Farewell Post!

Kayaking in front of Shoup Glacier outside of Valdez.

OK, if I'm able to kayak 16 miles and hike about in Alaska (with a side trip to perform with the Kingikmiut Dancers at the Alaska Native Heritage Center) then I think I'm done with blogging about my torn ACL, the surgery, the rehab, the physical therapy and all the rest. My knee fared pretty well during the trip. I did need to take ibuprofen regularly but it was fine.

I saw my surgeon yesterday. He said the ligament is strong but my quads are still weak. He said I have to get on rebuilding my muscles if I want to go skiing this winter. He also said that I probably caused some irritation with all the activity but it wouldn't have been so bad if I had been stronger! So I went right out and joined a gym. I did a good work out yesterday and didn't hate it (so much).

Good luck to all the newbie ACL reconstruction patients! Choose the best surgeon you can, find a physical therapist you like, and do the exercises. It will all work out. If I can do it, you can do it.

I MADE IT -- HIP, HIP, HOORAY!

Fin.

3 Months

This will probably be my second-to-last post. I'll write one more after my next doctor's appointment in mid August. Then, that's it. Blog over! Thanks for everyone's moral support.

It's been 3 months now since my ACL reconstruction surgery. My knee feels pretty good most of the time. The only time I have any discomfort (usually) is going down stairs and deep knee bends. But I'm sure it's because my muscles are still pretty weak. Which is no real surprise since I haven't done a very good job of keeping up with physical therapy. I missed all this week. And next week I'm off to Alaska for 10 days.

Last night was the first time in a month (just guessing) that I've had trouble falling asleep because of leg pain. It was strange. It was at the top of my tibia, on the anterior side. It felt like bone pain or very deep muscle pain. I'm going to go out on a limb and say it was muscle pain from the home exercises I did two nights ago. I may have over-done things in a misguided attempt to make up for lost time.

Here are some random fun facts.

Range of motion: I can bend my knee 145 degrees now. [That's in the normal range.]

High heels: I wore the tiniest of heel on Tuesday -- it did not feel great. That was probably a bad (but necessary) move.

Hiking: I'm clear to do hiking but I'm not supposed to take any HUGE steps.

Scars: Did I ever write about the scar treatment? I think I did. Well, the scars are fine. They are "loose" if you can imagine what that means (not adhered all the way through the depth of the incisions). I showed my scars off in Chicago to a stranger. He said my knee looks like it has a smiley face on it.

See some of you next week (I hope)!

Wrong Direction

Not doing my home exercises for two weeks finally caught up with me. At physical therapy today it was obvious that I've lost ground in my recovery from ACL reconstruction. Turns out these PTs might know a thing or two afterall! Back to squats, lunges, single-leg squats. And now we're adding some small jumping exercises to retrain my leg and knee to handle running down the stairs.

Holy Disintegrating Allografts, Batman!

I found a fascinating posting today on some site called Big Bob's Knee Blog* or something like that. It's about ACL allografts (i.e. tissue from a cadaver) failing because the tissue disintegrates!

Aaaaaaaaiieeeeeeeee! Something new to worry about.

This discovery led to me searching on "disintegrate allograft ACL". I'm happy to report I haven't found much (yet). But I did learn that a GoreTex synthetic ACL option exists. http://bioweb.usc.edu/courses/2003-spring/documents/bisc406-a.broosan.pdf

It has a high failure rate, so even if I had known about it before my surgery I wouldn't have wanted it. But it is cool to think that some day you could replace an ACL with man-made material.

One of the links to the right covers work early physicians did trying to find a suitable ACL substitute, such as using braided silk thread. Which reminds me that there's a book out there about the evolution of successful blood transfusion. You wouldn't believe what some poor woulded souls had to suffer coursing through their veins all in the name of science -- pig's blood, coconut milk. I heard the author on NPR a long time ago but have never followed up to read the book. The horror of what happens when your body rejects pig's blood has never left me.

Merde! What a morbid post!

*The actual site www.factotem.org/cgi-bin/kneebbs.pl/read/294003

Yoga with Witold

Today I took a private yoga session with Witold at Yogasana.
http://yogasanacenter.com/index.html

I was pleasantly surprised to learn that I can resume yoga classes. I'll go back to Level I. About a year ago I was poised to progress to their Level II classes. So it goes.

Witold gave me a routine to do at home that should help to strengthen both of my legs evenly. He said I should do it every day. It entails a sequence of triangle pose, warrior, and a modified pose that I forget the name of (it's sort of a combination of triangle and warrior). He also showed me how I can modify child's pose -- one of the last areas of flexibility I need to recover is stretching my quads when they're weight bearing and this pose is it.

I'm really happy to be back in yoga! I especially like the notion of working both sides of my body evenly. My hope is that it will help to restore the parity of the size of my thighs ; )

Eight Weeks

I had a big big weekend in Boston. I went to see the Cyndi Lauper et. al True Colors concert with my friend Stanley. It was reasonably good if a little long. Cyndi was the star. Debra Harry was a nightmare. Erasure rocked and the weather was beautiful. (The venue was held in a big tent.)

I wore a dress that I never get to wear. The tshirt concessionaire was selling "true color" tiaras for just $5 so I had to buy one. It went with the dress. It was fun to wear because I got a lot of attention. I think maybe people thought I was a man in drag -- or maybe a woman playing a man in drag. Either way, people thought it was a gas.

My friend Stanley has an old photo of me "dressed in drag." He said he uses the photo as a trick question: "Is this a picture of a man dressed as a woman or a woman dressed as a woman?" Scary! I thought I was just dressed in a flapper costume with a blonde wig.

The latest on my knee is that I can flex it to 133 degrees. It's practically back to normal in terms of straightening and bending. Now I just need to rebuild my quads and work on some lateral stuff. I still can't run for another 8 weeks but I should be skiing on opening day this winter.

Six Weeks

It's been six weeks since my ACL surgery. Overall, I think I'm doing well with recovery. The physical therapist is happy with how straight my leg is when I extend it. It looks almost normal, he says. I have about 15 to 20 degrees left to gain in flexing my knee. The last time they measured it was at 125 degrees after a little warm up.

Today I had ultrasound treatment for the tendonitis. The physical therapist seemed skeptical about the doctor's explanation for the tendonitis. He said that they usually only see that injury in basketball players. He seemed to think that my tendon is more likely irritated by the incision scar tissue that formed. Whatever. The end result is tendonitis and I'm supposed to take it easy and lay off the lunges and step-ups. No big loss in the short run. In the long run, tendonitis is something that is easy to trigger once you've had it once. Kind of a bummer.

Yesterday the surgeon said I will be doing physical therapy twice a week for at least another month. Or did he say two months? One extra benefit to doing this physical therapy is that I should be in good shape for rollerblading pretty soon. Something I've been meaning to do for the last two summers.

Which reminds me. Several people have commented about how athletic or active I am. My friend who writes quarkscrew.org said this to me most recently. It's weird because I really don't feel like an active person. In fact, I feel pretty slothful. Left to my own devices, the most active thing I would do is brush my teeth with a manual toothbrush. Luckily for me I have an active husband who likes to ski. Wait -- that didn't work out for me so well this winter...

Tendonitis

I saw the surgeon today. I've got tendonitis in my patellar tendon. The doc prescribed an anti-inflamatory I've never heard of (meloxicam). And he suggested I wear one of those neoprene sleeves to give my knee a little support. He said this is a common occurrence for ACL surgery patients. During the recovery when the muscles in your upper leg are weak (flacid, ugh) the tendon gets over-used and irritated. Luckily I am past the bone pain from my femur.

The doctor is pleased with my range of motion, strength in my leg, as well as how straight I can extend my leg. He gave me a prescription to give to the physical therapist to address the tendonitis specifically.

My next check-in is the first week of July.

Scars, Adhesions, Crappy Blogs

Yesterday Richard the PT "worked on my scars." That meant he pressed down and moved the skin around my scars. It's hard to explain, but it does not feel good. How come I'm the only person at the PT clinic that is ever yelling outloud? I never hear the nice 97 year old lady yelling out in pain when she's doing work on her hip. Am I that much of a wimp? Perhaps.

This is funny because it's true.
http://dirtymicrobe.com/products/your-crappy-blog/

Endogenous Opioids

I saw the accupuncturist today. She put needles in the joint opposite of where I feel pain; in other words my left elbow. It was a very strange sensation. I felt like my arm was pinned down by a sandbag. And when she manipulated one of the points it caused an electrical shock to run down from my elbow to my hand. I don't know how much (or whether) it helped. I still needed to take a painkiller at 5:00 today. So much for "quantities of endogenous opioids." Maybe tomorrow. She said that I should go two days in a row because the treatments are cumulative. I'd really like to get off these painkillers. They too seem to be cumulative and make me into a zombie.

PK Log:
5:00 PM Vicodin

Bone Pain on Wikipedia

Why does my femur bone hurt so much? Because the periosteum has nerve cells. And that is what the surgeon "smoothed" or "shaved." I watched him do it. It was like watching a stone mason sand a piece of white marble. The physical therapist said that this is going to hurt "for awhile." Great.

Bone
"The exterior of bones (except where they interact with other bones through joints) is covered by the periosteum."
http://en.wikipedia.org/wiki/Bone

Periosteum
"The periosteum is a thin layer of dense, irregular connective tissue membrane that covers the outer surface of a bone in all places except at joints.... As opposed to osseous tissue itself, periosteum has nociceptive nerve endings, making it very sensitive to manipulation."
http://en.wikipedia.org/wiki/Periosteum

Nociceptors
"Somatic pain originates from ligaments, tendons, bones, blood vessels, and even nerves themselves. It is detected with somatic nociceptors. The scarcity of pain receptors in these areas produces a dull, poorly-localized pain of longer duration than cutaneous pain; examples include sprains and broken bones."
http://en.wikipedia.org/wiki/Pain_and_nociception

Accupuncture
"Although the mechanism is not fully understood, it is likely that acupuncture stimulates the release of large quantities of endogenous opioids."
http://en.wikipedia.org/wiki/Pain_and_nociception

I'm seeing an accupuncturist tomorrow.

PK Log:
9:30 am Vicodin
7:00 pm Tylenol
9:00 pm Vicodin

One Month

For those of you keeping score at home, it has been 4 weeks since my ACL reconstruction surgery.

Things are going pretty well. I'm off crutches. I'm walking without a brace. I walk slowly but am getting faster every day. I have just started to take the stairs up like a normal person. It took awhile to be able to flex my injured knee enough to raise it in front of me to the next step, then it took awhile to get the strength to push myself through the movement on that leg. I'm not strong enough to go down stairs leading with my good leg -- it puts too much strain on my knee.

Today is physical therapy. I'm going to warm up on my bike at home before I go. This is the session that came with the "take your painkiller before your next appointment." Lord have mercy.

And if you're wondering how much knee surgery costs -- my doctor billed my insurance company $20,500. My share is $5,272. That's a little higher than I expected.

Lost Weekend

This wouldn't hyperlink, don't know why. Copy and paste the URL into your browser. I don't know who the artist is but I appreciate the sentiment.

http://www.flickr.com/photos/gregbiche/232224439/

I slept most of this weekend. I think I was sleeping off the cumulative effect of painkillers I took Thursday and Friday. Not that I took that many. I think on Friday I had 3 over the course of the day and night. I seriously think I'm having trouble metabolizing these things. Or maybe I take them too frequently?

I avoided taking a PK all day yesterday. I only took Tylenol for the constant, gnawing pain at the abraised spot on my thigh bone (femur). It persisted through the Tyleonol yesterday but I was able to ignore it while I was out walking around. It's impossible to ignore when I'm trying to sleep.

I was up at 11:45 pm, 12:30, 1:45, etc. Eventually just got up, took Tylenol, and read at 4:30. I was hoping I'd get sleepy and go back to bed. No such luck. The throbbing kept me from feeling sleepy.

I'm going to contact the accupuncturist I saw last year to talk to her about pain management. In the meantime, back on PK today. Blah.

PK log
8:00 a.m.
7:00 p.m.

House Hunting

We went to a few open houses today. Here's Brett studying his elaborate spreadsheet, keeping us to a tight schedule. No time for dilly dallying!






This van was parked outside one of the buildings we saw today. It sort of creeps me out, but I have to say I respect the retro-ness of the van.

[click on the photo of the van to see the detail of the window decals]

Lucky

Moby in the backyard. He says, "I fail to see the humor in this."

I made sourdough pancakes today with the sourdough starter my mom made while she was here. They turned out pretty well. Not quite up to the memories of my grandma's sourdough hotcakes though.

Anyway, the egg I used had two yolks in it. Isn't that supposed to be lucky?

SO sleepy!

I was out last night until 11:00. We watched an episode of The Sopranos (Season 5, episode 4) then went to bed at midnight. I slept until 9:30, then went back to sleep at noon and slept until 4:00! That's crazy! I think the heavy sleep today was a direct result of taking painkillers yesterday for the post-physical therapy. The physical therapist will say it has something to do with my "parasympathetic nervous system" blah, blah, blah. I feel like a loser! Who sleeps for 13 1/2 hours? Insane.

I've been in a lot of pain today. It's the spot on my femur where the doc "shaved" or "smoothed" an abrasion. After sleeping so much today I avoided taking any painkillers until after dinner tonight. Balancing pain and reaction to the painkillers is tricky.

113

This is a shot of me "walking up the wall." It's a closed kinetic chain exercise I do at home. I took a picture of my knees because I think my right knee (the rehabbing knee) looks like it's the widest part of my leg. (It is not. But my left thigh is 1" bigger in diameter than my right.)

My knee flexed to 113 degrees today. I should be able to push a bicycle pedal around one full rotation pretty soon. In fact, I think I can do it tonight now that Brett has brought my bike upstairs. We have one of those bike stands to make any bike into a stationary bike.

Ice Cream

We have two apartments above ours in our building. Our neighbor on the third floor brought me sorbet and a Sopranos DVD last week. Our other neighbor heard about that and emailed to see if I need a refill. She is going to bring me ice cream tonight. So sweet!

I'm walking without crutches all the time now. But today I have a long day ahead of me. Going all the way to Harlem for a meeting and then back to Brooklyn for my physical therapy. I had a similar day on Tuesday and was almost unable to walk by the end of the afternoon. Really regretted not having a crutch that day to lean on so today I'm taking one along just in case.

Sleep is still a problem. I woke up at 4:30 am with a lot of pain. Brett brought me an ice pack and Tylenol. I'm surprised I had so much trouble. I had a light day of walking yesterday and spent a good amount of time icing my knee. Drat.

No sleep till Brooklyn!

I'm not sleeping well at all. The brace was not the problem. It's my knee. The ports where they scoped my knee are still healing. The incisions were not long, but they were deep. There are at least 4 incision points on my knee. But there is one major one on each side of my knee cap that are the problem. At the end of the day when my knee is swollen I can't put any pressure on either side of my knee. I'm a side sleeper so every night I wake myself up from turning onto my side and bumping my knee. Last night was bad. And after today's physical therapy, I'm pretty sure tonight will be a tough night as well.

But it's all going to get better eventually.

Blog Title Inspiration:
http://www.youtube.com/watch?v=RI2IyHXJo5M

A little PT inspiration

At physical therapy today I was only able to flex my knee to about 90 degrees. I guess it's supposed to be flexing more so Richard the therapist called my doctor. He asked if he could "be agressive". The doctor said that would be fine and that he expects to hear me screaming all the way in his Manhattan office from Booklyn. Great.

And it gets better. On my way out, Richard said that I should probably take some pain medication before I come to my next seesion. Oh my God. I could hardly walk this afternoon. What's Thursday going to hold in store for me? The good news is that by the end of the session "we" flexed my knee to 108.

When I go in for PT there is always at least one elderly person doing stuff similar to what I'm doing. For instance, the gentleman I saw today was doing the side steps I did last week. He said he is rehabbing from a cyst in his brain that had to be removed. He said one day he woke up and couldn't walk. That's how he found out about the cyst. Afterward he had to rebuild everything -- walking, talking, everything. He told me that it's all worth it.

Cruel and unusual punishment

I started "REAL" physical therapy today. I thought I started PT last week. No. That was baby stuff. The real work started today when the therapist worked my knee from 65 degrees of flex to 95. I didn't get there in one shot. We worked on it incrementally and it was pure pain. Holy cow. (I'd swear but am afraid my dad, step-mother or nephew will see this.)

I seriously almost fainted at one point. Fuuuuuuuuuuuuu-dge. I haven't had kids but I don't see how it could be more painful. OK, it probably is. But, whatever. Today was real, honest to God pain. And I get to go back for more!

Morning Drama

Being close to a fire station is a mixed blessing. We hear a lot of sirens -- usually in passing. This morning, though, the sirens didn't move past the building. I was a little nervous for a second.
Thank God it was a false alarm.

I wish I were able to move more quickly. I would have taken a picture of the truck from the back so you could see the full-sized American flag this truck is waving.

It's very reassuring to know that should we ever need the NYFD, they will be here tout suite.

Week 2 - Post Op Appt

Today was my 2 week follow up appointment with the doctor. He was happy with the way my knee looks. He said "that's a strong knee!" with such enthusiasm, I have to believe he thinks it worked.

So, now I'm free to sleep and rest without the brace. I still need to wear it when I walk -- but it doesn't need to be locked anymore. Hallelujiah. I can't tell you how much I'm looking forward to getting my first decent night's rest tonight.

I have a couple of ideas to write about here but may not develop them. One thing I've been thinking of is that the blog is really an evolved slide show isn't it? I mean really. Come on. And probably the right word isn't 'evolve' but 'devolve.' In the old days you would have to sit through trays and trays of candid snapshots from some trip you didn't go on. But now you get images of post-surgery bruises. Delightful! And to add insult to injury, blogs require that you put in effort to READ the mind-numbing narrative instead of just listening in the darkened room while your least favorite uncle tells you about the family vacation to Busch Gardens.

Never mind about the other ideas. I'm going to bed.

Who Loves You?

Dogs and babies love the crutches man. See for yourself.

Postcard

Wasting Away

For your viewing pleasure. Here's what my leg looks like today.




And here's Moby sitting in the middle of an array of physical therapy doo dads. He's like a cat. Always has to be in the middle of whatever you're doing. Oh, hey! I know that looks like a glass of wine sitting at the ready. It's not what you think. I don't drink a glass of wine and do my PT exercises. I drink a glass of wine and THEN I do my exercises.

Day 9

Every day I wake up feeling a little better although I’m still really tired. Several people have suggested it’s the lingering effect of anesthesia. I guess that could be it. I think it is also because I have to sleep with this heinous brace on my leg and it keeps me from getting a decent night’s sleep.

1 Week

Hey, if you ever need a good cry, watch the season finale of Six Feet Under right after your mom leaves you after perhaps your best visit with her ever. Talk about emotional discharge! Holy mackerel. I'm a wreck!

I think the only thing that will make me feel better is either fish & chips from the Chip Shop or chips and guacamole at any one of six nearby Mexican restaurants. Whatever I do tonight, chips will be served.

So, I made it to the one 1 week mark. On one hand, I can't believe how fast it's gone by. On the other, I'm sick of wearing this brace, sick of walking with crutches, and feel like the recovery is never going to end. Blah. Then I think of how incredibly lucky I am in so many ways and then feel like a complete jerk for dwelling on a condition that is only temporary.

A friend of mine asked me if I wanted to go skydiving this summer. No way. Can you imagine risking breaking both my legs and/or every other bone in my body right after I get my knee and leg back to 100? No way, Jose. No way.

Day 6

First day of physical therapy. I was only able to flex my knee to 38 degrees at the start of the session. By the end I could flex it to 45.

Things are generally fine. Hooray. My mom is going back home to Idaho tomorrow. Awww. It's been pretty great to have her here even though she beat me at Scrabble 3 games to 2. I won the last game with 290 points to her 258.

My mom and I have been playing Scrabble for as long as I can remember. But probably since 6th grade. It took me a long time to become as good a player as she is. So for a lot of years I was playing catch up -- increasing my vocabulary and developing strategy skills. Then for a few years we were evenly matched. And then she had a series of "mini strokes." That slowed her down a lot at first but she's built back up and now we're at par again.

Life is certainly an interesting journey.


OH, and here's a pic of the hideous bruise that's developed on my leg. It's not pretty.

CPM

I'm using this thing called a continuous passive motion (CPM) machine. It very slowly flexes and extends my leg. The starting setting is 30 degrees. I'm supposed to increase the degree of flexion a little each day. I'm at 40 degrees now. It's uncomfortable when I increase the setting.

The grey thing over my knee is the cuff that is connected to a cooler full of ice water. The cooler is called The Iceman (see above). The Iceman has a pump in it (like an aquarium) that continually circulates cold water around my knee.

If you look closely at the first photo you can see two white tubes on my leg. Those are the in and out tubes that connect to the hose to the cooler. I think the tubes look like the milking machine attachments at dairy farms. See below.

Day 3

I think I've pulled a muscle in my groin as a direct result of dragging my leaden leg around like dead weight. For some reason the painkillers don't really help that injury. Odd.

In our apartment we have an upstairs & a downstairs. Kitchen is up and our only bath is down. The bedrooms are down as well. I've been going up and down stairs each day at least two times, but today I will limit that. I think that's what caused the groin muscle pain.

Hopefully I'll be able to go out this weekend to take my mom to someplace she's never been. She must be getting bored here in our apartment. The cherry trees are in bloom at the botanical garden. I'm going to call them to see if they have any wheelchairs. Ideally, I'd take her up to Harlem for some soul food.

Day 2

This is my second day of recovery from ACL reconstruction surgery. I slept so much better last. Thank God. It's been almost 7 hours from my last painkiller. That's much better than most of yesterday when I would start counting down the minutes to my next dose.

At this moment I am laying in bed with a ice-water cuff circulating cold water around my knee and a CPM (continuous passive motion) flexing and straightening my leg. The motion is supposed to feel good. It does not.

My mom is here and taking good care of me and Brett. She's been my nurse, waiting on me hand and foot (knee and foot?). She's cooked dinner two nights in a row. And to keep herself busy she's been out exploring the neighborhood. Each time she goes out she brings me a little treat. Cute!

Yesterday I received a beautiful edible bouquet of flowers made out of fruit. Tres delicious. And fruit is exactly what I need at a time like this. Thanks, Ellen!

Surgery Report

I did it and it wasn't so bad. I watched most of the surgery on a monitor but forgot some of it because of the IV sedation.

The first picture was taken in the waiting room where I spoke with my doctor and the aneshesiologist. The second is about an hour after my surgery. I was laying there waiting for the spinal block to wear off. And the last picture is me on my way home!























The first night was rough. Got no sleep due to pain. Then in the morning I overwhelmed with nausea because I had taken a double dosage of my painkiller.

Tomorrow

OK, this is it. I have to be at the hospital at 8:45 am tomorrow. I wish I could say that I'm ready. I guess I am. What's left to do? I took my toenail polish off (I'm not supposed to wear any make-up or nail plish). I did my rehab exercises one last time for good luck. I made Brett a nice hot meal. Now I'm watching episode 5, season 4, of Six Feet Under with my mom.

Speaking of which, I never realized how much SEX is in this series until I watched an episode with my mom. Ugh.

Getting fitted for my post-surgical brace

It's a beast!

(The brace, not the guy.)

It was delivered right to my house along with a CPM (continuous passive motion) machine.

I'll be wearing the brace locked in full-extension for a couple of weeks (or until I see my surgeon after the surgery.)

Apparently you have to force your knee straight or scar tissue could develop and keep you from ever straightening your leg again!

I'm probably spreading a lot of mis-information here. Don't take my word on anything I say. It's all hearsay and filtered through sheer terror.

Dr. A's Incompetent Staff and the MRIs

So, one more thing about Dr. A's abominable staff. Dr. A ordered an MRI. When I went to the radiologists to get the MRI, I filled out a form requesting that they send Dr. B the films as well so each doctor would have the same information.

Dr. B's office only got a report of the MRI reading and not the films. Dr B's staff called me one day a few weeks ago to see if I could get the films. HA! "Not too likely!" I say and tell them about the debacle one post below about just trying to confirm an appointment. Dr. B's staff member says, "do you mind if I try to conference them in?" I agree.

Dr. A's assistant Olivia picks up and says she's glad to hear from me so we can schedule the follow-up appointment. I say, "no need." I'm not coming back and I want you to send my MRI films to Dr. B's office. Olivia can't understand the problem. I explain the frustration I have with them. She says, "But I was out of the office." Lady, I don't give a damn. I'm dealing with a serious (though common, I know) surgery. I'm frightened, and I don't want to deal with two offices for my doctor that cannot communicate. She says she has to talk to Dr. A and puts me on hold. For five minutes. I eventually just hung up.

Today Dr B's office called to make sure I bring the bloody MRIs with me on the day of surgery! Oh my G-d! I say, nope. I'm not bringing them. I don't have them and am pretty sure it will be impossible to get them. This staff member is not aware of the travesty that is Dr A's office. I gave her the rundown. She said she'd try calling Dr A's office for me.

Fifteen minutes later Dr B's office calls back. She said NJ answered Dr A's phone. The Manhattan office is closed and not due back until Thursday!

Freaking unbelievable. So now, if Dr B really wants the films I have to pay the radiologists another $100 to get a copy sent to Dr B's office.

Crappy In-Network Insurance Schemes

We have Aetna insurance. They will cover 90% of my surgery if I see an in-network surgeon or 70% if I go to an out-of-network doctor.

I got a recommendation from my primary care physician for an in-network doctor. Then I got a recommendation from a friend who knows a doctor that's performed surgery on a friend of my friends' and my friend's neighbor. (The doctor also saw my friend but did not prescribe surgery.) This doctor is not in my network. Let's call in-network doctor "Doctor A" and out-of-network doctor "Doctor B."

I made appointments to see each doctor, A and B. I saw B first. I felt like Dr. B. was very pragmatic, obviously knew what he was doing, and probably extremely competent based on reputation (both first-hand and from the cover of a magazine he has framed with this headline "Best Doctors in NY").

Dr. A. was 45 minutes late to see me. That put me off. And his exam room was cluttered -- furniture from the 1920s was sloppily filled with supplies from the 80s. This also put me off. It's all I have to go on at this point.

But Dr. A turns up eventually and is very kind and I liked the way he manipulated my lower leg and knee. He has a very reassuring touch. He asked me if I was in pain (N.B. Dr. B did not). And he took my complaint about calf pain so seriously that he arranged for me to see a surgeon right away to get an ultrasound. He wanted to rule out a possible blood clot. This all made me really like Dr. A.

Then I had to decide between the two. Dr. A with his crappy office but gentle bedside manner and Dr. B with his nice office and arms-length patient-doctor relationship.

Cut to the next week when I will be having a follow up with each doctor. I needed to get in touch with Dr. A's office to find out when my appointment was. For some reason, when I was there the first time they hadn't written it down on an appointment card. I actually realized that then and should have spoke up.

Here's what happened when I tried to get in touch with Dr. A's office (and for context, Dr A has an office in Manhattan and an office in New Jersey. 212 is the area code for Manhattan.).

Thursday 3/29/07

I called Dr A's 212 number in Manhattan. NJ picks up. But it takes us both a minute to realize I'm calling from NY and they are in NJ. I explain why I'm calling and this woman tells me that she cannot see the NY appointments. She told me to call the NY office back on Monday.

Monday 4/2/07

Monday morning. I called the 212 number. NJ office picks up. Woman tells me (again) that they can't see the appts for NY. I said I knew that, and reminded her that they told me to call back on Monday. She said they don't know Olivia's schedule and to try after 1:00.

3:00 pm 4/2/07

Called 212 number again. NJ picks up. I state why I'm calling. She says she remembers talking to me in the morning. I said, "So you remember telling me to call back after 1:00." Receptionist says, "Well OBVIOUSLY she's not IN, MA'AM."

Tuesday 2:15 pm 4/3/07

Answering service picks up and says they cannot take non-emergency calls. Said to call back after 2:30.

Tuesday 2:55 pm

Answering service picked up again. Said Olivia should be there from 1:00 to 5:00 but is not picking up.

Questions for Dr A:

How much money is one surgery worth to your practice?

Why do you have an answering service that doesn't take messages?

Why won't the NJ office take a message for Olivia?

Does the your staff realize that patients are customers? That as customers they have a choice in providers? The staff must feel pretty comfortable if they can just out of hand cause you to lose out on the revenue of this surgery and the potential revenue from recommendations.

Luckily, we can afford to pay the 29% premium so I never have to deal with the people at Dr A's office!

Pre-Surgery Testing

Went in to the Hospital for Joint Disease (HJD) today for pre-surgery bloodwork. A nurse took my blood pressure and drew two tubes of blood. I spoke with two different doctors. The second was an anesthesiologist. She asked me if I preferred to have general anesthesia or a spinal block. I asked her questions she says everyone asks.



"If I opt for the general, is there any chance I will be awake and able to feel the surgery but unable to move or speak?" (She said no. But come on -- don't tell me it never happens. I've read the headlines of magazines like Redbook, Ladies Home Journal and Reader's Digest!)

"Is the spinal block the same as what women in labor have?" (Yes. Apparently the needle for women giving birth is bigger for some reason.)

What about the femoral block? Good question. That's just for post-surgery pain. It's not clear to me if they administer that after the surgery but that's what it sounded like.

At the end I had a funny discussion about the "no eating or drinking after midnight the night before surgery." The nurse added "not even gum." Good thing she told me that because I chew a lot of gum! I told her as much and she said that she's addicted to gum and showed me the piece in her mouth (too much information). We ended up comparing our favorite gum flavors! I gave her a piece of Orbitz mint mojito and she gave me some of her Trident tropical twist. Funny.

So, that's it. Next I'll get the CPM (continuous passive motion) machine and surgical brace fitted and then surgery on Tuesday.

I'm also going to talk to my physical therapist about getting her to work out with me in the gym or I have to see someone else. She only does massage and accupressure work. She gives me exercises to do at home but I want to do stuff at the gym with someone. I'm afraid that if it is just up to me that I won't do enough and that it will affect my long-term outcome.

Knee Surgery Countdown: 1 Week from Tomorrow

This is a picture of a tree knocked down in Rutland, VT by the storm of 2007.

I'm stranded in Killington, back at the scene of the crime. Just a little over a month ago I couldn't walk without crutches, couldn't bend my knee 90 degrees or extend it to a full 180 degrees. But apparently that is nothing compared to what Kate Gosselin went through when she had her tummy tuck!!! (I'm watching Surviving Sextuplets and Twins on TLC.) Poor, poor Kate! What an inspiration.

I think I'm supposed to have pre-surgery bloodwork tomorrow but will have to reschedule. As I wrote above, I'm trapped in VT. The big April snowstorm that hit the northeast made driving conditions too perilous to drive the 5 hours back to NY today. My plan is to drive back tomorrow.

ACL Surgery Details

Here's what I know about my surgery. The surgery is out-patient. I will not be staying overnight. I'll be given a spinal block which means I will be awake during my surgery and able to watch it on a monitor. Dr. Sherman says it won't feel like I'm watching my own leg be operated on. I'm pretty sure I will watch it but reserve the right to wimp out at a moment's notice.

I've chosen to use "donor tissue" aka allograft. From what I've read online the graft is bone-ligament-bone from a cadaver. It won't be someone's actual ACL. It will be tendon or ligament.

If you're younger than 40, the doc said they recommend using your own tissue. Over 40? Then they recommend an allograft because donors are typically younger than you -- you end up getting a used, but younger part. I'm not 40 but am close enough. And, besides, there is less pain if you use donor tissue because you aren't recovering from surgery and the spot where they take tendon from (knee or hamstring).

Apparently there is a risk of receiving a virus with the donor tissue. There was a story on NPR recently about this issue. I didn't hear it first hand but I'm supposed to make sure that the tissue bank my doctor uses guarantees that they provide sterilized tissues. When I spoke with the doc about this he said he's never had trouble with donor tissue except for one patient last year. The tissue bank had a scare about tissue from one donor. It just so happened my doctor used tissue from that particular donor in one of his patients. Things turned out fine for this patient and the doc assured me that that tissue bank destroyed any tissue that may have been circumspect.

So I guess the risk of the viral transmission is real. The doc said that the tissue is sterilized (via radiation) but only kills bacteria. In order to destroy viruses, the requisite radiation level would also destroy the tissue.

If I get really freaked out and change my mind about using donor tissue, I can decide at the last second to use my own tissue (patellar tendon or hamstring). As the doc said, I'll be bringing my own tissue with me if I do change my mind.

Brett will be taking the day off and will take me home from the hospital. My mom will be taking care of me for a week. A week might seem a little long, but I've never had surgery and am feeling like a big wimp. I want my mama!

Snowshoe Easter Egg Hunting

We're in Killington. I dropped Brett off at Bear and then took Moby snowshoeing. I took him to a public area near the Killington Town Clerk's office. Moby happily rooted around and found several candy filled plastic eggs leftover from the Easter egg hunt. And since he was wearing his backpack we filled it with colorful eggs!

We were out there for about 40 minutes. I took a little break at the swing set. Apparently Moby has never seen a swing set. He could not get it. He'd coming charging after me when I swung back and then I'd almost hit him coming forward. It was funny.

My knee is feeling good today. I hope I don't get as sore as I did after last week's snowshoeing foray. I came in and stretched for 30 minutes. The therapist said if I had done this last week I wouldn't have gotten so stiff.

There is still a lot of snow out here, and more on the way. We're expecting a Nor'easter.

12 Days of Anxiety

Yesterday was 1 month since my skiing accident. Here's a pic of me taken at Penn Station in NY 1 week after the accident.









Twelve days until ACL reconstruction surgery. In some ways, I feel like I'm getting ready to go away on a big trip. I have all this errata to take care of before I'm laid up. It creates a little excitement until I remember that I'm just getting ready to combat pain, atrophy and cabin fever with painkillers, DVDs and physical therapy.

On the upside of things, I can walk around without crutches or brace. I'm taking the stairs faster than ever. And I don't need to take painkillers at night to sleep anymore. It is nice to see improvements. In fact, I'm already sort of forgetting how it felt to be practically immobile. (Guess I'll get reintroduced to that shortly.)

I've been a little slow getting on with the PT. I'm supposed to get on an eliptical machine or stationary bike every day for 20 minutes. I haven't gotten around to doing that because I'd have to join a gym. I do do the stretches and some strength exercises at home. It's giving me a way to catch up on Six Feet Under, Season 2.

My first get well card

March 11 -- Forever known as "The Day I Tore My ACL"

I had a bad spill on the slopes. I was taking a jump in a terrain park on Bear Mountain. I landed unevenly, caught an edge, lost my balance, went off the ledge of the backside of the jump. Crashed hard on my feet. My skis didn’t release. I had to be taken down the mountain on a sled! Spent a few hours at the ER at Dartmouth. I have a torn ACL and a fracture on my tibia where that ligament attaches.

This photo shows bruising from the fracture.


Luckily our friends Wayne & Monique were able to take care of me last night as Brett had left VT on Saturday to take a flight out of NY to Beijing. I was suppposed to drive back to the city last night with them. Instead we spent the night at the hospital and pharmacy. I’ll either go back to the city with a friend from Dartmouth on Wednesday or wait for Brett to come get me on the weekend. Brett gets back to NY on Thursday.



In terms of pain, last night was bad. At first I didn’t think I’d be able to get out of the back seat of the car without passing out from the pain. Wayne had to carry me from the car to the door. I thought I could scoot up the stairs backwards, but was overwhelmed by nausea from the pain after moving up just one step. Wayne ultimately carried me the rest of the way up the stairs and into the bedroom on the first floor. (Thank GOD for Wayne and Monique! And thank God Wayne works out with weights and could carry me.)



I’m glad to report that today is much, much better. I’m propped up at the kitchen table typing emails, making phone calls, and doing fine. My leg is elevated and in a brace. Now I’m trying to decide if I should bother to follow up with an orthopedic person out here this week (Rutland, VT is supposed to have a good orthopedic group that treats professional skiers) or just wait to follow up in NY next week. According to the ER attending I’ll probably have to have surgery. So much for spring skiing this year.