Week Three

Can you believe it's been 3 weeks since my surgery? My knee is still a little swollen, as you can see from the most recent photo, but I find it amazing how small my scars are at this point. I did not expect that at all. An added benefit, I say.

I finally start physical therapy next Wednesday when I return from a business trip. I was supposed to start PT this week, but had a hard time coordinating with Michelle, the physical therapist I saw at CPMC last year. When a business trip got scheduled the same time as my first appointment with Michelle next week, I learned the next date available with her was more than another week out. I knew I had to find someone else. I called Presidio Sport & Medicine. I had been there years ago for training seminars with my training group, PacWest Athletics. Coincidentally, I attended high school with a physical therapist, Susan, at PSM. I called and spoke to a cheery women at PSM yesterday afternoon. She asked who did my surgery and when I answered Dr. Lesley Anderson, she replied, "Good, she's the best." I was immediately set up for sessions with Susan over the next 4 weeks. Good, done. I already feel like I'm a little behind, so I'm glad to be starting soon.

Overall, my knee still feels like it is on the way to recovery. The doctor said to expect 6 -8 weeks for recovery so I'm possibly halfway there, but maybe not quite. My knee does feel better every day, although I'm starting to wonder if it will ever feel normal again. I hope so, but I'm sure I will have to be good to it from here on out. I will do my best!

Distracted

Between watching the Tour de France this past week and reading the final Harry Potter book, I have been somewhat distracted from my knee pain. More than anything, I'm feeling in limbo. My knee seems to be healing at the pace stated by my doctor so far, but I'm not yet at a point to put it to the test. My first physical therapy appointment is not until next week, so I'm in limbo. I wonder, is my knee going to heal and will I recover from this 100%? Could I always have discomfort? It's less than 3 weeks since my surgery so I suppose it's still too soon to tell.

I have to mention I am impressed by my how Dr. Anderson stitched up the three points where she scoped my knee. I've mostly seen people's scars as round spots a little smaller than the size of holes in a 3-hole punch. My incisions were left as small straight lines with a dot on each side for the one stitch to each. They are like small division symbols. If they stay this way, the scars may be hard to see at all once they fade. Nice. Photo to come...

I Must Be Tired

I was a little tired at work today, then I got home and fell asleep on my couch! The TV was still on and it was the kind of nap that knocks you out and then it's REALLY hard to wake up. I'm not sure why I was so tired, but I had a few evenings out this week. I had a great time Tuesday night with some old coworkers from Pickett Advertising, my previous employer. We met at The Wine Merchant at the Ferry Building, then ate some delicious Mexican Food at Orale! Orale! nearby. It was good to see them and catch up on everything. Last night I went over to my friend Lisa's house, who is pregnant and on bed rest. I was planning to bring her dinner and keep her company, but she already had some wonderful pasta and bean salads and veggies brought by recent visitors. We even tapped it off with homemade oatmeal chocolate chip cookies baked by her Mom! Yum. As always, it's great to spend time with Lisa and even on bed rest, she is looking fantastic!

Neither Tuesday or Wednesday were late evenings, so maybe more rest than usual is best for me for a while longer. I've noticed this week that more swelling has subsided in my knee. Normally I would consider that a good thing, but I realized the swelling was providing some cushioning overall. Now, my knee feels even more tender to the touch. Hopefully, that tenderness will go away soon as well. My range of motion is about 90% and I'm working on it with my exercises. Once I get full ROM, I will be able to start on a stationary bike. I promise, I will take it easy though. I don't think I'll be out on my road bike for a while yet. In the meantime, I'll keep living vicariously through the Tour. Go Levi!

Allez! Allez!

I received two pieces of mail from California Pacific Medical Center this week. I have to say, the first one made my heart jump. I thought, "Are they sending me a bill already?" Then, I thought the envelope size did not look like a bill statement. They turned out to be cards thanking me for choosing CMPC, one with signatures from the nurses that helped me all day. They wished me well. I felt a little badly, since in all reality my doctor chose CPMC, not me. It is where she does her Thursday surgeries. That said, I appreciate their follow-up hoping I had a good experience.

I'm spending this evening watching Stage 8 of the Tour de France. I love it! It's exciting as the competitors chase each other up and down the Alps for 100 miles one day, then get up the next day and do it all over again. I don't know how they do it! When I was in my best shape two years ago, I rode in Waves to Wine, a local bike tour raising money for the MS Society. The first day I rode 75 miles, then 57 the next. I REALLY wanted to get off my bike at the end of that second day! I couldn't imagine cycling the next day, much less day after day for 3 weeks! Well, that's what these pros train to do. They are amazing. If you haven't watched it yet, I thoroughly recommend it. If you get Versus (formerly OLN) try to watch a day or more of the tour. You'll get hooked!

One Week Down

Wow, what a good night sleep can do! I can't say I slept for 8 hours straight, but I woke up this morning feeling more rested than I had in a week. Yay. It really seemed to make a difference in my day overall as I felt much more energetic and my knee didn't tire out as much by the end of the day. Here's a photo of my knee one week down. The "+" strips of tape replaced my stitches on Monday as they were literally glued to my skin. The physician's assistant told me to let the tape strips fall off on their own. I think my knee looks pretty good, don't you? There is a little swelling, but not nearly as much as I thought there could be. My knee does not hurt when I walk, but it's somewhat tender and when I bump it (as little as humanly possible) I feel a small jolt of pain. That is certainly to be expected.

Long Day

I haven't had one good night sleep since the surgery. This is mostly because I am not comfortable sleeping with my knee elevated on a pillow, as recommended. The lack of sleep is starting to catch up with me and I'm just plain tired. I did my physical therapy exercises last night and this morning I felt like they had helped my range of motion quite a bit. I even went to work with one crutch instead of two. By the end of the work day, I was beat. I hadn't done much rushing around, but it was my first whole day back in the office. I could tell. By 4:00 PM I was tired and my knee tightened up. As much as I dislike them, I wished I had both crutches again. I was ready to be home with my leg up on a pillow with ice. That's where I am right now. Is it the weekend, yet? ; ) One day at a time...

The Full Story

Today I was back at work, even if it was for just a half day. I was pleasantly surprised to learn it would not be just me leaving early today, but the entire building! Due to the fact that Old Navy Headquarters are located near AT&T Park, our President decided the hours for our office today would be 8AM to 2PM and tomorrow will be 8AM to 1PM. This is all because of the MLB All Star Game tomorrow and related events. Excellent! I was able to go to my post-op appointment today then home to rest with no guilt and tomorrow will be the same. Wasn't it nice for everything to sync up so well? : )

I walked out of Dr. Anderson's office today so happy, I almost cried. I haven't felt that way since I got my job offer from Old Navy and before that... I can't even remember. I received more details about what Dr. A found in my knee and the procedures she performed. While most of the doctors I saw felt my problem was primarily Patella Femoral Syndrome (Runners Knee/chondromalacia), Dr. A was leaning towards Hoffa's Syndrome as well, which is an inflammation of the fat pad under the patella. I had done some research on this in the past and it seemed to fit my symptoms. Hoffa's is also an overuse injury, but can be exacerbated by even standing for long periods of time so it doesn't go away easily. I thought Hoffa's was eventually ruled out since it didn't show on my MRI (only severe cases do) and the lidocaine shot I received back in January was supposed to help shrink an inflamed fat pad. The shot didn't help so I hadn't thought about it much since. Today, I saw Dr. Anderson only for a minute in passing as I met with her physician's assistant, Debbie. She removed my sutures and gave me the full report as she was present during my surgery as well. She showed me photos of the inside my knee and I have to say they are really cool. They look nothing like I would have imagined. Here are some of the operative notes from my surgery.

PREOPERATIVE DIAGNOSIS: Persistent Hoffa's syndrome, left knee.
POSTOPERATIVE DIAGNOSIS: Persistent Hoffa's syndrome, left knee, with chondromalacia.

OPERATION PERFORMED:
1. Arthroscopic patellaplasty.
2. Partial synovectomy and removal of fat pad, left knee.

Debbie explained that when my knee was in full extension there was an impingement of the fat pad between my femur and tibia bones. There are nerves inside and this causes inflammation and pain. Dr. Anderson removed the portion of the fat pad that was catching, as well as smoothing out some rough cartilage under my patella (chondromalacia). After my MRI last Oct, Dr. A told me the chondromalacia in my knee was typical for a runner my age and didn't seem all that concerned. Even then, I plan to be more cautious in the future since I have learned this can lead to arthritis in later years.

I've been telling everyone since the pain started in my knee that it feels like there is something "stuck" inside. It was hard to explain because I couldn't see into my knee and I'm the only person that can feel it. It seemed like a knot or silver dollar sized lump somewhere in the middle of my knee. Any amount of rest would not cause it to diminish. Now, even with my knee swollen from surgery, I can tell the knot is gone. Yeah! The main reason I feel so happy is that something has been "fixed." It really was something that needed to be fixed and it was not all in my head or would go away with more rest. Again, time will tell how everything heals and what my activity level will be in the future, but I am encouraged that I will be able to get back to the things I love soon. Next steps, some physical therapy sessions and lots of R.I.C.E. I'll keep ya posted!

Back in SF

I'm back home in San Francisco tonight, getting prepared for the work day tomorrow. Am I up to it? I'm not entirely sure. How hard will it be to get around on my crutches? I know I should use them, but I have a feeling I'll want to hobble without them quickly back and forth to the printer or to talk to people who's desks are near mine. I'll have to remember to take it easy though and ease off as much as I can. My Mom and Dad drove me back to the city tonight and I thought, "Can't I stay with them longer and get more rest and delicious meals?" : ) I know, I know... back to the real world. If I must.

I got home to three messages on my answering machine. I guess I should have given my doctor my cell phone number. Oops... Dr. Anderson left me a message on Friday checking in to see how I was doing and to remind me to start my exercises. I appreciated her follow-up. A nurse from the hospital, CPMC, called as well to check on me. Very nice. The last message was Dr. Anderson's office calling to adjust my post-op appointment tomorrow from 1:45 PM to 11:15 AM. Unfortunately, I don't think I can change that due to morning meetings at work, but I'll call early tomorrow to figure something out. I am anxious to get my stitches out and make sure everything is healing alright. Here's a photo of my knee sans the layers of bandages. There is one arthroscopy suture per bandaid (3). I'm surprised my knee is not more swollen, but it does feel tight and achy. I'm sure how my knee feels in the future will depend a good deal on how treat it right now, while recovering. I intend to continue the TLC on my own. Time for some ice, then off to sleep. Good night!

Already Sunday

Is it already Sunday? The last few days have gone by quickly. Lots of TLC from Mom and Dad. : ) I woke up this morning and felt just about ready to ditch my crutches. I learned how slowly I move on crutches when I went to a movie yesterday. It was a little awkward and frustrating. Once I had been up and around for about an hour this morning, I thought twice. The rule for getting off of the crutches is, "No swelling, no limping." My knee does not pass either of those stipulations yet, although it feels much better than I thought it would at this point. My knee does not hurt when I walk on it with full weight. What I need to work on now is increasing my strength and range of motion by adding in the physical therapy exercises on the list from my doctor. One step at a time.

I have to say, it's been so nice to simply take it easy since my surgery. I haven't had much to do in terms of being anywhere at a given time and that is nice. Other than seeing the movie (It was "Evening," and quite good. I recommend it), I've just been reading or resting. Naps are good, very good. : ) I read a great article in the August issue of Runner's World Magazine. Very timely for me, I thought. It's called "A Healing Head" and is about staying positive when an injury sets you back. The article quotes several avid runners, including some pros. It said one of the pros, Kara Goucher, spent more time in doctor's offices from 2001 to 2005 than on the roads. The had a series of injuries, but a little rephrasing to her thinking really helped her through it. "I had to realize that I'm not just a runner," Kara says, "I am a person who loves to run." I thought, while I am not a pro, I certainly wound my identity around running ever since I moved to SF and joined my run/tri team, PacWest. It's not always easy to find something you are good at and once I did, I grabbed onto it and held tight! I've needed to remind myself over the past year or so, there is much more to me than training and races. Even though it's been hard, in a way I'm glad I've had the chance to step back and recognize that. I found a great new job at Old Navy and I've come to really appreciate San Francisco and spend more time with my friends and family nearby. As much as I want to get on my bike and ride up through Marin, or run in the hills of the Presidio, I'll take my time getting back to it. Both for the health of my knee and to keep some balance in my life. No more "learning the hard way." Been there, done that.

Nap Time

I'm stuffed! I just ate a wonderful brunch consisting of a vegetable omlette (all from my parents garden), fruit, and toast. Yum. Of course, I never eat this well at home in SF. ; ) Overall, I'm feeling pretty good today. I'm not sleeping that well at night since it's hard to keep my knee elevated and be comfortable at the same time. Other than that, I'm happy with how my knee looks and feels after the scope. I took my bandages off yesterday afternoon. There were 5 layers wrapped up very tight! I'm sure that is the "C" part of R.I.C.E. Rest, Ice, Compression, Elevation. My knee looked only slightly swollen and there was a stitch on each of the three little incisions. Two below my kneecap and one on the top left side. Everything seems healthy so far. My knee is a little achy and a tender, but I'm sure the pain meds are helping too. I'm taking the minimum amount, as encouraged by the nurses at the hospital.

Yesterday afternoon and evening I continued to take it easy. I made sure I completed the gentle ROM (range of motion) movements and quad exercises instructed by my doctor. I can't bend my knee past 90 degrees yet, but I am supposed to add in more excersizes that will increase the ROM over the next few days. It's important to get my knee moving as much as possible. I've been feeling like I'm not completely dependent on the crutches, as it does not hurt to put some weight on my leg, but I am still limping. I figure it's best not to over do it, so I'm still hobbling around with at least one crutch. Crutches slow me down so much! It takes 3x as long to get anywhere and it's hard to carry anything with me. Oh well, patience...

My friend Tiffany is picking me up this afternoon and taking me to a movie for a change of scenery. I'm looking forward to that as it will be nice to get out of the house for a few hours. Still, I'm going to try not to do too much today. I'm sleepy right now... yawn. Lots of food and lack of sleep last night = time for a nap.

I'm OK!

It's after Noon at my parent's house in Lafayette, CA and I'm doing just fine. My left leg is covered from foot to thigh with layers of bandages around my knee that I was instructed to remove after 24 hours. Yesterday was a long day, but everything seemed to go quite well.

My Mom and Dad (Mom's golf game was canceled due to the hot weather) both picked me up at my apartment and drove me to Cal Pacific Medical Center. I got checked in and was taken to a pre-op room to go through some tests and questions from a few nurses and medical aides. A gentleman came in to bring me crutches. The form I signed off on stated they cost me $60.00. Did you know a walker runs about $120? Let's hope I won't need one of those. ;) I even got lessons on the crutches as to how to navigate stairs. Very good to know, as this was my first time on crutches. After that I was asked to change into the lovely hospital gown (opens from back) and put a stocking on the leg that was NOT to be operated on. Very important. A nurse came in to give me an IV of saline to keep me hydrated. This nurse was great and even showed me her own knee scope scars. She's a runner too. Once she left, my parents and I sat for some time just chatting and waiting.

Around 11:40 AM someone came in to take me off to the OR. He sat me down in a small waiting room where another nurse came in to "interview" me. I realized the hospital has a lot of checks to make sure they have the right patient and what procedure that person was about to receive. They were constantly checking my hospital bracelet to a card they had with my records and asking me what procedure I was about to undergo. My charts stated, Operative Arthroscopy, Partial Synovectomy, Left Knee. It was good they were being so thorough and made me feel pretty safe in that respect. Next, Dr. Anderson came in and said hello. She was her usual fairly non-emotional self, but she did reach over to touch my hand in reassurance at one point. She took out a pen and signed her initials on my left knee and headed out of the room. The anesthesiologist came in to tell me a few things and left too. I just sat there. I didn't feel like reading the old People or US magazines lying around. My head was spinning more or less not believing I was about to have my knee operated on.

At last, one of the nurses came to get me and walked me into the OR. It was sterile and ugly. I have to say, even without my contact lenses, I could tell it was very utilitarian, not meant for anything other than medical equipment. I got situated on the table as they told me to put my head here and leg there. The anesthesiologist gave me a few drugs that make me woozy. I looked around the room and counted him, Dr. A, a few nurses, and someone else. Why did they need so many people? And how much is each person costing me? Ha. I was asked to breathe in an oxygen mask as I made a silent prayer. I woke up an hour later in the recovery room.

The recovery room was big with many spots for beds to be wheeled in and out. The nurse there put a warm blanket on me which was cozy. I was worried about feeling nauseous, but felt fine so far. I tried to doze off again. It was then that another woman was brought in next to me. I learned she was a nun named Sister Catherine. Bless her, but Sister Catherine started to snore... loudly. Ugh. No more sleeping for me.

After a half an hour or so they wheeled me into another post-op room I had to myself. My Mom and Dad came in to join me and told me the report they got from Dr. Anderson. She told them she found inflamed tissue under my kneecap that she removed and there was also some rough surface under the bone she smoothed out. She mentioned something to my parents about "Young people doing too much and being hard on their bodies." I have to say, I was a little disappointed that there didn't seem to be any broken cartilage or something like that floating around in my knee. Hard to believe just some inflamed tissue has caused me all this pain, but it did support he point Dr. Allen from UCSF made that sometimes an inflammation will not go away on it's own until it is removed. My parents and I waited in that post-op room for some time as the nurse monitored me and let me drink some water and juice. Still no nausea, yeah! Dr. Anderson stopped by and gave me the report directly, which I appreciated. She did say my joints looked good and there weren't any tears. I'm grateful about that, as those problems are harder to recover from. I said, "Well, I hope this helps me." Dr. A replied in a sincere tone of voice, "I am very hopeful it will help you too." She seemed very positive about it and I figure she should know from experience with many patients over the years. After that I started to get a little bored and called my sister from my cell phone. I only got in a few words that I was OK, then the nurse came in to take out my IV.

Around 3:30 PM I could finally leave the hospital. I have to say everyone at CPMC was very nice to me, especially the nurses. Each one was so detail oriented and caring at the same time. Outside of the nurses, I decided that I'm not a big fan of hospitals. I was ready to go home. Once I got to my parents house they embarked on a lot of TLC. My Dad offered me his recliner for the next few days as it puts me in a good elevated knee position. My appetite was good, too good if you ask me. ;) I pretty much ate everything Mom and Dad put in front of me. I crutched myself off to bed around 10PM.

I woke up this morning feeling surprisingly well. I do feel some shoots of pain here and there, but I'm still bandaged up. I've been instructed to keep taking my prescription anti-inflammatory medication and Vicodin. They told me at the hospital, "Don't be a hero, take your pain meds." They explained that if I take them my recovery will be a lot faster and smoother. Good to know. Speaking of, it's about time to take those meds and almost time to remove my bandages. I'm supposed to start my range of motion and quadriceps exercises today. I'm hoping the pain does not get worse, but time will tell. So far, so good!

The Big Day

Gulp. My Dad is picking me up in 10 minutes to head to the hospital. I'm hoping it will be an easy procedure and no big deal overall. I'm a little nervous about being "put under." I mentioned it to a coworker earlier this week and he said, "That's the best part!" Ha. If all goes along schedule I should be back at my parents in Lafayette by 4:00 PM. Whether I feel like doing anything more than crashing on the couch, I don't know. A little TLC will be nice. Thanks Mom and Dad!

HAPPY 4TH OF JULY!

Happy Independence Day! I hope everyone is having a wonderful time at BBQ's and fireworks displays tonight. This is always a wonderful time of year. As for me, I didn't wake up this morning expecting to start my own blog. Not at all. I happened to receive a link to a friend's blog and got to thinking. I've enjoyed keeping a journal over the years. There have been times I write often and other times the pages stay blank for months at a time. Today, I decided a blog would be an excellent time for me to detail my road to recovery and other events in life I choose to share with family and friends.

Tomorrow is a HUGE day for me. After one and a half years of struggling with an injury to my left knee, I'm having surgery. It all started while I was training for the Boston Marathon in February 2006. To give you a little background, I have not been a life-long runner. I was one of those people that headed out the door for a jog from time to time, never really keeping track of my milage or speed. That all changed in 2003 when I moved to San Francisco and joined a running program on a whim. I thought it would be a great way to meet people. It was, and I was hooked quickly. In 2004 I ran two marathons, among shorter races. Then, in 2005 I embarked on triathlon. I was coerced to purchase a road bike and off I went, swimming, cycling, and running. I competed in a few Olympic distance triathlons and one Half Ironman that year. They were tough, but I had a great time. My life revolved around training and my teammates. I'm not an elite athlete by any stretch of the imagination, but I enjoyed some PR's (personal records) and was thrilled to qualify for the Boston Marathon. It was a big deal to me.

5 weeks before Boston, the pain in my left knee began. It started somewhere under my kneecap, in the middle on my knee, and radiated out from there. I had never experienced pain like that and realized soon, it was not going to go away like other aches and pains I felt in the past. I was literally heartbroken. I muddled my way through the next 5 weeks with the help of a chiropractor friend and physical therapy. As you can tell from the photo, I finished the marathon! In hindsight, remembering the excruciating pain, maybe it was not such a good idea, but I knew myself well. If it were any other race, I would have let it go, but it was Boston. From the moment I learned I was a decent runner, I wanted to qualify and run that marathon. It meant so much to me. Once my knee pain began, I was afraid I would never be able to qualify again and this could be my only chance. I finished in 4:10:54. It was slow and painful, but I got my medal.

That was the last race I completed. Ever since I've been on a course of trial and error and sometimes complete sedentary rest. The last thing I wanted was surgery. A year ago my coaches said I had enough recovery time and encouraged me to get out and try to run again. Each workout, even swimming, would result in aches and swelling in my knee. It was so disappointing. The multiple doctors I saw claimed it was probably Patella Femoral Syndrome (Runners Knee) and many of these doctors were condescending and rude. Words of, "You may never run a marathon again" were uttered or they would mention, "Running and triathlons are hard on your body." This, with gleam of you've-been-very-bad in their eyes. I had X-rays, another round of physical therapy, and finally an MRI last October. Even that showed I had the "healthy knee of a 35-year-old runner." This meant there was some wear and tear, but nothing to prove immediate surgery was needed. I went back to swimming, a little yoga, and mostly rest. January rolled around and I tried a lidocaine shot suggested by my chosen doctor, Dr. Lesley J. Anderson, a local orthopedic surgeon (I felt she cared a little more than the others about my situation). The shot did not help and she said I had two choices. 1) I could live with the discomfort or 2) She could take a more invasive step and scope the inside of my knee. She claimed MRI's can miss things. I decided to give it some more time and got another opinion. Dr. Christina Allen at USCF actually agreed with the scope. She claimed sometimes when an inflammation occurs, it will not go away until a surgeon goes in to remove it. On the side of caution, she suggested more physical therapy. At that time a training colleague suggested MAT (Muscle Activation Techniques) therapy and I gave that a try. I thought it was a great new type of therapy (seriously, I highly recommend it), but after 8 sessions I realized it was not working for me. In early May, I decided I was not willing to live with my knee discomfort and scheduled a knee scope with Dr. Anderson for July 5, 2007. I was happy to learn my coaches, family, and friends were supportive of my decision. It had been long enough and with all the rest I've given it, my knee should have healed by now. Maybe it just needs a little help.

My hope is that Dr. Anderson will find something she can fix. Something to at least get me back to normal exercise, then hopefully some training in time. There are still so many races I want to do! These days, I am not even able to workout at the gym like the average person. A 40 minute swim will result in some aches and swelling. While I sneak out from time to time for a short run on Crissy Field, my knee cannot really handle it. It takes a few days to recover after my secret jogs. If I am eventually able to get back to training and races, I will be much smarter about it this time. When the pain started, I was running, cycling, swimming, and doing BootCamp twice a week. Sometimes two workouts a day! I learned the hard way that this was too much for my body. More rest and recovery between workouts will be required in the future. I realize I may have to deal with "bad knees" for the rest of my life. First, the surgery. I will know MUCH more tomorrow afternoon at California Pacific Medical Center when Dr. A tells me what she found.

Thanks for reading my very long posting! I promise my posts in the future to be much shorter and to the point. I simply needed to get you caught up on this 4th of July, 2007. Happy red, white, and blue to all!