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.

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.

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.