Tuesday, April 29, 2014

Gentlemen, We Can Rebuild Him.....Part 1

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?

 These are my knees, with the one on the left (which is my right knee, just to be clear) the culprit.  I'm a little bowlegged, which is part of the problem.......

.....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........

Friday, April 25, 2014

Alabama Bound for Surgery #2

I met with my surgeon and friend, Dr Hasty, today to go over the results from Wednesday’s MRI and, just as I thought, there’s a reason the knee isn’t feeling so swift.  It’s been 26 weeks since I had microfracture surgery to repair a patch of worn cartilage on my femur.  And the surgery apparently was a complete bust.  For the record, Blue Cross Blue Shield allows microfracture as the only preliminary surgical option for a case like mine, so it had to be done unless I was going to pay for another surgery out of pocket.  Hasty and I didn't have much of a choice.  It doesn't have a very great success rate, so why they stick it to us can only be because they think it saves them money somehow.  What a crock that is.  Thanks, Blue Cross, and now I know the reason why there’s BS in BCBS.  Whatever, though.  I'm over it.  At this point at least it appears as if there are more options that my insurance will so graciously allow us to move on with and actually try to solve the problem. 

It's the one on the left, which looks just as fine as the one on the right, but evidently there's something sinister going on that we can't see from here.

So here’s the verdict.  Not only did the surgery to drill holes in the bones - and magically grow cartilage out of them where there is none - not work, but now my knee is in worse shape than it was before I even had the surgery.  Still no new cartilage down there where the two bones are rubbing together.  This explains why walking, standing, or anything that involves load bearing is painful.  There is also some concern I have osteonecrosis – partial dying of the bone. 

Here’s the plan.  Dr Hasty referred me to a colleage of his named Dr Jeff Dugas, who is evidently involved in surgeries for the NFL.  Dr Dugas at Alabama Sports Medicine will most likely do a procedure called High Tibial Osteotomy, in which a wedge is cut out of the tibia to realign my lower leg and redistribute the load more evenly across my knee joint.  I guess it will make me less bow legged too, so I’ll be better at hemming a hog in a ditch.  Then for the worn cartilage he’ll do a procedure which involves grafting living cartilage from a frozen cadaver, which means they have really big refrigerators, or some newer procedure I don’t know near enough about to talk about here.  We also talked about subchondroplasty but that sounds like a procedure for a different issue.  I’m trying to learn about this stuff as I go.  Dr Dugas apparently is fairly confident that I’ll be able to run again after all of this, which is great to hear but I know it’s a long way away.

The surgery will take place in Birmingham, Alabama the week of May 5.  Alabama!  Who knew?!  Is it just me or, when you think of Alabama, is that not the last place you would go, "Whooaaa, isn't that where all the best surgeons hang out?!"   Then I’ll come back home to begin my recovery and another 6 weeks of non-weight bearing crutchery.  Not looking forward at all to going through all of that again.  It’s a good thing I have a wife that’s hyper-nurturing.

And I threw away that infernal handicapped toilet contraption from the last surgery recovery, dammit.......

Anyway, when I know more I’ll update.  Thanks to all for the kind words of encouragement.  2014 is going to be a tough year, but I can hack it.

Sunday, April 20, 2014

Richter Kid is Still Going, but Not as Good as the Energizer Easter Bunny

Wow, how the time has flown!  Sorry for my lack of posting on the blog.  The last 6 months have been tough – really tough – as I’ve been trying to deal with the slow recovery of the knee since surgery.  To be honest, my attitude has not been positive enough that I felt I could write anything without it coming off as depressing.  And I figured out of my 6 readers none of them would want to read that crap.

But I’m managing, despite not being anywhere near 100% recovered yet.  I still have dull pain even in elementary activities like walking, putting on drawers, picking up a sock on the floor with my toes, or swinging my leg into the air to play it like a guitar.  How does anyone have any sort of quality of life without those things?!  Ha!  Anyway, because of this, I haven’t attempted even a light, short jog even though the doc said it was okay to give it a whirl.  I just can’t see the point in trying to if it hurts to even walk, and it’s not like I have any races on the calendar to hurry up and get ready for.  So, I’ll just postpone putting on the sneakers until the pain finally goes away or I run out of patience.

 So, I'm hooking myself up to another TENS thingie.  The increased blood flow is, at the very least, kinda soothing. 

Biking is going okay and swimming is going great.  So far, I’ve not put enough into them though to start getting my fat ass back into some sort of shape but with spring finally here I hope to start shedding some pounds.  I look like I ate the Bruce that went to Kona, and he must have been pretty tasty.

 Well, this kind of behavior certainly isn't helping!

On May 5, I’ll get another MRI to see if the cartilage is growing the way it should.  If it is, I expect the words from the doc to sound something like, “Tuck the string in and deal with the pain, Richter Kid.  It’s gonna hurt for a few more months but the surgery is working.  Damn, you're such a whiner.”  If it isn’t working, we’ll have to move into another surgery which sounds like it will involve stealing cartilage from another place somewhere on me or stealing it from somebody that’s done using theirs.  I’m not too keen on using some of my own.  I seem to be struggling to keep what I started with in the first place.  So, I've been keeping my eye on the obituaries for anyone that's been described as particularly "cartilagey."  They never seem to use that word though......

I suspect the verdict will be that I just gotta suck it up and let the new crop of rubbery stuff grow, though, if you're taking any bets.

If another surgery is on my horizon though, I don’t know how I’ll muster the gumption to take another 6 weeks on crutches for recovery.  Poor Angie if I do……

 I decided to soil myself today.  After planting all this stuff, I carried the pots to the patio in back.  It was with great shame that I had to tote the bigger pots halfway, give my knee a rest and then carry on from there.  Unbelievable!  If I ever run again I will spend every mile thankful for just being able to, no matter how slow the pace is.

The only other thing is the knee is a little bit swollen and misshapen, but it doesn’t seem to scare kids away so I guess it’s not that bad.  In the spirit of Easter, I think THIS would scare kids away more than my blob of a knee.......

At any rate, I haven’t given up yet and I intend to get back into triathlon as soon as I can.  Besides, I’ve run through all the sports that don’t rely on good knees in my head and I can’t come up with any that suit me other than darts and arm wrestling.  And those two just aren’t gonna cut it for Richter Kid.

 At least I've been keeping my competitive juices flowing by playing the good ol' game of War with army soldiers and a tennis ball: set 'em up, we'll knock 'em down!  Compliments to Dave and the Mirra kids for being worthy opponents.....

Happy Easter everyone!  It's wonderful to be alive and forgiven!  Thanks for supporting.....and I consider reading my useless drivel of a blog support.......