Crutch & Brace Fashion

Its hard to feel cute when you have a huge black mass of metal and velcro attached to your leg 24/7!

It's also really hard to find things to wear that can accommodate the brace without being too tight or too short. Luckily, perfect timing, tights or leggings are in fashion now. Since my incisions have healed some and the swelling is kept to a minimum, I don't have to keep it wrapped with an ACE wrap all of the time!

I bought a couple of pairs of leggings to wear. The black are my favorite because they help my brace blend in.

and the crutches...I guess I'll have to deal with those for a couple of more weeks!

3 Weeks Post-op

• It has been a tough few weeks, but I'm starting to see slow progress. I have now had two PT appointments and I am meeting my ROM goals with ease--thanks to the CPM. The hardest part are SLR's (straight leg raises). I get extreme pain around my patella and makes it almost impossible to continue.
  
  
  On July 8th, I had my second post-op appointment with Dr. Bothwell. He was very happy with the x-rays and my progress so far. He is different than most physicians. He sits down to talk; never in a hurry (at least he never leads on to that fact). His bedside manner is superior to most and I really appreciate that.
  
  
  
  It is so different being on this side of healthcare. I feel like I have gained a lot of insight that will make me a better practioner.
  
  
  
  So here are pictures from my most recent visit.
  Again, we changed the steri-strips--it looks pretty good!
  
  
  
  

Matt-my personal nurse and most importantly, the Best Husband, accompanies me to my appointments and asks all the questions that I don't want to!








Matt's knee wanted some attention too!

My ROM is at 90 degrees; which is my maximum for the first 4 weeks so that the meniscus bone plug has time to adhere.

I can't wait to be able to "swim"--okay, maybe not swim but do pool walking
When I asked Dr. Bothwell if I could get into the pool soon he said, "No." Then said, "Let me rephrase that. Hell No!" Of course I further questioned him and he told me about a recent infection in a patient of his after 12 weeks after surgery. Because my bone was drilled and I now have cadaver parts and screws; I have an increased risk for infection and neither of us would want to risk it.

We also talked about our upcoming move to California. Dr. Bothwell has an orthopedic physician friend in LA that he will refer me to for my follow-up appointments out there. It will be an hour or so drive to see him, but should only be once a month. But, until the middle of August, I will continue to see Dr. Bothwell every 2-3 weeks.

We ordered the Rebound Crutches, so I am looking forward to getting those. It is way too hot in Texas in July to crutch around very much. I immediately break out in a big sweat! Thank goodness I have a wheelchair to sit in class and wonderful friends to push me around campus.
Only 3 more weeks of NWB!

First Post-op Appointment

Today was my first follow-up appointment. My entire leg has been wrapped up like a mummy since Tuesday, so I was really excited about getting all of that off and seeing my incisions!

I knew in advance that my OS would not be there. Instead, Dr. Bothwell's physician assistant, Bonnie saw me. I really like Bonnie. She has been the one who I talked to about all the coordination. She is readily available and knowledgeable--and she has great suture skills!

So, when they got it unwrapped, this is what we saw.

***weak stomachs---do not proceed!***

So, doesn't look too bad, right?

I have 3 incisions:
the largest one is anterior-4 inches long

below that and medial is a 3 inch incision

the 3rd incision is lateral, also about 3 inches


They took off all my steri-strips and replaced them with pretty clean white ones, then wrapped me up again and put my brace back on.

Bonnie was impressed that I went to class this morning. We talked about starting Physical Therapy (PT) this week.

Her goals for me were simple:
Non-weight bearing (NWB) for 5 more weeks

Elevate and ice as much as possible for a least the next week

60 degrees ROM on CPM

Start PT

Are you getting all the abbreviations?

I still must keep my incisions clean and dry but can take a shower sitting down without my brace on. We have found that using press and seal or plastic wrap keep it nice and dry. The part I hate most is sleeping with the big brace. It is heavy and cumbersome--not comfortable, nor romantic!

Next appointment, Wednesday, July 8th with Dr. Bothwell.

Study Time

I just had a BIG surgery!
I've heard that people lay around for a couple of weeks after this but no, not me!
It's not that I wouldn't like to catch up on TV shows and watch movies all day or read a great book; NOPE I get to listen to the lecture that I missed on Thursday while I was still in the hospital!

I was tired of taking up the entire couch so I made a nice nest on the floor in the living room. I am pretty comfortable there with everything within reach.


I hope to be in class Monday morning. Luckily, it's just a half day since I have my first follow-up appointment.

Matt is working the weekend, but Mom and the pups are near by if I need anything!

A big THANK YOU to my friend Eva Marie who brought a wonderful homemade lasagna and fruit salad for us to enjoy a nice dinner!

I think Rigor Mortis is setting in!

I have dead people in me...it's true. I certainly don't mean any disrespect, on the contrary, I have complete respect and admiration for organ donors.

There is a side to donation that gets less publicity; that is tissue donation.

Can an organ donor also be a tissue donor?
Yes. In fact, tissue donation is a more common option for people wishing to be donors, as there are fewer medical reasons a person would be denied the opportunity. As many as 50 people can benefit from ONE tissue donor.

I am happy to say that I am the recipient of selfless gifts given by two families.

During my surgery on Tuesday, I received a cadaver Achilles tendon allograft to replace my torn ACL and a lateral meniscus allograft to replace my meniscus that I destroyed years ago.

Now I feel I have a commitment to fulfill; not only to myself and to my family that has taken care of me, but also to respect the gift that has been given to me.

I will never know those families that lost their loved one and gave me their biologic gift. My gratitude goes to all families that have made that decision.

My leg is sore and stiff!

This is my friend, the CPM (continuous passive motion). Since my surgery my knee has be locked in full extension all of the time, except when I do my CPM. The goal is 8 hours a day, but realistically I may not always reach that time goal. For now, my goal is 40 degrees of flexion; until I see my OS (orthopedic surgeon) on Monday.

I'm taking my pain meds, Ibuprofen, antibiotic, and stool softener on a schedule right now. Matt made out this great chart so that we can keep up with it all!

(Wow-I look rough, but still a smile on my face!)

Thank you Sheryl for stopping by. She brought me a great bag with a get well card, treats, magazines and notes from the class I missed on Thursday while I was still in the hospital. I hope to return to class Monday for a half day before my OS appointment.

Home Sweet Home

After spending two nights at Baylor All Saints Hospital, I was discharged at 11 Thursday morning. My pain was finally under control on oral medications and I was ready for my own bed and to see my pups!

I have to admit, for my first overnight hospitalization, it wasn't that bad. I was actually glad I was there because I knew that I wouldn't have been able to control the pain if I was at home (that's a scary feeling!)

In pre-op on Tuesday morning Dr. Bothwell said that he would try to get a nice room for me since I was "one of them" (health care professional courtesy)--and he did! I was on the transplant floor; which was legitimate because I did have an meniscus transplant. It remined of the hospital where Matt and I met, Parker Adventist Hospital in Parker, Colorado. I called it "Prissy Parker" or "Parker Palace".

We were comfortable there and appreciate the good care we received.

There were only a couple of incidences that were unacceptable; like taking an hour to get me in the computer system and get my pain meds to me and another nurse said that she wouldn't refill my morphine PCA because I needed to be on oral medications (yeah, thanks, I'm working on that!) I never thought that I would be a high maintenance patient or be tagged as a "drug seeker" but I'm sure that those nurses thought I was. What happened to, pain is what the patient says it is?" Didn't they learn that in nursing school! I just had my knee cut open, bone drilled with 3 screws, a bone trough made in my tibia and the periosteum of my tibia separated and sewn to my femoral condyle--and I have some dead guys achilles tendon and meniscus in my knee! Don't I deserve a little understanding and compassion?

Well, I ended up receiving over 90 mg of morphine between IV boluses (catch-up) and the PCA. My saving grace was my second night nurse who suggested that I try IV Toradol. The effects weren't immediate, but I slept well the second night and only pushed the PCA a few times. She continued to give me Toradol every 6 hours and I was able to completely stop the morphine! The next morning I was ready to go home!


So here I am, finally resting in my Home Sweet Home!

ug5qcvkzjp

Knee Surgery

ACL RECONSTRUCTION

MENISCUS TRANSPLANT

AUTOLOGOUS CHONDROCYTE IMPLANTATION

Well, I made it. My surgery was yesterday; they started at 8:15 am and finished at 2:30 pm - took a little longer than they expected but Dr. Bothwell assured me that everything looked nice when he finished.

After an hour stay in PACU, I was transferred to the transplant floor. We have a great room/suite with 2 flat panel TV's, a mini frig and a pull out couch for Matt to sleep beside me!


I had some significant pain when I got to my room and it took them an hour to get me into the system and for pharmacy to get my meds! Pain is much better now with Hydrocodone every 4 hours and Morpine PCA. (I thought that I was tougher than I am!)

Sarah and Brad came by Tuesday evening and brought me a goodie basket with lots of fun and thoughtful gifts. Two magazines, a puzzle book, snack foods, a candle, lip gloss and playdough! (which came in very handy later)

At midnight the nurse came in and set up my CPM (continuous passive motion). With my leg cycling up 40 degrees then flat again; I didn't get much sleep.

Mom and Matt have been fabulous nurses and I couldn't make it without them!

Hopefully I will go home tomorrow morning.

Unfortunately, I will miss my first summer II class.

History & Letter to insurance company

It's true. I'm getting old.
I can't believe that I had to dig up information from thirteen years ago regarding my knee history. (FYI-hospitals are only required by law to keep records for 10 years!) Luckily, I was able to obtain all of my records; which I thought was impressive given the time frame and the fact that the hospital has changed ownership/management three times!

In order to plea my case for medical necessity with my insurance company, Carticel (Genzyme or US BioServices) reps helped gather all of my information to present to them as a package. I felt a little overwhelmed at all the information but knew that I could do a better job at explaining my history and current symptoms than all of those pieces of paper. So, I decided to write them a letter of explanation.

Many times patients will write a letter similar to this after their request for precertification (pre-determination of medical necessity) of procedure has been denied. I wrote this letter in hopes of gaining approval the first time.

So, for those you you that are interested in my medical history or those who wish to have a format or help with wording or content for your letter, see below.



=============================================================


Aetna
Medical Review Board
P.O. Box 981106
El Paso, TX 79998-1106



Dear Sir or Madam:

I am writing to provide you a streamlined history of my left knee problems so that I might be of assistance in expediting the review process.

My left knee pain began in July of 1996 after I was a passenger in an MVC. Emergency room x-rays revealed a foreign body. Later that year, after intermittent locking and pain, I was seen by Sandy Bahm, M.D. In April 2007 Dr. Bahm performed an arthroscopy with foreign body removal. At sixteen years of age, not much could slow me down. I continued to be active in sports, running and cheerleading, but in 1998 the pain worsened and prompted me to return to my orthopedic surgeon. At that time Dr. Bahm ordered physical therapy for strengthening and I continued to treat the pain with NSAIDS, rest and ice. After about a month of PT, I had increasing pain with activity; a second arthroscopy was performed with microfracture of my lateral femoral condyle and partial lateral meniscectomy. Post-operatively I was involved in physical therapy but discontinued running and cheerleading per physician’s request. Pain remained at a basal level after that but never returned to a zero.

Again, in 2000, while I was an undergraduate in college, my knee began to grind and lock at times. After a few months of being symptomatic, Victor Ayers, M.D. performed a third arthroscopy. At that time a lateral meniscectomy was performed and “healing” of the lateral femoral condyle was reported to me.

In 2003, I graduated nursing school and began my career as an intensive care nurse. I continued to have intermittent pain that was mostly alleviated with NSAIDS and rest. I have maintained an active lifestyle with low impact activities like cycling and elliptical for cardiovascular health.

In February of this year, after riding a stationary bike at our fitness club, I experienced increased left knee pain. Over the next couple of weeks pain was not alleviated with NSAIDs, ice or rest and worsened with any activity. I saw an orthopedic surgeon (Bruce Prager, M.D.) and had an MRI done. When he suggested surgery, I consulted a personal friend who is a Sports Medicine doctor and he referred me to James Bothwell, M.D. Dr. Bothwell reviewed my MRI and examined my knee in the clinic. On April 9th 2009, Dr. Bothwell performed my fourth arthroscopy (see findings per OP report).

Today, I consider my knee recovered from my most recent arthroscopy but I continue to have significant pain with any physical activity. I am riding a stationary bike and doing strengthening exercises three to four times a week as tolerated. I have pain at times that renders me incapable of concentrating and unable to sleep at night. I continue to take NSAIDS on a regular basis and hydrocodone as needed.

Dr. Bothwell has discussed all of my options with me. He believes that I am a good candidate for surgery and that I will significantly benefit. My healthcare background gives me the ability to completely understand the procedures, benefits and associated risks. I understand that compliance to physician orders and physical therapy regime is pivotal in my recovery and success.

My knee injuries cannot heal on their own and procedures can only be successful if performed concurrently. I have had knee pain for over a decade and I am looking forward to this opportunity for restoration of function and some relief of chronic pain.

Thank you for your time in evaluating my case. Please feel free to contact me with further questions.

Sincerely,

Knee News - Post surgical update

Thank you to everyone for your care and concern after my knee arthroscopy.

Fortunately, it wasn't too bad and I was back on my feet after a few days.

Unfortunately, I got bad news on the results and another surgery is around the corner.

Those are my arthroscopy pictures. To the untrained eye it looks like a circle with white, black and pink inside. Actually, with a little help, I was able to see exactly what they were explaining to me.

So, here it is (diagnoses) :
1. Partial ACL tear

2. Femoral condyle articular cartilage defect 4.5 cm x 4 cm

3. Absent lateral meniscus

The plan is to reconstruct ACL, meniscus transplant and chondrocyte implantation (ACI) on the femoral condyle. These procedures are invasive, expensive and require special medical board review by my insurance company (Aetna) for pre-approval.

I have researched these procedures extensively on-line and have appreciated the few blogs that I have found that provided personal experiences. I hope to post information about my journey that could help guide others seeking knowledge.

In the mean time, I hope not to bore my casual friend and family readers!

Thankful Thursday

Yesterday was a crazy day...it all started at 4 in the morning when we were getting up and ready for my knee surgery. We pressed the snooze once, but then we were quickly jolted out of bed by a huge "Boom-Boom". We weren't sure of what it was, but it rattled our house. I looked out our window and saw a truck with three blown out tires that was stopped in the right lane of traffic, then I saw the 20 foot light post down in the median. Matt immediately called 911 and jumped over our back fence to check out the situation. To make a long story short, the girl was not hurt, lots of emergency personnel arrived and she was taken to jail after a road-side sobriety test.
I AM THANKFUL THAT NO ONE WAS INJURED!



Our house is the one with the dark roof and red brick.

Well, after all that excitement we finally made it to the hospital--just a little late. They checked me in and I got my cute gown on and waited.
BEFORE:

AFTER:

I AM THANKFUL FOR A WONDERFUL STAFF AT BAYLOR ALL-SAINTS, A GREAT CRNA, DRU AND FOR DR. BOTHWELL PERFORMING A SUCCESSFUL SURGERY.

We made it home a little after noon and I received these beautiful Tulips from M&D Miller. THANK YOU!

I was exhausted and felt drunk from all of the medications, so I propped up on the couch with my IceMan on my knee and my pup by my side and snoozed on and off for a few hours while my personal nurses (Matt & Mom) watched a couple of movies.

When I finally woke up my eyes were still a little blurry, but I thought that I saw smoke. I blinked a couple of times but saw it again out of our back window. I asked Matt where the smoke was coming from. He jumped up and looked outside where our deck was on fire! We still don't know what happened but I started barking orders from the couch. Matt grabbed the fire extinguisher and Mom unplugged the electricity to our sprinkler system. It started in my planter box and luckily I noticed it and my personal nurses responded very quickly!

I AM THANKFUL THAT WE GOT IT UNDER CONTROL QUICKLY AND THAT THERE WERE ONLY A FEW BOARDS BURNED.

So, that was our exciting Thursday. I am looking forward to a few laid-back lazy days. I've had enough excitement for now.

Well, here it is---doesn't look that bad right? Just a couple of holes.

I AM THANKFUL FOR ALL OF THE PRAYERS AND LOOK FORWARD TO A SPEEDY RECOVERY!

Do you see what I see?
I have been a nurse for almost 6 years but I probably couldn't tell you much about the above picture except the fact that it is a knee MRI.


The following is the radiology report:

Findings of post arthroscopic surgery linear fibrosis demonstrated in the infrapatellar fat.

There is evidence for post surgical foreshortening of the posterior horn of the lateral meniscus with moderate high-signal throughout the remainder of the posterior horn of the lateral meniscus which might be compatible with recurrent or residual tear.

A small amount of subchondral sclerosis demonstrated along the posterior most aspect of the posterior lateral joint space femoral articular cartilage and chronic sprain without disruption of the lateral collateral ligament and anterior cruciate ligament is demonstrated.

Grade I-II chondromalacia patella is demonstrated.

A small amount of chronic suprapatellar and infrapatellar bursitis is demonstrated.


Well, what does that mean??
Over the past couple of weeks, I have talked with a sports medicine doctor and two orthopedic surgeons who agree that I need knee surgery. (Again)

So, today I was scheduled for a knee arthroscopy on April 9th. The plan is to remove the torn meniscus and evaluate the surface of the joint to determine if a more extensive surgery will be needed. I will have the entire Easter weekend to recover at home. I will be on crutches for a few days, but recovery should be quick. Maybe the Easter Bunny will bring me some extra chocolate!