Just What I Kneeded

What happens after a life-altering knee injury?

The cracks in my facade

17 Comments

“What are we going to do with you? We can’t shoot you…” Very reassuring words from my OS. Glad we’re clear on that point.

Actually, I cracked up when he said that to me. We’re both pretty frustrated at this point, and I appreciate his ability to bring some levity to the situation.

Last week was a total whirlwind of doctor appointments and treatment plans and insurance. I saw my primary OS early in the week, and the long and short of it is that he agreed with the second opinion OS. What does that mean? That means that I have a new chondral defect in my lateral tibial plateau with a degenerative bony cyst, a spot on the medial side of my patella that didn’t fill completely with the DeNovo graft with bony edema indicative of patellar overload, significant scar tissue in the anterolateral area of my knee, and significant signal abnormality in my patellar tendon indicating patellar tendonitis. There were a few other inconsequential things noted, such as borderline patella alta (kneecap sits too high), a 9mm lateral subluxation of the patella (within normal range), and a bone island on the medial femoral condyle (a harmless deposit of compact (hard) bone in the cancellous (marrow) bone). But what does that all mean? That means that both surgeons agreed that I need additional surgery to address the issues.

The kicker was that, while he agreed with the suggested surgery, my primary OS said he thought I would have a better chance for a positive outcome if the second opinion OS did the surgery. I really appreciate his candor (more than he knows), but… suck. I have zero desire to go back to the second opinion OS. By all accounts, he’s an excellent surgeon and one of the leading experts in the country for cartilage restoration. Doesn’t matter. I left my last appointment with him feeling like he had no real interest in helping me; I was in tears before I made it to the parking lot (and, as I’ve mentioned before, that’s not my normal reaction to anything). I’ve decided that I won’t go into detail publicly here because perhaps he was just having a bad day. I’ve been trying to give him the benefit of the doubt, but that doesn’t change the fact that I don’t want to go back to him.

I diplomatically expressed my feelings to my primary OS when he was talking about sending me back to the second opinion doc. He mentioned there was another cartilage expert within a half-day’s drive that I could try to see, if my aversion was really that strong. I’m not sure how reasonable that is, given that my aversion is based on personality and communication, rather than actual surgical skill. He agreed to ask one of his partners if he thought he might be able to do the surgery, but he didn’t seem to think he’d tackle it either. I am rational enough to know that I should not be making these decisions based on whether or not I like the guy, but it’s hard not to take that into consideration when you’re trusting him to cut you open and fix you up. You want someone you believe truly wants to help you. Plus, you have to go back for all of the follow-up visits. I would go to him for the surgery, if that’s really the best option. I wouldn’t be happy, but I would do it.

I asked what I could do in the meantime because no one wants me to be on the narcotics, least of all me. He said that we could try Euflexxa injections again (apparently, Euflexxa has the least amount of chicken goop in it and isn’t as likely to cause allergic reactions). I was waffling whether or not to go through with them because they didn’t seem to help much last time, and my doc didn’t exactly inspire confidence when he said it’s not going to hurt to try them because “we’re just grasping at straws.”

As I was busy waffling, I got a call to schedule the injections. And to let me know that the partner had said he would do the surgery. But first, he wanted to meet me and discuss what he’d be doing. So I suddenly had an appointment to meet a third surgeon the very next day.

I like this guy. He’s open and straightforward–blunt, really. But I like that he didn’t beat around the bush. He looked over my scans, examined my knee at length, listened to my history, and… told me that surgery would be a really aggressive move right now. Say what? I just had two surgeons tell me that I need to have surgery, and I totally went into the appointment with the understanding that we would be discussing what he’d be doing during the surgery. He thought a better course of action would be to have the Euflexxa injections and try another round of physical therapy with a new therapist. (Nothing against my PT! He just said that all therapists come to the table with their own experience and ideas, and a new one might come up with something different to try.)

He also said of the surgery that “doing the same thing over and expecting different results is kind of the definition of insanity.” Yes, but that definition could also easily be applied to the injections and therapy. Been there, done that, got the t-shirt.

I have to admit to being confused and unsure about what I need to do. Because all three docs agree that the injections shouldn’t hurt anything, that seemed to be the path of least resistance. I got the first injection yesterday. Nothing to it. My primary OS’s PA does the injections, and she’s awesome.

I think, for the first time, the cracks in my facade are beginning to show. I’m having a lot of trouble mustering up any enthusiasm or optimism for this next phase. I’m going to give it my all, but it’s just a different feeling now. Before surgery, I was all gung-ho, let’s do this! Now, I’m more like, ok, I can try, if I have to, I guess. It’s kind of a weird feeling, and it needs to go away.

* * *

p.s. Writing that last bit reminded me of The Red Green Show. The Man’s Prayer. “I’m a man, but I can change, if I have to, I guess.” I used to love that show, but I haven’t seen it in a long time. My favorite quote was, “If it ain’t broke, you’re not trying.”

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Author: Laura

I have a fern I named Frankenstein. I like leprechauns, practicing kung fu moves on my dining room furniture, and pretending that one day I will move to Fiji. I dislike my neighbors' kids, anything that is chartreuse, and Ben Roethlisberger.

17 thoughts on “The cracks in my facade

  1. I feel for you…deciding about surgery isn’t easy in any case, and it gets harder when you’ve got evidence that doctors can’t guarantee a final outcome of “fixed!”

    Since more DeNovo seems like the centerpiece of the suggested operation, do you know personal outcome stats for the procedure for each of your potential surgeons? There really does seem to be huge variation depending on the particular surgeon’s technique, and getting each of the surgeons to quantify their results could give you important information. My 1st and 3rd opinions both said DeNovo was not the answer, that outcomes were 50-50, so PT and shots were worth trying first. My 2nd opinion, however, said that his own personal track record is around 85% in terms of grafts growing into adequate-to-good quality fill. He’s the one I picked. I didn’t want to kill more time and let the pothole expand when there was another doctor whose stats said he could make the procedure work. It was the numbers that made the choice for me…I feel that if the other guys had gotten success rates higher than 50% with DeNovo, PT would’ve been lower on their list of recommendations. I’d want to know if your third surgeon’s advice is coming from a similar situation.

    You’re in Indiana, right? The first results on DeNovo were published by Jack Farr, who’s with IU (I think) and practices here: http://www.cartilagerestoration.org/. If he’s not already one of your three, and if your insurance will cover him, I’d say he’s worth a trip.

    You probably know Marc Rubin’s DeNovo blog online. He mentioned having some kind of stem cell injection that they only do in Denver…I have no idea whether that turned out to be a productive procedure or not, but it could be worth looking into. Regenexx, I think it was called?

    Here’s a clip from my “oh crap, I need MORE surgery?” theme song for you: http://splicd.com/SEZrBw6mcSM/35/41 This actually started playing on my ipod exactly as my knee was buckling under me while jogging last summer, which was both painful and hilarious.

    • Bwahaha! That is an awesome song for these knee situations. Love it.

      Yes, I’m lucky to live in a city with a leading expert in cartilage restoration, and he is one of my three. I did a lot of research before the surgery, so I knew I was in a lucky spot being so close to the experts.

      My primary OS mentioned PRP, which I think is a bit different from the stem cell injections, if I understand it correctly. I have read Marc’s blog “cover to cover,” and he definitely tried a ton of different things. I’m a little stuck with what insurance will and won’t cover. Unfortunately, it won’t currently cover PRP or stem cell injections. Hopefully, that will change as more research becomes available, but it likely won’t happen in time to help me.

      I’m glad you said something about how PT might have been suggested if his personal success rates with DeNovo aren’t great. It’s actually been bugging me that perhaps the injection/PT route was suggested because, while he says he’s willing and comfortable doing the surgery, he’s still hesitant for some reason. I thought maybe I was just being paranoid. I am with you; I don’t want to spend time trying things out only to end up needing the surgery in the end anyway. And there’s always the potential that the problem could get worse, for sure. Heck, the tibial plateau came on in no time flat, and I wasn’t even doing anything other than prescribed PT.

      I will see my primary OS next week when I go in for my second injection, and I plan to follow up with him about the third opinion. I’m just going to hang tight until then. Mostly because I don’t know what else to do. :)

  2. I am recovering from a extremely similar surgery (8weeks post op). Your blog was one of only a handful I could find on the procedure. Keep your head up!!
    Below is an OS site, this office is awesome! Probably a drive for you, but thought I’d give you their info just in case….

    http://www.eandbortho.com/

    • I hope your recovery is going well! Thanks for providing the link. It’s always refreshing to hear when someone really likes their physicians. :)

  3. WOW! That really sucks to hear that. On the bright side your not crazy. You knew something was not right and you did what you had to, to find out even if it meant going to another doc. a lot of people would have just accepted what one doctor said. You ended up seeing you three different doctors. like I said at least you know what’s going on that’s half the battle, sometimes that’s the hardest part is not knowing. No surgery will suck if you have to do it again or when you have to do it again. At least this time you’ll be more prepared on what to expect and have a very long conversation with the anesthesiologist about what makes you sick and hopefully that will help with the after part. Just hang in there!

    so what does the third doctor I think you should do now, if he doesn’t think you should do surgery right now?

    • Hi Jesika! Thanks for the encouragement. The third doc thinks that I should try the Euflexxa injections and then PT one week after the third injection. So I went ahead and got the first injection since none of the three docs think it’s going to hurt anything. I feel like it might at least buy me some time to make decisions about the surgery.

      How are you doing?

  4. things are going really well, thanks for asking. This month marks 6 months from my surgery. This month I have been winging myself from my off loading brace. it’s been weird walking without any support but all in all it’s been good.

    • That’s fantastic! I’m so happy to hear that things are going well. I imagine that walking with no brace after six months really would be weird, but I bet it also feels kind of good. :) Keep up the good work!

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  6. Hi Laura, I’m sorry that you are going to have to go through another surgery and that you are still having to deal with the issues of the first one. I’m almost 6 months post surgery (same as yours) and as of the end of May everything was healed, was done with PT and was given the green light to do whatever I wanted. I drove down to my moms for the summer because my husband is deployed and got a membership to build up my leg strength. Started off really slow and minimal weight and stayed away from running because I knew my leg was not ready even though my doctor told me that I could. About two weeks of that and we go out to celebrate my birthday and while doing minimal dancing I hear a loud pop and down on the ground I went. :( I ended up with a CLOSED FRACTURE OF UPPER END OF TIBIA. :( I am now back in crutches & the bledsoe brace and have to be non weight bearing. I was so happy to be free of the brace, the crutches, PT and everything that involved the surgery. I was so ready to get back in shape because I have manage to gain back 30 pounds since my surgery. All very frustrating. I really hope that once you are strong enough for your next surgery that it goes well for you and that you have a speedy recovery.

    • Oh my gosh! While I’m glad to hear that your initial surgery was a success, I’m SO sorry to hear about the recent fracture. My goodness. Did it fracture around the screws? I hope that it heals quickly and uneventfully so you can ditch that brace and the crutches again. I can imagine the frustration; especially when an injury happened while you were doing something that shouldn’t have caused such problem. It’s very frustrating. How long will you be non-weight-bearing?

  7. It fractured just below the second screw. I got another x-ray on Monday and looks like the fracture has gotten bigger and almost all the way around. I honestly don’t know what is holding it in place. I have to be non-weight-bearing for another 3 weeks. He said he will do another x-ray then to see if its healing and if it is then he might let me start putting some weight on it and possibly let me start working on the bike. I think this time around I will take a few months of not doing any weights as far as my legs are concerned so that I don’t end up injuring myself again. And yes it is very frustrating when you are trying to do something good for your body and it continues to fight you every step of the way.

    • Hi Yansi,

      How is your leg doing now? Has the fracture started healing? Thinking of you and wishing you the best!

      • You are so sweet. I went in at the end of last month and it is not doing anything. The fracture is still pretty noticeable and the doctor said that if it doesn’t start to do something on its own that we are going to order a bone stimulator to get things going in a few months, but I’m not waiting that long for it. I plan on asking for it at my next visit so that I can start healing and so that I can go back home (At moms right now since my husband is deployed and have no one else to help me out). It is very hard on my body having to carry all my weight on one leg. The doctor told me that I can put a small amount of weight on the left leg but I’m afraid to do so because I don’t want to cause more injury to the leg. :/

        I was glad to read that you are having less pain now and that you are riding your bike again. I finally made myself stretch out because I can tell that my body has gotten really tight from lack of movement. I’m suppose to go back to the doctor on the 23rd of this month so we shall see what he says then.

        • Oh goodness. I’m sorry to hear that the fracture isn’t healing very quickly. I don’t blame you for not wanting to wait for the bone stimulator; it seems like everything is such a wait with these leg injuries. Crutches are incredibly difficult on the body, not just on the one good leg, but the arms and shoulders as well. I luckily wasn’t on crutches long after surgery, but I was NWB for eight weeks after the initial injury, so I can commiserate a little bit.

          Stretching must have felt good! Do you use a foam roller? I don’t really have a comment on those, just curious. A trainer showed me how to use them for my leg at one point, but I have to admit that I don’t really use one.

          I hope that your bone starts healing soon so that you can get back home (that’ll be good for mental health, I’m sure; just being more independent) and back on the path to recovery. Sending good vibes your way!

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