Post Op Visit

On Monday I had my post-operative visit with Dr. Gill, and he was very pleased with my progress. However, he cautioned me not to get back to vigorous activity too fast, and suggested that I only up the cycling to 30 minutes. He did comment that I could try the elliptical machine. 6-8 weeks looks like the timetable for full recovery, which would be early January. Luckily, my training partners (Dana and Aaron) have been complete slackers too and haven't been working out. In both their defense, they have had a lot to do (Aaron has started a grad program at MIT).

Meanwhile my knee continues to improve. I now experience virtually no discomfort at all when walking around, and have a tiny limp that perhaps only Anne and my dad would notice. The swelling, slowly and inexorably, is decreasing. When I cycle I can see my knee joint actually functioning.

The big question is, of course, what are the long term effects. To start, as Dr. Gill's nurse always says, any meniscectomy can increase the chance of arthritis. That being said, this procedure has positioned my knee to be in the best possible shape to avoid such problems, and Dr. Gill seemed confidant that I would experience no future problems - his actual quote was "you know, this might save you from future arthritis because we've removed the discoid portion." I think in the literature I've been reading, some future problems usually come about when the meniscus is both discoid in shape and overly thick; my meniscus was of the normal thickness.

Most importantly, I can downhill ski this season too. No restrictions after 8 weeks.

I think I've managed to attach some pictures to this post - yes, this is the inside of my knee. In the bottom one, you can see the obvious tear, and in the top set, you can see how he trimmed it back (notice the right angle).

Last comment - The MGH Sports Medicine Nurse Practitoner, Deirdre Fleming, is very pretty. She probably knows this, as every guy in the waiting room while I was there subconsciously against their will stopped reading their outdated magazine and acted like an adolescent. This most likely occurs 3-5 times a day, every day.

Warm Weather

There used to be this thing that happened in October called "Indian Summer" - when it would get warm for one last time before the November cold rain (and occasional snow) set in. With the advent of global warming, this now occurs in November itself, and my goodness its scary. The high temps have been solidly in the 50's, and it may eclipse 60 this week. Let's just say its perfect running weather, and yours truly is on the sidelines. That really stinks. Its worse because all of the recreational joggers are out and so happy with their I-Pods and their expensive clothes blah blah blah.

I rigged up my bicycle on the training stand and rode for about 20-25 minutes while the Pats won in a hard-fought game against Chicago. Since it was warm in the house, I actually produced sweat for the first time in a month. Today I have my post-op appointment with Dr. Gill, and hopefully he will tell me I can resume cardiovascular endurance work on the bicycle (e.g. 60 minutes with resistance) or the elliptical machine. I know the pool is best but unfortunately I'm a runner so I sink even though I can swim competently.

Odds & Ends: Today's thing you take for granted that I can do again: getting out of the driver's seat normally. Additionally, if you wondered who that was escorting Junior Seau to the locker room after he shattered his arm, yes that was Dr. Gill, team doc of the Pats.

Something completely different

This post will talk about something unrelated to my knee - which by the way is getting better still. I can ride a bicycle for 20 minutes or more with no pain. Back to the other story - on Tuesday, something weird happened. At about 8:30 AM, while at work, the left side of my face went numb. Not completely numb, because I could still feel my cheek if I pushed on it, but numb and strange. Seeing how my regular doc is only a 10 minute walk, and that any facial numbness can be a symptom of, well, you know, bad neurologic stuff, I did a walk-in and she performed a number of neurologic tests. They all seemed normal, but she ordered a head CT scan anyway just in case. I would like to point out right now that my regular doc is excellent, very empathetic, and was very supportive of me coming in (additionally, a Penn graduate like me). Well, the numbness went away, but my TMJ joint is still a little sore. I guess the whole thing was from stress, and I was gritting my teeth while I was sleeping - or a migraine symptom, or who knows. If anything had happened seriously, my doc assumed the radiologist would have called her. Quietly, she probably ordered the test for my piece of mind. My pulse rate was 125 in her office while I waiting as I started to build a circumstantial case, that my left arm was also sore, I had had pain in calf muscle underneath where the surgery was (a clot !). I seem to be fine.

I'm sitting with my beloved cousin Dave at my aunt and uncle's house in Westchester County for the holiday. Happy Thanksgiving.

Stairs

Well, as of Friday, I conquered yet another item that we all take for granted, stairs. Going up stairs had always been easy, but coming down them was another story - it just wouldn't bend far enough. Now it will, and I can go down them delicately, but it looks normal. Not so coincidentally, Anne reported at PT yesterday that I had gained almost 20 degrees of range of motion (excellent). She also allowed me to increase to 20 minutes on the bicycle, which is great because not only will it help my range of motion, but 20 minutes may even approach a cardiovascular endeavor.

Mentally however, its been rough, mostly the last 3 days have been in the 60's. Luckily, by next week it will be 42 and I'll feel much better. Anne didn't agree with me (she is from North Carolina).

Freddie Mercury Likes Bicycles

Yesterday I went to PT and had my first post-op visit. Although there hasn't been any loss in range of motion, there haven't been any gains either - which I guess is all right considering I had knee surgery in between the two appointments. Anne thought I was walking better, and she threw me on the exercise bike, which was pretty bizarre. My knee would not allow for going all the way around, so I just rocked back and forth. Finally, I got it to work going backwards, and then lastly forwards. I pedaled for about 5 minutes, which felt strange and not entirely pleasant. All in all, I'm satisfied with the improvement, although its starting to be less and less each day (more incremental than noticeable). However, I'm peeved because Anne gave me Dr. Gill's protocol which contradicted the post-op instructions that Eileen the recovery nurse gave me. Most notably, the protocol said I should take off the outer bandage immediately for icing, while his recovery instructions did not want me to do this. I didn't take off the bandages, and feel that the ice I used didn't really penetrate. This means that there is swelling in my knee that could have been avoided. On the upside, Anne gave me exercises in the 2-6 week recovery period of the protocol to do now - at only 5 days. This means things are doing well.
This week its been very warm, and I hate seeing everyone out jogging around the neighborhood. However, unlike pre-scope, I know that I'm improving slowly and inexorably, and will be back in action by New Year's Day.

A new side effect

Today I went to work, and it wasn't too bad. I brought along an ice pack and iced twice, 10:00 AM and 3:00 PM. My co-workers were sympathetic. On the way home, something very cool happened: for the first time in over a month, I climbed the stairs relatively normally. That was cool. My right leg was not perfect, but at least it was oriented in the right direction.

The side effect is this - I'm not running my guts out, or more accurately not doing virtually any exercise, so I am gaining weight. My mom essentially force fed me all weekend (not that I was complaining), and when I weighed myself, the scale read 149 ! I haven't been over 150 since college when I was sprinting and quite a bit more muscular. Granted, one of my goals this year on the track was to gain weight in muscle mass, but it seems I've arrived at my goal by adding a little flab. Then again, most 5-10 folks would probably love to be only 149 (especially my dad).

Patriots & Pouring Rain = Excellent

Sunday at around 1:00pm, and it looks like its going to be a slogfest at Gillette Stadium between the Patriots and their rival Jets. An absolutely lovely way to spend the afternoon, especially if the Pats rebound from their horrific performance against Indianapolis.

My knee continues to improve. Although my range of motion is very poor, I have absolutely no pain in any direction. I think that the PT will help things along, although Dr. Gill indicated there may be a higher chance of fluid in my knee because it was my lateral meniscus (outer) as opposed to the medial meniscus (inner). I also hope, that by the end of the week, I can stop driving to work and resume using the subway.

In other news, the Boston Globe published their ski preview today, which was depressing. Its a distinct possibility I might not ski this entire season thanks my stupid meniscus tear. It will be much easier to cope with the lack of skiing as opposed to the lack of running, because as awesome as skiing is, the best part is still taking off your ski boots (except for those moments where the snow is perfect).

The Diagnosis

As for the actual condition of my knee, the situation looks good. I said in a previous post that the MRI radiologist had said that I had menisci susceptible to tearing, but as it turned out the condition was called discoid menisci, meaning mine never fully developed and I had extra cartilage. The tear was primarily in this extra portion, so what Dr. Gill did was "saucerize" the meniscus, meaning he trimmed it down so it looked like a normal lateral meniscus, taking most of the torn portion with it. The tear did not extend into the vascular portion, so there was no need for repair. Dr. Gill was very happy, and said he anticipated my "full return to sports." Sounds good to me. My mom chimed in that this might be one time that all of the Tab she drunk while pregnant helped out.

As I am writing this, I am off of the crutches and gingerly walking around. Later today I will take off the dressings, shower & shave. I fully intend to work on Monday, as I have not needed to take a Vicodin in over a day (and not for sleeping last night). I can ride an exercise bicycle on Tuesday at PT for range of motion purposes.

The Details

Sorry for the delay on this post. My mom's wireless card has been malfunctioning, so I couldn't connect to the internet from downstairs where I have been living for the last day and a half. I can now climb stairs, so here we are.

This post will cover the details of Thursday, but not the diagnosis.

I was a little late thanks to the ongoing construction at Charles Circle. I'm totally in favor of the new construction of the T Stop because the Charles stop had the dubious distinction of being the closest to MGH . . . . but not handicapped accessible. I was supposed to arrive at 11:15, but did not check in until 11:35. My mom commented how much "hoo-ha" there was in the Day Surgery Unit, which makes sense as MGH is one of the largest hospitals in the region and does a ton of day surgery. Surprisingly, the specialties are not segregated, even though Orthopedics could probably have their own day surgery suite by themselves (as could abdominal surgery for hernias, appendices, and gall bladders). I was called at 11:45 to change into the surgery clothes (johnny, pants, slipper socks, bathrobe), and returned to the "Penn Station" waiting room. At 12:45 I was called in for good, and my mom went off to the 'caf downstairs to get a salad. I went into pre-op (by the way, the nurse who took me in wins the cutest nurse award, even though I wouldn't see her again) and proceeded to answer about 9,000 questions from various people and signed various consents. I met one of my two anesthesiologists, a lovely woman named Laurie Shapiro. She noted that the other anesthesiologist was named Daniel Goldfarb. You know you're in good hands when the two anesthesiologists are two Jews over the age of 40. We discussed the merits of general anesthesia vs. a spinal (I kind of had a choice), but the fear of the catheter made it a no brainer, and I'm a pretty young healthy guy anyway. She put in the dreaded IV, but did a fantastic job - she used a little fast acting anesthesia first. After reading a Boston magazine while I waited for a bit, the Ortho fellow showed up and explained the procedure while shaving my knee. His name was Dr. Vasquez, and was a native of Worcester, Williams College 1997 and Columbia Med School 2001. When he was done Dr. Goldfarb arrived in my bay and gave me some relaxant that made me feel like I had just drunk 3 martinis, and we were off to the OR (it was 1:40) - Dr. Goldfarb pulling and Dr. Shapiro pushing and directing traffic. We got to the surprisingly small OR room (which is good because Seinfeld says the smaller the better, implying fewer people would want to watch because it was routine), and Dr. Gill was not there. He was still finishing up on another person (that doesn't sound like fun, moving from OR to OR). No matter, I moved myself onto the OR table, said hello to the other people (nurses, Dr. Vasquez again), and Dr. Goldfarb placed an oxygen mask on me while Dr. Shapiro placed some monitoring instruments all over, apologizing that the EKG readers would rip off my Eastern European chest hair, hurting quite a bit, and that he would rip them off himself before I was awake. I was told later that actual surgery began at 2:05.

That's the last thing I remember. My eyes closed (although I don't remember them telling me I was going out), and I don't recall even seeing Dr. Gill. My eyes opened and I was in recovery with a zillion other people, with Dr. Goldfarb and my recovery nurse (Eileen) staring at me. I didn't feel all that great, so Eileen gave me some anti-vomiting meds through the IV. Dr. Goldfarb, seeing that I was awake, moved on to his next patient who was in pre-op. This would beg the question - is the actual surgery time the most relaxing for the anesthesiologists, because they don't have to run around ?

The anti-vomiting drugs worked, and I rapidly improved. My parents were astonished about how good I looked when they stopped by, especially my step-dad (Les). My two stepbrothers had just undergone small surgical procedures, and Les said they were like zombies compared to me - alert and able to have a serious conversation. This was a testament to my anesthesiologists who were knew what they were doing. Eileen maneuvered me into a chair for the second stage of recovery, and at that point Dr. Vasquez came in and talked to us. I had some crackers and Shasta ginger ale (Shasta being the only brand ever used at a hospital, but virtually never consumed outside of one), and left at 4:50 with crutches. I was only in recovery for an hour (the conscious part, plus maybe 20 minutes of unconscious), and we had to wait a second for Dr. Gill, who was trying to complete another scope while I was in recovery (!). I had to take a Vicodin to get to sleep that night, as the pain was significant on the side where the scope incisions were.

Schedule of Events

For those out there who are interested in the schedule of today's events, here they are. There is nothing else more to say; I am ready for the scope, and am hoping that the vascular portion of my right lateral meniscus is not torn.

Mom shows up at the office: 11:00
Arrive at MGH Same Day Surgery: 11:15
Move into pre-op: ~12:15
Scope starts: ~1:15
Scope finishes: ~2:30
My first vomiting episode because the anesthesiologist messed up: 3:00
The second episode: 3:45
Leave the hospital: 5:00
4x400 relay: 5:15 (women before men)

That is all. Feel free to call my parents' cellular phones if you have any questions.

Calm Before the Storm

Today is Wednesday, the last day before the scope (thankfully). I can't wait to get this over with, to begin the process of rehabilitation and recovery. Even if my vascular portion requires repair, I'll just wait longer until its healed up. I have confidence in Dr. Gill's abilities as well as his staff.

Speaking of his staff, I had a better PT experience yesterday. The radio was blaring louder, the receptionist was nicer, the stupid trauma ward curtains were pulled back, and Anne wasn't wearing her lame-brain way too serious lab coat. I even made her laugh twice, especially when I mentioned the blog. She said that no matter what procedure is done, I'll be like a "new person" at our next appointment next Tuesday. Her exercises seem to be working, as my knee shrunk by 2-3 centimeters (swelling down) and my range of motion increased by 10-15 degrees. This is good because today I had no qualms parking in the $9.00 lot, even though there is a two block walk to the office.

The Democratic party surprised me by doing very well. Now comes the tough part (are you listening Deval Patrick ?), now they have to actually govern.

Countdown at Cape Canaveral

Its Tuesday morning and there are a few days left until my scope. MGH has not called yet and told me what time they want me to arrive . . . I think I'm either the AM or the PM shift (hopefully, they don't cram in a midday shift too). I've never been so excited for something that will be so unpleasant.

In other news, the parking lot that I have been parking at spontaneously raised their daily rate to $12.00. I am going to start parking at the $9.00 lot that is further away. There didn't seem to be any rational for the increase; its not as if new property taxes were assessed yesterday. Truth be told, I'm hopeful that if the knee doesn't require repair I can start taking the subway again, because I greatly miss the subway despite the pleasure of getting to work really fast in my car. My car, with its 120,000 miles, did not sign up for this type of labor.

Additionally, today is Election Day. I am a far left liberal politically, and I hope that the Democrats do as well as they can. I did vote for one independent in the local election (Rosemary Macero for Governor's Council), and two members of the Green-Rainbow Party. I can't wait until January when the Congress changes over and Dennis Hastert has to give is position to Nancy Pelosi - a woman (oh no!) !

Stay the course

As I speculated in the previous post, I'm going to stay put with my scheduled scope procedure next Thursday. It seems like egos started to get punctured, and somehow Dr. Gill in Boston has decided that he will in fact repair the vascular portion of my cartilage if it needs repairing. Dr. Rodeo, the surgeon in New York who recommended Dr. Gill in the first place, assures me that the Patriots man is perfectly capable of doing the procedure. I guess there was a misunderstanding; Dr. Gill wasn't aware that we wanted to take the most aggressive approach. Perhaps the two docs had a conversation I didn't know about (entirely possible), or my dad gave him the guilt trip; who knows. End result - we're in countdown phase to Thursday. My poor father, who has been making all of the phone calls and emails and is a wreck, escaped to The Hamptons for the weekend. I'm focused on the surgery. Let's get it done.

Additionally, the knee itself is getting a little better. I have better range of motion (I can put on socks without pain for the first time in two weeks), and the swelling is down a bit. I'm not sure if this is due to a renewed vigor with the ice pack, or just the natural course of healing. I'm also doing the non weight bearing exercises that Anne recommended; they may be helping too.

Gimme some . . . . PT !

1) Concerning the previous post, things may be swinging in the opposite direction. I can't say what the outcome is yet, because I don't know. However, it is more likely now that I will have the surgery in Boston as planned in less than a week. I'll update you folks (the readers) when I get more info.

Yesterday I went to PT for the first time at MGH. MGH PT is serious business, I mean this place is the Ritz-Carlton of PT. You could eat dinner off the floors, very similar to my Mom's house. There are so many machines you could try a different one every day and not use the same one for a month. My therapist, Anne Viser, has to wear a lab coat. She also passes what seems to be the primary requirement for physical therapists, being really pretty. Now my cousin Mike Berne would ask which type of hotness we are dealing with here, and Anne definitely fits into Mike's primary gift to the world, his invention of the term "intellectual hotness." This means the initial reaction is not the same as one would have if they had dinner with a supermodel, but the sum of a quiet personality, looks, and an unknown secret potential combine for a serious candidate. Jill Hennessey of Law & Order fame was the pioneer of this description. Anne will read this and conclude I'm either wildly immature, or a 27 year old sociopath.

However, despite Anne and her attentiveness, MGH PT so far lacks a very important issue: fun. If I'm going to PT once or twice a week for many months, I want to look forward to it. This should not feel like I'm going to the doctor. The waiting area was no different than my dentist except with fewer magazines, and the exam area looked like an ER. If this persists, I'm switching to BU. At least people there smile and occasionally laugh.

It's the end of the world as we know it, and I feel fine

Well readers, if there are any out there, there has been a dramatic shift in treatment, surgery date, and surgeon. Yesterday, the New York opinion, Dr. Scott Rodeo , questioned the rush to meniscectomy by my original surgeon, Dr. Thomas Gill. I have a radial tear in my lateral meniscus, which starts in the avascular portion and MAY enter the vascular portion. The vascular portion is the part with blood flow, the part that will regenerate with a little help. Research has shown beyond a reasonable doubt that you always want to repair knees and keep as much cartilage as possible. If the tear is all the way through, and I proceed with the meniscectomy, I'll be left with two independent pieces of cartilage. This will not be as structurally sound as one piece, and it won't be a big deal immediately afterward but within 5-10 years I may not be able to continue at a high level in track and field if my gait is quietly affected. This is not an option. Dr. Rodeo has experience in repairing this type of tear, even though it is difficult and not very common. Dr. Rodeo's opinion was corroborated by Dr. John Richmond, who agreed that repair of the vascular portion is critical. Both surgeons were confused that Dr. Gill did not want to go forward with repair of the vascular portion if the tear was all the way through. Personally, I'm not sure that we have enough firepower, considering the three of them only work for the Red Sox, Patriots, Celtics, Giants, and the US Swim Team.

Dr. Rodeo has an opening November 22nd, and after a quick conversation with Dr. Gill (who may be guessing that the vascular piece is not torn) I'll be going that route. This means I'll have my procedure at the Hospital for Special Surgery in Manhattan. This also means I wait 10 more mentally excruciating days. However, with Dr. Rodeo at the helm, this means A) if the vascular portion is not torn, I've only wasted 10 days and B) if it is torn, I'll have a surgeon who I have confidence in to repair it. The recovery for repair is much longer, but it worth it if my athletic career is at stake. Dr. Richmond cited a study that only 50% of patients who have complete radial tears can fully function athletically at 10 years with their lateral meniscus in two pieces.

I'm praying for a cancellation so I can do it sooner. This is brutal.

Something To Pass the Time

Yesterday morning my surgeon's nurse called up and after a quick conversation recommended I go to MGH physical therapy (my surgeon is at Mass Gen Hosp as well) before the surgery to work on strengthening. This was a fantastic turn of events; at least I'll be able to do something to improve my healing time as I sit here on my arse waiting for my meniscectomy. Truthfully, its a good idea, because my quad is getting noticeably smaller. My downstairs neighbor is an occupational therapist, and when I showed her my muscle imbalance she was pretty freaked out. I have an appointment for PT on Thursday, and the hopefully one more before surgery.

Unrelated, they just announced the nominees for the Rock and Roll Hall of Fame, and none other than REM was among them. That's a little scary, as REM was the first band that I really followed independent of my parents. I bought the album "Automatic For the People" when I was 13 and memorized virtually every song. My friend Jon and I used to play it over and over at overnight camp back in the day. Anyway, if REM can be a nominee, I'm officially old.