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........

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.

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.......

Off Crutches....But I Got Work to Do!

For those interested in the knee status…….

It hurts.  It hurts something fierce.  It pretty much feels the same way it did at mile 18 of the marathon back in Hawaii, which I recall was paired with a pretty ugly grimace.  I came off the crutches a week ago.  I was a little wobbly at first as the leg muscles tried to remember how to walk again but by the next day I was pretty stable.  If I stood for too long it would get to quivering a bit since the muscles were so weak but that didn’t last long.  I didn’t feel much pain in the knee those first two days back as a biped, but the calf muscle and Achilles were really aching as they struggled to make up for the shortcomings elsewhere.

I went for an easy 1000 yard swim the next day and just refrained from pushing off the wall with that leg.  Last weekend I also went for an easy bike ride: 80 minutes at about 16 mph.  That bike ride was the only time I felt no pain.  Therefore, biking equals therapy.

It hurts to walk.  It hurts to stand.  The inside of the knee is painful to the touch.  And I’m not gonna lie…….it’s been pretty discouraging.  But Dr Hasty and Charlie Kresho the PA both said the knee would be irritated for a while and that I need to be patient.  I’ve also read from others online that have had microfracture surgery say that the first 2 weeks of load bearing were miserable.  So, there’s not really much I can do but cowboy up and take ‘er easy.  As long as what I’m experiencing falls within the realm of “normal” I suppose I can deal with that.

I’ve got a good start on a roll of fat around my midsection, and I’ve already retired two pairs of work pants until further notice.  I haven’t seen hair on my legs in years, so the fur is an unfamiliar look for me.  And the knee is a bit swollen and mis-shapen……..but for the sake of functionality I don’t mind most any bit of disfigurement as long as I’m not scaring kids away or nothing.

It’s good to be off crutches though and not have to plan ahead how I’m going to get my soda can from here to there, or how to get a hot baking dish out of the oven with one hand while balancing on one foot.

I guess this is progress in some fashion!

Having an Ablation? Here, This Will Help......

So, you were just scouring the internet to see what you could find regarding ablations, huh?  I did the same thing.  Good luck with yours......

Mine was for something called Wolff-Parkinson White Syndrome, or WPW Syndrome for short.  Which is really unfortunate that this dude gets the credit because his name is just awful even if you abbreviate it.  Wolfy White Syndy flows a bit better, but it's not my call.  Anyway, so there's this passageway in the heart that electricity is supposed to fire to make the thing work.  I'm a little skeptical because I've looked at a lot of anatomy charts over the years and I've never seen where we could keep a battery for such things, but then I'm not a doctor.  With Wolfy White Syndy evidently I was born with a second passageway, which makes the heart capable of short circuiting basically.  This explains my high school cross country episodes and the ones I had at the Washington Tri and Goldsboro Tri in 2011.  However, it wasn't properly diagnosed until I was under anaesthesia for my knee surgery 6 weeks ago.  Oh well.  I guess I couldn't expect my baboon heart to work perfectly forever.

So, here's what an ablation is like (at least the kind I had since I've heard from other experienced folks that they had more involved kinds - like weenie catheters and breathing tubes and stuff - yuck!).  It's an outpatient procedure - not surgery really.  They go in through your groin, find a great big artery, and snake their way up to the heart, stimulate the "short circuit" (in my case up to 245 bpm) and then either burn or freeze the extra passageway shut.  I suggested using duct tape but the doctor said he was kinda clumsy and couldn't do it without the tape sticking to itself on the way in.  I hate that too.

 It was early in the morning.  I wasn't yet in the mood for an ablation.

I was nervous about being sedated and not completely knocked out.  I really had no interest in being a part of the gang during this procedure.  

A girl named Shakira shaved my mess first.  Think of your wildest dreams in which Shakira gets you naked and shaves your mess and it's.........not anything like that.  It was actually very demeaning.  When she was done it kinda looked like a poodle.  I still wonder what she was snickering about when she left the room.  Then they put an IV in you and take some blood.  Because you probably showed up with too much to begin with.  Today I seemed to be in the mood to be a bit of a squirter.  It looked like she had smashed a bunch of mosquitos on my arm when she was done.

Then you wait a pretty long time until it's your turn.  They need you to wait because the quicker you go through the process the less likely you are to "use other stuff," and therefore they can't charge you for as much.  In my case, in addition to the procedure they got me for some Vaseline for my lips, use of the tv, some blankets and some cute yellow footie socks.

When they finally came to get me I was ready to go.  Pee.  I was ready to go pee.  So, I hobbled (still on crutches, here folks) to the bathroom with my white rear end hanging out of my gown before getting back on the gurney.  I gave my love to my wife and they wheeled me off to a room full of EKG screen things and video and machines that go "PING!"  I think this room was the hospital refrigerator as it was really, really unbelievably cold in there.  They started putting all kinds of sticky frozen EKG-type patches on my back and chest, which evidently were to ensure that I was completely freezing.  Once I was trembling uncontrollably from the cold, I think the nurses were satisfied enough to hook up the comfy juice to my IV (Versed and something else that is more for the pain).  And then the cold went away immediately, enough that I offered them my blankets in case any of them were cold.  They must have been really tough since they all declined.  The guy with the skull cap and goatie was the important one in this group, since he was the Drug Master.  He told me if i felt anything all I needed to do was ask and that he had plenty of drugs.  I tried to get his cell phone number.

I have to skip some stuff now because this part is all really fuzzy.

There were 3 big machines right in my face blocking my view of anything, but I could just barely see Dr Frazier (he looked really far away!) and the edge of a tv screen or two.  Judging by the show on the screen, he likes incredibly boring tv shows, but he was really into it.  "This is awesome!  Look at this!"

I didn't know who he was talking to but he had my interest peaked.  "What's awesome?!" I said and here came skull cap dude sticking something in my IV.

Sometime later........Dr Frazy again: "Oh this is so cool." 

"Hey, Dr Frayfray, what's cool?"  And then skull cap dude comes out again from behind his desk and knocks me out again.

Later......Dr Fre says something else and I barely get my mouth open as I look towards skullcap guy's desk and, bam, he's juicing me up again.  Lights out.

I don't know how many times that all went on.

These are the probe-zappers in my heart.

And then it was done!  I was getting wheeled back into room 13 where Angie was and I was feeling good but a little hungoverish.  The procedure was a success.  After they zapped the secret passageway in my heart the first time they evidently decided they hadn't got it all so they went back in and zapped it again.  I guess that's why I ended up with a hole on each side of my groin.  There was some confusion in between zaps as evidently they had told Angie they were wheeling me out prior to the decision to go back in, but all is good.  I got a twofer.  I'm sure that will show up in the bill as well.

This is a picture of a bunch of squiggly lines.  The doctor works himself into a trance, and then starts doodling lines like this until he works himself into a frenzy and the lines become uncontrollable.  At that point it's time to zap the heart.

I had to lay still in the bed for 4 hours before they would let me stand and walk, pee, and discharge me.  That was kind of boring.  I tried to make up hospital jokes.  "You will pay for your insulin!"  I thought it'd be cool to be the one to get to say that in a menacing way.  Obviously, I was still under the influence.

 The post procedure test: can you walk around the block?  Fail and they've gotcha in their clutches and get to force you to buy lots more stuff, pass and you go home.  Never been so nervous in my life!

Pretty simple procedure really.  And I was glad that they didn't determine my heart was 2 sizes too small since here we are right before Christmas.  I was nervous about that.

I went home and ate some Chinese take-out, which is always good for the heart, and then hit the sack.  I got a good look at my junk when I was taking off the bandages.  It looked like the poodle had been shot with an arrow in the head and you could see the bloody entry and exit wounds.  This is not a good look for me.

But all feels great the next morning.  I can't wait to try out my new ticker!

Light at the End of the Tunnel

This evening I planted the foot hard going up the garage steps and broke a mess of stuff on top of a cabinet during the process as I tried to catch myself and keep my body weight off of the healing knee.  That marks the 4th time in 4 weeks that I've slipped up on that, and the 2nd time that it happened on those steps.  I go up and down flights of stairs at work but those damn 4 garage steps continue to intimidate me.

What a great feeling that welled up inside me today as we drove home from a day spent in Raleigh.  I was hungry to ride my bike again, and I'm very hopeful that after next week's visit with the doctor I will be able to remount my beloved Merle III the P3 and get to work on this pathetic mound of a gut I've acquired during this process of growing cartilage anew.  But it is a deeply hopeful feeling and I'm energized in the thought of riding again.  Oh, and swimming too.  But yeah, riding moreso.

I'm exhausted of the crutches, and I've nearly worn out my welcome using them as an excuse to lay around in utter laziness while Angie puts up with it.

Anyway, I'll live.  Happy holidays, everyone!

Race Bib Coaster Project

3 weeks into my 6 week cartilage harvest in my knee post surgery and I’m going out of my mind.  Out of complete boredom I decided to try to make some coasters out of my Ironman Hawaii bib number.  Or you can buy them online for anything from $20 to $40 for a set of 4.  The DIY way costs about $7 and takes about an hour total time, assuming you aren’t going to just sit there and watch glue dry all day.  If that’s your thing, this process takes most of a day.

And you don't need this blog to follow the process.  There are plenty of other blogs out there that detail it pretty well.  

Here’s what you will need:

4 to 6 white 4”x4” tiles

Mod Podge

Foam Brush

Clear Acrylic Sealer

You probably don’t want to use your real bib number.  Well, maybe you do.  If you do it’s likely going to be too small to completely fill the tiles though.  So you might want to add some other stuff to the ensemble, like the date of the race or your finishing time.  I opted to print my bib a bit larger than actual size so it would fit on six 4”x4” tiles.  I printed the bib so it just about filled an 8.5”x11” sheet and it seemed to fit pretty well on the tiles.

I picked out some tiles at Lowes that were very rough.  Some of them were overly pitted but I wanted them to be rough so the paper would adhere better.  I haven’t tried this on smooth tiles but I suspect it’d be good to scuff them up a bit with sandpaper if you try it.

After cutting the bib into 6 pieces I also decided to bevel the edges of each square of the puzzle so the corners wouldn’t be easy to snag and peel off. 

I put a layer of Mod Podge (find it at your local crafts store) on each tile using the foam brush and then placed the bib piece on and added a layer of Mod Podge over it.  I chose matte finish but there are tons of different styles of this stuff so pick your poison.  I also went with a foam brush so I wouldn’t have little hairy pieces of brush stuck to my artwork.  The Mod Podge will look white and filmy as it dries.  Don't worry.  It goes away.

I let that dry for about an hour and then added a second layer of Mod Podge.  I then let them dry for about 3 hours and then I sprayed a thin layer of clear acrylic sealer over each tile to protect them from any moisture that they might collect with a nice cold brewski sitting on top of them.  After 10 minutes I sprayed a second layer and an hour later one more layer.

I let them dry for a few hours and then added some felt pads to the bottom so they wouldn't scar the table.

And that’s all it took.  Pretty darned simple!