Today was my third session of PT. We worked the knee pretty hard yesterday and I was expecting some resistance to further motion.
As I stepped into the exercise bike pedals I was not expecting much. I still could not complete a full rotation and cycled in alternating directions, pushing a little more when the knee said stop. Stop now.
Will Avery, my PT, was very supportive as I pushed the motion, with more emphasis on the normal rotation, but tugging for a little more range of motion over the top. I felt a little progress being made, more than I thought possible.
Could I?
And then it happened. I put a death grip on the side handles, and with my eyes closed in a place far, far away, I came around.
I had my first post-op follow-up on Friday. The doctor's branch office is across a busy port highway from where I work, and since I can't bend my knee to drive yet I decided to walk over. I had visions of the old Frogger video game with me being the frog trying to dodge the aiming of the big rigs. Fortunately for me traffic was light and no green guts were left behind.
Dr. Graham's PA was very thorough and answered my questions with detail. I always feel no matter what the situation, it is better to know exactly what conditions you are facing. My knee was not quite as swollen since the appointment was in the morning, and there was no evidence of bleeding through my bandaids which have been permanently discarded.
Thanks Google images
My knee, outside of the tear, is in very good shape. According to the operative findings, I had a "complex tear of the posterior horn of the medial meniscus." In the illustration, mine was like the bottom right, although I think the tear was smaller. The tear had folded over the meniscus as well.
The PA and I talked about the time I had left to train and the healing process itself. My concern was even if I could run, would doing the minimal mileage to run the marathon potentially compromise my surgery and make things worse. She told me how a small portion of the meniscus beyond the physical tear is removed to help prevent any further tearing. All of this area including the incisions is raw and inflamed from the trauma of surgery and needs time to heal. Any aggravation - like training for a marathon - can irritate the knee and will result in swelling, a precise indication to back off.
As a runner, we know we have to push through the discomfort of our effort. With an injury, it is imperative to know what pain is expected and what amount of unpleasantness we can tolerate like that of PT. The body must have time to recover; I know if I felt comfortable enough to run today that the knee is not healed.
I will be doing my PT at Private Therapy Services, which shares the Velocity Sports facility down the street from where I work. I'm already thinking once I have recovered to see about getting some strength training to help steel myself for the future.
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For this weekend I will be focused on doing my knee exercises, elevating and icing, and doing a little walking. I had a welcomed call from my friend Scott Rigsby shortly after I came back from my follow-up. We talked for some time about my injury in a realistic terms; I simply will not compromise my ability to run in the future to drag my injured body through a single race. We talked about the marathon course, one that will only be more familiar to me when my shoes are striking the pavement. I sent Scott some links to a couple of the elevation charts so he can prepare himself for this great adventure.
I've had many supporting inquires and messages about this bump in the road, all of them very appreciated. Yes, when I think of missing this year's race it is disappointing, only to get worse as April 16 approaches. Yet the thought I will get through this injury and have an entire year to train for the 2013 edition gives me comfort. Strange that not having a foot will not stop me, but this tiny piece of torn cartilage has derailed the entire train.
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I know this all sounds like I have written off this year's race and I don't like acknowledging that is close to the truth. It is still possible, but if I can't run with a high degree of comfort by next weekend this window may be nearly closed. Through my entire amputation journey I've come to find when things seemed to be going in the wrong direction, I would come to find a brighter light. This has been true every single time.
This injury is not life threatening. It is not a terminal disease. I will run again, and likely stronger than ever. And no matter what, I know I was to run this grand race with my friends.
My knee is as swollen as it was after surgery. I have to say I see the dimming of the Boston light for 2012.
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I had a large, the-heat-is-on kind of project at work that I simply had to do and was not able to elevate and ice nearly as much as needed. Being Wednesday as I write this, I should be able to take better care over the next 4 days. I have scheduled three physical therapy sessions next week; by the end of that week I will need some huge improvements to be able to start running to make it to the starting line of April 16.
Tomorrow I have a followup with Dr. Graham. On the plus side, I really don't have any discomfort in the meniscus area that was the source of this trouble. But given what I know of the body's ability to heal itself, I think my PT's assessment that I am 6 - 8 weeks from full recovery is accurate.
I suppose subconsciously or not, the idea of running Boston was once so far from me as to be unattainable, so it does not seem so strange it has moved away in its orbit from my desire. Yet here I am, on the entrant's list for the race I thought would be forever denied to me...and I cannot run a step.
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To run Boston in 2013 means I will have to run another qualifying race before the September registration begins. This will require me to run a late spring or late summer race, the latter even more difficult to train for in our sub-tropical summer. I would train to cover the distance, which would be my base training that I would carry forward toward the 2013 race.
I can't let my mind think too much of the place it spent so much time in until now: being on that starting line with my friends and feeling the emotion of the day. The image of going from wheelchair to finish line is almost more than I can bear. So I tuck the thoughts away and dream again.
Jennifer and I made the drive to the Roper Hospital Ambulatory Surgery & Pain Management on James Island on Tuesday, February 7 for my outpatient arthroscopic meniscectomy ("knee scope") surgery. This is one surgery that was never on my radar in the past. Even though I played sports in my youth, I never had a knee injury. Well...that's not quite true, I wrecked my cousin's 50cc Honda and that required stitches in my right knee, but there was no structural damage as far as I know.
I had no anxiety for this procedure. None. This is not to say I was not aware that things can and do go wrong in the OR, many if not most times through no one's fault. The human body is an anatomical miracle and no two are alike. It is an endless variation on a lyrical masterpiece beyond belief, astounding in every aspect. It troubles me some believe it can enter the surgical arena without risk.
Having had two major surgeries on my lower right leg at Roper St. Francis, I did know the level of care I would receive: none better. There many fine healthcare facilities across the nation, and we are fortunate to such a highly rated one here. In any large organization, sometimes there is a loss of identity with not only the client but the employees. With Roper, from top to bottom, I have a sense of humanity, harmony, purpose, and of something missing in far too many: integrity.
This does not come by accident.
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I signed in and Jennifer was given a tracking number that would allow her to see my progress monitor in the very comfortable and appealing reception/waiting area. Turns out the operation was so short she hardly needed to check my status.
Homeward bound
I was taken to pre-op where the nurses prepared me for surgery. IV in the back of the hand, shaved my left knee, and generally making me feel at ease with friendly conversation. Dr. Graham came in and discussed the procedure, then the anesthesiologist explained his role and started the process to ease me into unconsciousness. I recall going into the OR, I think I was able to carry on a coherent conversation until I was put under.
I awoke in the same pre-op room and was quickly alert. No pain in the knee; I had an elastic bandage from mid-thigh down and around my ankle. Very impressive, especially with my prosthesis on the other side. We were given instructions for home care and then I was wheeled out to the Pilot and Jennifer hauled me home. Far less discomfort than grocery shopping. :)
*******
I took the next day off from work, mainly to make sure I could keep my knee elevated and ice to reduce swelling. My pain level was very low, I only felt a little more discomfort from the incision areas when I moved certain ways. If I had no meds I would have been fine, and by the following evening I stopped taking them altogether.
Getting ready for first dressing change
For the two days following surgery I used crutches and went back to work on Thursday. In a perfect world I would have taken three days off, not that I was in pain, but I think it would help me heal faster. Being in IT with several important projects in the works, I felt I needed to be there and was able to ice nearly as often as I could at home.
By Friday I was down to one crutch, then transitioned to none over the course of the day. I worked some Saturday morning, and while walking I tried to concentrate on a shorter but more natural gait, trying not to limp but not forcing the issue either. I was surprise how well I could walk and knew once the swelling went down it would get better yet. On Saturday evening my kneecap has emerged from the swollen depths and is starting to look like its old self.
Now Sunday, swelling is only noticeable above and below the kneecap and looks nearly normal. With my first few steps I could tell a definite improvement and I hope the recovery will continue at this pace.
Jennifer is taking great care of me (again!) and will have to drive me to work until I gain a little more flexibility in the knee. I hope I can relieve her of this chore later next week. Thanks #1.
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I've read all sorts of messages on the internet from runners who have had this surgery. Several things will go into the success of this operation. I must mention meniscus tears are far more prevalent than I knew; many people have them through either injury or aging. If you are not active you may be asymptomatic to the injury, or it may hurt and go away after a few days.
The two incisions and swollen knee
My tear had folded on itself, so that was removed. Dr. Graham gave me a sheet of photos of the procedure, but I am not able to tell for certain what I am seeing. At my follow-up I will get the details as to where and how much was removed. I believe it was a small area that was shaved out, but after my surgery, even though I was alert, my memory of the conversation is spotty.
Crazy legs at work on Saturday in Charleston Marathon shoes
Anyhow, given I had an excellent surgeon, my tear
was small, and I was in good shape prior to the injury, my outlook is good. One younger man was able to return to running two weeks after his surgery; others took months. Some ran as much as they did before the injury, others had difficulty and some gave it up. I imagine many could have been helped with offloading bracing; there really are some excellent orthoses like Ossur's for the knee or Allard's for the foot/ankle. The later would be so wonderful for people with ankle sprains, a widely misunderstood injury by athletes, coaches, and some professionals. A great article on this subject is here.
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Sunday!
So where does this leave me on the road to Boston? My recovery is going well, as good or better than I expected. If I can start running by next weekend without worrying about hurting myself, then I would definitely make it. Another week would put me in the maybe gray area. A month off...I would be looking at only surviving the distance. March 16 is the drop-dead date to cancel our Boston hotel reservation.
For now...more couch sitting, icing, and dreaming.
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In the spirit of the "Little Miracles" post, I made my followup call for my surgery, and while on hold I realized I had worn my Field of Dreams shirt (bought at the farm where it was filmed) to surgery...I had changed it because the 1997 Chicago marathon shirt I was wearing had holes in it.
Saturday, just before noon, after considering my options, I decided to have the meniscus tear fixed. The operation itself is commonly performed and the success rate is high. My decision had been complicated by my desire, my dream, to run the Boston Marathon on April 16. I had wanted to train and run this race at a level I knew I was capable of. This is not to be.
Now, precisely like the Charleston Marathon, complications have undermined my goal. At best I will have 6 weeks to prepare for Boston. My fitness should return faster than before, but given the time I have already lost plus at least 2 weeks of no running will be my starting point. I could run close to optimal if I had 10 - 12 weeks; since this is not possible I will have to do my best with the time I have. Another life lesson?
Dr. Ohlson told me to text him when I made my decision, even though he was on vacation. Knowing what this race means to me, he had already made the arrangements that immediately put the wheels in motion to schedule my procedure. The surgery will be performed by Dr. John Graham, Jr., who Dr. Ohlson gave what I think is the highest recommendation: that he would not hesitate for Dr. Graham to operate on a member his own family.
I believe I may have briefly met Dr. Graham back when I first starting walking on my prosthesis. I am confident I am in good hands and very happy I can get this procedure without delay.
I go into the care of the fine professionals of the Roper St. Francis hospital system with no anxiety whatsoever. The woman who took my information today knew I was trying to run Boston and was so supportive saying 'we will get you there.' Again I am reminded that when I arrive on the starting line in Hopkinton, it is through the efforts of a small army of healthcare professionals, the best people on planet Earth.
The MRI verdict is in: I have a large meniscus bucket tear in my left knee on my intact side
I was at lunch on Wednesday with some business associates when I heard from Dr. Ohlson. The signal was dropped inside the building so I stepped outside and returned the call. Dr. Ohlson said I definitely had a tear - not what I wanted to hear but fully expected - and we discussed the options.
Should surgery be required, I would have a knee arthroscopy. Although Dr. Ohlson could do this procedure, he is a foot and ankle specialist and another surgeon in his practice would perform this operation. I believe this would be on an out-patient basis and it would take about 4 weeks to recover.
Given the pain has lessened since I first noticed it, I can start running again and see if I can tolerate the discomfort. Should it get more painful, I will not take a chance on making it far worse and immediately go in for the surgery.
Normally when coming back from an injury I take it slow until I am certain I am healed, "listening to the body" for any indication to back off. This situation is different. The Boston Marathon, my goal race, is April 16. If I have surgery then the sooner the better, although at this point there would be no way I could run the time I had hoped to.
If I can return to running without too much discomfort and train at a high level, I should be able to have a good race. At this point losing most of last month and having to train just to get back to that point will take at least 3 weeks. This leaves a couple of weeks to sharpen and then have a short taper.
Few marathon plans for us working mortals go according to schedule. Outside of injuries, things crop up like work deadlines or family needs or cutting a run short because of the weather. Injuries lasting a month, however, simply will not allow the typical marathoner to run their potential. You may be able to finish, as I did at the Charleston Marathon, but the race will be slow.
For me, I have come to terms that I cannot run to my potential at Boston. My training before Christmas near perfect and I had confidence I was heading toward arriving on the starting line ready to rock. Now, like Charleston, my conditioning may be closer to minimal than optimal.
My readers know what this race means to me. It would be impossible to be disappointed running one of the greatest footraces on the planet. I think to do your best would be the aim of most runners at this legendary event, and I wanted it to be all I had, no limits. It may still take all I have to run it, but not race it.
There is always next year. This would require me to run another qualifying marathon fairly soon under the BAA rules, something I will abide with even though MI athletes are given a little flexibility here. I do not expect, want, or will accept that leeway as I honor the tradition of this race.
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While driving to work this morning, many of these thoughts and more were on my mind. In a moment of enlightenment, I came to understand why I, on some level, expected this injury to end this dream of running Boston. It is this: I had given up on ever being able to run this race as an able bodied runner.
I had never given up on running. But Boston? It was as far as the moon. In 1608. But here, in 2012, I was registered to run this almost mystical race. And here, in 2012, my left meniscus has torn and spoken: maybe not.
As I was thinking on these things, my eyes grew hot of thinking how it would be to stand on that starting line, with my good friends Kelly, Shariff, Scott, and Mike about to take the first step forward into this dream. How is it possible I could be here? It is beyond belief; it is something beyond anything I could imagine.
I looked into the sun, and to the right, between some clouds, I saw it.
A small slice of a rainbow appeared, heaven's chevron.
