Disrobing the knee

So it's been 3 days since my surgery. I guess the whole procedure was pretty routine for my doctor, as nothing special was prescribed. As I suspected, I was overly nervous of the whole general anesthesia thing. My Anesthesiologist was really nice, very smart, and presented an amount of confidence that made me comfortable with what was going on. At last it was time for me to walk myself into the OR. The staff were nice enough to supply me with a blanket, so as not to moon everyone behind me through the opening in my gown, and they carried my IV's as well. As I walked into the OR, I saw the table there before me, long and cold looking, with the arm holders that could only remind me of images I've seen of tables presented to subjects about ready to be administered a lethal injection. It's all I could think of. I voluntarily climbed up and laid down on the table, doing my best to place trust in the staff that has treated me so well so far. I was pleasantly greeted to a warm posterior, to which I blurted out loud, "Hey, this ride has butt warmers!" That got a good laugh out of all in the room. The doctor and anesthesiologist hadn't arrived yet. Seconds later, my sleepy time doc walked in, and talked about all the good things he had in his medicine cabinet for me. That's the last thing I remember.

What seemed like a millisecond later, I was coming to in the PACU (Post Anesthesia Care Unit). I was given Saltines and Graham Crackers, and a can of ginger ale (my choice). Finally. I was still quite hungry, from not having eaten anything for 19 hours. Throat dry from drugs, I chewed on the plate of food, only able to swallow after soaking it in the ginger ale. Once I ate it all, I was given a percocet to help with what pain was still remaining. The anesthesiologist had given me a femoral nerve block that was taking care most of my problems. A little pain remained behind my knee and that's it. Over the next to hours a came to enough, read stuff, forgot it, and chatted with my wife and friend, who were there to take me home.

I've been on the CPM (continuous passive motion) machine almost continuously since I've been home and awake. It's amazing how it seems to keep the pain at bay. I'm to increase the Range of Motion by 10 degrees everyday, eventually working my way up to 110 degrees. Day 1, 45 degrees. So far so good. I've only taken drugs at night (except for the first day) to help me sleep. Standing up is probably the worst. I can feel the blood rush to the joint after being elevated, the the pressure can feel quite agonizing. It usually quickly subsides and lets me walk around though. I'm to only put 50% weight on my knee for the first 14 days, and I'm quite fine with that.

So after 3 days, I've decided to take of the dressings and inspect the wounds, make sure they are't getting infected or anything. Looks good to me.

It was quite an experience taking off the Ace bandage actually. I could feel blood beginning to flow where it hasn't flown all that well for the past few days, but it was different than standing up. Overall not to bad. 4 major holes. I was expecting 5, based on the pain I had been feeling, but there wasn't one from were the graft was harvested, and where I am feeling the most pain. I guess the doctor went through the incision made below my patella to harvest the tendons from my gracilis and semitendinosus.

Overall though, I think I'm doing well, and can feel improvements day to day. Either that or my tolerance to pain is improving. I'm going to continue the use of the CPM, and the RICE (Rest, Ice, Compression, Elevation) therapy until Thursday, when I have my first PT appointment. Supposedly I can get on my bike on day 21, and ride. Looking forward to that. Until next time...

T minus 4 days

If all goes as planned (I don't get sick between now and Thursday), I'll finally be going in for my anterior cruciate ligament (ACL) reconstruction surgery on my left knee. For the sake of any type of amateur comparative study, below is a picture of my current state. Post surgery images to follow soon. (I apologize for the ugly picture. I've decided there's no way to elegantly present this part my anatomy. For that matter, there's probably no way to present any part of me elegantly.)

As you can see, my right leg, in particular my quadriceps has significantly more muscle tone. It's also a little bit straighter. Since the injury occurred, I've been able to get most of my range of motion back. With a little pressure on my knee, and my heel elevated, it will fully straighten out, once warmed up. For flexion, I can get my foot about a hands width away from my rear before I have tension in my knee. I'm not 100% certain what is causing this, but my guess is that it is probably a combination of loss of flexibility in the muscles around the joint, and possibly scar tissue in my MCL needing to be stretched out. Maybe the crud of what's left of my ACL is getting in the way too, not sure. Regular use of the limb and performing of assigned physical therapy exercises have made good strides in improving my range of motion though. I'll be continuing them up until my surgery.

I'm not sure how much swelling there still is in my knee currently. It does look more swollen, but I'm not sure how much of that is from atrophy. To describe the current condition of my knee, it seems to work well enough. When I sit for a long time it does start to feel "lethargic" or as if the joint is full of molasses. The only pain I have is at the bottom of my patella, where it joins with the patellar tendon, and only to touch. It feels as if it's bruised, but not too bad. I don't have a whole lot of confidence in my knee. I'm comfortable hiking in relatively rough terrain, and on steep slopes. Snowshoeing is fine too, but when it comes to anything that might involve any kind of jarring, or stop and pivot type motion, I am definitely not comfortable. It's probably more perception than reality, but I'd rather play it safe than risk additional injury. I can tell that strength has certainly left my leg, but I've been able to ride my bike trainer for as long as I want to. I usually stop out of boredom, not physical limitation. On a side note, I've started pedaling with one leg to work the individual muscles, and I can last just as long on my injured leg, as I can on my non-injured leg. Where's the power cranks when you need them?

I believe that they will be harvesting the new ligament material from the part of the tendon that connects my hamstring to my tibia. Supposedly use of this site makes for a less painful recovery, though it takes a little longer for the tissue to bond with the bone.

Post operation recovery involves cructches for a week or so. They say I can put 50% of my weight on the knee as soon as I can tolerate it. I have my first PT session one week after surgery. They are also putting me on a continuously passive motion (CPM) machine as well. From the reading I've done, the machine makes no long term difference in a full recovery, but it does tend to help keep pain down, and get your range of motion back faster. I'm supposed to use that for at least 8 hours a day.

So with all that being said, I'll report back next when I'm lucid enough to put some thoughts down after surgery.

Thanks to everyone who has offered me and my family support during this time. It means a lot!

Getting Older...

Well,
It's been a long time since I've posted here. Only excuse I have had is that my life has been pretty mundane for the most part. Yes, I am busy with Alpine, but I have decided to not really post things about many aspects of what I do on the team. Mostly to prevent myself from posting things about missions or this involved with missions. Its to easy to stir up a hornets nest around that kind of stuff, so I have decided to pretty much not talk about it online at all. If you have much interest in what I do on the team, I'd love to talk, but through a 2-way conversation. Not a one way dictation via this blog.

So another turn of events has occurred in my life that I felt was significant enough to actually blog about. It's easier to discuss here, and I believe, a better venue than "microblogs" like facebook. Almost 3 weeks ago now, I got out on the ski slopes for the first time this season. Turns out it will be the last time this season now too. Soon after lunch, after a morning of "getting my legs" back, I had decided to try and push my skills a little and see what kind of fun I could have one some of the slopes. Needless to say I pushed them a little too far and had a pretty significant fall. During the fall, my ski failed to release from my boot, which in turn directed the energy of the twisting and flailing ski into my leg. It would seem that the weakest chain in the link was my ACL and MCL. The fall resulted in a Grade 3 tear of my MCL, and a completely torn ACL.
Here's a couple MRI images of my knee joint. From what I understand of other MRI images of knees I was able to find online, the big mess in between the bones is what is left of ACL. They should be nice defined clear obvious lines, but instead its all "blown to smithereens." I could certainly be wrong though, as I am certainly not a doctor. Either way, I think the pictures are darn sweet. I was able to get a CD of the raw MRI data from my doctor. It came with an app for windows that let's you view it as well. Since I use a mac though, I downloaded an app called OsiriX which loaded the data from the CD perfectly. From there you can export the images as movies, jpegs, etc....

The actually incident was probably pretty unspectacular. There were some people nice enough to watch me fall, and promptly stop after they noticed I didn't get up very quickly. While I was falling, I felt and heard my knee "pop" twice. I imagine that was both ligaments failing under stress. When I came to a stop, I actually thought it was just the knee popping out then back into place. As it was a little sore, but not too bad, and a lot stiff. I decided it probably wasn't wise to try and ski down on it, so I had the bystanders go fetch the ski patrol. They arrived shortly after and assisted me with putting their splint on. Yes, they assisted me, and got a kick out of it I think. I suppose they aren't used to patients knowing how to handle injuries, let alone on themselves. They wanted to take me down on their little ski patrol sled / toboggan thing. I asked if I could just sit in it and ride down, but they insisted on doing the full packaged deal. I'm not one to argue about being cautious one it comes to injury, so I let them. I was placed in the thing, head pointing down hill, and all wrapped up burrito style in the thing. After taking the ride down to medical, I was glad I did get all wrapped up. I would have been covered in snow if not. After a little while of icing and having medical/casual conversation with the staff there, I decided my nerves have calmed down enough that I could drive home. For some reason, I find myself a bit surprised at my attitude. Usually I'm pretty upset when I do stupid things that cause me injury or puts me in a situation where I can't do what I'm used to be doing, but I think I'm pretty accepting of what happened. Maybe it's because I was having fun when it happened. Kind of morbid I suppose, but if I'm going to injure myself, I might as well have fun doing it, right?

After seeing doctors and everything, and learning how to deal with what's going on, I find myself where I am today. I'm not in much pain anymore, only when I try to bend my leg past where its willing to go, or if I put pressure on my knee that causes "stretching" of my MCL. Other than that, I'm doing pretty good. I probably have about 30 degrees of flex on a good day. My nights are long, as I wake up every time I need to move, but I'm managing. The doctor says I really should get full range of motion back in my knee before surgery, in order to have the best outcome, post-op. So I'm signed up for Physical Therapy. That will start soon.

Surprisingly, the injury has not disqualified me from "PQing"(Physically Qualifying) at work for a trip down to McMurdo base (Antarctica). So I'm still going to McMurdo too. I'll be deployed from January 1st through the 15th. That should be interesting with this knee too. Oh well. I'm scheduled for surgery around the beginning of February. I'm hoping I can move it to a little more towards the end of January just to get it done with, and onto the post-op rehab process.

I'll be sure to post more updates about this journey as I find out more. But that's where I am right now.

Something to Read

Okay,
So some people have been complaining to me lately about the fact that I haven't updated my blog in some time. Little more than 3 months to be exact I suppose. So here's a post. Stop complaining.

Since I don't really have anything to talk about, I guess I'll just write about what has happened Since February. The short if it is, not a whole lot. People outside of our nuclear family (including extended family and friends) have been living with us up until a few weeks ago. It was both stressful and fun at the same time.

I have completed all my 'PM' (Prospective Member) Training with the Alpine Rescue Team and have moved on to 'PM' status. Yes, its the same... just stands for "Probationary Member" now. Basically that means I have to go to 50% of all trainings and make 25% of all calls (they refer to them as missions) between now and October when I get officially voted in, or kicked out.

Work is Work. 'nuff said.

Yesterday we took a hike where I did my overnight Bivy for the Alpine Team. I saw a waterfall in the distance so I figured it would be a fun easy hike for the family. Enjoy the pics.

I look like who?

Hrmm... I only know one person on that list (JFK). Can't say I think I look like any of them really. I suppose I should start looking up who these people are. What do you think, good matches? Is it because my look is that unique, or the face matching technology is good or bad?

MyHeritage: Celebrity Collage - Roots - Family name history

Search and Rescue Phase 2

Some time ago I had mentioned that I was going to apply to the alpine rescue team, and be an active member of their rescue contingent.  There were only two nights during the past two years that membership applications where being offered, and you had to be present, on site, at one of those meetings to get an application.  It was also in your favor if you showed up to both nights, even though they covered the same information (mainly to show interest).  One was in November, and the other in December.  Unfortunately, I could not attend the December meeting since I was deployed to Antarctica.  

That first meeting, there most of have been about 35-40 people there.  The existing membership told us what being a new member meant, and what it would entail.  They also had an ex-member there who tried to talk us out of joining as well, which I thought was interesting.  His story behind why he quit, I thought was kind of sad, but wasn't very effective for me.  Having been through what I've been through with the Fire Service and USAR teams in Pennsylvania has shown me how I handle the types of situations that caused this person to quit.  Overall, it sounded like they were mainly looking for people with the time to commit to the team, and might be in your favor if you had past medical certifications.  About the only other thing that I had in my skill set that carried over was some rope and knot tying skills, but that's even questionable since some of the things they do are different than how I learned.

 I wanted to get the application out of the way before I deployed, so I ended up turning in my application 2 days after receiving it.  Needless to say, I was the first to turn theirs in.  Applications weren't officially due until December 31st.  The next step in the application process was an interview.  Since I was the first to turn in my application, I had first choice of times to choose from to go in, which was nice.  The interview was quick, about 15 minutes in total, since they were tyring to keep to a schedule.  It was me in front of about 6 or 7 people (my memory is a little fuzzy).  The questions were simple, mostly concerned with time availability, life priorities, and why I wasn't looking for another volunteer fire company or USAR team.  I left the interview feeling neither good or bad about how I did.  I had of course formulated better answers in my head after it was over, but that's typical.

Anyhow, today I received a letter in the mail.  I'M IN!  Out of over 40 people interested in becoming members, 34 applied, and 14 were selected.  I still have to go through all the prospective Member training classes, which will last through the beginning of may, which includes a written and physical agility test, before I am an official active member, but I'm not too worried about that.  It'll be nice to get back to the types of activities I've missed so much since moving here from Pennsylvania.

So the team's primary response area is a 3 county area, Jefferson, Gilpin, and Clear Creek.  They get about 100 or so calls a year, ranging from lost hikers to fallen hurt rock climbers, to downed aircraft.  They've been around for about 50 years as an official team and have a good reputation within the state.

Update: Please note that anything that I say or post here on this blog are solely my ideas, observations, and opinions.  They do not represent those of the alpine rescue team or any of its members.  I do try to take into account the feelings of all who may read this, but sometimes somethings slip through.  I have edited specific statements of this post that others may have found offensive, and I apologize if I have offended anyone.

New Years Hike

Today the family and I went for a hike up in Rocky Mountain National Park with some friends. We had done this same hike the first week or so we moved to Colorado in November of 2007. Needless to say, the weather would have been considered by many more pleasant in November. I figured it would be easy enough to do in more hostile weather. We made it, not with complaining by the little ones, but we made it. I am personally finding winter hiking to be really enjoyable. For some reason the frigid wind and squeaky snow bring out the rawness of nature that I love to connect with. So the final destination, as seen above is Emerald Lake. This is a composite image of about 8 different photos put together.
I wish you all a very happy new year, and here's to many hikes out in the woods! Cheers.