Sunday, January 24, 2010

Bracing for reality

***I'm posting some arthroscopic pics near the end of this post, fair warning for queasy readers.

This time around has had an interesting start.

By the second day after surgery, the knee was bearing weight unusually well when compared to my first two ACL reconstructions. Thursday I got stitches out and did a round of physical therapy. Quads are firing well, straight leg raises are strong, about 70 degrees of flexion and a degree or two of hyper-extension. The slight hyper-extension is a most pleasant surprise, usually that doesn't come along until much later in the game.

I was approved to go without an immobilizer brace during passive activity, such as working at my desk or around home. I'm supposed to continue wearing it as a matter of security until this week's session when my gait will be re-evaluated.

Tomorrow I return to the real world, going back to work for the first time in 2 weeks. We have overlapping responsibilities in my department, so I have all confidence that my partners have provided due diligence in my absence. Hopefully I won't be drowning in backlogged work to do!

Truth be told, I've done just about everything I can around the house, got a few 'administrative' things out of the way after many long delays. I'm ready to get back into a routine, although it won't include Karate for somewhere around 14-16 weeks.

I plan to continue my bench-time tradition of watching sparring classes on Monday nights to help keep me connected with my fellow students, and help satisfy my craving for Fight Night. It helps to keep me focused on what I need to do, and the encouragement from my friends on a regular basis is truly a balm for the soul.

I have made the very difficult decision to stop sparring for a long time. Sparring is part of the curriculum, but for folks over 35 they will adjust requirements for black belt as necessary. I don't plan to give up sparring forever, but 3 major injuries requiring surgical work and 2 other injuries have cost me well over a year of time.

By many accounts I would be screening for black belt later this year, but reality says it'll be some time in 2011 at the soonest. I'm tired of the annual re-set of my training and want to remove the one activity most responsible for my injuries.

There are no guarantees in life, but I need to start stacking the odds more in my favor if I want to continue with Karate for the foreseeable future. I'm damned good at open hand and weapons forms, time to focus on those strengths. I'm not any more afraid of sparring than before, but I am concerned that my reflexes are telling me to move in ways that are dangerous.

1st time: I was falling backwards, torn ACL from trying to stop a fall.
Lesson: Just fall.

2nd time: I was landing from a powerful tornado kick, torn ACL from a planted foot on landing.
Lesson: Don't go overboard on fancy kicks when you're tired.

3rd time: I was ducking under a punch way too far, torn ACL from trying to explode upwards.
Lesson: Don't go overboard on moves you haven't drilled on.

I don't want any more of these lessons.

As promised, here's 2 pics:

This one is of the floater found while inspecting the meniscus. Looks like a tiny bit of meniscus that had torn loose, not a big deal.

Here's the ACL. It starts at the top left looking great, the rest is simply a shredded pile of silvery ligament spaghetti.

Saturday, January 16, 2010

Been There, Done That, Got The T-Shirt.

Hello, dear reader. It's been a while.

As I mentioned briefly on New Year's Eve, I re-tore the ACL in my right knee December 28th during sparring class. This is the knee that started all this business almost exactly 2 years ago.

I ducked under an opponents punch way too deep, with my right leg forward, and tried to explode upwards with a back fist while most of my body mass was still moving from right-to-left. I made it about 3/4ths of the way up, then my right knee bent sideways and I went down.

Last Monday, January 11th, I had an ACL revision done on the knee. The procedure is much the same as ACL reconstruction, except with a lot more prep work and bigger hardware. The prior ACL is removed and loose tissue cleaned up, and the old fixative screws are taken out. (I have my old screws as a token now.)

As with the prior 2 reconstructions, I opted for a femoral nerve block with a spinal block so I could observe the procedure. Good news is that the meniscus continues to be well anchored, with no signs of damage save for a tiny floater they caught doing laps in the saline on camera.

Again, like in December 2008, the spinal wore off a bit prematurely and I had major cramps in my lower back due to the position I was in on the table. Also, I began to feel the pins and needles in my right leg as the spinal wore off, and the tourniquet was removed. Yes, I could have opted for some sedation or pain killer, but I weighed the cost of $100 a pop against my short term discomfort--we have new insurance that would have me paying more out-of-pocket now--and I decided to save a buck or two.

Because the bone tunnel necessarily has to be enlarged, the replacement tendon and hardware are also larger. The original upper fixative screw was installed into the end of the femur 'from below,' essentially within the knee joint. This time, the screw was installed into the end of the femur from above, which meant my quads took a beating from being retracted while this somewhat gruesome business was conducted. I saw that bit from the arthroscope and realized that it's gonna sting like the dickens when the blocks wear off...

On a funny side note, Dr. K had some difficulty tightening this upper screw, losing his grip at one point and nearly knocking over some monitors and IV poles in the operating room! I suggested perhaps an impact wrench might not be a bad idea, but he replied that using motorized assistance tightening screws could result in over-torquing.

Once Dr. K was done and the other surgeons could take over closing things up, I reminded him of my request for a t-shirt from the clinic; I figure a guy is due something for his trouble after 3 operations! He not only made good on the promise, netting me a nice long sleeved Under Armor shirt with embroidered logo, he even put it in a gift bag with a birthday card and delivered it personally while I was in stage 1 recovery.

The card reads "Each year the wishes just get bigger and better!" with a note: That's 3 years in a row! Enough already! (Just kidding.)

So the first 36 hours post-op sucked as usual, peaking on Tuesday night when I had a major charlie horse in my thigh that felt like a dagger was stuck there! Fortunately a bit of Tylenol with Codeine took care of that and I could sleep peacefully. Since Wednesday I've taken nothing but Ibuprofen, a good thing and par for the course.

First PT session was Thursday. My prior PT clinic has closed its doors due to the recession, so I opted to do PT at the clinic where the surgery took place. There I met Ben, who will be my main PT this time around. I was encouraged by being able to toddle around the house with just a cane already, a very positive early milestone that the knee can bear weight well already.

Surprisingly my quads were firing quite well, and I could do straight leg lifts without too much difficulty. I even have a bit of hyper extension, already nearly equal to my good knee. Flexion is only at about 60 degrees while on my back, maybe 70-75 hanging over the edge with assistance from the good leg. The biggest stopper right now is the local knot of swelling to the outside of the quad, the result of insult to the tissue from installing the fixative screw.

Last night I was wide awake at 3am with a mild fever coming on. So on top of the typical post-operative pain, I had body aches as well, and lay awake for probably a good 2 hours trying to find a comfortable position. I should also mention, it's the first night back in my regular bed upstairs, and not on the totally comfy couch downstairs, so re-adjusting to sleeping on the mattress probably contributed to lower back cramps. Meh.

Well, tonight I'll be hanging out with Mrs. Shaft while G-Shaft goes to a schoolmate's birthday party for a few hours. We plan on tossing back a few Amaretto-Sour's while watching a movie and enjoying a new recipe for cold Thai peanut noodles.

More tomorrow, possibly pictures, and what the future holds for Paul "Hack Shaft" Pederson.