Scar Tissue, Manipulation, and Screws

I went for my pre-op appointment with my surgeon yesterday. From looking at the MRI he doesn't think that I have a cyclops lesion. I looked at the images myself and I THOUGHT that I saw one. It wasn't really obvious. I had to look at them several times and reference online before I located it. We'll find out who's right when he goes in next week. There has to be something there. Why else would my quad be atrophying?

So I'm scheduled for scar tissue removal, manipulation (this is when they bend the hell out of your leg to loosen up everything) and... screw removal. Apparently, these screws (used to hold the new ACL down in the beginning) don't dissolve as well as they are supposed to. Mine seems to be working it's way out of the bone. Fun. My surgeon says that in the best case scenario, they are able to just use a screwdriver and back the thing out. This idea has me more creeped out than the manipulation. I was tempted to just tell him to leave it in but I remembered a woman who had several screws put in after a knee surgery. Her body was rejecting the screws and she was having a lot of difficulty getting the strength back in her leg. He's going in anyway, might as well get the darn screw.

I've been cleared to start physical therapy the day after surgery. However, my doctor warned me about pushing to hard after surgery. Part of the reason I am going to PT is because if left to my own devices that is what I am likely to do. Also, my big fear is not being able to get full motion back in my knee like last time. I am not going in for another surgery so what I get after this one, is what I get.

Well, At Least I Can Swim

It is a little over a week until I go back in for surgery. My knee has calmed down quite a bit now that I'm not doing things that make it unhappy. That means I have had to cut out the leg press and forgo any aggressive stretching until the scar tissue is taken out. Running in any form is out, this includes the elliptical. I can still cycle indoors but the only thing that I seem to be able to do without any restrictions is swimming.



So I have been swimming and swimming and swimming a lot. This is the most that I've done since before my first surgery. I know that I am going to have to take a couple weeks off from swimming after the proceducre. I'm trying to get as much training in now so that maybe I'll bounce back faster once I can get in the pool.



We had a couple of our cats, Strider and Beans, farmed out to be watched by another family while inspections were being done in our apartment complex. It got delayed so they ended up being gone for 5 days. Beans had a great time playing with his friend, Oliver. Oliver was the cat that we had watched a couple weeks ago. However, our other cat, Strider, refused to eat during that time. He holed up in a room by himself for days at the house. The person who was watching them is my husband's coworker. He started calling him Ghandi. The day before we went to pick him up from the house, Strider disappeared. They searched their house. We searched their house. No Strider. We started calling him Houdini. Yesterday he was finally found by Oliver, holed up near the ductwork in the ceiling of the basement. Poor little guy. He was so thin and sad when we finally got there to get him. Now that he is home, he's eating well although he's still a little skittish. I guess we'll be having in-home house sitters from now on.

Get It All

I'm a bit calmer today after resigning myself to the fate of another incision. I now know what to completely expect: the pain, the stiffness, the swelling. This time should be different. This time it should turn out better (or so I am told). What I am finding out this time is that I'm not that afraid of the surgery, it is the rehab that has my stomach in a knot.

I'm returning to the site of my last clinical for my rehab. I stopped over there yesterday because after contacting Dale he told me to rule out a meniscal injury. I really didn't think it was that because I didn't have the symptoms in the right place. Everything that is clicking and grinding is right underneath the kneecap. Right now, scar tissue looks like the culprit. My patella has adhered down and is not moving well. And if your kneecap doesn't move, neither does the rest of the knee.

So I've been told, if the surgeon is going in, make sure he gets EVERYTHING and that I get full flexion and extension with surgery. Remind him several times, if need be. Apparently, my body likes to make scar tissue so removal of the offending stuff is crucial along with early mobility of the knee. Remembering from last time, it is going to kill. However, I am hoping that the pain tolerance I have developed from rehab after my last surgery is going to carry over to this time.

Later on, I got my MRI taken. This time, they made me wear a gown (no safety pins flying out of my pocket this time!) and I didn't get any music to listen to. Just ear plugs. I only had to go in partway because it is my knee that they were looking at. I spent my time trying to figure out all the buttons on the machine. I found the emergency stop buttons. Those were bright red. The whole thing was done in about 30 minutes and I got to leave with a copy of the images. I tried to look at them this morning but I can't see much. It looks like there is some tissue under the kneecap. I found my new ACL. It was near the PCL. The reason I found it is because it doesn't look "normal". It is where the ACL would be but it looks different and there are suture lines in it. Or something like that. As long as it holds, I'm fine with it.

I head back to the doctor in a week. I don't expect him to change his mind on surgery. And unless there is a way to take a chisel to it, I don't expect the scar tissue to disappear on its own.

Under The Knife... Again!

Yep, I'm headed back into surgery. I had a check up with my doctor on Monday and he wasn't happy about the clicking in my knee. Or the fact that my quad is slowly turning back into mush.
Late last week, I had tried jogging again (only made it 5 minutes!) and then did my usual strength routine. Later that evening I was stretching my leg out on the couch and I heard a "pop". No pain, I must have just broken through some scar tissue. In fact, I think my knee gained a little extension after that.

I didn't lift again for a couple days and was back in the gym on Saturday. It was there that I noticed my knee swelling a little more and I couldn't push nearly as hard on the leg press with my left compared to my right. The two used to be nearly equal.

All this I brought up to my doc and it took literally 2 minutes for him to tell me that he wants to do surgery (Again!). Actually part of me was relieved to hear this because I've felt like I've plateaued in my recovery. I'm not happy at all with the state of my knee the way it is. It feels like something is pinching inside there when I bend it. I think that this is the reason why it has been so painful getting back this last bit of motion.

So what is it? Most likely, a piece of free-floating scar tissue or a cyclops lesions. I've heard that cyclops lesions often form if you don't get back your extension right away and scar tissue forms between the two condyles of the femur. With full extension, the ACL sits in that space preventing them from occuring. Apparently, it occurs in about 10-15% of cases. Sometimes being problematic (as in my case).

So what is the cure? Physical therapy is one option although I am so far along that it is unlikely to help. Something is irritating my knee that has to come out. Surgery (or a arthroscopic resection) is the other that I know of.

Granted, we still don't know for sure what is going on with my knee. It could be a number of things but scar tissue is the most likely culprit. Tomorrow I go in for an MRI (have to remember not to request rock music since they want me to sit still) and next week, my doctor will see me and we'll follow through with surgery if this does not magically resolve by then.

I also have a script for physical therapy which I plan on starting the day after surgery.

I Still Can't Squat

When I first got my injury and then subsequent surgery 6 months ago, I pictured things to be a little different by the time that I reached this point. I thought I would have all my motion back and I'd be starting my run progression and other than getting used to the impact again, my knee would not be talking to me quite so much. Wrong!!!

I think that I have been very patient with myself. I've adapted to having a stiff knee. Perhaps a little too well. I realized today that I still can't squat down onto the floor using both knees. I have to kick my left one out behind me and do a sort of lunge or one knee down sort of thing. This is sad. I was in such great shape last summer and I'm not anywhere close to that anymore. (Yes, this is me feeling sorry for myself.)

I really should have gone to physical therapy a couple months ago after I left my last clinical. Since then, my progress has slowed a bit and I think that I have actually lost muscle in my left leg. The motion continues to get better but not as fast as it would if I had more time. This clinical, even though I'm working the same number of hours this week, has been a lot more draining than the last one. I think a lot of it is because I worked through my break this winter and went straight to the site that I am currently at. That and the patients are a lot weaker and sicker. It just zaps the energy right out of me to be there. Then I come home and I'm too tired to work out as hard as I could be. Mind you, I still work out and ride my bike almost daily. It is just by the time I get to mid-week, I'm exhausted and all I want to do is sleep. Or vegetate in front of the TV. I've already gotten sick twice in the past 3 weeks.

I seriously just need a break.

I'm headed to the doctors on Monday: my surgeon for my 6 month check up and a family practice doctor for a script for physical therapy. THe plan is to start physical therapy sessions and try to aggressively get back my strengh and motion. If that doesn't work, I'm planning on getting an MRI to determine if there is something in my knee joint that is blocking the motion. I don't know where I am going to find time to fit all this in since I work 8:30-5:30 five days per week. But I have to make the effort because if I don't have my health, then I don't have anything.

The Plateau

You know you have poor control over your dog when you call and call and then you see her tearing across the neighborhood. In Sparta's case, she was chasing rabbits and there wasn't much I could do except wait for her to get tired, notice that I was calling for her and come back.

Today has been a rough day. I've been concerned about the state of my knee. I've been working so hard trying to stretch and strengthen my knee but none of it seems to be working. I've been thinking that there might be something else wrong with my knee (other than the fact I had surgery). It just feels like there is something inside it that keeps rubbing. It used to be a larger area. It has gotten smaller but hasn't gone away. At my last clinical, there was some joking about my possibly having a cyclops lesion. Now it doesn't seem to be out of the realm of possiblity. A cyclops lesion is an area of scar tissue that forms in the middle of the knee, usually in the intercondylar notch. One of the main signs is a loss of extension (which I have). If I do have something like this, it means that I'll have to have surgery again to remove the offending tissue.

If anything, I've hit a plateau. Since February and now into March I haven't seen much improvement.

So I'm calling in reinforcements. I am already seeing my ortho doc next Monday. I'm also going to my regular doc for a physical therapy script and a referral for an MRI. Between all these things, something has to be figured out. Whether it is more conditioning, some manual therapy, or going under the knife again, who knows?

Poor Joseph

I've been really busy these past couple weeks. So busy that I would have felt guilty if I had spent some of it blogging. Last week we sold our house so Aaron was there for a good part of the week directing the movers: what goes to our apartment, what goes to the storage unit, etc. I stayed here because I am only allowed a couple days this semester for doctors appointments and in case I get sick.

Aaron also attempted to dig up one of the St. Joseph statues we've had buried in the yard since last June. For those of you that don't know, burying one of them in the yard of your home is supposed to help sell your house faster. You bury the statue head-first into the ground, facing the street (some say pointing to the house works as well). Once you sell the place, you are supposed to dig up the statue and put it in a place of honor in the new home. If the statue is left in the ground after the house is sold, the house is supposed to continually change owners.

For extra help, we buried two statues. One of them was placed under the For Sale sign which is now gone so there is no way to locate it. The other was in the flower beds in the back yard. Mind you, this was February in Michigan, so when Aaron went to dig him up, the ground was frozen solid. Aaron was determined though and he spent about 4 hours dig and dumping hot water into the hole to soften the ground. The movers thought he was digging up a dead body. Finally, St. Joseph was ressurrected. In the process, he lost his arms and his workbench. He is now sitting on a shelf in the apartment. After all that work, Aaron decided that he wasn't even going to attempt looking for the other statue.

Another new event is that I had my first run since my surgery. It was time. I had thought about calling my doctor and asking him if I was okay. He'd probably say let's wait in see when you come for your appointment in a week. I felt ready and everything that I have read research-wise states that it is safe for me to begin. I have nearly equal strength in both legs, full range of motion, no swelling. I still have a bit of scar tissue in my knee that makes it a bit stiff at times and that has been my only concern. I found a return to running protocol that lasts 8 weeks and gradually moves you up to 30 minutes of running. You start with 5. I warmed up on the bike and stretched and then got on a treadmill. I was scared. First thing, I don't usually run on treadmills. I will run outdoors unless it is below 0 degrees, the roads are a complete sheet of ice or under more than 8 inches of snow. Even though winters in Michigan are rough, there are usually only a handful of days when I am unwilling to go outside to run. The other reason is the fear that my knee wasn't ready and that it would hurt. I have been told that the first run after an acl reconstruction is the worst. Some people do just fine. Others feel like they'll never be able to run well again. My run was kind of in the middle. Those 5 minutes felt like an eternity. My left leg didn't want to keep up with the right and I kept shifting a lot of my weight over to my good leg. It didn't exactly hurt to run. It felt odd though. Like my bones weren't used to the jarring. It got easier towards the end of the run and everything felt a little smoother. That evening my lower leg ached a little bit. I iced the knee even though it really didn't need it. It didn't swell up and nothing broke. Next run is on Tuesday. Another 5 minutes.