Knee stress

After the news about my surgery last week I had a lot of strong emotions, I just wanted to go home crawl up in a ball under a blanket and cry, yep that was basically it.

But we (I went to the hospital with my mom) had a lot more scheduled that day, so I just had to suck it up, something that I’m pretty good at in general.

We went and checked out the rehab hospital in Amsterdam, I didn’t like it, but mostly I didn’t like the idea of it at all, all in all Amsterdam is a no go for those 6 weeks of rehab. Luckily I had 2 options. After that it was time to go to physio, I told her the plan and broke down and cried, I was mostly upset about the long period that I had to be admitted in a rehab hospital. She comforted me by telling me we would find a good place where I would feel okay.

After that we went to my grandfather and all in all it was a long day and I was exhausted by the time I returned home.

By that time I got in a state where I didn’t want to talk about at all, I just wrote my blog and that was it for a few days. I continued the prehab with physio, to get me in the best place possible for surgery. But my knee gave out again,….. it is getting lame, come on you can make it, it’s just 3 more weeks. I have been in an increasingly amount of pain and have been put on painkillers and anti-inflammatories to keep my knee happy and calm. Walking is not really happening anymore these days, well I guess I’m just easing into the stage where I can’t use my leg for 6 weeks. And it is harder than I thought since the other leg is of no use. So I do realize that those 6 weeks in a rehab hospital are extremely necessary, there is no way I could do it at home, safely.

I checked out the other rehab hospital this week and I liked that one better, so I guess I’m starting to feel better about the whole thing. Heliomare is near the beach and has younger patients, the whole atmosphere in general just made me feel better, and there are a lot more sporting options.

Wednesday I had my consult with the anesthesiologist, talking through my options and what I wanted. General anesthesia, that is clear there is no way I’m staying awake for this one, way to stressful considering what happened in 2007. They wanted to give me a nerve block for the postop pain but the surgeon doesn’t want that because he can’t test my nerves that way.

And that just makes me a little stressed, I have felt calm about the procedure itself, comforted myself by saying it won’t happen again. But the truth is that even though chances of it happening again are slim there is no guarantee. The doctor has been honest about that, even though they have an idea why it happened they are not sure. The surgery in 2007 left my right leg paralyzed, the surgery took approximately 100 minutes during  that period there was no blood flow in my leg, my muscles didn’t got enough oxygen got ischemic and died.

So 100 minutes of surgery can’t be done, but with a good planning that long won’t be necessary, but how long is safe for me? How much can my muscles take? A hundred minutes is considered long for ACL surgery, most ACL surgeries won’t take that long, it also is the maximum amount you can have a limb without circulation during surgery.

So in general 100 minutes is safe, borderline, but safe…. Not for me apparently. The thing is no one knows how long is safe for me, it is to be expected that I should be ok if they manage to drastically decrease the amount of time without blood flow. That’s why we chose for a procedure with a donor graft, they can prepare that graft beforehand and that way save a lot of time. Normally they will take a graft from either the hamstring or patellar tendon and prepare a new ACL out if it during the surgery, with a donor graft I save that chunk of time.

Doing the surgery without the tourniquet so with blood flow isn’t safe because the visibility is not good enough and I will lose a lot of blood that way.
I trust this surgeon a lot, and if anyone can do it he can. But there is no certainty and that makes me stressed. And I guess I started realizing that it freaks me out when they explained me that I couldn’t have a nerve block for pain control, because the nerve testing is more important than the most effective way of pain control in my case…

Well I will have morphine and be very enjoyable for other people.

Cathing up…. Injury update 

Never ever has there been a gap this big in my blog, oops.

I still owe you guys the story about my Whistler adventure in July, I have tons of pics, but that still has to wait.

Usually when there is a gap in my blog it means that I am either confused or injured or both…

Well I guess I am both.

All though it is not like I haven’t been blogging at all, I have been blogging on my Vancouver blog. So there are a lot of stories over there and a million pics, even the promised Whistler pics, just follow the link pictures at www.annikainvancouver.blogspot.com.

Injury

On July 18 I fell while free skiing slalom, I was just moving through a turn when one of my ski’s lost control, my left knee hyper extended and I fell.

The coach on top figured that this was a bad fall and worried, but I felt ok, no pain.

So I got back up and skied down, before entering the line for the T-bar I went over a small bump and realized my knee acted ‘dodgy’. I didn’t think too much of it but decided not to ski anymore that day. I went home and iced the knee although there was no sign of swelling, I did have a limp and a small problem with full extension.

Later that day I went to the club cabin for dryland and after 45 minutes of cycling my knee was as new, limp was gone and extension was fine, I thought it was just a muscle thing and did the rest of the training with my group, no problem.

At the end of the training we did some balance stuff and walked the slackline, I had a lot of fun mastering the slackline.

I stepped on the slackline took a few steps but then realized that holding my balance was a lot harder than it used to be, I ended up losing it and jumping off…. To save myself from falling. I had jumped and landed on one leg, my left leg, a million times before, but this time something went horribly wrong. I landed and my knee totally gave out, there was a moment of full seperation (according to one of the trainers that saw it happen), I felt my lower leg move in sideways, my body move out and my knee sliding and separate. I screamed so loud and cried an rolled over the floor holding my knee, that was back in place again at that time.

After icing for a little bit the pain faded a bit and my muscle spasm kicked in, ultimately stabilizing my knee. I had it checked up but my muscle spasm was to severe to say anything concrete at that time, also I had a very limited amount of swelling.

So even though in that moment I was sure that my knee was completely blown I started to think that it still could be ok.

I could still walk, with my leg spasmed bended in something like 20 degrees, so I was limping badly, extending the leg more was impossible.

Three days later I returned to the city, Vancouver, and that was the moment my muscle spasm started to wear off. Walking became more difficult and I started to get some pain and swelling. The next day I was diagnosed with an ACL tear. Long story a bit shorter. The first month I was doing fine, I had a brace and used the wheelchair but still walked ok.

Then after about a month my knee gave out again, on the beach, even though I was wearing my brace and taking it easy. And from that moment on my knee was bad. A long discussion with my health insurance, because the doctor wanted to do an urgent mri. It was denied at first. Finally on September 9 I got X-rays, and they found an ACL avulsion fracture, meaning that my ACL broke out of the bone of my tibia, explaining my pain. And also putting me on a none weight bearing regime, in the wheelchair.

Still the insurance didn’t think I needed a MRI, after a long time with a lot of doctor’s giving their strong recommendations both in Canada and the Netherlands, the insurance said ok.

The MRI was done the next day (October 4), in a place with a 7 month waiting list that is quick. I got the results a day later confirming I had what they called an unhappy tried or blown knee, The ACL was broken off like I already knew but also sustained a full tear, the MCL was damaged just like the meniscus.

Looking back it is hard to say what happened when, but looking at the injury mechanisms the professionals have an idea. I probably sustained the avulsion fracture during my ski crash, it is explained by the hyper extension and high impact. Also this could have left my knee still reasonably stable if the fracture stayed in place, that’s why I didn’t notice too much problems.

But when I jumped on it, it couldn’t help but give out, ripping up the rest of it.

It was a long road so far but in November I took my first steps.

On November 10 I traveled back to the Netherlands in business class because of the knee.

November 14 I had my first check up with the surgeon in the Netherlands. We decided on a prehab period with a checkup after 6 weeks to decide on a plan for surgery.

Prehab; meaning pre rehab, before surgery to optimize outcome.

I started a 4 times a week physio schedule and made some great progress, starting out with Compex to get more control over my muscles.

But soon I moved to the real stuff, with leg press, squats and step up. I also started cycling and I even was able to do some track cycling, that went very well (but I’ll write a separate post on that). All in all prehab was going well, I am able to legpress 100kg. But balance, coordination and walking remained bad. I can walk about 200-300 meters with a very bad limp and a lot of effort, that used to be so much better and easier. Also the knee remained unstable, it gave out again damaging my LCL leaving me with 3 out of the 4 ligaments damaged.

So yesterday when I returned to the surgeon for my checkup we decided on surgery.

I will have surgery on January 27, during this procedure I will get a donor tendon in my knee for my ACL. The MCL and LCL will get checked and repaired if necessary, both meniscuses are damaged and will probably get trimmed.  I will stay in the hospital for the first 5 days and then move to a rehab hospital for approximately 6 weeks.

My situation is complex and with the other leg being paralyzed I probably won’t be able to take care of myself properly during that period. After 6 weeks the new tendon will be grown in and I will be allowed to walk a bit on it again at that point it is save to return home. I hate it to stay hospitalized for so long I really value my space and freedom, but I do realize that it is in my best interest to protect my knee.

That is the story so far, to be continued.