Wow, Lake Tahoe is Amazing from a Bike

On May 31, 2008, I loaded my bike into the back of the truck and drove to Tahoe at 8:00 p.m. to ride in America's Most Beautiful Bike Ride. They close the highway from South Shore to Homewood, so you get to ride about 35 miles, including the amazing Emerald Bay, without concern for cars. I met up with my group at 6:30 a.m. wondering if my knee could take 72 miles, and 4,000 feet of climbing. I had never gone more than 50 miles before, and this was my first real athletic test.

I rode like crazy, and kept pace with some very talented riders. I finished the 72 miles after 4 hours and 3 minutes in the saddle. My knee was a bit sore at the conclusion, but nothing that Advil wouldn't cure. I didn't ice until I got home that night, and my rear was a lot more sore than my knee. I graded my knee as an A+.

I had my 6 month follow up a few weeks prior, and Dr. Stone seemed thrilled with my result. I started walking the golf course, and for the first time in more years that I can remember, I was pain free!!! I used to dread the soreness that I would have at night after walking the course, but that is a thing of the past.

My biggest complaint at this point was having to anwswer the questions regarding my knee scars. As soon as you say meniscus transplant you will be in for 20 questions, so be prepared!!!

My First Sprint

About 12 weeks into my recovery, my daughter ran out into the street in our normally sleepy neighborhood. Instinct kicked in and I sprinted to grab her. While it felt completely awkward, my knee didn't blow up! I was now doing agressive rehab including steps ups and theraband side stepping. My leg still was "skinny" but it was coming along nicely.

I was riding my road bike 3-4 days a week and doing about 125 miles per week. I was pain free, but I continued to ice down after each workout. My BREG machine has been used a ton, and it was worth every penny.

My knee was not swelling much, and it was hard to tell the difference after 4 months. PT became training, and I was fanatical about it. I don't want to do this surgery again, and I was going to do my damnedest not to. At 5 months my focus was on rehab and riding, and I was only weeks away from my 72 mile ride.

Time to Make Some Birdies

One of my first questions to Dr. Stone at my follow up appointment was when can I play golf. I'm a 7 handicap, and I'm fully addicted to golf. Dr. Stone told me to pull my putter out of the bag, and that I could putt in my living room as soon as I could weight bear. At 6 weeks, I was putting and hitting chips in the living room. By 8 weeks, I was taking little half swings in the backyard with my pitching wedge. And, without telling Dr. Stone, I played my first full round on March 15, almost 4 months to the day later. I wore a protective knee brace, and couldn't turn on it at all, but I played. I shot an 81 and placed second in a tourney. I obviously rode in a cart, and walked very little, but I was pain free. My confidence in turning on the knee (it's my back leg) was nonexistent, and I toned my agressive swing down a lot, but I was able to play. It took another two months or so before I forgot about protecting the knee, but I never really looked back.

I saw Dr. Stone at my 4 month follow up, and while I can't say he was thrilled about my early game, my knee was perfect. My knee was smooth as silk, and he gave me the go ahead to play as much as I could. While I was still focused on rehab, it sure felt good to play golf. The next big test was June 1, 2008 and 72 miles around Lake Tahoe.

Setting New Goals

So, after a couple of more weeks the nerve problem was gone for good and I was off and cooking. I was rehabbing 4 days a week, and started seeing exponential improvements. My range of motion was around 120 at week 8, and by week 12 it was only 8 degrees or so less than my good knee (that turned out to be close to what I have a year later). I was training hard on my bike trainer (a road bike hooked up to a wheel in my bedroom) every night for an hour or more. I was getting into great shape and signed up for America's Most Beautiful Bike Ride on June 1, 2008 in Tahoe. It was 3 months out, but it would be a real challenge and my first hard athletic test. From weeks 10 on I started training on my own at my gym. I pretty had direction from Trish at the Stone Clinic and checked in with John at Rocklin PT here and there. Wehn I would have questions, I would email Trish (she would promptly respond!!!). I was pain free, and other than residual swelling, my knee was on the back end of the rehab...I was almost there. No crutches, no brace, and no limp.

A Good Pop!

I was tremedously thrilled to be "walking" and I immediately set up my bike trainer in my bedroom to start logging miles. I had my first couple of rides on the gym exercise bikes because it was easier to get on and off. For a week, I simply spun with little or no resistance going from 15 minutes up to 30. I started to add resistance as my flexation increased, and the ability to fire my leg muscles came back. However, about day three of "walking" I started to get a searing pain radiating down the front of my knee around to the outside of my ankle. As my I began to bend my knee more, the pain got worse and more consistent. I figured it was "one of those recovery pains" and ignored it for a fee more days. About week middle of week 6, I ditched the crutches entirely. I kept my brace on when walking until exactly 6 weeks. At that point, my knee felt stable enough to walk without out it and I didn't look back.

However, the nerve pain continued, and even got worse. Now every time I bent my knee past 70 degrees the nerve pain would trigger when I straightend the knee out. There were times when the pain was 10 of 10, and I decided I had better email the doc. I emailed Dr. Stone, and he had me come down that day. I didn't mind the drive, I needed relief.

Dr. Stone saw me and told me it was a suture that was rubbing on the nerve. He told me we could go in for a short procedure in the OR to remove the suture (you need a sterile environment), or that the suture would dissolve. I wasn't in a hurry to get back into the ER, so I told him I would just wait until it dissovled. I went next door for an appointment with Trish. It would be the hardest PT appointment of the entire recovery.

The plan was to break through the scar tissue that was rubbing the nerve. The operative words are "break" and "through." Trish warmed up the knee, and then began cranking on it. It was all I could do not to cry. I've been through some injuries, played through pain, but this was repetitive and severe pain. We spent about a half hour cranking the knee, and it left me literally shaking. I couldn't wait to ice it.

I drove home disappointed, and wondering what I had done to myself opting for this surgery. My knee had hurt before, all the time, but I was used to it and the pain wasn't this severe. After two more days at home, I was sitting on the couch watching TV, and got up to go ride my bike on the trainer. As I got up the nerve fired, and I was done. I could not deal with this severe pain every time I got up. I decided at that momment, I would call Dr. Stone on Monday, and schedule an appointment for the surgery. I limped upstairs and to go do my rehab and ride. I started my rehab and pulled my ankle back towards my butt to flex the knee (I was well past 90 at this point). Just then there was an audible pop! It was loud, and I thought I must have really done something bad. but there was no pain. I got up, and the nerve didn't fire. I rode the bike hard for 40 minutes and got off (normally the nerve pain would be severe when I got off), and no pain. I didn't have another nerve "episode" again after that day. My knee was still numb, but the excuruciating pain was gone. If I hadn't been dedicated to my rehab (as Dr. Stone requires) I would have had another surgery, and who knows. My rehab would accelerate from this day forward...and the worst of it was over.

Yeah, about this nerve thing.

I was quite excited to start riding my bike (on my trainer indoors at first), and to start walking without the crutches. It was harder than I thought, and my leg had atrophied a lot despite my rehab. The problem was that as soon as I started bending my knee, I started having a searing knee pain that ran down the front of my shin. This pain was a 10 out of 10 and felt like a broken bone. It would happen almost every time I bent my knee, and would last between 5 and 10 seconds. I was devastated. I was barely walking with crutches, my knee was still very swollen, and I had severe pain. I was worse off than before, and wondering what I had done to myself.

I waited a couple of days and it only got worse. I could ride my exercise bike, but as soon as I got off and straightened my knee I had a brief but agonizing pain shoot down my leg. It was so bad that I dreaded bending my knee. I figured out that if I put pressure on the inside on my knee with my hand it didn't happen as bad.

This was bad, and it was the worst pain I had experienced since the first week. I continued to ice, walked with my crutches, and was going to see where this went. I was very concerned.

On Bended Knee

At exactly 4 weeks I traveled back down to SF, this time by myself, to see Dr. Stone for my 4 week follow up. Why exactly 4 weeks? Because I wanted to have my brace unlocked and start walking.

Dr. Stone checked my knee, and it was healing very well. He put my knee through a very gentle series of tests and it moved smoothly for the first time in 8 years. Gone was the grinding and popping that had plagued my knee for so long. I asked Dr. Stone about the numbness below my knee, and he told me it was related to swelling and the sutures holding my new meniscus in place. The numbness was pretty severe, but if that was to be my worst side effect, I could live with hit. However, this issue would get much worse the next day.

I was given the clearance to start walking on the knee with crutches and my brace unlocked. I had another torture session with Trish, and this one was very tough. My knee was already at the 90 degree point, but Trish wanted more. She pushed pretty hard and we started the process of breaking down the inevitable scar tissue in my knee. I was allowed to sit on the exercise bike and pedal without resistance.  I made it all the way around with no resistance and at a snail's pace, but I was riding again!  I was quite happy to have a 10 minute session...I finally felt like I was starting my true rehab. My rehab sessions would be very tough from here for the next few months. I was overjoyed to "walk" out of the Stone Clinic on my crutches with my knee bending (still in the brace).

The ride home was pretty brutal since I had some serious soreness from my PT session with Trish. As soon as I got home I iced and took a pain med. I was allowed to sleep without the brace (which would come off as soon as I felt confident with my gait), but side-sleeping would prove to be quite uncomfortable due to the incision sites on my inner knee. I had a lot of pain when my knees met since it was right on the incision line. I solved this problem by wearing a heavy sleeve the Stone Clinic gave me after my surgery.

Thank God I was out of the brace for sleep!!!  Above is the brace and a picture of the swelling at about 4 weeks.  Note the swelling on the inside of my knee...that's the side where the sewed in the new meniscus.  I kept my compression stocking on most of the time during the first 6 weeks because it kept the swelling down at work.  It looked aweful, but made a big difference in reducing my swelling and pain.

How is your Marlin? (Two Weeks Post-Op)

Two weeks in and my knee is doing a lot better.  I had two pesky portals that didn't heal well, but I decided to remove the steri strips and let them air dry.  They finally closed entirely, but scared pretty badly.   Bummer.

Gale Sayers blew out his knee when he played for the Bears and he quickly tired of the question, "how is your knee?"  So I believe it was Brian Picalo who would ask him, "how is your marlin?"  It was a way for him to make light of the situation with his friend, and I understand why he would need that. 

I rehabbed on my own 4 days we week at my gym in addition to the three with John.  The first two weeks were strictly core, range of motion, and leg lift stuff.  My gym has a specific area under the stairs with mats for ab workouts, and that would be my base camp. The only problem was its right in the middle of the gym's high traffic area.  I must have been asked a million times what happened.  When I would tell them it was a meniscus transplant it led to a 5 minute conversation every time.  I feel a bit compelled to share this story (in part the reason for this blog), so I would go through the million questions over and over.  I wear an Ipod, so sometimes I just ignored people, but I did realize the knee injury fraternity was quite large.  

My knee was still really swollen as you can see above.  Two weeks, and I was getting used to being on crutches and the severe pain was gone...for now.

You will pay for this!!!

Christmas fell on a Wednesday, and I felt like I could go back to work the next day. I work in an office at a desk, and I can pretty much make my own schedule, but when I don't work my work doesn't get done so I went in on the 26th. I couldn't drive yet, so I was dropped off at the office exactly one week after my surgery. This was a major miscalculation. I couldn't take meds at work at all, and I couldn't really keep my knee elevated (I had it on a chair, but it was still below my heart), so I was in trouble after only a few hours. I toughed it out for a few more, but I was more than happy to leave early for my therapy appointment with John. I was going down to SF for my 8-day follow up the next day, so I wouldn't be back in until Friday. Even that would be too soon. Due to the nature of this operation, I would recommend staying home for two weeks if possible. I was far more comfortable where I could continuously ice, elevate, and pull the knee out of the brace for range of motion exercises. Sitting at my desk was agonizing and caused swelling and pain.

I went for my 8-day with Dr. Stone. They removed the stitches, and I had another therapy session with Trish. She worked my range of motion pretty hard (okay really freaking hard), and showed me some more core work. It was a far better day than the last time I saw her on Day 3.

We were far more prepared for the trip in the car this time, and I had pillows to keep my knee comfortable in the car. We stopped to see friends on the way home, and we had our first dinner in a restaurant. The chairs were really uncomfortable and there was no real way to keep my knee on one. The place was packed and when we were seated, the hostess parted the Red Sea to our table practically shouting "here comes the Gimp!" Okay, well she probably didn't do any of that, but it felt like everyone was looking at me anyway. You just get used to it after a while, but its really amazing how a perfect stranger will come up and ask you what happened. It's just weird (more on that later).

I went to work the next day, and tried to get back to a normal routine. I still hadn't drove yet (this was my right knee after-all), but I also figured out that I could unlock the brace in the car for a short time, and that made rides far more comfortable. Due to my therapy schedule and the fact I couldn't fly for about 6 weeks, I had to make a lot of adjustments for work. I was basically part time for the first 5 weeks when you account for the trips to SF, therapy everyday, and times I just had to leave early. I wised I hadn't gone into work so early.

All I Want for Christmas is a Meniscus Transplant

Christmas Eve was pretty funny.  I was moving around my house pretty well, and was getting used to the fact that I was pretty much moving slow for awhile.  We have a two story house, and I decided I would only come down and go up once a day, so I had to make it worth it!  My wife was still filling the Breg Ice Machine all day for me, and I was pretty successful at controlling breakthrough pain with icing.  Thankfully, I had felt nothing like the day 3 pain I had.  Sleeping, however, was very challenging.  I'm a side-sleeper, so sleeping in a full leg knee brace on your back is brutal.  Dr. Stone had prescribed Ambien, and I was still taking pain meds, but falling asleep wasn't easy.  Christmas Eve I took my Ambien and Percocet, and decided to sit with my wife and brother-in- law and put together the kids presents.  However, after about 30 minutes, I fell asleep on the couch, and started speaking in tongues.  Tina and Demetri got quite a kick out of it, so I decided it was time to crutch it upstairs for the night...Santa would have to work without me this year.  

I spent Christmas morning watching the kids tear through presents, icing my knee, and writing down gifts so we could write thank you notes.  I didn't move from the couch for several hours.  I was starting to clear from the fog and taking less pain meds, but I was know fully understanding the term "major knee operation."   The incisions were painless and the soreness was all but gone when I sat still, but moving was still painful.  I made sure I completed my rehab drills for the day, and took a nice hot shower.  Showering was a one-leg balance act, and if you have the space, put a stool in the shower to sit on.  I had more than one scare during the rehab where I slipped on my wife's hair product remnants in the shower.  

We went out to Christmas dinner at friends, and that was a mistake.  Its was the third night in a row going out and I was miserable.  I should have called in sick on this one, but being on pain meds certainly effects your judgment (don't sign any legal documents or drive!!!).   I didn't have my ice machine or a comfortable place to sit.  I ended up stuck in their family room with the little kids watching a movie since I could stretch my leg out on the couch.   I could hear the Stone Clinic's warnings not to overdue it, and I just knew at that moment I just had.  I would make a bigger mistake the next day.