Sunday, April 29, 2007

The Cutting Room

This past Wednesday I finally had surgery on my utterly-destroyed left kneecap in the form of knee arthroscopy. I can't say it was incredibly fun, but it was interesting to say the least.

The pre-op processing went extremely quickly, as I was in the pre-op room being interviewed by a nurse and an anesthesiologist just ten minutes after my scheduled arrival time. They seemed surprised by my low heart rate (it hovered around 45-50 bpm on the various vital signs monitors I was hooked to throughout the day) and by my request to remain conscious during the surgery. Apparently, most people are all-too willing to be knocked out, and they weren't used to someone saying "I wanna watch!".

It took a while to finally get in the OR, but once I did, things moved very quickly. Another anesthesiologist, a deadpan Asian doc with a great sense of humor, gave me the spinal injection that reduced my legs to lifeless stumps and my surgeon went straight to work. The insertion of the scopes into my knee was a little disconcerting, because I felt the pressure if not any pain. A few times he moved my kneecap around and brushed my femur with the scope and I got a little queasy. Other than that, it was smooth sailing.

I was able to watch the whole procedure on a TV screen next to me, and got to see all of my ligaments, tendons and leg bones in high definition. My surgeon explained everything he was doing and specifically pointed out what we were looking at on the screen. It was all very fascinating.

He pulled out a huge chunk of cartilage from my kneecap that had broken loose when I initially dislocated my joint, and granted my apparently strange request to take it home with me. I now have a chunk of cartilage in a little cup. I'm so proud!

I spent the rest of the afternoon in various recovery rooms trying to regain the feeling in my legs and trying not to piss myself, since I was dead below the waist and helplessly subject to nature's various whims. Eventually, five hours after the operation, I was cleared to go home.

Now, several days later, my knee is still a bit swollen and my stitches (three entry points, three small cuts) are a little gross-looking. I'm regaining mobility each day and I'm off the Percocet. I couldn't wait to get off of it. It didn't make me feel euphoric or happy or at ease---it just made me feel dizzy and disoriented, and totally uninterested in getting out of bed.

I guess I'll never be a drug addict.

My surgeon will remove the stitches a couple of days from now during my follow-up appointment and we'll begin outlining a rehab program. I've already lost a month to this injury and I'm ready to start walking, riding and working out, just like the old days. If I never see these crutches again, it will be too soon.

Saturday, April 21, 2007


So the date of my knee surgery draws nearer. I'm not nervous about the actual procedure or the subsequent pain I'm sure to endure, but I can't shake this nagging feeling that my knee will never be the same as it was.

I'm not an anxious person, and I'm not a worrier. In fact, if anything, I tend to blow things off too often, even when they're important. I roll with the punches, go with the flow, float like the wind, etc. But thinking about my knee I just can't relax.

The swelling has subsided considerably, and I've regained a significant range of motion. I can now almost fully bend my knee and there is no longer a dull ache to the joint. That dull ache has been replaced with very sharp pains any time I move my leg in the wrong direction or try to walk on it. The pains are very localized and very specific to the area around my kneecap.

That's what I'm most worried about---my kneecap. I've heard that once you dislocate your patella, the chance of it slipping out of place in the future is increased considerably. I can't imagine getting hurt again. Just thinking about the sound my knee made when it gave out and the pain that it caused makes my stomach turn, and the idea that it could happen again at any time scares the crap out of me.

I've never had an injury like this before. I've never broken a bone (other than a toe or two), never been seriously cut and even the crashes I've had on the bike were nothing more than bruises and road rash. My knee is different. It's serious. It requires surgery.

All I can do is recover from the operation and begin a rehab program, and be serious about it. And above all, be careful. I can't imagine my life without weight lifting and bike racing, and a damaged knee could compromise both of those pursuits. I'll do whatever it takes to come back fully fit and stronger than ever. I have to.

I'll drive myself crazy otherwise.

Monday, April 16, 2007

Finally, A Diagnosis

After two weeks of hobbling around on crutches, still unsure of the extent to which I damaged my left knee, I finally saw the orthopedist to follow-up on my MRI scan.

The diagnosis is much better than I had feared. No torn ligaments, no severe damage, no broken bones. To get a good idea of what I've got going on in my knee, I'll share with everyone my MRI report:

There is a large joint effusion with fluid observed in the medial gastrocnemius-semimembranosus bursa.

Translation: I have fluid in a pouch behind my knee joint as well as in the front. I could have told them that.

Full thickness cartilage defect measuring about 16mm in transverse dimension is observed at the patellar apex and medial facet on the axial series. The displaced cartilage fragment lies adjacent to the lateral side of the lateal femoral condyle. The displaced cartilage fragment measures about 14 mm in AP dimension and about 2 cm in craniocaudal dimension.

Translation: I knocked a chunk of cartilage loose when I dislocated my kneecap, and that sucker is still floating around in my knee. It's big.

There is marrow edema in the inferior pole of the patella medially. There is also marrow edema along the lateral aspect of the lateral femoral condyle with a little depression in the lateral distal femoral cortex.

Translation: Marrow edema is a common result of joint trauma, and indicates that I did indeed screw up my knee. There is marrow edema in multiple locations of my knee joint where trauma occurred.

The large joint effusion distends the joint and the patella is positioned slightly more lateral than usual. However, frank disruption of the medial retinacular complex is not appreciated.

Translation: The fluid causing my knee to swell is limiting my mobility. Duh. Also, my kneecap is just a tad out of place due to the pressure of the swelling, but overall the extent of the damage is not that severe.

But the most important observation, as far as I'm concerned:

The cruciate ligaments, collateral ligaments, quadriceps mechanism and muscles and tendons all appear normal. The medial and lateral meniscus both appear normal. Cartilage in the medial and lateral compartments is preserved.

Translation: I didn't tear my ACL, my MCL or any other ligaments and I don't have meniscus damage. I can't express in words how relieved I am to know that.

The bad news is that I'll still need surgery, though, to remove the chunk of cartilage that is still floating around in my knee causing pain and swelling. Luckily it will require no more than a small incision and arthroscopy, and won't result in a huge nasty scar like ACL surgery might.

I'm scheduled for surgery next Wednesday morning. After that I begin rehab and work toward getting back on the bike. With any luck I'll be able to make the Madison Cycling Regatta in Madison, Indiana in mid-July. I love that race, I'd hate to miss it.

More updates to come, of course.

O'Grady Finally Wins Something

photo courtesy Luc Claessen

I must admit that since Floyd Landis' major screw-up in last year's Tour de France, I haven't really been following pro cycling at all. It's almost impossible anyway, with half of every article written about the pro peloton being about drugs and scandals, rather than the actual racing.

But watching Stuart O'Grady finally win something, and win Paris-Roubaix of all races, and win it BIG in a solo break, was really impressive. I'm sure by next week he'll fail a doping test and be banned for four years, but in the meantime, congrats to him. He's always been a tough racer and never, ever gives up, and it's high time that his dedication to the sport received a prize like the cobblestone trophy from the Hell Of The North.

Good work, you Aussie bastard.

Tuesday, April 10, 2007

Peering Within

Today I had a date with a sexy Hitachi Airis II open MRI scanner, and I have to say I think we really hit it off. That's her pictured above. The only downside of our little rendezvous was that I kind of just laid there the whole time, but I don't think she's mad at me.

In all seriousness, though, I'm bummed out because I can't see the doctor for the follow-up until Monday, almost two full weeks since the initial injury of my knee. Then, finally, I will know the extent of the damage and if I will need surgery. Considering that it's been a full week since my knee collapsed and I still can't walk on it, move it quickly or bend it fully and my entire leg looks disfigured (seriously, my calf muscle is now half the size it used to be and now it's lumpy), I'd kind of like to get a quicker resolution.

The variations in medical care in this country are really astounding. If I was a professional athlete, say a football player, and I blew out my knee during a game, I'd be in surgery and then in rehab within two days. Since I'm just a regular dude, I have to wait in the emergency room, then wait to see an orthopedist, wait for an MRI, wait for a follow-up appointment and then wait again for actual surgery. If it turns out I need to be operated on, it will be a miracle if I go under the knife within three weeks of the injury date.

At least I'm finally getting some kind of return on all those medical insurance premiums I've been paying for years.

Friday, April 06, 2007

The Road To Recovery Part 1

After three days of lying around the house in pain with a giant, softball-sized left knee, I finally visited the orthopedist. After looking at it for about two seconds, the doctor decided to drain the fluid from my kneecap. He took out about a pint of a tasty mix of fluid and blood with the largest needle I've ever seen. It felt great.

My knee is now considerably smaller, and until the lidocaine wears off, a lot less painful. I've got an MRI scheduled for this coming Tuesday morning to finally see the extent of the damage I've done to myself, and to determine if I'll need surgery. The final word on that will come on my follow-up appointment scheduled for Monday, April 16.

So I've still got a while before I know for sure how bad my knee is and how long it will take to recover, but at least the recovery ball is now rolling.

I just hope my whole racing season isn't shot. That would suck.

Wednesday, April 04, 2007

Day 2

I've pretty much lost all mobility in my left knee today, and the swelling has yet to subside. Whatever I did in there (I'll find out for sure on Friday) is pretty serious, it appears.

These crutches are really starting to hurt my armpits, but the tops of my lats even more. I guess next time I plan to get injured I should lay off the back workouts.

Live and learn.

A Brief Hiatus, I Hope

Yesterday afternoon I managed to dislocate my knee while working out in the gym. Mind you, I wasn't training my legs. In fact, I was doing shrugs. As I was returning the 55-pound dumbbells (one in each hand) to the weight rack on the other side of the gym, I stepped on my foot wrong and immediately felt my left knee pop out of place. I hit the floor with a thud and immediately knew I had done something bad. I was able to stand and attempt to walk it off (yeah right), but by the time I got home the knee had swollen to the size of a softball.

I eventually went to the emergency room and they immobilized it. I now have to wait until Friday to see an orthopedist and determine the extent of the damage. The initial x-rays came back with no breaks or bone damage, but only an MRI will reveal any tendon or ligament tearing. Hopefully the results are not as bad as the pain in my knee.

At any rate, I won't be racing again for at least a couple of weeks, minimum. It sucks because I was riding really strong and was hoping for some good showings in the upcoming crits and circuit races. But such is life.

Below is a photo of me just home from the hospital. Go Team Bolla!

Maybe someday I won't be such a moron.