Down On One Knee. Very Down
About 10.8 million visits per year are made to physiciansí offices because of a knee problem [1]. It is the most often treated anatomical site by orthopaedic surgeons.
As long as I can recall, Iíve had knee problems [2]. As a kid my ìtrick kneesî would sometimes cause problems as I played baseball. Riding a bike I would sometimes feel some odd clicks and pops, strains in my right knee.
Despite being a very good hitter, and a better-than-average fielder, I was never much of a speedy runner. As an adult a friend on a softball team commented that it was clear how bad my knees were, just watching me run. And he said, ìNo-one ever taught you how to run, did they?î Well, gee, I never new one could be taught how to run. Did this get put into the curriculum after I was finished being a kid?
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In college I took a stumble that blew out my right knee. A series of visits to Dr. Joseph Milgrim, then considered tops in the Orthopaedic field, was illuminating. Given the x-rays and what he could learn from poking about, twisting, and generally probing, inspecting and exploring my knee, he came up with a diagnosis. ìYour knee is all but shot,î he said. This was back in 1972.
He presented three options:
#1: Have surgery to attempt some repair. After the surgery it would be six months in a wheelchair, another six months on crutches, then probably six months using a cane, and after that, possibly resume normal walking. But possibly be afflicted with a limp if all did not go well and heal to the optimum.
#2: Do nothing and see if it just heals, or be stuck with a blown-out knee and always have some trouble walking. Never run again, never participate in sports, abandon any hopes of ever becoming a male Rockette.
#3: Take his experimental but so-far-so-good procedure. That included using a special bandage. Much like a regular old Ace bandage, except this was a super strong, elastic-mesh sort of material, used on racehorses. Acquire the bandage, let Dr. Milgrim show me how to properly wrap (and, actually, set) my knee. Do some exercises, always with the bandage in place, and use this unorthodox procedure to strengthen the knee, and allow nature to take its course and rejuvenate the knee. Also, the whole time, be aware of the risk of this option, as the success rate was a little less than 50%. And know that the surgical option was still there if this did nothing after 90 days and I wanted to abandon the bandage method.
I chose #3. After about six months, the knee was significantly better. Not perfect, but then again, who ever knew from perfect, what with ìtrick knees?î
By the late1970s I was playing some baseball (well, softball, really) again, always wrapping the knee before engaging in any baseball or other sports. Some day I might scan and post a picture taken of me at the plate, just as I had hit a home run, in the follow-through of my swing. Watching the loft of the ball, the catcher and I are both fixed on the trajectory. This was in the public ballfields in Rockaway, NY, just over the Neponsit Bridge. I can still smell the air, remember the pitch, and feel what it was like to connect and know in an instant that the ball was gone, over the fence.
In the very early 1980s I was jogging for a brief period of time. Jogging, however, was not the pursuit for me, for my knee, or my general temperament. It also gave me shin splints, so I happily abandoned any further thought of ever jogging again.
Fast forward to the mid to late 1980ís, and I am on a volleyball team and a softball team. No longer wrapping the knee, feeling like I am back in decent shape.
Oops.
Little did I know that Volleyball, with all that jumping, was about the worst thing one could do to precarious knees. In a late Spring evening softball game I hit a shot to right-center, and was running from 1B to second, when suddenly my wobbly right knee fell out from under me, and fell out of joint in the process. I fell to the ground with it, and couldnít get up. My uniform pants leg was ripped, and various members of my team and the opposition were grossed out, freaked out, or peculiarly fixated with my out-of-joint and quite misshapen knee joint. Two fellows lifted me up to walk me on their shoulders to the bench. I then snapped it back into place, felt the most piercing pain ever of my being, and decided to go see a doctor.
As for the ìself-snappingî of the knee back into place: this is not recommended for those of you at home to try. See a doctor. Go to the emergency room. Get a pro on the case.
So in July of 1989, after a few visits to a renowned Orthopaedist (former Yankees Team Physician, knee-doctor to the stars of the sports world) some x-rays, therapy, exercises and frustration, we schedule surgery.
Even back then, still in my 30ís, ever optimistic and hoping to resume playing softball, I get the news: my knee is far gone. I am already a candidate for knee-replacement surgery. But this go-round will be some reconstruction and repair, a lateral release, clean out the shredded cartilage, reset the torn and offset ligaments, and improve the bone movement. Frankly, just being able to engage my kneecap in something approximating normal seemed like a fine concept to me at that point.
Walking stairs had become a major difficulty. Walking any distance was pretty tough. And running (despite never being taught how to do so properly) was out of the question!
The doctor warned me that the surgery might not be a success. Could be it would be all for naught, but worth the effort. If nothing else, it would relieve the pain and help to reset the joint, the bones, the general structure.
The operation, actually five surgical different procedures, was pronounced by the surgeon to be a moderate success. ìYour knee is never going to be 100%, and we found more damage when we were in there than weíd thought. But we did a lot of repair, reconstructive work, and now you can rehab it. But donít expect to run the marathon anytime soon.î Then he gave me a series of exercises to do for the rest of my life.
And he made sure to remind me that I was as likely a knee-replacement candidate as heíd ever met. There I was, not yet 40, being told a knee-replacement was in my future. In 1972 the leading knee doctor in New York said my knee was shot. In 1989 the Yankeesí Orthopaedist declared me a future member of the knee-replacement society.
Which brings us to 2002-2003.
Back in October the knee began to cause me some distress, more than the usual or occasional aches to which Iíd become accustomed. Walking stairs had become a source of some minor discomfort again, on a regular basis. Walking any duration also was a source of considerable knee pain. I began to keep the cane in my car, as there were times the knee was just giving me arthritic woe, and the cane enabled easier walking.
In November I noticed some swelling, and more consistent pain. Come December, I decided to get back in touch with the doctor who did the surgery in 1989. He has since retired, so it was time to find another Orthopaedist. Research and recommendations led me to another doctor of significant renown, an authority in Sports Medicine , and the team physician for the New York Knicks. Only the top NY Sports team physicians for my formerly-athletic knee!
My annual December travels [3] and a snafu in my insurance coverage forced me to move back my plan to make an appointment with the newly recommended doctor. By the time I returned from the December travels, it was getting harder and harder to walk. By January, I was on crutches, and in constant and rather severe pain, and the knee had swollen pretty badly. I visited my GP, who made an emergency referral to the Orthapaedist. He also prescribed some pain killers [4], and told me to get right over to see the specialist.
Fortunately, given the urgency and severity, the specialist agreed to see me a day later. No more waiting until the end of the month to get an appointment ñ this time it was ìcome right in, we will make room for you, given the circumstances.î A friend drove me in, on one floor they took x-rays, and then it was up to another floor for the appointment.
Despite this being a New York City doctorís office, there was virtually no wait! And this was an appointment that was ìscrunched inî during a day when there had been no openings or cancellations. But no sooner had I completed the paperwork and sat in the (very crowded) waiting room, when they called my name and into the examining room I went.
A look at the x-rays, some twisting, turning, bending of the knee (ouch!), some discussions, and then comes the diagnosis and the plan.
All sorts of damage is apparent from the x-ray, the swelling, the reactions to the twisting, maneuvering, et al, and the description of the pain indicated other problems, not all of which are so readily visible on the x-ray.
Next step is an MRI for a closer look and some more in-depth imaging.
The there's exploratory surgery around the corner, to determine which of three possibilities will be in my future:
1. While doing the exploratory surgery the Orthopaedist sees how easy it will be to remedy things and does just that right then and there;
2. While doing the exploratory surgery the Orthopaedist sees that the reconstruction and such and will require more time and schedules me for a second go-round to do just that;
3. While doing the exploratory surgery the Orthopaedist sees that all is beyond saving, and schedules me for knee replacement surgery.
He prescribes some additional pain killers [5], tells me to stay on the crutches, and to rest it as much as I can. I explain that it only hurts when I breathe, and that leaning back on my recliner chair with my right leg propped up on a pillow on the armrest is where I am able to sit still with the least amount of discomfort. Ah, the joys of Osteoarthritis, and a debilitated knee.
So now I am on potentially habit-forming pain killers. But they are more like brain-killers than pain killers! I feel like the 3 Dwarfs: Woozy, Groggy and Fuzzy. My mental acuity while on the pain killers is not up to snuff. Off them I am sharper, but in something akin to agony.
Now I am waiting for the HMO to anoint the nearby MRI facility. The Orthopaedistís office said it usually takes up to 48 hours to get approval. Not counting the Martin Luther King Day (observed) Holiday, it has now been three business days, so hopefully the approval comes today or tomorrow. If so, then later this week I go for the MRI, next week back to the doctor, and into that exploratory surgery, with any luck, the following week.
Not that I look forward to undergoing surgery. But getting this behind me, either via remedial, reconstructive, and/or replacement surgery, will be a pleasure. Surgery followed by whatever the rehab process will be, and I will be resume walking, without the aid of a cane or crutches.
There is a silver lining in this cloud --no, not the silver as in that graphic of the replacement kneeóafter years of being urged by friends to get a Handicapped sticker for my car, I am finally breaking down (no more superstition!) and getting one. Once I can drive again, that will make for less walking, and less driving around looking for a space!