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.