Monday, November 19, 2012

So the time has come for... Surgery #2


I've had time to heal, taken loads of joint supplements, and done countless hours of physical therapy... but things are not getting any better!
When I straightened my leg, it grinds an awful audible sound that reminded me of the rock salt I twist through my salt grinder. People hear it and cringe! Stairs are of course the worst. I'm still only able to walk up and down the stairs one leg at a time... like a toddler! My 2 year-old niece and I do stairs at the same pace, and she'll leave me in the dust when her legs grow another inch or two! The sound is just a constant reminder of the pain when I walk.
I can't explain the feeling of instability and discomfort when I put weight on my leg. I try to do all the things I've been taught by Todd (my physical therapist). I've focused on quad strengthening, range of motion, gait training... I feel like I've given it 100%.
I got a steroid shot last month... which, by the way... hurts worse than a steroid shot in my heal. He poked and drove that needle right up under the patella (kneecap) and then pushed liquid fire into my knee as slow as possible. As the tears welled up in my eyes I kept trying to remind myself how bad it hurt after the accident... trying to put things into perspective. But in that moment... all I could think of was that damn needle!!! And it hurt like hell!!!
Needless to say, after that experience I was hoping that shot was going to fix things... and it didn't. So when Dr. Larsen suggested another surgery as an option, I didn't know what to think! On one hand, I thought this surgery could get me to a better place... and it would be worth going back under the knife for that chance. However, the greater part of me can't let go of the pain and all the hard work it has taken to get to this point... and I don't think I can take a setback. Not physically or emotionally. It's been 9 months of grueling hard work... how can I go through that again?
To make things more questionable, Dr. Larsen informed me that of the 3... Yes, that's 3... procedures he'd like to perform, one of them may not do any good! He wants to do what is called a lateral release. The severe pain and grinding in my knee is caused by the poor alignment of my kneecap. A lateral release is a surgical procedure used to help realign the kneecap. The kneecap moves up and down in a groove on the end of the thigh bone as the knee bends... and Dr. Larsen think that my kneecap is not sitting in that groove! But, x-rays haven't been able to show things clearly enough too see if doing the release will fix anything.
He is assuming that the kneecap is abnormally pulled towards the outside of its groove. When the kneecap does not slide well within the groove, cartilage irritation and pain can result. There are several causes of patellar maltracking (the name given to the kneecap being pulled to the outside), and the most common is tight tissue attached to the outside of the kneecap (the lateral retinaculum).
Lateral release is best for patient with excessive patellar tilt. When the lateral retinaculum is too tight, it can act as a tether to the kneecap. A lateral release is a procedure performed to cut through this tight retinaculum, and allow the kneecap to sit properly within its groove.
Dr. Larsen is being very up front with me, and said that the procedure doesn't always work. He said that he doesn't like suggesting it to his patients, and it's not something he does often. He said that in the past
doctors were performing this procedure too commonly, and some patients didn't find relief. Then there are the side effects... The most common side effect of a lateral release is bleeding into the knee, which can lead to pain and swelling. Then there is infection and scar tissue!
He feels that a scope is necessary, to clean out loose cartilage and smooth the back side of the kneecap. He thinks things are pretty chewed up.
Then the funny thing he said "... and if I'm already in there... and I've got a screwdriver... I might as well take out all the hardware!" But he had a look in his eye, a familiar look. It's the look I get when I've got a can of spray paint and unfinished wood. The look I get when I've got extra cash and a 3-day sale. The look I get when I've got a client with wet hair and I'm holding my insanely sharp scissors. Not that I'm complaining about getting pounds of cold hard metal out of my body... but that look in his eyes was unmistakeable!
I asked him when he would want to do all of this... he said "as soon as possible". Which meant next week! Then the conversation I was dreading. He brought up weight loss.
The past 9 months have been difficult, and my fluctuating weight is an indicator of that. I'm in a position I can't control. My weight increases due to lack of activity... and yet my injury limits my activity. At this point weight loss would be solely based on diet. I have never been disciplined with eating, and I've had the luxury of exercise to make up for that. So now... my exercise consists of riding a recumbent bike for 30 minutes with zero resistance. Which burns a whopping 75 calories! I don't know how I will get where I need to be. Dr. Larsen suggesting talking to a Dr. Rassmusen... about medical weight loss. It's just depressing, and I've got to figure something out! One more thing to try and fix... one more thing I don't feel that I have control over.