Whatever the trouble…

“Whatever our individual troubles and challenges may be, it’s important to pause every now and then to appreciate all that we have, on every level.” — Shakti Gawain

In my case, the trouble was a messed-up knee. It was all kinds of messed up. As The Hubs so astutely pointed out, it’s been messed up ever since he’s known me, which is some 20 years. Day after day of running, jumping, squatting, and lunging was taking a heavy toll, as was years of escalating stair-climbing, box-jumping, and jump-roping, all in an attempt to achieve and maintain a level of physical fitness that “they” say thwarts disease and ensures a long, happy life. Well, I blew the thwarting part, and despite my best efforts, disease found me, but I won’t let that discourage me from my pursuit of the kind of fitness that fires off a slew of endorphins and allows me to do things like easily hoist a 40-pound bag of dog food into my shopping cart.

My pursuit and its inherent impact and repeated pounding has caused me some big-time, ugly trouble in my knee. Seven years ago, I had enough of the pain and grinding and had it scoped. A thorough cleaning of the underside of the kneecap and a few tweaks to a ragged meniscus breathed new life into my beleaguered joint, and the running, jumping, squatting, and lunging, et al, resumed. However, one scope can’t hold me for life, especially when you add in a borderline obsessive tennis habit. Fast-forward to now and you get a knee that is one big mess.

I’m not one to slow down, take precautions, and tread lightly. I’m not a fan of admitting weakness and succumbing to pain, either. But sometimes our bodies and the universe have other ideas, and this busy-body was felled. A quick consult with my favorite orthopedic surgeon revealed that it was time to stop the madness and sort out this mess. An x-ray and MRI confirmed that there were some big problems that needed to be fixed: chondromalacia (denigration of the cartilage under the kneecap), lots of inflammation, and a bad case of patellar maltracking. Another scope as well as a lateral release were in order, preferably sooner rather than later.

Oh, goodie: more surgery.

I’d rather take a beating than go under the knife, again, but I’d ignored this hot mess as long as I could. Just the scope would have been no big deal, with a couple of weeks recovery, but the lateral release meant a much longer, more involved recovery. And, in typical me fashion, the situation was complicated even further by a surprise once the surgeon got inside my knee: a few tears to the meniscus, a couple of small tears to the ACL, and the biggest surprise of all: the complete lack of cartilage under the kneecap. That’s right folks, the cartilage was gone, baby gone. Hmmmm, no wonder my knee hurt.

Here’s what a normal kneecap looks like: lots of healthy white cartilage on top, all shiny and smooth like a cue ball or a full moon, with no bare spots or blank spaces.See that shiny, white segment of cartilage on top, just above the tool that’s been inserted into the knee? On me, there is none. Instead of that glossy white section of healthy stuff, there’s nothing. Oh, bother.

 

There is hope that the PRP can help regenerate some of the missing cartilage. But as the oh-so-wise Peggy Hill once said, “You can hope in one hand and poop in the other, and see which fills up first.” No, there is no guarantee my cartilage will regrow, and the more likely scenario is a knee replacement at some point in the not-so-distant future. Uh, huh: yet another surgery.

But not for a while. I’m going to tuck my head and soldier through this recovery. I’ll take solace from the fact that my doc and his PA were surprised by how well I’m walking, even thought I’m impatient to be healed. One week should be enough, right?? I’ll relish hearing my resident experts say that most people are still on crutches and pain pills at this point while I’m hobbling and grinning & bearing it. I’ll feel the swell of pride in knowing that my no-cartilage kneecap lives out loud in my doc’s and his PA’s minds: “Oh, yeah, you…the one with the gaping hole where smooth cartilage should be. Cool.” Physical therapy isn’t my favorite, and being sidelined from the things I want to do is even less so, but this is where I am right now. So be it. PT, limited mobility, pain, swelling, and stiffness will be my constant companions for a few more weeks. Then, like a little chick hatching from its shell, I expect my new, improved knee to make its way into the world, no longer still and helpless but bending and flexing and strengthening. As Marie’s challenge reminds me, I can appreciate that, on every level.

 


Surgery update

The knee surgery went well yesterday. Got up at the crack of dawn to truck on into the Medical Center and was at the surgery center at 6:10 a.m. Sherpa Amy came prepared with a rollie bag full of projects and snacks, even a picnic lunch. She reminded me to tell the doc that morphine is not my friend via IV but intramuscularly in the behind works fine. She brought me home while Trevor filled my prescriptions, then helped Macy with her knitting. I would love to sing her praises even more but don’t want to risk someone else wanting to partake of her medical concierge services. I’m selfish like that.

After filling out the requisite paperwork, I was escorted back to anesthesia land, one of my favorite places. The anesthesiologist was flat-out awesome. He looked about 25 and played football in college. Based on the size of his thighs, I’m guessing he special-orders his scrubs. He held my hand and said he was taking me to the prom–his little joke to distract me from him inspecting my veins, which are combative and uncooperative on a good day. One quick poke to my left hand, and my prom date was in.

My surgeon came to visit and to double check that I did want the lateral release procedure in addition to the arthroscope. I said yes, please. Ever since I learned that my kneecap was dislocated, I’ve been creeped out and was ready to get it back in line.

After our chat, I got half of my anesthesia cocktail but had to wait for the other half until I got into the OR. I had to haul myself up on the operating table, which would have been difficult if I’d consumed the entire cocktail. I vaguely recall being in the OR but don’t remember getting on the table.

A couple more pics of the lateral release:

Next thing I know, I’m waking up in recovery and fighting hard to keep my eyes open. I’m weird about wanting to prove that I’m ok and ready to go home. Even when I know in my heart of hearts that I should stay, I want to go. Kinda sounds like the basis for a country song. I’ve got an ace bandage from mid-calf to a several inches above my knee, and lord knows what’s under the ace bandage. I’m not all that curious to see. I know that there are 3 incisions, all of which are stitched closed. The ace bandage can come off tomorrow, and I’ll get a look at the stuff inside.

The good news from the surgeon: both procedures were successful. The bad news: I have no cartilage under my knee cap. None. Nada. Zip. So while my kneecap is realigned again, I’ll still be dealing with the pain. Hopefully not as bad as it has been; I’m optimistic, or delusional, either one fits. Dr Alani also said that even after the scope and the lateral release, I can’t do squats or lunges. Ever. Sigh. That makes me quite sad because those are things I actually like to do. I’m weird that way. And stubborn, too: the fact that he says I can’t do it incites me to try. My handlers are going to be hard at work on this one.

Because there’s no cartilage under my kneecap, I will most likely need a knee replacement at some point down the road. Add that to my list of things to do.

Today I have 2  goals: to take my twice-daily antibiotics without letting myself be transported to the awfulness that was 267 straight days of antibiotics after my post-mastectomy infection. I can do this. The second goal is try to bear some weight on my right leg and see how the knee responds. My guess is that its response will be angry. I’m tempted to start weaning myself off the pain meds, but I can hear my handlers protesting that it’s too soon, and that I’m going to need the meds even more after I try to put some weight on my bum leg. But the Lortab makes me itchy and spacey. I can’t take anti-inflammatories because of the PRP he injected into my knee. The autologous injection’s purpose is to stimulate the inflammatory response that helps our bodies heal. Anti-inflammatories short-circuit that response. Same for ice: I’d like nothing more than a big bag of ice on my knee right now, but it too can hinder the PRP’s success. So no ice, no OTC meds for me.

The surgical center staff talked a lot about the pain associated with the lateral release, and I smiled knowingly because I’ve been through so much worse. All I have to do is toss out the words “bilateral mastectomy,” “nosocomial infection,” “multiple tissue debridements,” and “DIEP reconstruction,” and the nurses realized that it’s all relative. An IV in my hand, a few little incisions and some cut connective tissue don’t scare me. Looking back on my previous surgeries reminds me that while it’s a hassle to hobble and a drag to be on crutches, it’s a piece of cake comparatively speaking. If one good thing has come from all the surgeries I’ve had it’s that I’ve learned to be much more patient with the healing process — a big step for a busybody like me. Instead of gnashing my teeth because I’m on the DL again, I’m sending happy, healing thoughts to my beleaguered body. As my sweet survivor sister Jenny reminds me, “It’s temporary.” Hopefully I’ll be recovered in time for some fall tennis, when the sun-soaked TX weather eases a bit.


Home again, home againI

Our glorious vacation is over. Sigh. Many thanks to our wonderful hosts for such a wonderful time. It was a fabulous 17 days. Best weather ever, which meant tons of good times on the beach, laughing, reading, sunning, and sipping–the things from which memories are made. This year’s trip was made even more memorable by the addition of one important item from home: my dear friend and medical sherpa Amy! She and her boys spent some time with us on our beloved Salisbury Beach and she now knows exactly why we love it so much.

3 of my most-favorite things: Amy, lobsters, and champagne. Perfection!

A quick blast of photos as I tackle my gigantic to-do list, with promises to come back with a real photoglut soon. The clock is ticking and my list is long–gotta get ‘er done before my knee surgery on Wednesday. Among the gigantic pile of mail awaiting my return was the letter from my health insurance describing the procedure as “Lateral retinacular release open and arthroscopy, knee surgical, with meniscectomy (medial and lateral, including meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment.” Blech. Ouch. Yuk. What part of that sounds fun? None of it. But alas, I will get through the lateral release, scoping, shaving, and debriding in hopes of rocking that bionic knee for years to come.

Meanwhile, I’ll think about this:

my favorite beach

I never get tired of this view!

early morning on a day that holds much promise

beach essentials

as much lobster as I can hold!

lobster & eggs

lobster roll!

lobster! lobster! lobster!

In between all the lobster, we ate cheese & crackers with fruit on the beach. Sublime!

A few beverages to wash down all that yummy lobster.

My favorite orange margarita from Agave in Newburyport

Big-bucket margs on the beach

homemade michelada

My daily Bloody Mary

Until next year, Salisbury!


Another day, another MRI

Long time, no blog, I know. Thanks to you faithful readers who have inquired about the reason for my silence. Sometimes no news is good news, but once you bare your cancer-laden soul in a blog, silence can be interpreted as a sign of trouble. Not so here; rest assured that if there were new and nasty developments, I’d spew the gory details. That’s how I roll. I’ve been busy with summer stuff: ferrying my favorite girl back & forth to day camp, hounding my video-game-addicted boy to work on his “page a day” algebra packet, devising a piggie-proof lock for the pantry, and keeping my potted plants alive as we alternate between drenching rains and scorching sun. Oh, and wading through the mounds of red tape that ensued after my girl and I were in a pretty bad car crash last weekend. Wet roads, bald tires, and independent rear suspension became a perfect storm that landed us in a ditch with the airbags deployed and the car inoperable 200 miles outside of Houston. Never a dull moment.

In light of all this, the MRI that I had Wednesday was a high point. Thankfully it was not cancer-related, but it brought back a whole lot of cancer-related thoughts. I guess it’s the case of once a cancer patient, always a cancer patient. In fact, it got me thinking — a lot — about May 7, 2010, just days after I’d been diagnosed with invasive breast cancer at the tender age of 40. On that day in history, I was enduring “test-a-palooza” in which I spent the entire day at the hospital for an L-DEX, chest x-ray, MRI, and bone scan.

Here’s what I had to say back then about the MRI:

Three vials of blood and a dose of radioactive dye later, I was ready for the MRI. I’ve had an MRI before, and this was not what I expected. Instead of lying on my back and going through the tube, I was face-down on what Mona the tech called a massage table (I noticed real quick there is no massage). Imagine my claustrophobic heart singing when I saw the piped-in oxygen for the tiny little space in which my face was smushed.

Mona asked what kind of music I’d like, to drown out the noise. She said most people choose classical to help relax. I told her I prefer alcohol to help relax, but I’d try the music. She promised me a double martini, extra dirty, when we got done.

The sweet chirping of birds and melodic harps were quickly drowned out entirely by a ruckus that can only be described as a marriage in hell between a jackhammer, nuclear-reactor alarm, and emergency broadcast signal, in a successive repeating pattern. Mona wasn’t kidding when she said a lot of people come out of there with a pounding headache. I decided right then & there that I needed a double on that double martini order.

While it seemed like I was in there forever, it was really only about 40 minutes, and instead of lying there thinking about what an unholy racket and uncomfortable experience it was, I heard my mom whisper in my ear: “Every pounding noise you hear is you gearing up to kick the crap out of the cancer.” Course, she never would have said “crap” because she didn’t like cuss words, and would have said “peewaddle” instead, but I added “crap” for a little color. I had lots of time to think about her and her courage while I was in there, and it worked. Before I knew it, Mona came to get me off that crazy thing.

Wednesday’s MRI was on my knee, which has been barking at me for months and doesn’t always go along with my big ideas. Tennis, working out at the gym, swimming, and climbing stairs seem to be more than this old knee wants to do, and after stretching, foam-rolling, icing, and self-medicating with cold beer, it was time to face the fact that it wasn’t getting any better. My orthopedist says that some knees need to be scoped every 8 to 10 years, and my scope was 7 years ago, so there ya go. I guess 7 years of lunging, squatting, jumping, running, and springing have taken a toll. As per my usual, I refuse to go quietly into the night, and plan to do whatever it takes to get some more use out of these joints.

Conventional wisdom suggests two scenarios to fix my problem: do a PRP injection and see how far that gets me, or do another scope along with the PRP. The PRP alone is the much simpler course, and I’m all for quick recovery and little downtime, but in my heart of hearts I know I need the scope, too, and I learned long ago in my cancer “journey” to always go with my gut.

The PRP represents some pretty cool cutting-edge medical thinking in an emerging field called Orthobiologics, and all the cool pro athletes are doing it so why not me, too? Troy Palamalu and Hines Ward both did it, as did Tiger Woods — repeatedly, and perhaps to correct some of the damage his jilted wife did to him with a golf club. Kobe Bryant got some, and Alex Rodriguez traveled to Germany to get his PRP. He thinks he’s so special.

Here’s how it works: under the beautiful twilight haze of propofol, 30 ml of blood is collected and spun in a centrifuge to separate the plasma from the whole blood. The plasma, which is very concentrated and full of healing goodness, is then injected into the injury site and the magic begins. Because PRP is autologous, it’s a good choice for me: my body is quite the xenophobe and reacts quite strongly to anything foreign like tissue expanders or a port.

I was all geared up for the idea of the scope and the PRP when my awesome orthopedic surgeon called to say there was something unexpected on the MRI. Surprise! A complication! My kneecap is misaligned and has slid to the outside instead of staying in the center groove at the end of the thigh bone as the knee bends. Fantastic. There goes my tennis season. Me and my stupid patellar maltracking. The fix? A lateral release, which is done during the scope and involves cutting the lateral retinaculum, which is the tissue attached to the outside of the kneecap.

If it were just the scope and the PRP, no big deal. A bit of a slow recovery for a go-getter like me, but very manageable. The lateral release doubles the recovery time, and involves a lot of pain and swelling. Sigh. Big sigh. Never a dull moment, indeed.