I’ve had several questions about what happened to me with respect to my recent knee surgery and the subsequent complications. I’m going to borrow liberally from an email I sent to my coworkers and adjust for a broader audience.
I’ve been planning a PowerPoint presentation about the whole ordeal. I don’t expect it to take more than an hour, I’ve got it down to under 400 slides now. If I cut out the candlelight vigil to “Angel” by Sara McLachlan I can shave another 6 minutes or so. I unfortunately have yet to find a venue that will allow for a live demo using a cadaver knee – something about biohazardy blah blah blah.
No, I wouldn’t seriously do that to you. At no point in my life has a PowerPoint presentation led to anything good, unless you count naps. It’s just like how I’ve noticed more than half the time if I’m staring at an Excel spreadsheet something has gone horribly, horribly wrong and I start questioning my career path. I mock not the products but the circumstances. In fact, if you ever have to manage a disaster or personal tragedy, I hope Excel and PowerPoint are there to bring order, clip art, and windings to bear.
I had sustained an injury in December that destroyed much of the articular cartilage in my left knee and caused a crush fracture in my femur for anyone that does not know. I’ve had bad knees for many years so there was already a lot of cumulative damage and the event in December was probably just the straw breaking the camel’s knee. What I remember is finishing a personal best set of barbell squats at 103KG and racking the bar. I took maybe three steps and saw a flash of white. My next recollection is laying on the floor and wondering why I was there as I felt the moment bleed into a wave of shuddering pain. I’ve never been shot, but I can’t imagine being shot in the knee would have felt too much different, other than the police report.
There had been other knee-related incidents before this, including one in October during an intense “wall ball” set that was nearly as painful in the other knee. (I think I just heard many a CrossFitter sigh.) That one only lasted a few minutes and I was fine and walking less than an hour later. I thought this might be another one of those as I sat on a bench for about 15 minutes and recovered. This was different. I went to stand up and immediately the pain was back, and just as bad. I sat for a while longer and eventually limped out of the gym and home to Advil and ice packs.
Within the week I was at the doctor and having my leg poked and prodded. He suspected a bad sprain and sent me home with a prescription for Naproxen and told me to come back in two weeks if it didn’t get better. It got worse. The X-ray didn’t show anything interesting so when Christmas came around I flew home to see my family and just tried to stay off it as much as possible. It was actually kind of nice having an excuse to have people bring me cookies, considering this has for a long time been an important life goal of mine.
An important moment came to be in front of a hot dog stand during my Chicago layover. There was a Hudson News Nearby, but that’s like saying there was a Starbuck’s nearby in a major city – it does nothing to give you any sense of location. I was forced to stop and hold on to a railing when I felt something in my knee shift. My knee wouldn’t straighten out when I took a step. It felt like someone had jammed a screwdriver into the gears. I got that wiggly gross feeling all over that’s usually associated with realizing someone else’s snot is on you. It just wasn’t right.
When I got back, my doctor sent me for an MRI. When I walked in, I saw a machine that was not dissimilar from a CT, something I had been through before. I didn’t think much of it but then I was warned it would be very loud. I thought it was so quaint as the tech handed me hearing protection. Surely this was like “suburban” hot and spicy and five stars would have me asking for Sriracha. I had heard loud before. I had no clue that this machine was a sonic jackhammer. I think it knocked my soul loose.
The results came back later and the extremely technical diagnosis I received was “Wow, your knee is really screwed up”. I was told that the X-ray I previously received would not have shown the tissue damage nor the crush fracture, which is just basically a very bad bone bruise. Imagine stepping on clear ice in the winter and you can hear it crack and it turns white. That white is what my femur looked like in the MRI.
I was supposed to go in for arthroscopic surgery on my knee in February. Due to the bad weather (two weeks of snow is known in Seattle as a “Snowpocalypse”) all surgeries had already been delayed two weeks and I had already been walking around with the aid of a cane and making the injury worse. As if that were not enough, I received a call informing me that the surgery was again delayed because my surgeon would be traveling for a speaking engagement. I walked on it for another couple of weeks. On the day of my surgery an exhaust fan burned out in the OR and it was delayed again and relocated to a different facility. Omens, my friends.
I was told going in that the X-ray and MRI were possibly not showing all the damage so I had only a basic prognosis (see “screwed up” above). Once they got in they found that most of the remaining cartilage had delaminated from the bone. Originally, they had planned on transplanting plugs of bone with cartilage from donor areas to the previously believed to be small tear but they ended up having to remove most of what was left to keep it from further delaminating. It’s somewhat analogous to finding a thread hanging off your sweater and pulling on it only to end up with a very long thread and no sweater shortly after. They cut out a large amount of thread to keep what they could of the sweater. They also drilled holes in my femur to let magic blood and marrow escape and form a new but thinner layer of cartilage. At least that’s the way I remember it after tanking my saving throw against the Narcotic Spell of Purple Opiate Haze +1 and Hospital Gown of Great Unflattery.
One chemically transmundane week later I went in for my follow-up with severe pain and a purple leg. The doctor got very serious after poking around in my calf, or as I would now refer to it, “ow button”. I was rushed off to an emergency sonogram where they discovered a clot (a DVT). The next stop for the party bus was hematology where they started injecting me and feeding me pills to thin my blood. I was sent home with a self-injection kit and multiple huge bottles of pills, only two of which were any fun. I had a special moment that week where I found myself on heavy doses of Oxycodone sticking needles into my stomach. Say what you like but it was a hobby I had never tried before. It was positively Burroughsian.
There may be some of you thinking that this was the end of the story and where I started recovering. Where would the fun be there?
Several days (at least I think it was days, I was clown hammered on Oxy) later I was propped up in my living room and suddenly it felt like I was being attacked by a boa constrictor. I just couldn’t get a full breath and everything went tunnel-vision and dancing spots on me. Thankfully, my dad was in town watching me and thirty minutes later I was in an emergency room with a fog of nondescript humanoid shapes making muffled noises around me and wheeling me through hallways. I started to come to and as things became clearer it was explained that I was on my way to a CT scan and they suspected my clot had possibly broken loose and gone somewhere “bad”.
About an hour after getting to a small room in the emergency area, the doctor came in and was notably somber compared to the reassuring and friendly tone I had experienced on the way to the CT. The diagnosis was flatly delivered, “you have a PE (pulmonary embolism) and two more thromboses in your leg”. This was nearly immediately followed on my part by an “unexpected metabolic response”. There was a very pregnant pause as I waited for Ashton Kutcher and the camera crew to come around the corner. Alas, I was not punk’d.
This was serious. I was made to understand that this was serious. Very serious. You almost just bit it serious. Serious specialists were paged, admission procedures began, I was asked about a living will “just in case”. Seriously.
I spent a couple of days in the hospital. I had never done that before. They kept me awake for two days with blood draws and sonograms every three hours and on my second day they put me in a room with the thermostat set to eighty. I’m guessing the room was vacated by the previous tenant dying of heat exhaustion. Eight hours and – I’m guessing bureaucratically – a presidential order later I was enjoying a substantially less dank seventy degrees. There was talk of keeping me for another three days but upon reaching this exalted level of physical and emotional abuse I was hoping to find someplace better, perhaps a location inhabited by people whose charge it is to care for one’s well-being, a health sanctuary for the infirm. Sadly, I don’t think such a place exists.
Obviously, as you’re reading this, I lucked out and won this round of Pulmonary Plinko. It could have gone many ways but the clot eventually settled in an out of the way, less life-threatening area of my left lung. I went home and continued my pain and prescription buffet, wondering if it was possible to live if you were to have the entire left side of your body removed. Kids, don’t do drugs.
What’s next you ask? Why, dear reader, a bronchial infection briefly thought to possibly be pneumonia of course. It was laughable at the point it arrived, which naturally caused more coughing of course.
At this point in time the pulmonary embolism is gone. It either dissolved or wandered off someplace. I could have lived without the second option in that sentence when the doctor told me. Sometimes when I hear a noise in the house at night I think it might be stalking me. I believe the DVTs in my leg are gone based upon the lack of pain and that my leg is no longer the color of Grape Ape when I stand up. I have an ultrasound in a couple of weeks to verify but confidence is high.
I’m generally not in constant pain anymore, it’s progressed to the point where I usually have to do something to my knee to cause significant pain. I’m currently averaging about four or five medical appointments per week. I’m hoping the anticoagulation checkups might presently become once a week instead of two or three times. Because of the protracted complications I’m behind in my recovery and therapy I still have to keep my leg near straight and elevated as much as possible. I’m allowed to work but it I’m restricted in what I can do. In about two weeks I should be hopefully on a cane instead of crutches. If all goes well and I’m careful I should be walking unassisted in the next couple months.
I had a discouraging moment during a recent PT session where I told the person working on me I hoped to be able to start some light running soon because I’m getting a budding buddha belly even though I’ve been trying to watch what I eat. She got pensive for a moment and a little sheepish. “I would probably plan on next year or at the earliest this fall.” My heart sank. I’m starting to think that 103KG personal best may stand for the rest of my life.
At least it continues to improve slowly. Other than the occasional re-injury and regression almost every day is ever so slightly better than the day before. I’ll never take just walking across the street to the store for granted again, that’s for sure.
The pulmonary embolism also has me thinking nutty thoughts, like maybe I should do what I want with the rest of my life. Crazy talk. Maybe. Being crazy living in Hawaii sounds a lot better than being sane here.
Paging Dr. Brynzo 