Monday, June 23, 2008

Decisions, decisions

I am at Dr. C’s office now – he was recommended by Andy. His daughter, Alison, had her ACL reconstructed by Dr. C. She did an autograft (her own patellar).

Yesterday I went canoeing and then to a movie – afterwards my calf and ankle were quite swollen. I really hadn’t thought too much about it; I thought that it happened because I was seated most of the day. It turns out that it was a good day to see doctors.

This morning I saw Dr. A – he’s the doctor that reconstructed Eric’s ACL using an allograft (cadaver). He saw some interesting stuff. First, he noticed how swollen my ankle was and this concerned him. I’ve noticed that when a doctor is concerned, one should worry a little bit. He thought that I might have some sort of blood clot (when I think of blood clot, I think of something going to my brain and killing me) and possibly DVT (Deep Vein Thrombosis – don’t quite know what this is, but I will look up. I have heard of DVT but only when I’ve been flying). So back to my knee…Dr. A looked over the x-rays. He showed me the bone bruise that is typically seen in ACL tears. He showed me the PCL (posterior cruciate ligament) which was still intact. And then he showed me some things that again freaked me out. Apparently, I also have some articular cartilage defect (not sure what the manufacturer’s warranty on that is…). This will require micro-fracture surgery and/or (not sure yet) an OATS procedure. I have to look these up. He also mentioned damage to my medial femoral condyle. All sounds so wonderful. His concern first was the cartilage damage – apparently the cartilage isn’t easily fixed, that’s where the different surgeries come into place. All I know about micro-fracture surgery is that Amare Stoudamire and Greg Oden have had it done and it Amare 2 years to get back to playing shape. We’ll see about Greg Oden. At least they have million dollar contracts in the bank…got to love the guaranteed contracts in the NBA.

Dr. A scheduled an Ultrasound for my blood clot. That was interesting – I only thought that ultrasound was for pregnant women. Little did I know that ultrasound was used for diagnosing blood clots! So they put gel on my leg and tried finding a clot, which they did not (thank God!). My appointment with Dr. A began at 8:30 and I got back to DC at 1:30. Dr. A followed up with me to go over the results with me, which I found to be very professional.

(Now writing after meeting with Dr. C.) Dr. C discussed with me the surgery options. His opinion was that because I am tall and heavy (6’3”, 200 lbs) with big feet, a long femur, and a long tibia and fibula, that I should use an autograft instead of an allograft. His judgment was based on my aforementioned physical attributes, my age, and my future athletic goals. He said that because I am big and long, I will put more pressure on the ACL specifically and the knee in general than a lighter or shorter person. This alone might cause me to “stretch” a cadaver graft. My age was a factor because I am young enough to still push it athletically for years to come. He mentioned that if I were 44, then he might lean towards a cadaver and that if I was 74, then he definitely would use a cadaver. Of course at 74, I just might know the cadaver. Maybe at that age I just might be the cadaver! Finally, the athletic factors in favor of the autograft option were my future athletic goals of playing basketball and soccer again as well as the type of training that I do. Dr. C told me that I will need a strong ACL replacement and the professional basketball players that he’s worked with have done the autograft option.

After thinking about all the options I decided that would go the route of an autograft. Dr. C sold me on that option. Now, I had to choose a doctor.

The decision-making process on choosing a doctor was tough – I felt that they all knew their stuff, but which one would be best for me and how would I decide.

Dr. D was the first doctor I saw, so I had no level of expectation, I didn’t know what questions to ask – basically I was in the dark. He went over everything with me, but since I was clueless at our initial meeting, I felt like I was rushed, but at the same time in capable hands. He assured me that he would fix everything, check out the knee for possible other (read: cartilage) damage. When I left his office I felt that I had scheduled a surgery that I knew little about.

When I saw Dr. A, I was more informed that my initial doctor visit. I had a bunch of questions and he had answers. When he showed concern with the swelling I felt that this guy really cared and would look after me. He gave me his cell phone number and called to follow up after the ultrasound. He also showed me what he saw on the MRI and explained what it all meant and what the options would be. He was indecisive on the surgical options for ACL reconstruction as his main concern was the cartilage damage.

Dr. C was the most “doctor” of all three – he was very matter-of-fact and I felt that this guy would do a fantastic job. However, I felt that since he was older that he was would use “older” methods, i.e. not stay up with the latest in ACL replacement trends or surgical techniques. It was funny, but I judged him on his age and the layout of his office – it was old and not modern, where Dr. D and Dr. A both had modern facilities, with Dr. D having the best. Maybe it's the businessman in me - I see a new, modern facility and I think: "this place is doing well, which means that they're doing good work, which means that they will look after me."

Later that same week I called Dr. D to talk about the issues and questions I had with the different surgeries. Since I was a bit more knowledgeable that I was the first time we met my questions were more on point and his answers made more sense. My concern was this: Why would I want to damage a perfectly good patellar tendon to repair the ACL? Wouldn’t I be “robbing Peter to pay Paul”? Wouldn’t I be better off with a 100% patellar tendon and a cadaver ACL? Dr. D explained that the autograft would fit better since it’s basically the same length as the ACL and that a cadaver would be hard to match. Plus, the patellar tendon would fill in over the next 2 years to the point where it would appear to be normal under an MRI. That answer alone was enough for me to feel more comfortable. Add to the issue that my body might reject a cadaver or I might get something from it (highly unlikely, but sill a concern.) At the end of the phone call I felt better about both the operation and the surgeon.

Friday, June 20, 2008

The year that Tiger and I combined for 2 ACL surgeries and 1 US Open Championship

Blog #2

Well at least I know that I am good company:

Yes, el Tigre tore his ACL last year and then finished second in the Masters and won the US Open in arguably his best victory.

Here are the questions that I need to ponder as I decide which surgery to have:

1. Which surgery – using my own patellar tendon (autograft) or a cadaver (something-else-graft) will be the best long term solution? Specifically, which will be better as an ACL in the future? The second part of this question is how will be knee react to having 2/3 of a patellar tendon?

2. Taking away the risk of infection, what are the risks of using my patellar tendon vs. the risks of a cadaver? Are they both strong? Is one stronger than the other? How does this compare to my old ACL, i.e. will a reconstructed ACL be stronger than it was before?

3. What is the recovery time on each surgery? How much time will it take to return to “normal” activity? What’s the return time to sports activity?

4. How will my patellar tendon fare with just 2/3 remaining? Does this re-grow?

5. What supplements should I be taking before and after surgery?

6. What is Tiger Woods doing? He’s the best in the world! I want to see his doctor!

I am scheduled to see 2 other doctors on Monday – the one that did Eric’s ACL (cadaver) and the one that did Alison’s ACL (her own patellar). I am also going to see Dr. D again to go over these concerns that I have. Andy, Alison’s dad and with whom I’ve been playing basketball for 4 years, put it bluntly – both options suck!

So now I will get into the psychological part that I am dealing with. As I mentioned, last Friday morning was D-Day for the ACL – getting the news only confirmed what I knew since I couldn’t move my leg and the swelling wasn’t receding. I cancelled my noon client and then went to the pool – I had to wrap my head around the idea of surgery, rehab, being immobilized for weeks, and losing both my fitness level now and long-term. The goals I had this summer: rock climbing, dunking, and getting down to 8% body fat are out the window. It just sucks not being able to do the things that I am used to, especially in the summer, which is my favorite season (hey, I’m from Maryland – heat and humidity are welcome; you can have the cold). It has taken this injury to make me realize how important fitness and health is to me. I know that generally speaking, it’s better to be healthy than not, but for me, being active is both my hobby and my career. It’s been a struggle this past week training as I can’t demonstrate, participate, and, mainly, motivate as well, or at all, as I typically do.

Next, I will catalog the exercises that I have been doing and the diet that I am going on to minimize weight gain and muscle loss.

Wednesday, June 11, 2008

What did I just do to my knee?

On Friday, June 6, 2008 I tore my ACL while playing basketball. After getting my results from my doctor a week later – after the MRI and some physical assessments – I decided to write a blog to detail my progress. This blog will serve as a document for any other person who tears an ACL and wants a first-hand account of what to expect.

Some background: I’m a personal trainer. I’ve been doing this for about 8 years now – 4 at Washington Sports Clubs and 4 with my own gym, Balance Gym. Somehow I fell into post-rehab work – getting people back from MCL tears and sprains, ACL tears, meniscus tears, low back pain, herniated discs, broken wrists, etc. Right now I have a client, Zoe, who tore her ACL a year ago and had her surgery with Dr. D. She also rehabbed with Chris. I started training her a week before I tore my ACL. So I’ve been doing balance and core stability work for years. It’s not like I’m a de-conditioned person carrying extra weight. In fact, since I returned from my trip, I’ve been training like mad.

First, the incident: It was another regular Friday night at the gym, playing 3 on 3. I drove to the paint, went for a jump-stop and upon landing, felt my knee go side-to-side, giving out on me and then I fell to the ground. I didn’t hear the “pop” that is common with ACL tears, but looking back, I did feel a slight pop. Knowing what it could be I iced my knee throughout the night. The next morning I knew I was in trouble. I couldn’t straighten my knee and it was pretty swollen. The swelling, I would learn later, is from a vein/artery/blood vessel that runs through the ACL and ruptures when the ACL tears. This fills the knee with blood, hence the swelling. Fearing the worst, I called Chris, the Physical Therapist that my gym has a referral reciprocity agreement with. He came by in the afternoon, did some assessments and determined that my MCL was still intact. The ACL? He couldn’t tell.

It was still swollen and wasn’t getting any better. Sunday was spent hobbling around. In fact, I took the scooter out for a drive around all the monuments – I figured since I can’t walk, I might as well scoot.

On Monday I headed in to Chris’ office to get the knee checked out. He gave me ice and heat therapy, electric stimulation and had me contract my quad 20 times in a minute while a machine measured my progress. My quad wasn’t firing off – shut down, basically. On Tuesday, I saw Chris again and then saw the orthopedic surgeon that he works with, Dr. D. Dr. D performed another physical assessment – which didn’t give him any conclusive evidence of a tear. So he scheduled me for an MRI on Wednesday. The MRI took about 20 minutes – they took 5 series of photos from all angles – I know this from looking at the photos. I looked at the MRI photos, but I couldn’t see more than my PCL. The rest I wasn’t so sure about.

My next appointment with Dr. D was Friday morning at 8 – D Day for my ACL. I didn’t have a good feeling going into the appointment. My knee was still swollen, I couldn’t straighten or bend it all the way – I knew it was fucked (a very scientific term, by the way). Dr. D confirmed my fears – he said, “Do you want to bad news or the good news?” I replied, “I know it’s torn.” He said, “Ok, here’s what’s next” and then began to outline my choices.

So Dr. D gave me the low-down. My ACL had to be reconstructed (as compared to repairing it, which can't be done). This would be done through surgery – my ACL would be reconstructed with a graft of a bone-ligament-bone piece into the 2 bones that the ACL connects to – the femur and the tibia. The graft options are the patellar tendon or the hamstring tendon. The patellar is the first choice since its similar in length to the ACL (isn’t our Creator creative?). And this graft could come from me or a cadaver, and by cadaver I mean a dead guy. Hopefully this dead guy had good knees. So that’s my first decision. I’ve been researching the pros and cons of each. There are plenty of sites detailing these, so I will sum up. If I choose to use my own patellar tendon, they will slice open my knee and take 1/3 of my patellar tendon out. They will also take a piece of bone from the femur and tibia (shin bone). The pros: it’s my own tissue. The cons: It’s basically 2 surgeries – one to cut the front of my knee and the other to reconstruct the ACL. I could also experience discomfort kneeling in the knee since it would have been cut open. The cadaver? The pros: it’s only one surgery. I won’t experience front knee pain. The cons: it’s dead tissue that my body could reject. Some report that it’s not as stable.

So I’ve been asking around to get other opinions and find out other people's experiences who have also torn an ACL and undergone surgery. Sophie, Eric, Erica, and Holly all had cadaverous replacements and they seem to be happy with them. Sophie and Eric recently had them done; Erica had hers done about a year ago. Eric’s surgeon works with DC United, so he’s got professional athletes to repair. Not sure if that’s a good thing, though. Professional athletes need to get on the field quickly, so maybe the “fast” option is taken so that they can play while still under contract. I am thinking more long-term; I want to able to be active forever, not just the next three years!

So, more research today. I am also going to get into the psychological part that I dealing with. I am also going to outline the training I will do both before and after surgery,

The other thing I have to deal with is the psychological part of surgery. I am very active, both in my personal life and my business life.

Here’s what I am told is the time frame: Now to July 10, rehab the knee – building up the muscle and getting back range of motion. I am told that from research, this will speed the recovery of surgery. July 10 - Surgery. Then rehab...