Synovectomy Follow-Up Appointment

On to more serious matters. I had my follow-up appointment yesterday morning with Dr. Dye. It was another rainy day as my Mom drove me back to the city in the pouring rain. I was a little sad to be leaving Lafayette, but knew I needed to move on to my next stage of recovery from surgery. I wanted to hear what Dr. Dye had to say and whether my knee was healing appropriately or not. I also wanted to get back to my apartment to rest more and catch up on my TiVo'd shows. Hey, a girl has to stay up-to-date on Lost and The City, you know? ; )

We arrived at Dr. Dye's office around 10:00 AM. Dr. Dye's assistant Lesley brought me into the exam room, took out my stitches and checked the temperature of my knees. Huh? This was the first time anyone had done this before! The "temperature" of my knees? Lesley pointed a laser at each knee and aimed the red dot right on top of the patella. My left knee temperature was around 89 degrees and my left knee was 81 degrees. Interesting. This seemed to make sense to me as my left knee was the one healing and probably requiring more energy than the right one. Lesley confirmed this was normal. Then Dr. Dye came in and took a look at my knee. Very quickly he repeated some of what he told me in the hospital. He said he found the problematic synovitis under my kneecap and removed it. He said the synovitis (inflammation of synovial tissue causing pain) had attached itself to the underside of my patella. I think this sounds a lot more creepy than it really is and made me wonder how common this is and how misdiagnosed this origin of knee pain can be. I'm sure in most people, if they take the time to rest, the inflammation dissipates and even goes away. Dr. Dye repeated, yet again, that this was not the case for me and it needed to be fixed surgically. I asked him about my silly white stockings and he said for safe measure to leave them on until the weekend. O... K... 

I was given a referral to physical therapy and Dr. Dye said the next 2-3 months of my recovery is critical. I must not do more than what is prescribed by my physical therapist. I should also try not to get up and down as much as I usually do from my desk at work. He said to have someone "get the files for me" whenever possible. Anything that causes any pain in my knee should be stopped immediately. I need to stay within that "envelope of function" Dr. Dye always mentions. The PT referral said I should go to 2-3 times a week. What? I thought this was a lot, but I figured, alright, this is what he requires. I'll do my best to follow his program.

After my appointment, my Mom took me to Trader Joe's for some milk and needed groceries. We hauled everything (my suitcase, flowers, and food with my Mom doing most of the work) into my apartment and soon after she was on her way back to Lafayette. I stretched out on my couch and turned on the TV. It continued to be a rainy afternoon which, again, made it easy to be cozy indoors. I soon realized how hard it is to stay in one place in your own apartment. Each time I sat down I thought, "I need this, I need that." It took me a while to get set up where I could reach what I needed and not get up constantly. I iced my knee as much as possible and finally got online to answer personal emails and start to update my blog. I love my laptop! It makes it so easy to keep my leg propped up and type away. My knee felt pretty achy as I hobbled around on my crutches. I just kept telling myself, take it easy. I tried to do the same as when I was at my parents. Rest, read, watch TV, keep that leg on a pillow and ice. The main difference was that I had to get up and cook for myself. Even though my kitchen is only a few feet away, it's amazing how much effort it took to grab my favorite soy crisps or cut up an apple! Don't worry, I didn't starve. I've never been the type to go without! 

I was officially in recovery stage 2. 

The Hospital

I checked into California Pacific Medical Center, Davies Campus, at 7:30 AM, Wednesday, February 11. This was my second knee scope and I was nervous about the outcome, besides the fact I had never stayed overnight in a hospital before. Well, other than my stay at Alta Bates Hospital in Berkeley when my sister and I were born over two months premature. I don't quite remember that visit. ; )

My parents picked me up early in the morning. I had packed my things for the overnight as well as for staying with my parents house for the week afterwards. I was admitted to the hospital and was taken up to the 4th floor to prep for surgery. I changed into the gown and a nurse came in to attach an IV to my arm. Around 9:15 AM, I was taken all the way down to the "B" floor for surgery. I waited for a while and finally the anesthesiologist came in to speak to me. The first thing she said was, "I understand you know my colleague Theresa Chang!" I was glad to hear Theresa's name and that she worked with the doctor that was about to put me under. I explained that Theresa and I attend the same church in the city. She told me Theresa was in the hospital today too. I was surprised and happy to hear this since Theresa told me she was never at Davies on Wednesdays. Dr. Dye stopped by, said hello, signed my left knee, and off I went to the OR. The doctors and nurses talked to me about my job at Old Navy as they got me all situated. Eventually that very calm feeling came over me... and I was out. "Yeah, " I thought, "My mind can finally rest for a while."

I woke up in the recovery room an hour later and Dr. Dye was suddenly by the bed. He talked fast (as usual) and I was still quite out of it, so I only got the gist that the scope went well. I wasn't sure if there were any specific details he may have mentioned, it just seemed positive. My friend Theresa walked up and it was so great to see her. It was nice to see a familiar face in such a strange place. Soon after, I was wheeled to my room. I was in room 313 and had the bed near the window. This was the view that first afternoon, a rainy day in the city. At first, I felt fine. Maybe a little nauseous, but I thought that was because I hadn't eaten anything since the evening before. I ordered some soup and fruit. My parents stayed for a short while, but left once I was settled in so I could get some rest. It wasn't long afterwards that I decided (excuse my candor), hospitals suck!

There is NO quiet. Either my roommate was groaning or watching TV. Honestly, I'm pretty sure she never watched the TV, she just left it on for background noise while she slept soundly. Err... Or someone down the hall was crying out loud. Really, there were screams of "Help me! Help me!" Wow. I'm a light sleeper, so this all was rough. Then, I got more and more nauseous. Nurses came in to check my vitals (not because I didn't feel well, they were on their usual rounds) and insisted I order dinner. I listened to the meal options over the phone and almost hurled right there. Sorry again for the candor, but I'm just trying to explain the situation. The dinner options weren't bad, I was actually impressed at how much they had to offer, I just felt so sick. My friend Becky came by after work and I did my best to hold it together while she was there. I was really happy to see her! I don't know why, but I didn't expect any visitors. Even though I didn't feel well, it made me feel really good that my friends took the time out of their evenings to visit me. Theresa stopped by when she was done with work and convinced me I should accept the nurses offer of the anti-nausea medication.It didn't cure it, but it did take the edge off. Another friend Lauren and her friend Sherman, visiting from out of town, came by too on their way to dinner. Very, very nice. I managed one bite of the quesadilla I ordered and a few spoonfuls of chocolate pudding. Ick, no more. The next nurse came by and gave me some saltines and graham crackers. I had those nearby on my tray in case I needed them. Around 10:00 PM my nurse at the time offered me a Vicodin and a sleeping pill! Woo hoo! ; ) Still, the night was awful. Even with a sleeping pill, hospitals are not for sleep. The staff checks on you all the time and nurses wake you up for new sets of vitals. Blood pressure, temperature, etc... Everyone tending to me were quite nice and very good at what they were doing, but I was miserable. A saltine here, a graham cracker there, I tried to eat something and drink lots of water.

With little sleep under my belt, I sat up around 7:30 AM and turned on the Today Show (I made sure to watch using my headphones as to no disturb anyone else). This is what the morning looked like out my window. Yes, a little bit brighter. Dr. Dye came in around 8:30 AM and checked out my knee. As usual, he was efficient. He unwrapped the bulky bandage and took the drain out of my knee. Oh, I guess I forgot to mention the little contraption hooked up to my knee making sure any excess fluid did not accumulate in my knee. The first thing Dr. Dye pointed out to me on my MRI when he diagnosed the Synovitis was the extra fluid in my left knee due to inflammation. Anyway, he carefully took the drain out, added a few Band aids over my stitches and said my knee looked really good. He said he definitely found Synovitis (inflamed synovial tissue) in my knee and had reduced it significantly. He also said (somehow he knew this was important for me to hear) this would not have gone away on it's own. I would have continued to suffer without the surgery. Whew, it was good to hear. Dr. Dye plopped a big bag of ice on my knee and told me to rest and ice my knee as much as possible. He would see me the next week for our follow up appointment. My Dad arrived to pick me up a short while later. It was so great to change into my own clothes and get out of there! The car was all set up for me to stretch out in the back seat. My Dad even brought an ice chest holding frozen peas for my knee. Thank you Dad, you think of everything! I was glad to be on my way to Lafayette for some real rest and TLC.

Resting Comfortably

Just a quick post to say hello and I'm now resting comfortably at my parents house. Dr. Dye said my knee scope went well. There is much more to report about that and my overnight hospital stay, but it's best for me not to be sitting up typing on a computer right now. I'm basically icing my knee, reading or napping. This post is being done on my iPhone, but the screen is small and it's not as easy as I hoped it would be. For now, I am well and I will catch you up more soon!

Good Correspondence with Dr. Dye - II

After my first correspondence with Dr. Dye, I still had questions. Here is my second email:

Dr. Dye,

1) You mention "multi factorial" and that you are addressing the synovitis component of my knee pain. What are the other factors do you feel have lent to my pain? I imagine the synovitis is a result of some other factor such as patellofemoral syndrome. Is this correct? My main concern is that once I am through the synovectomy and slowly on my way to recovery, what can I do to keep this from happening all over again? If I don't know what exactly caused this problem to begin with, what can I do differently in the future?

4) New question. What percentage of your patients are athletes compared to patients with degenerative issues due to age or poor mechanics? Do you see many patients similar to myself? If so, how many of them experience a full recovery?

Thank you for your quick response to my email. I appreciate you being open to answering my questions.

Alexandra

Dr. Dye's response:

We often don't know all the factors that contribute to kneecap pain, but excessive loading is common to all such knees. The most important thing following surgery is prevent excessive forces out of the envelope of load acceptance for an extended period of time. It takes a year to a year and a half to maximally heal a knee, typically. It also depends on the 3rd leg of the stool (Dr Dye says recovery is a three-legged stool, 1) surgery, 2) taking care of myself after surgery and 3) --the biology of your knee., including the extent of the pathology discovered and the effectiveness of your healing properties as encoded in your DNA. We won't know until we "cross that bridge" Most people 85- 90% do well.

4) about 50% and yes most improve substantially as a function of their unique biological circumstances.

Best wishes, Dr. Dye

I am impressed with Dr. Dye's response to my questions. Most doctors take quite some time to get back to you and when they do, the answers are even more vague than the ones I received from Dr. Dye. Still, he did answer the best way he could as a doctor and did not make any promises.

Good Correspondence with Dr. Dye - I

So, I've been second-guessing myself as I'm now 5 weeks away from my second knee scope. *Gulp* Dr. Dye's assistant gave me his email address before Christmas and was basically staring at it since thinking about the questions I want to ask him. It's taken me weeks to finally write. I'm happy to say I had some quick, efficient email correspondences a few days ago.

Here is my first email to Dr. Dye:

Dear Dr. Dye,

I have scheduled my left knee Synovectomy for Feb. 11, 2009, a little over a month from now. I have some questions prior to my surgery.

1) Now that I set the date of my surgery, I'm suddenly second-guessing myself. I asked many questions during our last follow-up appointment back in October, but since a few months have passed I need to ask again. I have been suffering from my left knee pain for almost 3 years and this will be my second attempt at arthroscopic surgery. The last one did not help although did not make the pain worse. Based on how long I have been sidelined from this overuse injury, will it ever go away on it's own without surgery? I'm sorry I have to ask. I remember you mentioning if the inflammation is not removed, it will eventually start breaking down cartilage in my knee. That sounds like reason enough to get in there to me, but I just want to make sure I have all the information. I do not take any kind of surgery lightly.

2) I am taking 10 days off work after my scope, as you recommend. That said, I travel every few weeks for work. Is there a certain amount of time you advise that I should not get on an airplane? Little leg room and changing air pressure can cause some stiffness in my knee once I have arrived at my destination. I wouldn't want this to hinder my recovery, but I do need to plan ahead in case a colleague will need to help cover some of my travel for a short time.

3) Will I receive additional information on the post-surgery recovery plan before my scope? I have your instructions in icing and rest, but I'm curious about physical therapy and how quickly that will need to ensue. I had a hard time setting up my PT appointments last time around (had to wait awhile before I could start), so I wonder if I should set up my initial appointments now. Please let me know if there are any specific PT's you prefer I see.

Thank you for your time.

Best,
Alexandra Bottomley

Dr. Dye's answer:

Alexandra,

1) It's doubtful this will get better on its' own with the symptoms lasting this long. The source of your pain is no doubt, multi factorial -- the synovitis component is one which can be safely addressed with gentle surgery like we are planning. The idea is to clear out a roadblock that is delaying your knees' ability to restore homeostasis - heal itself.

2) I would recommend not traveling by plane for 4-6 weeks.

3) You could go ahead and make an initial Post Operative physical therapy appt with the the PT dept at this campus (who know well my philosophy) on the Wed following your surgery (Feb 18th) call 600 ----.

If you have any more questions , please re-contact me.

Dr. Dye

Surgery Scheduled

Today I called Dr. Dye's office and scheduled the Synovectomy for my left knee on February 11, 2009. Wow... I can't believe I'm going through this again. Hopefully the 2nd time will be the charm!  

I Lied

So, I lied to my Mom yesterday (sorry Mom!). It wasn't a terrible lie, just one where I felt like keeping something to myself. Yesterday afternoon I told my Mom I was on my way down to Crissy Field to go for a walk. The truth was, I had been thinking about going running all week. I considered this carefully and decided, why not? Through all the research and doctors I've seen, it seems that running won't necessarily make my knee injury worse than it already is at this time. Sure, I may flare the inflammation up again and deal with that achy/burning feeling, but I'm not talking about running great distances here. Like any person beginning an exercise after an extended sedentary period, I planned to take it slow. 

I got down to Crissy Field with the intent of a 20-30 minute run. Heart rate monitor, check, iPod, check, Nike Free sneaks, check, Cho-pat knee strap, check, Boston Marathon jacket (for the added confidence boost I needed), check, long leggings for the chilly afternoon, check... I was good to go. I walked for 5 minutes as a warm-up and then picked the pace up to a jog on the flat, dirt path towards the Warming Hut. At first, it felt a little foreign to me. I hadn't run more than 5 minutes continuously since before my knee scope July, 2007. My ankles felt a little weak, my heart rate was high (even though I wasn't running fast), and I was running straight into a head wind. Ugh. Still, it was nice to be outside. I had my heart rate monitor on more for keeping track of time than anything else, although I do love looking to see how many calories it predicts I have burned after exercise. : ) After looking at my high heart rate at the start of my run, I decided to disregard my heart rate altogether. This reminded me of when I used to run outside before I ever owned a stopwatch or ran competitively. I never used to know how fast I was going or how far, I would simply run to some specific landmark, then turn and run back home. My run yesterday took me out to the "hands" on the fence by Fort Point. As long as I wasn't breathing too hard or was feeling any pain in my body, I let everything else go and simply ran. 

I turned at the "hands," my halfway point, and felt pretty good. I pushed away the annoyance of a woman that ran past me. Let... it... go... Having  the wind at my back was a help on the return to my car, but I also felt like my body was slowly remembering how to run. At first, my footfalls in my Nike's felt a little awkward and rough, but on the way back, I didn't feel any jarring to my body, my steps felt fluid and comfortable. There was a little ache in my quads and the Velcro from my knee strap was digging into the back of my knee, but all in all I felt fine. In the end, I ran for 30 minutes and walked for 10, 5 minutes at the beginning and end of my run. 

Today, I woke up feeling a little sore, but not too bad. I can feel it in my calves and my quads, but my knee feels fine. To be honest, I expected my knee would be OK. I iced it when I got home and followed the usual precautions. One 30 minute run on a flat, dirt path was not going to bother my knee. That said, my prediction is that if I keep this up and run 2-3 times a week, especially if there are any hills involved, my knee will eventually flare up on me and I'll have to back off on the running. I'm OK with that. This week I'm planning on scheduling my Synovectomy with Dr. Dye for early next year. After that scope, I am anticipating the slow recovery period he recommends, even as he claims the scope is a fairly gentle procedure. The slow and careful recovery is all part of healing and hopefully keeping the inflammation from returning again.

For now, I'm just trying to keep some semblance of running in my life. A short distance here and there is not going to hurt me. If anything, I'm finding it may bring me a bit of hope for longer runs in the future. 

What is...

... Synovitis?

Synovitis in the most common case of pain and swelling in the knee. The synovial cells line the inside of the knee joint and make the lubrication fluid (synovial fluid) for the knee - which functions as a living biologic transmission. The synovium is the thin tissue that is made up of these synovial cell. This tissue is at a very high population just behind the patella (knee cap) and happens to be full of sensory nerves. This tissue is easily pinched with activities that load the patellofemoral joint such as climbing up or down stairs, hills, or incline, and with getting in and out of a chair, squatting or kneeling. This is just like biting the inside of one's cheek. It can cause sharp (and dull) pain and can persist because the previously thin tissue swells and more cells are replicated leading to a situation of increased vulnerability of these newly swollen tissues to re-impingement along with the symptoms of continued pain and swelling.


a Synovectomy?

The synovectomy procedure is designed to carefully remove the abnormally swollen and inflamed tissue from the inside of the knee joint. When this is done, it leaves a "raw" surface inside the knee that must re-populate with new cells that will hopefully be less painful and eventually allow greater knee function (i.e. an expansion of the Envelope of Function).