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.

 


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.