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.

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.

3rd time: NOT a charm...

I'll be brief since we're heading out the door to a New Year's party (Happy New Year, by the way).

Monday at sparring I tried ducking under my partner's kick and coming up with a back fist from underneath.

At a guess, I was moving sideways too much, and tried coming up while the mass of my body was still shifting sideways.

The result: That too-familiar shifting sensation of a joint dislocating.

Tuesday was the MRI.

This morning's visit with Dr. K confirms that I re-tore the ACL in my right knee - the first knee that started this blog in 2007.

Surgery in 2 weeks. Sorry, everyone.

Seeing Red

Whew, what a busy month July turned out to be!

I tested for my half-belt (or "stripe") at the end of May, the day after officially having all restrictions removed by my surgeon. It felt like the toughest test I'd done, but I was very proud of my performance and felt stronger than ever.

Throughout June and into July I suffered a string of weird minor injuries, all outside of Karate class.

I strained both quads sprinting way too hard during a routine Saturday morning run, was knocked out of commission for a week with a nasty virus, and two weeks ago I twisted my left ankle something fierce stepping into a pothole on a local walking path that was overgrown with grass.

Waking up with stiff joints and pain has become de rigeur in my morning routine until I've loosened up with a hot shower. I'm OK with it, though, since it's a predictable thing.

What I didn't predict was testing for Red belt just shy of 2 months after my last belt exam!


It went well, but with all my down time I was less conditioned than I cared to be. This was most noticeable when doing slow-count kicks. Remember those??? Well, for Red belt and above, you no longer do them holding a barre or against a wall to steady yourself.


You're in the middle of the room.


And you darn well feel it when the test is done!


I talked to my instructor about having such a short interval between belts after the test. The curriculum requires a progressively higher number of classes between belts as you move up through the ranks, but he feels I'm ready for advanced belt classes based on my progress since returning from injury. Wow, how cool is that?!?

Tomorrow night's class is canceled. My school's head examiner for black belts is personally conducting a special class for advanced belts, which is predicted to be well over an hour long--possibly closer to two hours. It's intended as a preview of black belt screenings, and I'm both nervous and excited to take part in it.

When I went to watch the Family That Fights Together during their final screening back in November, the Examiner spotted me coming into the lobby and took time out--right in the middle of the screening--to offer his condolences, emphasizing that "there is life after this."

You see, he's a 5th Degree black belt with reconstructed ACL's in both knees.

We're an immense distance apart in rank, but wear the same scars marking our initiation into a regrettably elite club.

I look forward to working out with him if for no other reason than to thank him for his encouragement and his faith in me.

Freedom

I'm free...I'm free!
And freedom tastes of reality.

"I'm Free" from The Who's rock opera "Tommy"

1. Saw Dr. K this morning, restrictions are removed.
2. "Have a good life," he said.
3. Made a pact with him that we shall never meet again under these circumstances.
4. Got the above song stuck in my head.
5. Testing for my next belt tomorrow morning.
6. Sparring Monday night...

Sparring, sweet sparring...

My Karate school has an intramural team tournament coming up in a week from Sunday, so Monday night sparring classes for adults have focused on tag-team strategy.

Needless to say, the fighting gets pretty intense, but with some goofy moments as well.

I did extensive taping of our class this past Monday:

http://www.youtube.com/view_play_list?p=F44D11BC0DF6CA18

Check out #5 at 6:25 - the slide kick that was more slide than kick
Check out #6 at 5:30 - Ouch...

The tape of ground work was for the woman in the video. She, along with my instructor, are competing this week at the East-West Open, a "Martial Arts Olympics" held annually in St. Petersburg, Russia. Since some fights at that event include grappling, she's receiving a cram course in basic ground defense. I shot this so she has some study material to review.

Best of luck to both of them!

For Thursday's class we had a guest instructor who was well-versed in one of my favorite torture techniques, the slow-count kick. As a warm-up, we did a lot of stationary work, simply holding stances and fine-tuning them . Then we did slow-count kicks.

While working slow-count kicks, I idly remarked that it'd be interesting to combine stances with slow-count kicks; She took me up on the concept, and we did just that!

So imagine this for a strength exercise:

1. Begin in a fighting stance.
2. Rotate hips forward, squaring yourself up, then bend your rear leg and slowly squat until the rear knee touches the floor.
3. Raise up from the floor slowly and execute a slow-count front kick with the back leg.
4. Lower the kicking leg forward into a fighting stance on the opposite side.
5. Repeat, marching across the floor and back again. Slowly.

I hated it, and loved hating it...

On a side note, big thanks to Black Belt Mama for the free book. Should make for interesting, light reading before bedtime.

2 out of 3 ain't bad.

Today is week 16 since surgery, 8 more to go until no restrictions.

2/3'rds of the way, and feeling great!

That first week back was absolute murder on my quads, hams, and shoulders, but absolutely no complaining from my knee. I made it to classes Thursday evening, and though I could hardly walk Saturday morning, I went to a 30-minute class, primarily to loosen up all the stiffness. Last week my muscles complained far less, so I think my body is beginning to acclimate to my return.

At the end of Thursday's class we worked on some kicking drills, including an offensive side kick. No, it's not meant to offend, it's just an attacking style versus a defensive style.

From a fighting stance, the front foot crosses over the center line of attack as the rear foot steps behind the front. This leads to a natural chamber of the front leg for a side kick, and covers a lot of distance while delivering a powerful blow to your opponent.

My partner holding a large body shield was a 13-year old boy who plays football besides studying karate. Since the first side involved kicking with my left leg, I simply walked through the motions. My foot just touched the body shield, no hard kick at all. That was fine, just going through the motions.

Then we switched sides, and the instructor, Miss O, suggested she should probably hold the shield for me, knowing my past kicking ability.

The Kid, being reasonably good-sized, said not to worry--he's used to hard hits playing football...

...and promptly folded like a flying soft shell taco.

Miss O held the shield for me the remainder of the drill.

It's good to be back.

I'm born all over.

Monday I attended a beginner's class to 'wade in the water' a bit. Plenty of slow kick work and fundamentals.

That sucked!

Then I recovered and re-hydrated while watching sparring with a Cheshire Cat smile on my face, basking in the afterglow. It was tag-team drills, and an absolute riot to watch.

Tuesday was the intermediate belt core class.

The first half was open-hand form work, which came back to me quite well. However, while it looked good when I faced the mirror, somehow working form away from the mirror left me feeling unplugged, suddenly unsure of my moves. Strange.

The second half was spent working our Bo (staff) form. I had just begun this form when I was injured, but I still had fundamentals in place for holding the Bo, and remembering what each move was when it was called out by the instructor. By the end of class I could barely hold my Bo, and my shoulders were killing me.

That sucked--HARD!!!

But I got over that too and realized just how much I missed Karate.

How fun it is to push yourself, even with restrictions in place.

How nice my fundamentals still look.

How intensely focused I get while sensing all the feedback my body is giving me.

How priceless it is to come home dead tired and fall asleep with a grin so wide my cheeks hurt.



I.

Am.

Back.

Going Home...Again...and Lemonade

For the regular reader of this irregular poster, you'll notice the updated countdown clock.

After passing the mid-point of my 24 week rehab period, I made the decision to update the clock to reflect my return to Karate on Monday.

Am I crazy? No.
Just feeling fat, uninspired, and bored to tears.

The PT I currently do at home in many ways is more aggressive on my knee than perhaps 80% of my Karate activity. I may as well work out in the company of friends rather than in isolation!

Therefore I've decided to return--with certain restrictions until June 1st, the end of my 24-week "restricted" period.

Forms / Kata shouldn't be an issue, since they don't involve jumping or spinning kicks, and the few kicks that are present are with my non-operative leg.

I will make appropriate substitutions for the next 10 weeks:

- Instead of kicks with hard snaps, I do slow-count kicks, substituting a strength exercise for a power drill
- Kicks with my non-operative leg will be performed with the chamber action slowed down (which usually involves some degree of pivoting on the supporting leg)
- Spinning kicks? More slow-count kicks.
- Jumping kicks? More slow-count kicks.

So basically between now and June, I'll be doing a ton of strength work, deep stances, careful pivots, and drill on learning my new weapon form with the bo staff.

Come June 1st, I'll be more than ready to get back to sparring!

I want to thank Black Belt Mama for the "When Life Hands You Lemons" award:


Like any good blog award, there are some rules:

• Post the logo on your blog.
• Nominate blogs that show great attitude or gratitude
• Link to the nominees within your blog post.
• Notify the recipients of the award by commenting on their blog.
• Share the love and link back to the person from whom you received your award.

Paying it forward, my nominee is a fellow Martial Artist, Bobspar.

Bob is a self-declared Middle-Aged Martial Artist, and the first blog I came across when seeking other Martial Artists with ACL tear stories. My own blog title is inspired from his attitude of not only embracing where he is in life, but also having begun his journey in the Martial Arts as a middle-aged person!

Bob found a particularly sour lemon to make lemonade--he was literally minutes away from completing his black belt exam when his knee decided to play a game of "Pop Goes The Weasel," tearing his ACL and delaying his black belt for over a year as a result. He is training hard for his test coming up this May, and I wish him the best of luck!

Old doc, new tricks

Thursday's visit with Dr. K went as expected. No surprises, and I'm cleared to begin running. Granted, in the chilly state I live in it's not been above freezing the entire month of January, and mornings are still dipping into the negative numbers even today. Combine that with a nasty cold I've been dealing with over a week, and I'm just not ready to head out for an early morning jog! I do promise to post some pictures when I do, however, since the mornings are so beautiful this time of year.

Having been through all this before, I had some fun with Dr. K and the medical student working with him. As I sat on the table with my legs dangling down, he asked "OK, which knee are we looking at today?" I told him to guess. "Well, they both look the same," he quipped.

I replied, "If you can't tell, then you must have done a pretty good job!" as I pointed to the left knee. Truth be told, they did look very similar in terms of minimized scarring. The only real give-away would be the slightly shorter patch of hair around the left knee and shin, still growing back from being shaved.

He demonstrated good surgical results to the student with a cursory Lachmann test and a pivot-shift test that months ago would have insulted the MCL sprain accompanying my torn ACL. We also chatted about the mechanics and root cause of injury to each knee, making for really rich conversation between surgeon, patient, and student.

At my 6-week appointment last year, I was asked if I had any more questions. "Sure," I said, "Am I going to be able to play drums??"
A puzzled Dr. K: "Well, I certainly don't see any reason you couldn't."
Me: "Great! 'Cause I can't play them at all!"
(insert rim shot: ba-dum bum)

This year: "Am I going to be able to pilot a plane?"
A year wiser Dr. K: "Could you do it before?"


See, you can teach an old Doc new tricks!

Equality.

This morning's PT report:

- Flexion at 138°, full extension.
- Approved for slow-count kicks with the operative leg only, supporting on the non-operative leg. Cool!
- Step-down exercises are assigned to work further on strength and smoothness of transition when walking down stairs.

My last measured flexion in the other knee was 138°, so they both seem to be about the same. Further flexion is limited simply by my physiology, at least until I can kneel and sit on my feet!

Using 2lb. ankle weights for straight leg exercises (raises, abduction, adduction, standing hamstring curls). I can do about 20 reps without a pause, working up to 30 solid reps before increasing weight. By the end of the program, the goal is 10 pounds, 30 reps.

My non-operative leg is no stronger than my operative one, so I'm making an effort during PT to emphasize both legs equally.

For those who don't know what they are, slow-count kicks are an excellent exercise for strengthening your hip flexors. Their purpose is to enable greater height and control of kicks.

You begin in a fighting stance, then kick in 4 steps.
This example is for round kicks:

1. Pick up your kicking leg in its chambered position.
2. Slowly extend it out.
3. Slowly swing it just across that centerline.
4. Slowly swing it back.
5. Repeat 3 and 4 until your leg drops like a lead weight.
6. Re-chamber the kicking leg.
7. Put your kicking leg down (if it hasn't dropped of its own accord!)
8. Switch your stance and repeat with the other leg.

They are murder to do at first, but I've grown to enjoy slow-count kicks. When you begin, start on a wall or with a barre to grab, gradually progress to doing them without holding anything for support. Your hip flexors will be crying for mercy, so watch those first steps when you're done! If you do them for a while and they start to feel too easy, try adding ankle weights. Even 1/2lb. at the end of your leg is a huge challenge.

Kicking high takes two things: flexibility and strength. Leaning the torso way back does very little for improving kick height if you don't have strength, and slow-count kicks are probably the best exercise I know of to develop that strength. Enjoy trying them out--I know I will!

The 30's: Arriving and Leaving

Tomorrow I enter my 40's.

Today my PT confirmed that I've entered my 30's, so to speak...I have 133° of flexion in my knee!

That gives me a great feeling of accomplishment, especially in light of being just over 3 weeks out of surgery. By comparison, I was at 126° at this point with my right knee.

My final ROM in the right knee settled in at about 138° of flexion, -10° extension, so hearing my left knee is "in the hood" is quite exciting.

My extension still needs work, as I'm not quite into negative (hyper extension) numbers, but that mostly comes with time. I plan on prone leg extensions to push that issue. You lay on a bed face down, dangle the leg out with your knee at the edge of the bed and allow gravity to gently stretch things out into a slight hyper extension.

Taking stairs going up has become quite easy, but I'm still a bit unstable bending the operative knee going down. I'm fine until the last inch or two before my other foot lands, so I need some more strength work in that part of my range. I expect massive improvement when I begin squats in the next week or two.

I'm hoping my nighttime leg cramps go away soon. Other than ibuprofen--which is eventually gonna wear a hole in my stomach if I'm not careful--the practical solution has been a combination of a hot water bottle applied to the thigh and a large pillow between the knees.

The pillow keeps stress off of my sprained MCL, which I'm still nursing while in rehab for the ACL. Padding between the knees gives Mrs. Shaft a better night's sleep; I can sleep on my side comfortably and avoid waking her with snoring!

The weather around here is hovering near zero degrees, with forecasts into the negative double-digits next week. Boy I sure hope it warms up a bit before I start running!!! I'm looking forward to Robert Frost moments.

Happy Thursday, everyone!

Phase Won.

My rehab program is in 4 phases:

I. 0-4 weeks: Range of Motion. Goal: ROM of 0-120° and walking without a limp.
II. 4-6 weeks: Strength, balance, and proprioception. Goal: Unrestricted walking, including stairs.
III. 7-12 weeks: Power, speed, and more strength. Goal: Begin return to running program.
IV. 13-24 weeks: Function, agility, hopping, sport specific drills. Goal: Complete rehabilitation.

Sunday marked the end of week 3. My last PT visit had me at -3° to + 116° ROM, which seems far ahead of my prior rehab! I've been taking stairs leading with the operative leg going up now, but we're waiting on leading with the good leg going down until I demonstrate more control.

The busyness of the holidays has kept my mind occupied, and these first 3 weeks have simply flown by. Here's the basics of where I'm at currently:

- ROM: Objectively I'd say I'm well into 120°+ of flex, and extension isn't hardly uncomfortable at all.
- Swelling: I have dimples around my kneecap again!
- Scarring: Scars are healing up nicely, just one persistent site that's still rather swollen but not painful. My PT is having me massage the scars to keep them from bonding to the underlying tissue.
- Mobility: Haven't used a cane since the first week.
- Bruising: The last traces of pooled fluid in my foot have faded to nearly nothing now.
- Walking: I still catch myself in a conservative gait, working on lengthening my stride.
- Strength: Strapping on 2 lbs. of ankle weights for straight leg lifts currently.

Since swelling has gone down, my other ligaments have taken the opportunity to get some exercise of the knee-cracking variety. Things are still a bit tender in that area, so I'm careful whenever getting up from sitting for long periods. I still get these wicked charlie horse cramps in my thigh in the evening, but ibuprofen usually takes care of those. If they continue much past about week 6, I'll get them investigated in case there's funny business with nerves in my back.

I'm two days into my resolution for sit-ups and push-ups, hoping it's a good habit that will develop over the next few weeks. Can't wait to start running in another 3 weeks, which is odd since I'm not normally much of a runner to begin with--but it always manages to fire me up for the day.

Black Belt Mama is heading in tomorrow morning for some corrective surgery on a protruding sheath from the interference screw installed in her shin. Keep her in your thoughts that her healing will be quick and devoid of any PT requirements!

Thursday is the next check-in with my PT. Friday is my 40th birthday. I expect great things from both.

Love

My wife loves my knee.

She said as much this week.

Well, she loves the rest of me, too, but my operative knee in particular comes in handy for Christmas shopping since it nets me a handicapped parking pass.

Notable milestones:

- 110° of flexion, -3° extension, and straight leg lifts with no noticeable lag.
- Beyond weight-bearing and walking without a limp, I was actually able to balance on the operative leg on a mini trampoline at PT!
- Stitches are out.
- Immobilizer brace and cane are gone. Amen.

Only noticeable ongoing issues are my leg coloring up (normal, but rather gruesome looking) and mild cramping in my quads. I'm strictly on Ibuprofen, and should be weaning off that soon.

This year we added a Wii to the household. With the addition of the Wii Fit, I hope to work a lot on balance as I work on strength and flexibility throughout my rehab.

As I reflect on the events of my 39th year, I realize that I am approaching 40 with 3 people and 4 screws inside me.

My resolution this year is simple; Start daily push-ups and sit-ups January 1st, adding more each week. Starting at 10 of each daily, in addition to my PT regimen, and add 1 each day. By my anticipated return date in 20 weeks, I should be at around 150 daily. Wish me luck!

What's your fitness resolution this year?

Hack Shaft II: The Clone (Pictures!)

Welcome to the sequel.

Unlike many movie series, my second ACL reconstruction experience so far has exceeded expectations. Here's a few comparisons:

- Initial injury. No swelling vs. puffing up like a balloon. My ACL had somehow managed to fold over itself immediately after rupture, effectively choking off any hemorrhagic blood flow and preventing swelling. What a miracle and a blessing, it saved me from Pre-Op PT to restore Range Of Motion.
- Locating the femoral nerve. Got it the right away vs. needing a few minutes (and hitting some raw nerves in the knee joint.)
- Lower sedation levels. The spinal block injection didn't bother me any more than the prick from insertion of the I.V. catheter; last time they knocked me out for about 15 minutes. Since I was far less sedated, I was able to experience the whole surgical procedure without memory holes. Yes, I'm one of those sadists who watched his own surgery...Again!
- No nausea from pain meds. Since Vicodin made me constantly nauseous, I raised the issue this time. We ended up with good ol' Tylenol 3 (Tylenol + Codeine) and it worked like a charm. Vicodin and its analogs are powerful Codeine synthetics, and my pain threshold just didn't justify the side effects. I remembered tolerating Tylenol 3 in the past, so we combined that product with 800 mg doses of Ibuprofen and I was much more satisfied with the results. As of this morning I'm strictly on Ibuprofen since I had no significant pain when I woke up.

Some things weren't as positive. The spinal block began wearing off as they were closing up; last time it didn't begin wearing off until I was in Stage II recovery hanging out with Mrs. Shaft.

It didn't cause problems with any surgery-related pain since the femoral block was still active, but my posture on the table made things uncomfortable at that point.

My operative leg was strapped to an immobilizer board, and the end of it was digging into my left butt cheek. My right leg was dangling unsupported over the edge of the table at perhaps mid-thigh position.

The resulting dead (rapidly becoming live) weight pulled my lower back into an increasingly uncomfortable arch and began tweaking my lower back something fierce! I tolerated it to a point, and when it seemed like closure was still gonna take a bit I brought it to the attention of my nurse anesthetist. Since lumbar support wasn't available, and raising my torso to a higher angle just exaggerated the discomfort, I ended up with a shot of some narcotic (under protest.)

I felt it was overkill, and when the first dose didn't settle my lower back I got another. That settled things down, but made me a bit more woozy in recovery than I cared for. Leave it to an anesthetist to conclude the solution to any pain is more drugs.

My advice for anyone reading this and preparing for surgery: If you're awake, get lumbar support in place if possible!! My conclusion is they probably couldn't place anything there since it was the injection site for my spinal block, and perhaps they needed to watch it or something.

Once closing up was done, my cryo-cuff was installed as well as the immobilizer brace I'd brought in for re-use. This time, however, they installed a compression wrap along the length of my leg, rather than just gauze to hold dressings in place. Unfortunately this resulted in a lot of insulation between cryo-cuff and my knee, so it was pretty much ineffective until dressings were changed the following day and a few layers removed.

This morning was the 48-hour mark and so I removed the dressings to shower up. Things look pretty much as expected, but my leg as a whole seemed much more swollen than last time. I assume removing the compression wrap probably induced that, as well as a lack of proper cooling for the knee the day before.

The only thing out of the ordinary was a nickel-sized blister at the end of some of the steri-strips on my shin. I contacted a nurse at the clinic, and the conclusion is it was most likely the result of unusual rubbing at that spot. I trimmed back the steri-strips to better expose the blister, then padded the site with some larger gauze to protect it until it either drains or the fluid is re-absorbed. Fluid in it was clear, so I'm not too concerned unless it bursts and creates an opening for infection. Just something to watch over the next few days.

As for getting around, I'm on a cane at home already and crutches in public (for speed), so am able to bear weight well. Couldn't do a straight leg raise at PT yesterday, so I'm working on quad sets and assisted raises using my non-operative leg along with passive extension while icing and such. My numbers are +10° extension (should ultimately be around -10°) to about +75° flexion.

I got a looong way to go, baby!

For the gruesome of yousome, here's before and after pics of the ACL:

The tip of the probe is in front of the Posterior Cruciate Ligament, the ACL's partner. "Cruciate" refers to the crossing of the two ligaments working in concert to hold the shin in proper position relative to the thigh. The lower end of the ACL took some bone with it when it ruptured, and somehow folded over itself choking off blood flow that would have otherwise caused massive post-injury swelling.


Welcome the PCL (top-left to bottom-right) and it's new ACL partner (bottom-left to top-right.) May they perform their duet perfectly in concert until the day I die.

In closing this post, I want to take a moment to thank two anonymous people for their decision to be organ donors. Since my replacement ACL's are both allografts, (harvested from cadavers) I give my most heartfelt thanks to them both for checking that box on their state ID or driver's license forms. I hope you both enjoy the ride as I cruise into my 40's next month and continue my journey to black belt and beyond.

For Daze

Saturday I went to cheer on 5 people from my school testing for black belt. All 5 were awarded thier black belts, and I'm very proud of their efforts!

I decided to hang out and catch the fights on Monday night. I was pleasantly surprised to see all 5 of our new black belts show up for their ritual beating (except one, who doesn't spar due to low back complications.)

Each fresh black belt faced off against everyone else present, from under-belts to 2nd degree's, finishing with our head instructor. That was a blast to watch!

I plan to make Monday nights a regular thing. It's karate-related activity that will keep my spirits elevated, I can keep connected with that particular group of folks regularly, and very importantly, I can study my opponents and plan strategy!

Now this all sounds somehow underhanded or sinister, but I'm a visual learner and will absorb anything I can while laid up and rehabilitating my knee. One guy in particular, John, has always been a wonderful partner and a particular challenge to me. He's an inside fighter, and I prefer to keep guys like that at a distance with kicks, which are my stronger weapon.

I hate when he gets inside my kicking range!!!

However, even in the short down time I've had I can see massive improvements in John's technique. He's putting more kicks out there, and is developing a wicked-sharp reflex for getting his head out of the way of punches. I'll have to keep an eye on him for certain, and really look forward to getting back in the ring with him in June.

Four more days; Thursday-Friday-Saturday-Sunday.

To be honest, I'm ready for this. My left knee has gotten progressively weirder and unreliable, with more "tricks" than I care for. I want my predictability back.

Sing it with me, folks:

All I want for Christmas is my A-C-L,
My A-C-L, just my A-C-L
Gee, if I could only have my A-C-L,
Then I could wish you Merry Kicks-mas!!!

Nesting Instinct

Being a father, I've seen this sort of thing before but never experienced it quite as much as I have lately.

The Nesting Instinct.

It's a phenomenon which occurs among pregnant women nearing birth. They get this burst of energy and seem driven to 'get the nest ready' for the new arrival.

In my case, I've been tackling not only the necessary details for surgery (PT, pre-op physical, follow-up appointments, FSA funds) but also a number of other projects around the house. I had a trim job on the stairs that I've buttoned up before Winter arrived. Gotta re-organize the garage and swap the lawnmower for the snowblower so it's ready for Mrs. G when that first big storm arrives. Buying some comfy, large pillows for leg padding. Gift-wrapping my sparring gear and uniforms.

And very importantly, getting my studio cleaned up and organized so I can perhaps do some music writing while I'm laid up!

I have no other way to describe it other than a nesting instinct. I'm making sure all I'll need those first few weeks following surgery will be at-hand without any fuss.

On a side note, please welcome Wei who is in late stages of ACL reconstruction PT as of this writing. She's a student of Tae Kwon Do, and a worthy read. Plus, I discovered the cool new gadget for blog links you can now see!

Time, and time again.

The date and time are set, the countdown reset.

December 15th, 8:30 am.

Saw Dr. K on Friday, he confirmed it is a complete ACL tear, and is just as baffled as I am as to the lack of swelling. He mentioned that sometimes it's the result of chronic ACL wear, but he saw no indication of that. Guess I'll just count my blessings I didn't have to go through the whole swelling-reduction program prior to surgery!

No indication of Meniscus damage, and signs of an MCL sprain which will resolve itself without surgical intervention.

As I head for my repeat, it's a reminder of all the things I had to do last time. Pre-op physical. PT appointments. Follow-up appointments. Work scheduling. Short-term disability. Allograft decision.

On.

And On.

And yes, I will be watching surgery again. That was cool the first time, gotta catch the sequel!

I will pack and gift wrap my uniforms and equipment this weekend. It was a ritual I used before, and one worth repeating. It symbolizes the pain of putting away my Karate for a while, with the promise of rebirth, restoration, and renewal in 27 weeks.

Happy Thanksgiving, all!

Really Weird.

I want to thank everyone who commented for your support. It may be a few words on a blog, but I'm glad to know I'm not taking the trip (again) alone!

Friday night's screening was really cool. I'm sure the 5 people from my school will fly on to the final exam with no problems! Lots of people were asking about me, whether what they'd heard was true.

I hadn't the assistant instructor from that night since the injury, and he took time to step off the mat and check in with me. Mr. Fab was, ironically, the only one present for both ACL ruptures.

Most impressive, however, was our 5th degree in charge of Black Belt screenings. Mr. War took a moment--right in the middle of screening--to give me his personal condolences. He himself has had both ACL's re-constructed, and stated "There is more after all this..."

So on to the "Really Weird" bit.

This time, my ACL tear emitted a 'pop' as one would expect. However, there was no swelling whatsoever! Now, I've no idea how that's even possible, unless some unusual situation--perhaps a bit of bone on the end--managed to immediately close off the blood vessels that typically run through the ACL. Normally these suckers swell like a balloon almost immediately from the hemmorhage, but not this time.

Weird, huh?

While Dr. W stated the MRI did confirm a torn ACL, I forgot to ask if it was partial or complete tear in his opinion. Hopefully Friday's visit with Dr. K will shed light on that particular mystery.

So tell me: Anyone reading this experience a partial tear only, or some level of injury where no swelling occured???

Details

For the creatively challenged trying to read last Tuesday's post, here's what happened on Election Night:

1. Obama won the Presidency.
2. Hack Shaft lost another ACL.

Oy. Well, it's been shocking to so many in my extended Karate community to hear the news, and everyone is surprised at how well I'm taking it.

Should I take it some other way?

Wednesday night I did some power-grieving with a few beers and a surprisingly large quantity of Jack Daniels. Understand, folks, I'm not a heavy drinker and don't recommend my blatantly juvenile, childish, alcohol-fueled reaction--but that night the reality of being out until June again hit me hard.

Why June? Primarily financial reasons. Like last time, I plan to use pre-tax money from an FSA at work to pay for surgery expenses, and the new funds aren't available until January 1st. The medical services have to occur in the same year as the FSA funds.

Then again, I may forgo the tax benefit if I can get surgery scheduled in early December. Guess I'll know more Friday after my visit with Dr. K.

Primary considerations are scheduling--such as carpools, time off from work, holiday parties--but maybe, just maybe, I can trim a month off the process...

Well, 'nuff for tonight. I'm heading out to support 5 friends from my school at their final Black Belt screening session.