This was supposed to be a blog about how gloriously mediocre I am at triathlon. I'm sorry to shift it to a personal account of my journey through knee surgery. I didn't do a good job of it through the last surgery, but I think it'd be a good thing to put all this into words and pictures for the next guy that scours the net to learn about his impending knee surgery just like I did. Maybe this info will help such a fella. For you other three that follow me, I apologize. This might be boring, gross, or just not what you signed up for. Pictures of Hawaii are way cooler than pictures of a screw in a bone. So, this will be the first post in a series as I go through this process of rebuilding a knee that once did some pretty cool things.
So, how did my knee get this way? I don’t think it’s from wear and tear from all the running and training for Ironman if that’s what you’re thinking. I say that because, in the wise words of my friend Carl Bonner (who is a Professional Engineer, so he’s qualified), my left knee ran just as far as my right knee (and it’s just as old too) and there’s nothing wrong with it. So, I think the finger has to point to a previous injury. In my case, back when I was a twenty-something invincible know-it-all (18 years ago, and I'm still a know-it-all by the way) I was wave jumping a Yamaha Waverunner and tried a trick I wasn’t good enough to pull off. It probably had a really cool name and trying to describe it would be lengthy and off topic anyway, but I looked really cool for a split second trying to stick it. I didn't though. I landed on the deck on my right knee and it swelled up to the size of a cantaloupe. A few weeks later I was having an arthroscopic meniscectomy to clean up some flaps and tears. And I never thought about it again until last year. Pretty impressed it got me this far.
Training for Kona 2013 got off to a bad start as I started experiencing knee pain I had never had before 4 months prior to the race. A cortisone injection helped, but not for more than a month. A rooster comb injection might have helped more than it did in my case, but perhaps that's my fault – Dr Hasty cleared me to run after it, so the next day I pumped out 13 miles. That, evidently wasn’t what he had in mind, and the pain came right back. I never said I was smart. I said Carl was the Professional Engineer. I'm the Rubics cube engineer, which makes me just smart enough to remember things like SOH-CAH-TOA and other embarrassingly simple ways to remember middle school math. Anyway, by then I was too close to Kona to try surgery and I knew my dream of racing that course was going to turn into a sufferfest of walk-dragging the leg on the Queen K. It was. For 16 miles I ground my teeth and clenched my fists, fighting back tears of pain and, even more, feeling sorry for myself hobbling in an arena I had been hell-bent on giving my all for.
As a reminder, that looked like this......
....but at least the finish looked like this.
As soon as I got back home, I scheduled for surgery. An MRI showed I had more damage than just a torn meniscus this time. I had significant “articular cartilage degeneration of the weight bearing medial femoral condyle,” which is fancy doctor speak for a bald spot in my cartilage on the inside of my femur where it was contacting the tibia.
.....which looks like this......gross.
Did that 16 mile walk on a knee that was already damaged do me in worse? I don't know. Maybe. But I still think it was worth it. Anyway, at the time, my only option was microfracture surgery (drill some holes in the bone in the spot where the cartilage has worn out, get it bleeding, and over time perhaps new cartilage will grow in its place). I say that, because that’s the only one Blue Cross Blue Shield would cover. After you’ve had mfx, they’ll open the door to other surgeries but you have to start with that one first. Because it's the cheapest, and your insurance company is all about not spending money on you rather than actually bringing you back to health.
Now, while all this was going on, a Slowtwitch (it’s a tri forum full of crazy multisport nerds and I’m an addict) forum member named Graham was trying to reach me about my knee situation. Evidently he was in the same boat. I didn’t pay it any mind. I guess I had enough on my plate. But I got a call from him a couple days after the surgery and his message was pretty clear: mfx surgery was a joke. And, in the same position as me, he did extensive research and decided that paying $15k out of pocket for a different, and very new procedure called Denovo (grafting fresh, living cartilage from an infant cadaver) was way better than the crap out-of-date mfx surgery that insurance companies were forcing surgeons to waste time with. He was 3 weeks out from his surgery when I had mine. Throughout our recoveries we kept in touch, comparing notes. I seemed to recover faster initially – at least through the next 3 months. But his healing continued and seemed to surpass mine, and I felt I began to stagnate. It was becoming clear his surgery was superior to mine.
I had opted for physical therapy sessions with Kevin Youngs shortly after coming off the 6 week non-weight bearing phase (crutches suck so bad!). That was helpful. But even past the 4 month period, when Dr Hasty had cleared me to start easy jogging, I was in pain with anything load bearing. Standing. Walking. Putting on a shoe. Why bother? If it hurts to walk, I couldn’t see the point in running. That went on for two more months in which I saw no progress in my knee. I could bike and only rarely would it hurt. Even bombing down a Strava segment for a KOM didn’t bother me most of the time. And swimming was fine for the most part……just the occasional twitch of discomfort usually in a flip turn.
Now, 6 months past surgery, and with no progress to speak of, I figured it was time for an MRI and to get Dr Hasty’s opinion. I fully expected him to say, “These things take time to heal. You’ll have pain for a good year. Just be patient.” What I didn’t expect him to say was that the MRI not only showed that the surgery didn’t work, but my knee is WORSE than it was before the surgery! After some confirming x-rays he laid out his plan. A colleague of his named Dr Dugas works for Dr Jeff Andrews at Andrews Sports Medicine in Birmingham, AL. The list of pro athletes that have been to Dr Andrews for knee and shoulder surgery is impressive, including names like Michael Jordan, Troy Aikman, Emmitt Smith, Drew Brees, RG3, Tom Brady, Hope Solo, Bo Jackson, Brett Favre, Charles Barkley………and soon to be Bruce Richter. The first step will be to correct the alignment of my lower leg – I’m kinda bowlegged – so that the load on my knee is more evenly distributed rather than concentrated on the medial (inside) part of my knee, where the cartilage is worn. For this, they do a High Tibial Osteotomy (HTO), in which a wedge is cut out of the tibia and either bent back in shape or a piece of donor bone inserted into the wedge and a plate screwed in to hold it at the new angle. Then, to repair the worn cartilage, a graft from a donor will be inserted onto the femur. There are several ways to do this and I’m not sure which way Dr Dugas will go at this point but will know more after Monday’s consultation.
This is an example of one way to do HTO. Cut out a wedge in the tibia and screw a plate into it to hold it together in the new position.
The surgery is one thing, but the bigger issue for me is going through that 6-8 weeks of non-weight bearing recovery and being stuck on crutches all that time. That was tough over the holidays for me, but I could bear it one time. I don’t know if I’m ready to go through it again so soon. The key will be to stay positive and not worry about my weight and how much of a setback I’ll be taking in training. I have a lot of friends around me that are moving forward with their training and it’s easy to slip in to a feeling like I’m getting left behind. I’ve already been feeling it for the last few months. So, back on crutches will make it all the more difficult. But what else can I do?
.....now, this is a bee's knee. Note the difference: hair which I don't have, weird brown color, some sort of hook thing on his upper "tibia" which I assume holds pollen. I don't have that either and I'm skeptical that that would help my situation. Pretty much my knee doesn't look anything at all like this......
I'll end today's post with the above. How did the bees get such a great rap for their knees? First of all they have 6, so I can hardly see how they would even have any reason to bitch if one goes out on them. And their butt falls off when they fly off the handle and try to get ya. I need to shoot higher than the bee's knees.....
More to come........