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.

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.

A few tips for ACI patients

ACI surgery hasn't been like any other surgery I have had before.  Because it is so different and new, I wanted to pass along a few observations and tips for others that might be thinking of or are planning to have ACI surgery.  Here are a few things noticed in my initial weeks of recovery.

1. Stock pile lots of movies...you can just plan that the first few weeks you will spend sitting in a recliner or in bed.  To help pass the time I have watched way too many movies and TV shows.  Netflix instant stream has been a huge blessing.

2. Get married...I cannot imagine going through this on my own.  Seriously!!!  You will need someone to help you with your brace, CPM machine, fix you meals, to get random things for you, help you get to the bathroom, and lastly...bathe you.  I am pretty close with my parents but would much rather help from my wife than my mom when it comes to certain things on the list.  Be ready to lose some dignity as you walk through the recovery...don't fight it.

3. Have WIFI and a computer or ipad...my ipad hasn't left my side for the last two weeks.  I use it for everything from checking the web, watching Netflix, to updating the blog.  It has really kept me from going crazy.

4. Develop a routine...without having a specific routine it would have been very difficult to get all the hours on the CPM machine.  Needing to put in 8-12 hours/day on the CPM machine forces you think about how you are going to spend every minute you are free, as in finding time to ice, to spending time with the kids, to getting a shower.  The time you have gets eaten up very quickly.

5. Buy a toilet seat riser...get one with handles.  The handles really help you push off back to your feet.  Also, I look forward to placing the "cadillac crapper" on the toilet when guests come over for visits.  It will be a great conversation starter!

6. Know your insurance...I am already getting surprised by what the insurance company covers and what they don't.  Make sure you have a good understanding of what your benefits include, keep track of all your paperwork, and be prepared to appeal anything that comes back not covered.  For instance...we just found out our insurance wants to cover the CPM machine for 21 days and not the entire 6 weeks.  You never know how and where this blessing/curse will show up.

7. Lean on loved ones...you are going to need help and lots of it...even more if you have kids.  For the first little while you will need someone with you 24/7.  If your spouse needs to run an errand you will need to find a friend or family member to come and babysit you.  Furthermore, your spouse will need a break and it is ok to ask a friend to come and sit with you as they get a little rest.  We have been extremely blessed to have people bring us meals, take the kids to the park, help around the house, etc.  We couldn't have done it without having some outside help!

The knee continues to heal.  Here is a quick pic of the scar as it stands now:

Also, we picked up something to help me get out of the house this weekend.  I am looking forward to going to church this Sunday for the first time in a few weeks.  This wheelchair we found on Amazon has the leg extensions to support my leg in the immobilizer. (which was harder to find than you could imagine)

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.