciting news.  The first news I got was that my doctor has decided to drop my health care provider.

Yes...not my fault.  And really I can't blame him for the challenge doctors have to face with providers these days.  What does that mean for me?  It means I have to go back to my old doctor that couldn't provide surgical services because the provider wouldn't cover the facility.  At least...I think I can go back as long as they haven't dropped my provider too.  Just another fun think to navigate through...

Back to the knee news...

1. The knee is still swollen but that isn't something that is totally abnormal at this point.

2. I have to wear my unloader brace for another 6 months and then for any periods of extended time on my feet.

3. Everything looks and feels like it is healing nicely.  I do have some popping and grinding still when the knee is flexed but the Doc told me that is fairly normal at this point and over time it should go away.

4. Stationary bike is a good thing as long as I don't overdo it!  Thus, I keep doing what I am doing and I actually road 5 miles yesterday.  My furthest bike ride in almost a year.

5. I asked if I could eventually Mountain bike again...while keeping my fingers crossed.  To which I couldn't believe my ears...the answer was YES!  In 18 months I can begin to mountain bike again.  That news was almost too good to hear.  I can't wait to get back on a bike soon- 18 months will not come fast enough.  (And yes, I will be allowed to single speed as long as it isn't a steady diet of it)

6. Dr. Tarlow, also felt that the cells are growing like weeds and that over the next 20 weeks they should begin to morph into a thicker substance that resembles the new cartilage that is to come.

Overall, the news was all good.  I couldn't be more excited.

12 week update

Wow...almost three months have now passed by.  There have been lots of ups and plenty of downs.  The biggest change is that I am finally off the crutches.  My fun, out of the house, conversational piece is now out of my hands.  Honestly, I feel like a new person and yet, I look like a baby colt trying to walk for the first time.

Walking feels great because I like having the freedom to get things on my own and the freedom to pick up my kids and walk around the house.  Those are the few things I have found I really took for granted.  Overall, the pain is doing ok.  When I am on my feet for an extended period of time the pain increases.  As long I have time to rest and sit down things stay pretty manageable.  Sunday was Easter and as a result I was on my feet a long time...that meant by the evening time I actually had to take a Vicodin to help me recover and sleep.  I hadn't had to do that for weeks.

Physical Therapy is slowly coming along.  I have reached full range of motion on the stationary bike with the seat fully lowered.  That means that I can now slowly begin to increase a no resistance spin for 30 min every other day.  That feels good to finally get to this point.  I am really looking forward to my doctor visit at the end of the month to see what he has to say about my chances and timing to ride outside again.

At this point I am getting really comfortable with the unloader brace.  It really helps manage the pain and gives me great support when getting around.  In the evenings I walk around the house without it and that isn't necessarily a pretty thing.

I am also getting to do 45 degree wall sits.  I hate wall sits...I have always hated wall sits...but I guess it is one thing that is good to help develop the muscles around my knee.  45 degrees is better than 90...but I still hate doing them.

Overall, the knee feels good and I look forward to my next doctor appointment.

5 Thoughts on Loss and Pain

My goal is not to be a “Debby Downer” today.  Actually, my desire is to do the complete opposite.  I hope some of my reflections inspire you and even encourage you in some of the challenges you face.  One thing is for sure...life is full of challenges.

Over the past ten months I have faced every emotion I can think of.  At least, I think so...but now we are getting into some deep philosophy that probably only interests me...so let me get back to where I was.  The last six years I have experienced some great moments of joy and at the same time have walked in seasons of pain and hardship.  The season of pain has been eerily marked by six different surgeries.  Each surgery provided its own unique challenges and unique recoveries.  The latest of which has been the most difficult.

My ACI surgery (coupled with the Fulkerson Osteotomy) has not been the easiest surgery to recover from by any means.  The 5 weeks spent in bed and the hours spent sitting in my chair has been challenging physically, but also emotionally.  Knowing that life will have a new normal is part of the problem.  However, the time down has given me great time to ponder the implications of pain, loss, and grief.  Here are five things that I have learned, pondered, and even come to appreciate.

1. Balance - Pain, illness, injury...whatever you want to call it is exhausting.  I have regularly found myself feeling or wishing that I could do more to handle the demands of life, to help around the house, to play with the kids.  However, I have come to understand that even some of the most simple and mundane things become quite difficult when dealing with the stress of pain and illness.  Not only does the physical pain see-saw back and forth...so do your emotions.  I found it normal to watch my emotions go back and forth from negative thoughts to positive thoughts and back again in a matter of minutes.

In these moments it is helpful and very important to manage your energy well.  Knowing that the stress of injury, illness, or pain drains your energy tank is a critical piece to the puzzle.  Thus, you have to manage your energy wisely. Find things or people that bring you energy and avoid tasks and even people that drain energy. Make sure you to-do list is reasonable and don’t push your self beyond your energy level or you will pay for it!

2. Don’t let your injury or pain win - There have been moments that I have felt like succumbing to the pain or my identity as the guy with knee issues.  Even spending time with good friends the conversation easily moves towards talking about my issues, my recovery, my pain as though there is nothing else to talk about.  Don’t allow this to be come the new normal.  Focus your conversations and help lead others to talk about the many other interesting things that help make you.

3. Talk with others who have been there before - Even with six surgeries over the past six years I had never gone through a prolonged season of being in pain.  If you are anything like me...you probably haven’t either.   In preparation for my last surgery knowing that the pain would be tremendous and the time laid up would be lengthy I sought out several people that had walked through similar hardships.  These people gave me great information, understanding, advice, and ecnouragement.  All of these things helped create for a foundation that would help me persevere through the challenges of surgery and rehab.  The shared experiences showed me I wasn’t alone in this journey...which trust me is a nice reminder.

4. Don’t isolate yourself - When I am in pain and nursing an injury I find it easy to isolate myself from activity, people, etc.   Bed rest also made it extremely easy to isolate myself and to spend time watching TV (not mentioning the pain meds).  I think part of this is normal based on circumstances.  However, fight through it.  Ask people to visit and to bring your favorite milk shake from time to time (Mexican food was helpful too).  Watch things that are uplifting and that don’t add weight to your already shaken emotions.  And when possible...get out of the house.  Going to church and even a restaurant helped me feel normal again.

5. See the bigger picture - I have come to recognize that without pain and hardship I would never come to know God as my Comforter.  2 Corinthians 1, tells us that in times of trial and in times of hardship, when we turn to God for answers and help He will be there and will be our Comforter.  If we were to live life without pain, then we would never get to fully experience God for all that He is; without pain there is no need to be comforted.  If this be true, then for us to truly mature and to become Christ like we must have periods of pain in our life!  Thus, pain in the long run really is a blessing, because it is in our pain that we get to see and experience God.

Another Random Update

Today, I am at 9.5 weeks post-op.  I have been a little hesitant to post anything lately because the progress is very slow.  The knee is still a little swollen, the scar is healing nicely, my pain is manageable, and I am still in need of crutches to get around.

When it comes to the pain...I would never classify the knee as feeling awesome, but it does feel a lot better than it use to.  If I am honest, my progress seems to be moving at a glacial pace...the small increases in my ROM seems hardly enough material to write a blog about.  However, for your own boredom I will keep on keeping on!!!

Yesterday, brought some more progress.  I have slowly lowered the seat on the bike to help increase my range of motion.  I only have three more notches until my seat is all the way down.  I road for another 15 minutes yesterday.  It did take a few minutes until the knee warmed up so that I could actually make a full revolution.  Over the entire 15 minutes I set a new record for distance traveled.  I rode bike a total of .59 miles over 15 minutes.  Being a former competitive rider...It is hard to believe that I am celebrating such a small milestone on the bike...but you have to look at the little things.

I am getting more use to the brace everyday.  I did try to take a step around the car door this week with out the use of my crutches.  It was such a small distance I decided to give it a go.  Let's just say that if it wasn't for the brace and the car being so close to me I would have been flat on my face.  I am still not ready to walk unassisted yet.  Monday brings some more changes and more to share.

Stylin in my new brace!

This week has been a real test for the knee (8.5 weeks).  I attended a conference for the last three days which meant a lot of time on my feet and walking from session to session.  The time out of the house and the new routine proved to bring some great relief to the soul but a little more pain to the knee.  I also got really good at giving the short and modified story of what happened to everyone that had the nerve to ask me why I was on crutches.  Even though the extended time on my feet brought pain...it was all worth it!!!

The good news of the day is that I finally got my brace.  At least I think so...I mean, I think it is mine.  I took Aaron with me this afternoon to have a little father/son time.  As the tech assistant was opening the box holding my brace I asked Aaron what color he thought my brace would be.  He thought about for a minute and shrugged his shoulders.  With great enthusiasm in my voice and without hesitation, I told him it was black!  That was when I heard a the little voice of the tech assistant say..."Silver."

"What?" I questioned.

"It's silver.  Isn't that what you ordered?" she asked.

Evidently, the order was black, the order sheet also showed that it was suppose to be black.  But what we got...was silver.  I guess God thought I needed a little more bling in my life.  After convincing the tech to not send it back (I can't afford another week waiting for a new brace) we finally moved on to the fitting.  Here is a look at what the unloader brace looks like.

This view of the brace shows how the unloader brace actually works.  There are different numerical settings that correspond to the amount of pressure that gets placed on knee.  The pressure point is placed on the opposite side of where the relief is needed (the higher the number the greater the pressure).  In my case the pressure point is on the outside of my knee.  I will leave it in the second position because I have damage on both sides of the knee and we don't want to damage the outside of the knee trying to unload the inside of the knee.  The reason for having the brace is because the damage and the patch on the inside of my knee is so large...it should help that section of the knee have a better chance of healing.

The knee still continues to be slightly swollen- Swollen enough that I still have no real contours in the knee joint.  The best part of it is that my knee no longer looks like a watermelon, but more like a grapefruit.  The outside of the knee is still quite numb, but I guess that is normal.  I am enjoying my time working on ROM on the stationary bike.  I pretty much have no problems getting full rotation.  That means tomorrow I get to lower the seat and work on getting another full circle once again.  The most time I can spend on the bike is about 15 minutes before the pain gets to be too much.  Besides the bike I do some straight leg raises and that is really about all.  I can't wait until I hit a few more weeks and can begin walking exercises.

At least it is March Madness!!!  Go Kentucky!!!

Not this week...

I was planning to update everyone with my stylish looking brace today...but there is no brace.  I have been waiting all week to hear back from the doctor that my brace had arrived.  After waiting around until Thursday afternoon I decided to give the office a call to see what was going on.  What I found out is that the brace was just ordered on Wednesday due to slow insurance approval.  That means I have to wait another week to get my unloader brace. Now, don't get me wrong.  I am not super excited to wear another brace for a few months.  However, the brace will allow me to introduce a little more weight into the joint.

The bike work (ROM) is going well.  After slowly warming up the knee I have finally made a full rotation on the bike at a speedy rate of 15sec/rotation for 15 minutes.  At fifteen minutes it is time to fall off the bike and ice.  That's about all right now.