I have left out one thing from The Verdict. In part, that is because I don't know enough about it yet and I don't know if it will be required for my particular situation. Dr. Trice may recommend doing another procedure concurrent with the ACI which is called an osteotomy. There are many different kinds and I don't know which one we are talking about yet.
Basically, an osteotomy is a surgical procedure where the bone is cut, to allow a reshaping or a realignment.
This second procedure is essential if my knee alignment is not straight, because ACI is not effective in poorly aligned knees without fixing the alignment. If it is necessary, my recovery may be slightly more complicated than already planned. I am not sure it can hurt any more than the ACI alone, so I have to admit I am not that worried about it.
If I need it, I will definitely learn and share more.
Wednesday, January 27, 2010
Monday, January 25, 2010
Less than Two Months to Go
I am in the preparation phase. Perhaps seeing what I am doing will be helpful for others in the same position. Check out the links on the right because Ray's ACI and Osteotomy site has a great checklist. I already have most of those items since the microfracture rehab is like "ACI rehab lite."
Ray also provides a picture of a Bledsoe brace, which I had heard of but never seen. Crazy! I don't know if I will need one of those or not.
Things that need to get done:
- Call the physical therapist I used after the microfracture and get her fax number so Dr. Trice's office can send her the preliminary rehab protocol.
- Begin looking for an in-home physical therapist for the first few weeks.
- Work with my darling hubby for him to request time off work. From what I have read, it is wise to have someone there 24-7 for the first two weeks. He can always go back early if that turns out to be too conservative.
- Make a list of questions for my pre-surgery appointment with Dr. Trice in late February. This will be ongoing.
- Call my short-term disability insurance company to let them know I will be out. This one can wait a little while.
- Get things in a good place at work so as much upfront planning is done as possible and everything is covered.
I also wanted to share the most awesome leg brace pants! In case the link doesn't work in the future, I will describe them so you can look for something similar. They are short lounge pants, also called gauchos, offered by Old Navy. They are knee length, very stretchy, baggy, and so soft. As an added bonus, they are quite inexpensive. I have ordered several pairs in different colors. They are stretchy enough that they are easy to get on and off over a big brace and they allow easy access to get the brace on and off while wearing them. Having clothes that you don't need to fight against really does make a difference.
Ray also provides a picture of a Bledsoe brace, which I had heard of but never seen. Crazy! I don't know if I will need one of those or not.
Things that need to get done:
- Call the physical therapist I used after the microfracture and get her fax number so Dr. Trice's office can send her the preliminary rehab protocol.
- Begin looking for an in-home physical therapist for the first few weeks.
- Work with my darling hubby for him to request time off work. From what I have read, it is wise to have someone there 24-7 for the first two weeks. He can always go back early if that turns out to be too conservative.
- Make a list of questions for my pre-surgery appointment with Dr. Trice in late February. This will be ongoing.
- Call my short-term disability insurance company to let them know I will be out. This one can wait a little while.
- Get things in a good place at work so as much upfront planning is done as possible and everything is covered.
I also wanted to share the most awesome leg brace pants! In case the link doesn't work in the future, I will describe them so you can look for something similar. They are short lounge pants, also called gauchos, offered by Old Navy. They are knee length, very stretchy, baggy, and so soft. As an added bonus, they are quite inexpensive. I have ordered several pairs in different colors. They are stretchy enough that they are easy to get on and off over a big brace and they allow easy access to get the brace on and off while wearing them. Having clothes that you don't need to fight against really does make a difference.
Saturday, January 23, 2010
The Verdict
When I went back to my next appointment with Dr. Trice (January 11th 2010), he was very pleased to hear that the brace had helped. At this point we were at 10 months post-MFX. I knew that Dr. Trice wanted to wait to perform ACI at least one year after MFX to try to maximize the chance of success. 10 months out was enough to start scheduling! In fact, his staff had already submitted my information to my insurance company and they had already received approval for the surgery, so they were ready to schedule me right away. I took the first surgery day available after the one year MFX anniversary, which works out to be March 24th 2010.
I am managing better. That’s kind of the irony as I get closer to my surgery date. With the brace and the Ryzolt (painkiller) I am actually doing better than I have at nearly any point since this all started. However, it still feels like it is slowly getting worse and better is not nearly good enough.
So now I am preparing. One of the more clever ideas I have heard is to have a pre-surgery pedicure, so I have scheduled that. You do tend to spend a lot of time looking at your feet and I won’t be able to reach my right foot! After the microfracture, my right foot itched terribly but I still have plenty of anti-itch Gold Bond lotion. That was a weird side effect. Another act of preparation is obviously to set up this blog and cover how I got here. Now that I have caught you up, I am not sure how much I will have to update it with until I get closer, but there will be plenty later.
I am managing better. That’s kind of the irony as I get closer to my surgery date. With the brace and the Ryzolt (painkiller) I am actually doing better than I have at nearly any point since this all started. However, it still feels like it is slowly getting worse and better is not nearly good enough.
So now I am preparing. One of the more clever ideas I have heard is to have a pre-surgery pedicure, so I have scheduled that. You do tend to spend a lot of time looking at your feet and I won’t be able to reach my right foot! After the microfracture, my right foot itched terribly but I still have plenty of anti-itch Gold Bond lotion. That was a weird side effect. Another act of preparation is obviously to set up this blog and cover how I got here. Now that I have caught you up, I am not sure how much I will have to update it with until I get closer, but there will be plenty later.
Lady in Red
The Don Joy salesman came to my house the week before Thanksgiving. He showed me the different options and recommended the Defiance. It will last me a long time as I can wear it even while recovering from ACI when returning to activities. The others don’t support as much activity. After looking as the pictures of it, I realized that this is not a subtle brace. If I can’t hide it, I may as well flaunt it, so I ordered it in metallic red!
I received the brace about two weeks later. (Picture – GR of 1) I think it normally takes less time, but the holiday was in there. The salesman came back and showed me how to wear it and set me up. He was really helpful. It felt so strange because it pushes in on the right side of my knee to ease up the weight on the damaged left side. At first I was really unsure about it and I had to keep loosening the plate that adjusts the degree of offset. After a few days though, it wasn’t so bad so I very slowly began increasing the offset again and continued to over the next few weeks. Now, I usually don’t even feel it.
This brace has been wonderful. I have been able to actually walk and have even done four full grocery trips now! That is about all I can do and it totally wipes me out, but I did it! It also changed my symptoms from a constant fear of “bad steps” to instead frequently needing to “pop” my knee to release pressure. I prefer the pops.
I received the brace about two weeks later. (Picture – GR of 1) I think it normally takes less time, but the holiday was in there. The salesman came back and showed me how to wear it and set me up. He was really helpful. It felt so strange because it pushes in on the right side of my knee to ease up the weight on the damaged left side. At first I was really unsure about it and I had to keep loosening the plate that adjusts the degree of offset. After a few days though, it wasn’t so bad so I very slowly began increasing the offset again and continued to over the next few weeks. Now, I usually don’t even feel it.
This brace has been wonderful. I have been able to actually walk and have even done four full grocery trips now! That is about all I can do and it totally wipes me out, but I did it! It also changed my symptoms from a constant fear of “bad steps” to instead frequently needing to “pop” my knee to release pressure. I prefer the pops.
Sunday, January 17, 2010
What’s Next?
I left off my story when I had run out of non-surgical options and was forced to consider more specialty procedures, and was specifically looking at ACI. My surgeon, who had performed the MFX, did not perform ACI, so I sought out Dr. Trice.
By the time I got to him, I was in an awful lot of pain. I had been forced to start taking Tramadol again (a non-narcotic prescription painkiller) and it was making me very confused. It seems I always get the “messed-up head” side effect. This was truly a bad time. It didn't take Dr. Trice long to classify me as a failed microfracture.
ACI requires two surgeries and we scheduled the first for September 23rd, 2009. The purpose of this relatively minor first surgery was to see what was going on in my knee and also to perform the cartilage biopsy, so we would have a sample to grow in the lab. Actually trying to fix my knee was not a goal of this surgery. So unfortunately, when it was over and I had healed, I was in as much pain as before. Bad times.
Dr. Trice found that the microfracture had actually been somewhat successful in forming fibrocartilage over the worst of the damaged area. At least I got a little vindication since it showed that I had followed the rehab instructions to a T! However, there was an area of about the same size next to it where the cartilage was soft and squishy and that appeared to be the source of the pain. Here are some pictures which I will give a gross rating of 3. (Picture 1 and Picture 2)
At this point I went to a pain management doctor since things were getting way out of control. He gave me four things to try together: a different pain medication, an anti-inflammatory, a goop that is used externally, and a new short hinged brace. The anti-inflammatory made me really ill, so I was only on that for a few days. It turned out that it was good that I stopped that. Dr. Trice didn't want me on an anti-inflammatory since apparently it can interfere with bone growth. That was definitely a lesson learned.
The other three things improved the situation enough that I could return to work (at least from home) and not be quite so miserable. Having the right tools to manage the pain can make a huge difference, but it isn't the same thing as healing.
At my next appointment with Dr Trice, I was doing better but of course was still experiencing pain. Dr. Trice was beginning to worry whether ACI would even be able to provide sufficient relief to make it worth the recovery. He wanted me to try a custom unloader brace. This specialty brace takes the weight off the damaged side of the knee and redirects the load to the good side. If it provided relief, then we know that the identified defect is the source of the pain and that would be an encouraging sign.
By the time I got to him, I was in an awful lot of pain. I had been forced to start taking Tramadol again (a non-narcotic prescription painkiller) and it was making me very confused. It seems I always get the “messed-up head” side effect. This was truly a bad time. It didn't take Dr. Trice long to classify me as a failed microfracture.
ACI requires two surgeries and we scheduled the first for September 23rd, 2009. The purpose of this relatively minor first surgery was to see what was going on in my knee and also to perform the cartilage biopsy, so we would have a sample to grow in the lab. Actually trying to fix my knee was not a goal of this surgery. So unfortunately, when it was over and I had healed, I was in as much pain as before. Bad times.
Dr. Trice found that the microfracture had actually been somewhat successful in forming fibrocartilage over the worst of the damaged area. At least I got a little vindication since it showed that I had followed the rehab instructions to a T! However, there was an area of about the same size next to it where the cartilage was soft and squishy and that appeared to be the source of the pain. Here are some pictures which I will give a gross rating of 3. (Picture 1 and Picture 2)
At this point I went to a pain management doctor since things were getting way out of control. He gave me four things to try together: a different pain medication, an anti-inflammatory, a goop that is used externally, and a new short hinged brace. The anti-inflammatory made me really ill, so I was only on that for a few days. It turned out that it was good that I stopped that. Dr. Trice didn't want me on an anti-inflammatory since apparently it can interfere with bone growth. That was definitely a lesson learned.
The other three things improved the situation enough that I could return to work (at least from home) and not be quite so miserable. Having the right tools to manage the pain can make a huge difference, but it isn't the same thing as healing.
At my next appointment with Dr Trice, I was doing better but of course was still experiencing pain. Dr. Trice was beginning to worry whether ACI would even be able to provide sufficient relief to make it worth the recovery. He wanted me to try a custom unloader brace. This specialty brace takes the weight off the damaged side of the knee and redirects the load to the good side. If it provided relief, then we know that the identified defect is the source of the pain and that would be an encouraging sign.
Thursday, January 14, 2010
Begin at the beginning
So where did this all start?
One day I was sitting in my office and when I stood up, my knee hurt. I thought it was strange, but after stretching it still hurt, so I just called my coworker instead of walking to his office. It was just kind of an ache. The next day, it was much much worse and I could barely walk. I figured I had twisted it or something so I stayed home and kept it elevated and warm all day. That seemed to help, and it was better the next day.
I still noticed a clicking when I walked on the stairs and it was still just a little achy. After two more weeks of that, I went to my family doctor. He gave me an anti-inflammatory ordered an X-ray. Before I had heard the results of the X-ray, I had to leave on a trip across the states to Arizona (I am in Maryland). I was waiting in the airport and got in line when they started boarding, and then realized I had left something at my seat. I lightly jogged back to the seat and back in line. My knee started hurting terribly!
I saw two orthopedic surgeons, and both provided the same diagnosis of Osteochondritis Dissecans (OCD). This is a condition with no known cause where the cartilage basically dies off in a limited area. It can be extremely painful. The recommended surgery was called Microfracture (MFX for short). This surgery is basically drilling into the bone under the defect to force a healing reaction. Scar tissue is formed which hardens into fibrocartilage, covering the damaged area. My surgery date was set for 3/20/09 and I could hardly wait as the pain grew worse every day.
The MFX itself was easy. It was over in 30 minutes. I woke up and the nurses asked about my pain level. Compared to before, it was nothing! No big deal. Here are the pictures from the surgery. I will give them a gross rating of 3. Picture 1 and Picture 2.
With MFX, the recovery is the important part. I was non-weight bearing (NWB) for 6 weeks with my leg in a straight locked brace whenever I was moving around. This was to prevent scraping off any of the scar tissue as it was forming. The scar tissue was the whole point! Also, during the first three weeks I used a Continuous Passive Motion (CPM) machine for four hours a day. This machine bends your knee over and over again very slowly and to an adjustable angle. The point of the CPM is to make sure the scar tissue forms in a shape that will allow continued use of the knee. One big blob of scar tissue that locks your knee would not be very useful. I also began physical therapy to regain range of motion and strength.
Things started to get better for a little while, but after about two months it all went downhill again. The pain was getting worse and the clicking or catching was returning. I tried Supartz, which is like WD-40 for your knee. I only had one injection as I had a bad reaction to it. The pain doubled, which is not normal. That was my last non-surgical option. However, the surgeon I was seeing did not perform ACI, so this is when I went to Dr. Trice.
I will pick up here in another post.
One day I was sitting in my office and when I stood up, my knee hurt. I thought it was strange, but after stretching it still hurt, so I just called my coworker instead of walking to his office. It was just kind of an ache. The next day, it was much much worse and I could barely walk. I figured I had twisted it or something so I stayed home and kept it elevated and warm all day. That seemed to help, and it was better the next day.
I still noticed a clicking when I walked on the stairs and it was still just a little achy. After two more weeks of that, I went to my family doctor. He gave me an anti-inflammatory ordered an X-ray. Before I had heard the results of the X-ray, I had to leave on a trip across the states to Arizona (I am in Maryland). I was waiting in the airport and got in line when they started boarding, and then realized I had left something at my seat. I lightly jogged back to the seat and back in line. My knee started hurting terribly!
I saw two orthopedic surgeons, and both provided the same diagnosis of Osteochondritis Dissecans (OCD). This is a condition with no known cause where the cartilage basically dies off in a limited area. It can be extremely painful. The recommended surgery was called Microfracture (MFX for short). This surgery is basically drilling into the bone under the defect to force a healing reaction. Scar tissue is formed which hardens into fibrocartilage, covering the damaged area. My surgery date was set for 3/20/09 and I could hardly wait as the pain grew worse every day.
The MFX itself was easy. It was over in 30 minutes. I woke up and the nurses asked about my pain level. Compared to before, it was nothing! No big deal. Here are the pictures from the surgery. I will give them a gross rating of 3. Picture 1 and Picture 2.
With MFX, the recovery is the important part. I was non-weight bearing (NWB) for 6 weeks with my leg in a straight locked brace whenever I was moving around. This was to prevent scraping off any of the scar tissue as it was forming. The scar tissue was the whole point! Also, during the first three weeks I used a Continuous Passive Motion (CPM) machine for four hours a day. This machine bends your knee over and over again very slowly and to an adjustable angle. The point of the CPM is to make sure the scar tissue forms in a shape that will allow continued use of the knee. One big blob of scar tissue that locks your knee would not be very useful. I also began physical therapy to regain range of motion and strength.
Things started to get better for a little while, but after about two months it all went downhill again. The pain was getting worse and the clicking or catching was returning. I tried Supartz, which is like WD-40 for your knee. I only had one injection as I had a bad reaction to it. The pain doubled, which is not normal. That was my last non-surgical option. However, the surgeon I was seeing did not perform ACI, so this is when I went to Dr. Trice.
I will pick up here in another post.
Here we go...
On March 24th I am scheduled to have a type of knee surgery called autologous chondrocyte implantation (ACI). The surgery itself is pretty easy to understand and sounds very sci fi. Basically, some cartilage cells were harvested from my knee last September and, now that the second surgery has been scheduled, they will be grown in a lab to be a larger amount of my own cartilage. The company that does this is called Carticel and they explain the details of the surgery and the recovery process on their website.
This blog isn't to educate about what ACI is all about. That information is out there. However, the experience of the surgery and the recovery is significant and not undertaken lightly. I have read and appreciated the blogs and diaries written by others who have experienced ACI (and I linked a few). So, one purpose of this blog is to add to those available resources for others who will eventually be in a similar position to where I am now. If you are one of those people reading this, then good luck!
The other purpose of this blog is to let people in my life know how I am doing. I know there are many people in my life who care deeply and would enjoy the ability to sort of be there with me as I go through this. If you are one of this group then I thank you and hope that you leave a comment, especially when things get rough. The encouragement really does help!
I have a lot to cover before I even get to S-day, including how I got here and what I am doing to prepare. There will be lots of pictures, but I know a lot of people are squeamish about these things so I promise they will all be behind a link with warnings on their gross-out factor. I think this is enough for right now. I am optimistic about the outcome and glad you can join me on this journey. Now here we go.
This blog isn't to educate about what ACI is all about. That information is out there. However, the experience of the surgery and the recovery is significant and not undertaken lightly. I have read and appreciated the blogs and diaries written by others who have experienced ACI (and I linked a few). So, one purpose of this blog is to add to those available resources for others who will eventually be in a similar position to where I am now. If you are one of those people reading this, then good luck!
The other purpose of this blog is to let people in my life know how I am doing. I know there are many people in my life who care deeply and would enjoy the ability to sort of be there with me as I go through this. If you are one of this group then I thank you and hope that you leave a comment, especially when things get rough. The encouragement really does help!
I have a lot to cover before I even get to S-day, including how I got here and what I am doing to prepare. There will be lots of pictures, but I know a lot of people are squeamish about these things so I promise they will all be behind a link with warnings on their gross-out factor. I think this is enough for right now. I am optimistic about the outcome and glad you can join me on this journey. Now here we go.
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