Day 840: Surgery Part II

What labels define you? Human, husband, engineer, painter, writer, philosopher? Some labels are absolute. The arrival of my first child made me a parent. There was no ‘sort of’ about it. It was a biological absolute. But some defining labels are applicable only by degree or based on some subjective or undefined secondary criteria. At what point do people who run become "runners"? If you can survive a misstep that leads you into the deep end of a swimming pool, are you therefore a “swimmer”? Or do you need to swim by choice on a regular basis? Sometimes there are measurable criteria that can warrant a label. Crossing the English Channel without a boat, for instance. That would certainly qualify you as a "swimmer". Not to mention a bit compulsively ambitious. If the label describes your primary means of employment, then surely that’s what you are, at least for the moment. But what if it’s just a hobby? Lots of people take pictures. And yet clearly they're not all "photographers". Most people know how to ride a bike. But that does not make them all “cyclists”. I began considering this label idea a few weeks ago when a co-worker found out that I play guitar. “Oh, you’re a guitar player,” she naturally concluded. I responded by clarifying the extent to which I felt the label was appropriate. “Well yes, I play a little bit.” The fact is, I’ve played a little bit for the last 25 years but I'm still not sure that makes me a “guitar player”.

This morning I revived a label I was more than happy to be rid of for a while. “Are you the patient?”, I was asked. “Yes”, I answered somewhat reluctantly, “I am the patient”. This is one of those absolute labels. It is something you either are or you are not. Yesterday I filled out all the pre-surgery forms and liability releases for a second time and went through all the preparatory rituals, and invisible shudders, and second guessing, and today I was once again a “patient”. After two years of struggling to recover from knee injury and surgery I finally decided that it was time to go under the knife again with the hope of resolving at least some of what was still not quite right with my knee. And so this morning I shaved the offended leg, got hooked up to the IV line, and climbed up onto the table once again.

I was in the same operating room with the same surgical staff as the first surgery. I woke up in the same recovery bed and I was wheel-chaired into the same elevator that led down to the same valet parked car as before. Now I'm lying in the same fold-out bed in the same San Francisco loft with the ferret hazards, the blood red walls, and the giant stuffed and mounted zebra head. The same crutches, ready once again at the side of the bed. The hum of the same ice-machine and the mildly nauseous mind numbing post-surgery anesthesia hangover, both present and accounted for. Thankfully, even on days like today, there is a strange comfort in the familiar.

" Right now I'm having amnesia and deja-vu at the same time.
It’s like I've forgotten this before. " - Steven Wright

A few things are different this time though. Most notably, so far the pain level is quite tolerable. That said, my knee is still entirely numb from the local anesthetic so I’m enjoying my condition with guarded enthusiasm. The nurse pulled out the “it’ll get worse before it gets better” card to properly set my expectations of the next couple of days. On the official surgical scoresheet, this second procedure was listed as a "Major Debridement and Chondroplasty".
Major - Involving multiple areas or surfaces
Debridement - Removal of foreign matter or dead tissue from a wound
Chondroplasty - Surgical repair of cartilage
Meniscectomy was a late add to the agenda as yet more meniscus damage was found once they got inside my knee.

Although this procedure was considerably less traumatic than the original surgery, the decision to venture into the surgical fun house again was far more difficult the second time. Surgery was the obvious - the only - reasonable choice in the first round. But this time I already had a relatively functional knee. Day to day tasks were no longer a problem. Only the more aggressive activities were still an issue. Mountain biking, hiking, soccer - all caused varying degrees of pain. Still, with as good as my knee was doing I didn’t exactly expect the doctor to open it up and find he had accidentally dropped his car keys in there last time or anything. The symptoms were just not that drastic. So then how exactly does one justify the risk and expense of a second surgery? How much of our original selves should we expect to recover after a catastrophic injury? At what point do we become too greedy for improvement? These are questions I knew I couldn’t successfully analyze, so I just didn’t.

My post-op appointment is tomorrow morning - bandage changes, physical therapy, and a post-op evaluation including the review of a new set of amazingly clear endoscope photos (a deeply intriguing yet slightly stomach-churning part of the post-op proceedings). After that, I return home and start local physical therapy all over again. This has been a long road that just got longer at the end. It’s a bit like arriving at what you think is the top of a long climb only to find that the actual summit was hidden from view and is still just a little further up the trail.

Time for one final push to the top.

Day 600

First off, my apologies to those who have requested an update to this blog and heard in response only the virtual chirping of crickets. The need for a long overdue update has been lurking in the back of my mind regularly over the past few months. Also on my mind has been an overdue appreciation to those of you who have made the effort to read and post comments to the blog since the beginning. It really has meant a lot. So thank you.

As a half-baked attempt to rationalize my recent absence I have to admit that I had grown exceedingly weary of talking, writing, and even thinking about my knee. In the roughly nine hundred thousand minutes that have ticked off the game clock of my life since that Christmas night when my knee was folded into a trembling mess of torn connective tissue, there have been very few waking moments during which I have managed to be completely free of at least the awareness of my knee.

That said, there have actually been moments. Just a few months ago for example, in the midst of my one awkward excursion to a golf course every few years I actually shot a hole-in-one. Even for a reasonably proficient golfer (which I will never be), a hole-in-one is, on average, a significantly less than once in a lifetime event. But there was my blindly determined tee shot anyway, headed straight for the hole. The ball bounced twice on the green and then as it miraculously disappeared into the cup I jumped into the air with such unrestrained delight that I traveled to an altitude from which I already damn well knew the landing would be well beyond my knee's ability to comfortably absorb. I had, in that single wonderfully liberating moment, completely forgotten about my knee. The pain that shot back up to my eyeballs upon impact was a jolting reminder of my condition and although it was not enough to deter the celebration, my fleeting moment void of knee awareness was over. I winced a bit and continued to jump around like I had just won the lottery, only with slightly less spontaneity, from that point forward consciously crafting my leaps in the direction of my uninjured left leg for the remainder of the happy hole-in-one hop-fest.

The rest of the rationalization for not posting recently, aside from my overwhelming desire to just try to forget about it all for a while, resides in the simple fact is that if there were any knee related developments worth posting, I certainly would have done so. But the fact is that my knee has barely improved at all since my last blog entry in January. I now regularly walk down stairs, but still not without a slight shudder of pain just prior to my left foot touching down. I can now run, but only as fast as necessary to be the Center Referee for my daughter’s U-9 rec league soccer games. And of course I ride, but I’m still not fully able to hammer while standing on the pedals - and trying to do so anyway leaves my knee with a lingering ache for several days afterward.

My single biggest constraint with the right leg is still the fact that I cannot put pressure through it when it is bent. The more pressure, the more bend, the more pain. Keeping my bodyweight down has definitely helped but still I can only bend to about 60 degrees before pain overcomes the knee’s ability to support my weight. On the upside, I would estimate that the failure point was closer to 30 degrees a year ago - and so I continue to work on it and I remain hopeful that someday I will have full use of my knee again.

A week or so after my previous post, I finally quit physical therapy for good. Yes, I do realize that it hardly makes sense given the improvements I was making, but after many months of struggling through lengthy PT sessions I was beginning to question the cause-effect relationship between therapy and improvement. In fact after I quit PT, I did nothing physical at all for a few months. I didn’t run, ride, or work out in any way. I didn’t even do any general stretching or massage. And my knee actually felt just a bit better - most likely due to the fact that it was not being pushed, prodded, and strained in therapy every couple of days. And as I got back to focusing on other areas of interest, my knee and the PT sessions to improve it began to lose some of their importance in my life. Don’t get me wrong here - I definitely believe that physical therapy is an absolutely critical recovery element. But after a year of it, I was beginning to realize that I had moved well down the diminishing returns curve and it was time to cut bait.

The one year anniversary of my surgery passed in February without any special fanfare or consideration. Since then I’ve just been living my life. I’ve been working and playing, and generally doing whatever is necessary to keep things together at work and at home. I’ve been coaching and ref’ing youth soccer for both my girls’ teams. I’ve been playing guitar in three different actively gigging bands. And at the end of July I once again signed up for the Tour de Tahoe.

This year I had only 6 weeks to train for the TdT after 6 months off the bike so I knew it was going to be a challenge but I was determined to cram in as much preparation as possible. As I started riding every other day and eating more frequently, I quickly shed unnecessary weight, dropping back down from 165 to 148 in four weeks. And although my training rides were going well, I could tell I was not going to be quite as strong as I was in 2008. My average speeds were down by at least a mile per hour and my overall strength just wasn’t going to come back in time. And so it was that in a flash of brilliance so inconsistent with my deeply ingrained natural need to measure and control every detail that to this day I’m still not sure how or why I ever thought of it, I decided to do the Tahoe ride without a bike computer. I would have no idea how fast I was going, my average speed, my elapsed riding time, nothing. If you regularly ride with a computer, you know how nearly incomprehensible this idea is. I hadn’t ridden without some way to at least measure my speed since I was a kid. And that, as it turned out, was exactly the point. I have always had a bike and I have always loved riding. The reason that I rode as a kid was for the pure pleasure of riding. It is true that at this point I would feel less naked on a bike if I rode without pants, but riding without a bike computer leaves you with only one thing to focus on - the beauty and joy of the ride. And so that’s what I did. The six weeks of focused training rides were still necessary, and I still rode hard, even occasionally engaging in extended sprints with different groups of roadies, but I also backed off just a bit once in a while to enjoy the sights. At one point I slowed to ride with a couple on a tandem who were blasting 80’s rock tunes from a boom box tied to a basket hanging from the handlebars. It was an entirely different experience this year. No numbers, no stats, no results - except for the one simple result of a great ride on a perfect day with a bunch of wonderful people around a stunningly beautiful lake. Riding stats just don't get much better than that.

One strange result of my efforts to regain some riding strength again is that my legs are developing differently. Despite all the stretching and weight lifting and massage focused primarily on my right leg, it is my left side that is growing. My right leg has been thinner than my left ever since most of the swelling of surgery subsided but as of a few months ago, the difference between the two legs was not readily noticeable. Now, after being back on the bike for a couple of months, the asymmetrical development makes it look like I borrowed one of my legs from another body. I do realize that I still favor my right knee - getting in and out of the car or the bed or up and down from a chair or walking off the curb or in or out over the step at my front door. In all of these simple daily activities I still subconsciously employ my left leg to do the bulk of the work. Now it's apparent that I'm also pushing harder with my left leg even on intrinsically balanced movements such as pedaling.

Today I took my oddly asymmetrical legs out for the annual Oyster Ride, a one-way group mountain bike ride that begins in Mill Valley and travels over the top of Mount Tamalpais down to Point Reyes for oysters and beer. The route is only about 35 miles but there is a significant amount of climbing involved and some of the terrain is fairly technical especially in the last few miles of descent where erosion has cut deep ruts in the trail. Last year, just eight months out of the operating room, I did the ride with a reasonable level of caution so as to protect my newly reconstructed knee but on one of the final descents I was following another rider who went straight into an erosion hole and fell across the trail, sending me directly over the bars. I purposefully rolled to my left in the air and absorbed the full impact of the fall on my left side and back. My right knee never touched the ground.

This year’s ride was unusually rough - exceptionally hot and full of flat tires and other mechanical failures among the group. For my part, I was primarily intent on avoiding another unscheduled dismount. I rode well toward the front of the group all day and on the descents I left plenty of room to any riders in front of me. On one of the more deteriorated sections of the final descent my chain got momentarily hung up mid-shift and I looked down for half a breath to check it. When I looked back up I was veering just slightly to the right where years of erosion had quite unfortunately created a long shallow ditch running along the edge of the trail. Despite reasonably good bike handling skills and expert use of high quality profanity to help fend off the impending disaster, my normally well mannered front tire began to slide defiantly away from me into the ditch as I launched into a hasty 30 mph departure from the bike and emotionally braced for impact. My mind briefly flashed to the ending scene from ‘Over The Hedge’ wherein Dwayne the Verminator accidentally gets caught along with his client in the Depelter Turbo. He cringes knowingly and says, “Prepare for a lot of stinging….”

After a short and relatively uneventful flight I landed on my left side and slid furiously along the hardened surface of the sun baked trail, gradually donating the first few unnecessary layers of skin from my knee, hip, and elbow and embedding bits of earth and rock into the exposed tissue as unwanted souvenirs I would be forced to take home from my ride. When I finally came to a stop I instinctively grabbed to check my right knee - which was fine - and then I turned over, spit the accumulated debris from my mouth, and took inventory of the rest of my body while the blood began to slowly seep through my new protective outer layer of dust. As can clearly be seen in this artist’s rendition of the scene (included here with the gracious permission of my 5-year old daughter) another rider who was apparently saddened by my fall then came to offer me a band-aid.
Tonight I’m limping just slightly once again, and the stinging parts of my body are smothered in Neosporin. It looks rather like I shoved a bean bag just under the large bright red section of raw open skin on my hip. Certainly nothing serious, but an interesting reminder of what a fresh injury feels like. I opened, for the first time in about 18 months, the box of gauze and tape that I had once used to cover my various surgical incision points. It seems like a lifetime ago that I was changing post-op bandages and requesting refills for the ice pump. My journey back to a healthy knee is not over, but it has been long and I’ve learned a lot along the way. For the most part I’ve kept a pretty positive attitude about my injury, although I still occasionally have fleeting bits of bitter anger at my slow recovery. Toward the end of one of my training rides for the TdT, discouraged and disappointed by my low average speed, I began to blame my aching knee for holding me back. Quickly my mind started to spin with anger and resentment and I wished for the days when my legs would push as hard as I asked them to. It was just then that I noticed a woman in the distance. She was jogging with a slightly awkward stride. As I rode closer I could see why - her right leg was a prosthetic from the knee down. In an instant, I was thankful for my own condition once again.

Perspective, as it always has been, is everything.

Day 342

Let it be known throughout the land that on this, the 342nd day in the year of our most gracious and holy donated Ligament, a heretofore impossible set of stairs was descended, for so it was that pride of triumph was shared among all who witnessed the conquest. And there was much rejoicing.

– My ACL Chronicles, 33:342

Yes, I went down stairs today. Not a lot of them, and not without pain, and not without just a bit of a stutter just prior to my left foot landing with each step, but I did go down stairs – one at a time, and without even touching the railing – for the first time in well over a year.

I am amazed. I am thrilled. I am relieved to the point of tears.

During my PT visit last Friday, Craig worked with me on the stairs for a bit and then developed a theory that the severe pain that remained and prevented me from putting pressure through my bent knee may be due to scar tissue that had developed on my patellar tendons. To test out this hunch, he delivered some very focused and aggressive therapy above and just below the kneecap with my leg slightly bent so as to bring the tendons closer to the surface.

This was the first time a non-electronic therapy tool was utilized directly on my knee – the “jacknobber”, an oversized plastic jack, with different sized spheres on the legs. Despite what has become a vastly increased tolerance for discomfort over the past year, the jacknobber repeatedly brought me to my limits. I then went to the weights and did multiple sets of isometric leg extensions – at 90 degrees, at about 45 degrees, and then at near full extension. It was somewhat painful, but the endorphins were already flowing from the jack treatment so in a strange way the isometric pain actually felt good.

After a weekend of icing and rubbing and stretching my knee which was still significantly sore from Friday’s session, I came back to PT today, this time accompanied by my 8-year old daughter, and after the usual treatments and exercise I headed over to the stairs. The stairway goes down eight steps to a small landing and then from there turns down to the lobby. I approached the top step full of fabricated confidence in my ability to simply walk down, and to my ecstatic surprise – I did. After arriving at the landing I turned and went back to the top. “Did you see me? Did you see?”, I anxiously queried my daughter. “No, do it again.”, she said, careful not to commit any emotion in her response until she could figure out what I was talking about. Again I walked down the stairs and stopped at the landing. “Yea!” she yelled, innocently understating what I saw as the significance of the achievement. I walked back to the top of the stairs and hugged her. “Wanna see me do it again?”….

I realize that being able to walk down stairs is not a big deal, that is, until you can't anymore and then believe me it becomes a very big deal. My entire outlook and attitude has remarkably changed as a result of this simple event – an activity that I more or less mastered when I was three years old and have taken entirely for granted ever since. I’m sure that at three, I felt quite proud of finally being able to navigate the stairs. But certainly I never considered that one day I would once again view it as a major accomplishment in my life.

The corner of dramatic improvement that I have been looking to turn for so many months now - finally, it seems to have arrived.

And not a moment too soon.

Day 324

Christmas will always have special meaning for me. And not especially good either.

I've never been an exceptionally big fan of Christmas. Not a terribly popular position to take, I realize, but I’m not religious, so that whole made up Christian story about the manger and the baby doesn’t mean squat to me. And the Santa thing, well, I’ve always managed to come up somewhat short of warranting an actual Scrooge classification but I must admit I’ve never been fully onboard with the endless strings of lights and rampant consumerism and the unnecessary killing of trees that are meticulously decorated and honored with center stage in our homes only to end up unceremoniously tossed out on the sidewalk along with the garbage bags full of shredded wrapping paper and empty boxes after the pagan festivities are complete. I guess that unless and until I progress to something even remotely resembling a full recovery from this injury – which at this point does not appear to be an overly promising eventuality – Christmas for me will always be the day that I lost part of myself. The part of me that ran instead of walked and hiked every trail in Yosemite and played soccer with the neighborhood kids. The part of me that sprinted up stairs and scattered back down only barely arresting my descent with each step. The part of me that lived without constant reminders of my knee, and the physical limitations that now come with it.

At this point my ability to suppress the underlying feelings of resentment and negativity whenever I hear a random Christmas song on the radio is made possible only by the voices of my kids as they sing along, shamelessly making up as they go along any lyrics they’ve not yet memorized.

Am I bitter? You bet I am. Bordering on violently depressed some days. I don’t tell anyone of course because in this world where every minute of every day people are starving to death, or suffering with disease, or being injured and killed as a result of pointless, misguided wars, to suggest in such a world that the condition of my knee is at all significant is overwhelmingly myopic and short-sighted. And that’s not who I am. Or at least, it’s not who I want to be.

That said, the last month and a half of all-out effort and physical therapy has yielded minimal improvement, and I’m beginning to consider, really consider that I may very well be quickly closing in on as good as it gets. I know there are no guarantees with knee surgery. I know the numbers. Believe me, I’ve read the stats. I’ve watched professional athletes end careers with a single knee injury. I know that in rare cases the physical losses can be permanent. But it’s just that – rare. And dammit, that’s just not me. I’m never part of the extreme minority. I never exist at the thinning edges of the bell curve. And on this recovery in particular, I would have bet my world. There was just no way this wasn’t going to work.

But so far it’s not working. Sure, I’m better than I was six months ago, but for the first time since my first month post-surgery, I’m not measurably better than I was a month ago.

All I want for Christmas… I tell you at this point I would trade my two front teeth for a good right knee in a reindeer heartbeat.

Day 296

Thanksgiving Day.

And just what do I have to be thankful for? Well for starters I was able to walk around Disneyland with my wife's extended family for three full days last week and watch the joy and amazement in the wide eyes of my two beautiful girls as they soaked up all of the magic and mystery that Walt and his friends had to offer. It was wonderful. I struggled with a stairway or two during our short vacation but overall my knee, thanks in large part to continuing physical therapy, held up well.

Of course I'm also thankful for my loving family and a select handful of exceptional friends and the fact that I still have a great job and can comfortably provide for the basic needs of my family. If you're currently in this condition or better, now's a good time to stop and consider that many people are not.

Take for example, the thieves that robbed my house a couple of weeks ago. They probably don't even have decent health insurance. What they do have unfortunately is more than ten thousand dollars of what was until recently my family's stuff. At around 11am, in broad daylight, with about an 18 minute window between the time my wife left the house and I returned from PT, the heist was complete. It can take longer than that to get through the goddam express lane at Safeway. Apparently it's just not all that difficult to invade someone's home entirely unnoticed and walk out with as much as you can carry.

The real problem of course is that it's not just "things" that get taken. It is personal privacy, a carefully cultivated and highly imaginary sense of security, and perhaps most importantly, any feeling of control. All gone. In the past couple of weeks since the theft, I have been flooded with many of the same emotions that I had in those first few days after my knee injury - anger, despair, frustration, helplessness, an overwhelming desire for prescription narcotics. What I have finally come to realize is that loss is loss. Whether it is the loss of some healthy part of ourselves or the loss of material possessions, our reactions always seem to contain, in varying degrees, similar elements. Most notably, the primary component of any loss we incur is naturally accompanied by a renewed awareness that we are in fact not in control. Of course this lack of control always exists, but it does so in direct contrast with our (ok, my) inherent need to feel in control. Without a strong belief that my future is a direct result of my own focus and dedication and effort, I wonder if some of my self-generated motivation is in danger of being precariously relocated beyond the frayed edges of my character. If you can't turn the ship, why bother steering?

I now more fully realize something that I suppose deep down I already knew - that in this, as in all areas of life, there is a balance. No, we are not in control. Far from it. But at the same time our inability to control our future is balanced by the fact that we are also not entirely unable to affect the outcome. The reality lies somewhere in the middle - in an ability to have the effect of our input considered in the results. The obvious fact is, any bit of effect we can muster is always mixed with and sometimes superseded by the effect of outside forces, like other people and sheer luck - both good and bad. I suppose real character includes the ability to continue to strive to do the right thing, to work with unwavering dedication at improving and making a positive difference within ourselves and for the people around us, even while maintaining a conscious awareness that our efforts may at any time be counteracted by a random act of man or nature, or an unexpected dance move.

As part of my recovery and general goal of optimal health, I have recently increased my focus on vitamins and supplements. I haven't gotten around to any fun stuff like EPO or Viagra but I do now have a daily regimen that includes a highly nutritional meal replacement shake, a scoop of some sort of thoroughly disgusting veggie powder concentrate, Chinese green tea, a multi-vitamin, fish oils, glucosamine, MSM, chondroiten, and extra C and E supplements. By now I must be the healthiest person on the planet. Or maybe all of this is actually having no affect at all. Then again, maybe I will eventually become as healthy as I can be only to be hit by the crosstown bus. I guess I'm still struggling with this whole destiny control issue just a bit.


Speaking of vitamins, late for work a few days ago I tossed my daily handful of morning pills into the pocket of my jeans and headed to the office. Unfortunately in my haste I failed to consider that the aforementioned pocket may not have been entirely empty to begin with. After I arrived at my desk and got my computer started up I opened a bottle of water and thoughtlessly started gulping down the contents, tossing in a few pills with each swallow as I read through my email. Thankfully, a small but critical part of my consciousness apparently reserved for such things managed to notice the soft pliable texture of a foam earplug as it lodged against my tonsil and I was able through a skillfully executed combination of forced gagging and heaving bodily contortions to violently choke the wayward plug back out and onto my desk, much, I'm sure, to the enjoyment of my coworkers. Medical crisis averted, my immediate surroundings subjected to a freshly expelled mixture of spit bubbles and vitamin drool, I slowly checked the remaining contents of my pocket. The other earplug was, alas, already gone. Swallowed. Ingested, as it were, along with any false belief that I had long since matured beyond such an episode.

Turns out, we never outgrow the benefits of paying attention. Be careful out there.

Day 272

Welcome to PT, Phase 3.0

First there was the challenge of pre-op physical therapy. Twenty visits, maybe more. Then there was post-op PT - another couple dozen visits to the original pre-op clinic, a handful of encounters with the painfully competent Stone Clinic torture crew, and one stop at a third place where a still-in-school therapist spent most of my session consulting a PT book to determine how far he should try to bend my leg. He never got the chance.

Shortly after that I fell off the PT wagon. I was back to riding. I was playing music. I built a patio cover in my backyard. I was too busy getting back to my life to bother with mediocre PT and far too discouraged to find anything better. Maybe I could just finish recovering on my own.

Fast forward to my six-month follow-up with the Stone, and another visit to his PT room. “You really need to get back into therapy”, I was told by the therapist, her eyes staring directly into mine to clearly convey the “or else” element of the message. “You don’t want to wait too long.”

Too long, she explained, was now quickly approaching. One year is the the generally accepted window for improvement. Beyond a year, physical improvement, although possible, is as about as likely as keeping all of your blood on the inside during a shark attack.

So at the direction of the Stone therapist, and from somewhere in the haze of discomfort following the Condor Century, I decided to follow my neighbor's recommendation and check out yet another local PT clinic - BodyMax. With little in the way of expectations, last week I went to my first appointment. Craig, the owner, met with me and assessed my progress: “You're a bit behind”, he pointed out. "Well we've covered the obvious", I thought to myself, "So what now?". But before I could ask he moved directly into explaining what I needed to do to catch up – stretching, ultra-sound, myofascial release*, and targeted weight training. No surprise, the BodyMax PT clinic looks like a gym, with an impressive assortment of weight machines and cardio contraptions - stationary bikes, ellipticals, stair masters - all in a large open room. Surrounding the gym area are a dozen smaller rooms - therapy rooms and offices. In short, the facility is excellent and Craig and the rest of the team are pros. By the time that first appointment was over it was clear to me that I was finally in the right place. In fact, it was so overwhelmingly obvious that my joy quickly devolved into a subtle resentment of the situation as I realized that had I started there first, I would probably be done by now.

*Technical note: The web has abundant information about this but the following should suffice for our needs here: Fascia is the seamless web of connective tissue that covers and connects the muscles, organs, and skeletal structures in the body, which is located between the skin and the underlying structure of muscle and bone. Muscle and fascia form the myofascia system. Myofacial release is the name of the therapy that is designed to release bound up or stiff areas of that system. Apparently the foundational premise of this therapy is “if it hurts to rub there, then keep rubbing”.

In any case, I have now completed five sessions with Craig at BodyMax. My strength and flexibility are both improving. I am thrilled with the results already. There has been an increase in pain but seemingly as a necessary and presumably temporary result of the therapy. Craig was not satisfied with the zero degrees that I had achieved in extension and wanted as much hyper-extension as the “good” side so we're "fixing" that. He also reasoned that in order to protect the joint during activity, the end point at extension needs to be slightly soft and pliable. Before I started at BodyMax, my knee still had a rather painful and abrupt stop at full extension – no give. In the world according to Craig, no give is no good. For one, it’s asymmetrical, and two, it causes the knee to be more injury prone. Creating “pliability” where none currently exists is not a pleasant process to say the least, but that kind of unpleasantry is nothing new at this point either.

I suppose the message of the day is Hope. It is a sensation that I have only recently begun to regain in terms of recovery and although I’m definitely not ready yet, when I’m sufficiently rehab'd I will be eligible for the BodyMax ACL Bridge program – which is designed to bridge the gap between simply functional and athletically able. Hopefully by the time I post next, I’ll be knee deep in that program. If I’m still not ready, it sure won’t be for lack of effort.

Day 251

Just a quick post to say that I survived my first road century on Saturday. And what did I learn? Seven hours on a bike seat is plenty long enough to leave you with a couple of rather specific sore spots. Yes, fresh off the much needed confidence boost that resulted from the 72-mile Tahoe ride, I signed up for the most immediate 100-mile ride I could find - the First Annual Condor Classic Century. (Note the ironic, if not purely optimistic use of the word "Classic".)

The ride started at 7am at the San Juan Oaks golf course in Hollister, California and went 38 miles down to Pinnacles National Park and then returned by way of a longer route that swung out to the east. Much to the amusement of many of the old-school roadies, I completed the ride on my trusty hard tail mountain bike - the same one that had carried me around the lake just a few weeks earlier. My knee complained desperately for the first ten miles or so and then eventually gave in and for the most part worked well for the rest of the day as long as I kept my butt firmly planted on the saddle. There were no super long climbs but there were countless shorter climbs, all were 2-3 miles or less, and a couple were dizzy-inducing steep. 4065 feet of ascent in all. Still, the real issue for the day was not so much the climbing but the wind, which blew relentlessly head on for the vast majority of the ride time. This simple movement of air (which I was later told was already 15-25 mph by 10am), was loud and gusty and brutally discouraging as I rode alone through some of the longer open stretches. By mile 60 it was clear that the best (and maybe for me the only) way to get to the finish was to actually ride harder to catch and stay with other riders, trading time at the front - which is exactly what I did, for the entire final 40 miles, furiously pushing at increasingly commitment threatening levels of exertion for the last three hours of the ride.

I was asked by many people on the event staff afterwards what I thought of the scenery. "Wasn't it beautiful?", they all suggested, shamelessly leading the witness. Some of the views were in fact quite pleasant, but the vast majority of the ride was... well... I mean really, we're talking about the remote nowhere that is south of Hollister. Yes, it was certainly beautiful if to you that means absolutely endless stretches of dead grass and crop land, an occasional cow, a broken down tractor, and a handful of two-block long towns, one of which had a bar called "The Hole", on who's sign, in case you were not clear as to the offerings of the establishment, and I swear I am not making this up, were the words "Food and Booze".


In any case, the riders were a great bunch, none of whom seemed to mind at all when I infiltrated their pace lines, and the rest stops were adequately stocked with water and what I suspect is a typical century event assortment of bananas, bagels, and power bars. I felt reasonably strong throughout but in the end despite my best efforts the headwinds and climbing held me to a frustratingly slow 14.5 mph average. Still, I was one of the first 25 of the 100 riders to eventually finish the entire 100 miles - apparently the relentless winds convinced at least some of the century-intentioned to opt for the homeward shortcut of the 60 mile route. My total ride time including stops was just under eight hours, covering a perfectly consistent 25 miles every two hours. Not exactly a pro-level performance but given the conditions I was pleased with the results. At least it was good enough to finish well ahead of the ride-time cutoff and the event’s SAG crews who, when I finally left the post-ride bbq at 5pm, were still out, tracking groups of riders as they struggled through the final few miles. In the end I was glad I decided to take on this challenge and afterwards I was more than happy that it was over. Now if I can just find a soft place to sit down.

Unfortunately my knee did not respond as well after this ride as it did after Tahoe. Yesterday and today have been unusually painful, especially at full extension. I think the only problem with riding 100 miles is that people say, “wow, your knee must be all better now.” Well no. I don’t mean to confuse anyone, but no, it’s not all better now. It’s capable, but it’s definitely not good. I can pedal a bike, nearly all day long if necessary, but it’s often painful and there's a limit to the pedaling force my knee will withstand. I still struggle to go down stairs. I still cannot even begin to break into a jog. No, it’s not good – certainly not good enough. And it doesn’t seem to be getting any better anymore either. And in the darkest recesses of my consciousness it’s really beginning to worry me.

Yesterday I decided to head back into physical therapy. I can’t imagine how they are going to resolve the residual pain at this point, but I have a recommendation for a local place so I figure I might as well check it out. I keep thinking that maybe I just didn’t do enough last time I was in PT. Maybe I didn’t push hard enough or go long enough. Regardless, whatever has gone wrong with my recovery, it has to change, I can say that much for certain. Something has to change.

Day 216

Here’s a bit of wisdom, obvious perhaps, but important never-the-less: If you tear the ACL in one of your otherwise healthy, active knees, everything that goes along with it – the shock, pain, worry, fear, anxiety, regret, anger, despair, research, options, crutching, limping, hobbling, therapy, surgery, drugs, exercises, stretches, rehab, milestones, frustration, improvements, setbacks, hope, goals, accomplishments, recovery – every aspect of the experience will be more important to you than to anyone else. It's true.

This can be a bit unsettling at first, even strangely discouraging unless and until you realize that this is natural, reasonable, and not at all unique to ACL injury. From migraines to ankle sprains, broken bones to cancer, your damaged physical condition is important to you. And even if you are fortunate enough to have well meaning, genuinely sympathetic friends and/or family, there will still likely be between you and them a gap in the perception of the importance or severity or impact of your injury or illness. It's not because they don't care - they really do. It's because there is, by the very nature of physical injury or illness, a fundamentally personal element to it that cannot be entirely shared or fully understood by anyone else.

I thought about this from a related perspective a few weeks ago as I considered the doctor who recently performed reconstructive knee surgery on Tiger Woods. Woods, in case you’ve been living in a cave for the past ten years, is a legend of golf - and right up to surgery he was still winning, still breaking records. It is exceptionally rare that a person dominates a sport like Woods has. Jordan, Gretzky, Armstrong. The list of athletes who have existed at this level is very short. I don’t even really like golf all that much and yet still I am fascinated by the play of Tiger Woods. His recent mid-career knee surgery had to be one of the most important medical procedures ever in golf, perhaps in all of sports. I wonder if the surgeon considered that. I wonder if he prepared any differently. Or if he was just a little more focused than usual as he made that first incision into the skin of Tiger’s injured knee. I mean, this is one seriously important knee. That said, I can tell you this without hesitation - to me, my knee is far more important. Even as a truly ardent admirer of Woods (and believe me I am pulling for him) if for some reason I had to choose between a successful recovery of my knee or his, well, let’s just say that the only amazing golf shots Tiger would be making in the future would be the one's that sneak into the tunnel passed the spinning windmill. In this respect I suppose I have to admit I am unapologetically selfish. The fact is, the only people on earth to whom I would give away my chance at recovery are my own two kids. Sorry Tiger.

If you’ve been following this blog (and certainly if you’re reading this far, you must have been) then you know that yesterday was the Tour de Tahoe – the annual bike ride around beautiful Lake Tahoe. “Bike Big Blue”, they call it. I had been “officially” training for about eight weeks for the ride, although I suppose in some sense I'd really been working toward it nearly every day since last Christmas when I first summoned for the Advil and a bag of ice. With a few 50-mile training rides from recent weeks under my belt, I knew that unless something catastrophic occurred, I would be able to finish the roundtrip around Big Blue. What I didn’t know was how fast or strong I would be. Turns out my knee did about as well as I expected - no major problems except the usual pains in the first couple of miles and then later when I tried to stand and pedal through some of the climbs. I kept a close watch on a slight pull in my left hamstring (likely the result of weeks of compensating for the right knee) and I focused on adequate fueling, starting hours before the 7am ride.

The event nearly ended early for me at mile 26 while I was spinning along at full speed in a tightly arranged paceline with five other riders. As we closed on a rider in front of us, he abruptly slowed and swerved into our path, resulting in the bodies and bikes in our group colliding into each other. Amazingly, no one went down, although there was of course a healthy release of yelling and profanities afterwards – the “no blood, no foul” rule definitely does not apply to road biking. A couple of hours later I had another wake up call as I went through Incline Village and only barely avoided a rabid squirrel in the road who frantically changed directions six times in about a second as he desperately tried to remember the number one rule of squirrel-bike engagement – was it run toward bikes or away from them??? - aaaahhh!!!

Other than those two bits of excitement, the ride went essentially without incident. Intoxicated by thoughts of the imminent finish line I did begin to lose my focus on hydration at around mile 50 but thankfully didn't really pay for it until a few hours later when my calves and feet cramped up and curled into pretzels at the after-ride pool party. The final big climb (Spooner Junction) was just as mind numbingly long as I remembered but I still made it over, and much stronger than expected, repeatedly announcing "on your left" like a broken record as I passed riders over the final few miles. In the end, I crossed the finish line 17 minutes faster than in 2006 when I did the same ride with two perfectly good knees, so there was definitely an overwhelming sense of victory and accomplishment above and beyond the simple joy of just completing the route.

I have to admit I was somewhat surprised by how emotional I was at the finish. My wife and kids had stayed at home with lingering colds, so I just slowly rode around the finish area, alone and rather aimlessly for about fifteen minutes after I crossed the line. With an abrupt deep breath I finally let go of some painfully overdue tears as I considered how long the last eight months had seemed. Those first few nervous appointments, the incessant knocking of the MRI machine, the earliest realizations that my knee would never be the same – all of it seems now like it was years ago. I can barely even remember what it was like eating, working, sleeping, literally living full-time on a blow up mattress in my family room in the weeks following surgery. After I had processed the initial rush of thoughts and feelings and pulled myself together, I handed my camera to a man waiting for someone at the finish line and I rode back under the banner while he captured the re-enacted moment of my triumph. Paper signs made by my kids and taped to the window of my hotel room overlooked the scene at the finish. With the exception of my missing family it was a perfect day and a wonderful ride.

Interestingly, today I have a few of the usual post-ride aches and pains but my knee is not among them. In fact, my knee, which six months ago was only barely able to support my weight at all, actually feels noticeably better today than it did before the ride. It is as if it’s trying to tell me something - and apparently my doctor agrees. At my six month follow-up a few weeks ago I asked Dr. Stone if he thought I would need a second surgery to fix whatever is still wrong with my knee. “If it was my knee", he said with a smile, "I wouldn’t touch it. Just keep riding the hell out of your bike.” Sweet man. He always knows just what to say.


TdT 2008 STATS
-----------------------------------
Distance: 72.5 miles
Elevation: 6,300 - 7,100 feet
Total Gain: ~3000 feet
Max Speed: 49 mph
Average Speed: 17.2
Ride Time: 4:13

Day 175

Fifty days since my last post. That’s how long it has taken to notice any improvement in my knee. Change is frustratingly subtle at this point. I have a follow-up with Dr. Stone ten days from now at which time I had planned to ask for another MRI to find out what had halted my recovery. That still may be a reasonable request but as I look back at previous posts it is clear that rather than halted, my progress has just shifted into super slow-mo.

By mid-July I had dropped another 10 pounds, thinning down nearly 15% in 3 months and frighteningly close to the weight listed on my high school driver’s license. I’ve since bounced back up a bit to settle in right around 155 - a good lean weight for my 5’10” frame and 20 pounds lighter than I was at my heaviest after surgery. Thankfully with my increased activity levels and a little focus on diet, the shedding of surplus weight has not been difficult for me - and it has undoubtedly helped my knee.

I’ve not been to physical therapy for quite a while, and whatever you do don’t tell them this, but I don’t miss it. Not even a little. It’s true they did get me through some rough sections (the Stone PT crew in particular) for which I will be forever grateful. But at this point I’m quite confident that I can use the information obtained in a single session for many weeks without the joy of regular PT visits. Over the past couple of months I’ve been exercising and pushing and testing my knee every day on my own anyway. I am plenty motivated.

A few weeks ago I went out to play 18 holes of golf, not knowing if I would even be able to swing a club and secretly afraid to death that I might do some sort of damage to my healing knee. I did have to change my swing a bit to rely less on my right leg but I didn’t think it would make much difference in my game. Tiger had just won the US Open a week or two earlier with a torn ACL – and it’s not as if he’s a significantly better golfer than I am, so I figured I’d give it a shot. I did take a cart, which is not legal at the Open, but with the high degree of random accuracy in my game there was still quite a lot of walking involved. I managed two glorious pars on the day and was quickly reminded of my knee on the few occasions that I thoughtlessly started into a jog across the fairway in search of a wayward (and thus, I reasoned, likely defective) ball. In the end I got my money’s worth by getting to take well over a hundred shots, a dozen or so that actually went in the intended direction, and I walked much farther than I had on any other day since the Christmas “incident”. Most importantly, I didn’t hurt myself in the process. I was quite pleased with the results.

I’ve also recently been going out on my scooter. Ok, let’s get past this, yes, I have a scooter. And no, not one of those implicitly gay Vespa mini-motorcycle type scooters that you see gleefully scootering down cobbled European streets piloted by young artistes heading to the nearest picturesque Euro café for a latte and a scone. I’m talking about a simple old-school two-wheeled you push it with your own legs or it goes nowhere type scooter. And if you think you can push a scooter without bending your knee, well think again, Scooter. Although I’m right footed, I push with my left leg – a childhood leftover from my goofy-footed skateboarding days. This leaves my right foot, assuming all goes well, firmly planted on the scooter platform. The right leg must bend forward at the ankle and down at the knee, support the body through the push, and then straighten again, lifting the entire weight of my body back up in preparation for the next push. It has never seemed like an unusually challenging or heroic movement. Until now. Scootering puts my right knee in exactly the role it wants so desperately to avoid – moderately bent full body weight bearing. It is agonizing. At peak scooter output I am grunting and grinding my teeth through every push and my seven year old daughter on in-line skates still leaves me in the dust. She’s a good kid though and she always waits for me after she’s proven her superior abilities. The scooter has convinced me that my problem is not only the pain. Although it hurts plenty, I’m also still considerably challenged by the weakness in and around the knee joint. If I can survive another month of outings on the scooter with the roller-blading kid, that will surely change.

I’ve also been riding my bike at least once every week, heading out for increasingly longer rides on tougher routes, and pushing for more speed and better pedaling form. My times on set routes continue to improve and this past weekend I was able to stand and pedal up a hill - a very steep but reasonably short hill at about 50 pedal rotations long - for the first time since the injury. The pain was there but easily dismissed by the overwhelming feeling of power and strength and the imaginary fanfare that awaited me at the top as if I was cresting the famed Alpe d’Huez itself. Of course when I did reach the top there was no one there except for a single jogger who appeared genuinely concerned by what I realized in hindsight was the deep hurling growl, not unlike that of a sick dog, that came echoing from my lungs during those final few yards.

Despite the challenge (or maybe in part because of it) the bike has been my main vehicle for regaining movement and strength and sanity. My knee still suffers on long climbs, but it is certainly improving, and the specific discomfort in my knee is often lost in the flurry of pain signals as the rest of my body suffers right along with it. Misery loves company and there is no surer path to self-inflicted misery than pointing up a long climb and willing yourself to the top as fast as you can possibly manage. It is difficult, and distressing, and desperately rewarding.

A few months ago in a fleeting moment of blind optimism I signed up for the 2008 Tour de Tahoe. It’s just like the Tour de France except that it’s not a race and it’s not in France. It’s actually an annual ride around Lake Tahoe with about 1300 other cyclists. I did the ride for the first time a couple of years ago and the support staff and the riders were wonderful. I prepared meticulously and spread my effort perfectly across the 4 ½ hour ride. A walk in the park for serious roadies, the route sits at an average elevation of about 7000 feet and covers 72 miles with about 3000 vertical feet of climbing. It was and still is most difficult road ride I have ever completed. When I signed up earlier this year, I could barely walk around the block. A ride around the lake seemed like an impossible goal. But at the same time, September 7th seemed like a lifetime away. Now it’s less than six weeks. My longest ride so far this year was 32 miles, mostly flat, at about 300 feet above sea level, two days ago. Typically I do 25 miles with a couple of small climbs and I’m done for the week. I have a lot of work to do. I need some longer rides and more time at the gym. But I also really need this ride. For some reason, a significant contributor to my sense of who I was and who I am and who I will be is strangely bound to my ability to push myself around that lake. This time it holds more meaning than ever. If I’m ready by September, it will be just barely.

Day 125

Where were we…? - ah yes, the knee thing. I know it’s been over a month since I last posted, a complaint I’m sure my legions of regular readers would have if they had ever existed in the first place. Fact is, I just needed to escape from the whole challenge of the ACL project for a while. I stopped posting on the blog, stopped reading the ACL stories of others on the internet. I began to limit the details in my answers to the many thoughtful questions about the status of my recovery and I cleared a dresser drawer to stow my impressive collection of knee braces and compression wraps. I even temporarily stashed away the pile of medical bills and statements and purposefully difficult insurance forms. I started riding – on the trainer every night and outside whenever possible. I started a simple daily exercise program that included knee strengthening work but didn’t focus on it. And I started eating better – staying well hydrated, eating smaller, more frequent meals, with more nutrient dense foods, and I simply stopped eating after 6pm every night.

Over the last month or so I’ve managed to drop the 15 extra pounds and the majority of the convincing second trimester pregnancy profile that I had cultivated during my post-op immobility and at the same time I’ve gotten stronger – both mentally and physically. In short, I’ve taken a more holistic approach to my knee rehab. The initial improvements in my knee have finally allowed it to become another working part of my daily life rather than the center of my every waking thought.

That said, there are things that I still cannot do. Simple things that are made all the more frustrating and concerning when I recall the published rehab schedules that I long ago made a conscious effort to ignore. I still have some degree of pain with every step and most of my shin feels oddly like it’s under the lingering effects of a low dose of Novocain. My physical limitations now all seem to center around an inability to put any significant amount of pressure through the knee, especially when it is bent past about 20 degrees. I still cannot quite walk down stairs. I cannot quite stand and pedal my bike. And I absolutely cannot run, jog, or otherwise motivate myself any faster than a normal walking pace. Attempting any of these activities results in an immediate line of pain up the front of my kneecap. Overall, the pain is improving somewhat, but only so slowly at this point that my progress in that particular area is not even noticeable unless I recall my condition over the course of the past few months.

My range of motion is now reasonably good. In flexion I can typically get to within an inch or so of heel-butt contact. I’ve not worked on this post-op so what I have gained is just the natural result of the reduction in swelling and the improved flexibility of the muscles and connective tissues involved. Extension, on the other hand, was a long and painful struggle – one I took very seriously. Thankfully, my knee eventually conceded that particular battle and I now have essentially full (hyper-) extension nearly equal to the “good” leg.

“If you do too much, you’ll know it.” This simple excerpt from the book of wisdom was given to me at some point so early in the recovery process that I can’t even remember who said it. Regardless, credit to someone is well deserved as this bit of information turns out to be entirely true.

On Day 95 I went out on the bike again. I’d done my first short ride on Day 90, and I’d been riding 30 minutes every night on the trainer for a few weeks so I figured it was time to try a slightly longer route. 18 miles this time, with a few mild hills thrown in. The ride was a success. In fact I felt so good afterwards that the next day I welcomed the chance at a short family walk through Mill Valley. We were a few blocks out when my 3-year old wore through a blister inside one of her shoes. No problem, I simply carried her piggy-back style on the return trip like any caring and physically capable father would do. Later that day a small group of extended family prepared for a hike up one of the many trails of Mt. Tam. Clearly it was expected that I would sit that trip out as I was given instructions on staying behind alone – “the TV is downstairs”, “help yourself to the kitchen”, that sort of thing. I surveyed the expedition team - a handful of healthy adults, a few young kids, including my wounded 3-year old, and one of the grandparents. I could certainly keep up with this group. And so I did, and with only a handful of sharply painful missteps and ill-executed strides. It felt so good to be out and active. I was becoming normal once again.

But as I woke the next morning I quickly realized that I had slightly overestimated my return to normalcy. I had trouble just putting enough pressure through my knee to stand. The new swelling was quite apparent and my range of motion was reduced by many degrees on both ends. Eventually I became stable on my feet again but for the next couple of days I walked with a renewed limp and pain levels that I had nearly forgotten ever existed. I had done too much and as I was promised, I knew it.

Since then I have been much more careful, and I’ve pretty well limited my knee-related physical rehab to bike riding and slow, controlled strength developing movements like the ones that can be had on a high quality leg press sled. Every Saturday morning I ride semi-leisurely for a couple of hours and then on Sunday mornings I hammer with everything I have through a 25.1 mile loop that includes a 3 mile out and back climb into a local canyon. I race against myself, against my own ability, and against the clock. And my average speeds have been steadily increasing every week at every checkpoint along the route. A few sections of the canyon road are as steep as I can possibly climb at this point and if I push hard enough in the return downhill I can sometimes hear the announcer voice of Bob Roll in my head as I slice through the French countryside ahead of the furiously chasing peloton. With an all out effort, my speed is limited at different points on the ride by either my knee or the conditioning of my cardio-vascular system. On my most recent ride the limiting factor was often the cardio – which in terms of my knee is a strange victory in itself.

Day 90

Ask your doctor if knee surgery is right for you. Side effects may include short-term discomfort and a slight limp. The direct effects of having your knee cut open and holes drilled through your leg bones are reasonably obvious and have panned out for me more or less as expected. But as I continue through this experience I am beginning to take note of the ever growing list of additional effects caused by the resultant lack of mobility, symmetry, and balance.

Of course the initial crutching and lingering hobble has caused minor alignment issues with my lower back, hips, ankles, feet, etc. And the temporary immobility has managed to transfer a good bit of body mass away from my legs and toward my mid-section. But now we begin to get into the less obvious. For example, last month I stopped shaving my legs (I began shaving both because as my wife’s sharp fashion sense noted, shaving only one looked rather strange). Now the hair on my injured leg is growing back at about twice the rate and density as the uninjured leg, leaving me to assume that there is so much regenerative biological activity going on in my recovering knee that it’s actually causing an increase in hair growth. I’ve also been sleeping on my left side almost exclusively for the vast majority of the last 130 days. Occasionally I'm on my back but never on my right side where my injured knee would be in direct contact with the bed. Could this consistent lack of sleep side symmetry cause a misalignment of my jaw? Possibly coincidental I realize but now whenever I yawn, my mouth gets momentarily stuck open and then abruptly pops back into place. Good times.

My three month checkup was today. Doctor Stone took a quick look at my knee and then did that now very familiar lift and tug maneuver with my lower leg, after which he commented, “That’s a perfect ACL.” Certainly there is a potential bias in his assessment but the fact is I gave up second guessing him long ago. If he says it’s perfect, that’s what I’m going with.

PT, however, well that was another story. Thor wasn’t in so I met with his female counterpart. Let’s call her Xena.

As this was my three-month visit, a sports-fitness test was on the agenda. After scribbling out a half dozen or so exercises on her clipboard, Xena had me start with "The Plank" – lie face down, feet together, hold the body off the floor, resting on the toes and the forearms with the elbows directly under the shoulders while keeping the body straight (like a plank of course). I lasted in that position just 1 minute, 26 seconds. Average at best.

Second was a timed 25 rep bench squat. I had been doing these at home for a couple of weeks so I went through these pretty quickly with only a bit of pain through my knee.

Third was a timed 15 rep bench squat holding a 45-lb straight bar. Forget it. I could not do a single rep. As soon as my leg was bent more than about 20 degrees the vertical pain through my patella was instant and sharp and the message was clear – “Go any further and your next stop will be on your ass with a 45-lb bar stuck to your forehead.” Scratch that test.

Fourth was a step test – step up onto about a 12-inch block and back down. Here too my knee was useless. I could not step up with my right nor step down with my left. Again, it was the pain through the patella that would not allow me to complete the movement. At that point the entire test suite was cancelled and we went onto some reasonably aggressive and uncomfortable patellar mobilization and quad and IT band grinding and mashing.

I knew I was behind the standard recovery schedules, but still, I honestly thought I was doing pretty well. I was exercising and getting around without much trouble, and if I took just a bit off my normal pace I could finally walk without a noticeable limp. But my PT session left me soaking in a newly formed puddle of defeat and frustration. I had come to accept my struggling recovery but despite my efforts to dismiss it, the fitness testing at PT was a real confidence killer. There was only one possible cure.


When I got home I decided to that I would ride across town to a friend’s house to pick up some random articles left by my kids the last time we were there. The truth is that the idea of getting out on the bike had been rolling around in my head for weeks and the stated purpose of the errand was entirely irrelevant. The real reason to go was to see if I could actually make the 9.5 mile round trip at all. I needed another data point on my progress. I needed to assess my condition on my own terms. It would be my first time outside on a bike in nearly five months. My mind worked through various reasons to postpone the outing - too windy, too close to dark, too risky, and the like. But as part of my brain ground through the list of excuses, the rest of it continued to prepare to ride as if I had no actual choice in the matter. I checked everything on the bike twice – tire pressures, brakes, quick releases. Finally I rolled down the driveway and headed off.

Riding was initially somewhat awkward but within a few blocks I had pedaled myself into a slow rhythm. I quickly learned that pushing too hard through the downstroke on the injured side produced the same pain that I had experienced earlier in PT and that standing to pedal was entirely impossible for the same reason. With these limitations regretfully acknowledged I rode on. It was 7pm, slightly cool, with the light of the sunset just beginning to sneak into the trees on the ridgeline. The afternoon breeze had stopped entirely. Conditions were perfect. And even though I was unable to accelerate with any force, rather like a car with something stuck underneath the gas pedal, the riding itself was still amazingly empowering. Random people waved to me as if somehow they knew. There were too many of them to simply discount their unexplainable awareness of my endeavor. I waved back as if to thank them for noticing. I focused intently on every turn, on every minor change in the pavement. And I pedalled with as much force as my knee would allow. I made the trip out at a 14.4 mph average. On the return trip I pushed even harder and heaved and wheezed my way to a one-way average of 16.4 mph. Not exactly new speed records for certain, but at last some positive results. A personal victory of sorts. Of course it was a small and meaningless accomplishment in the big picture, but still, for today it was a small and meaningless accomplishment that was very much needed. My heart and soul and even my body thanked me afterward. And I quietly basked in the glory of the ride for the rest of the evening.

Day 72

I do realize that much of the content of this blog is rather self-absorbed in nature. It is after all my blog about my knee so it seems there is little sense in writing everything in terms of random third person fictional references. Still, I find there is a somewhat uncomfortable level of implied self-importance involved with being the topic of most of these posts. A few people have said that rather than reading a blog when they want to know how I'm doing, they would rather just talk to me directly. This is certainly more personal, maybe even more meaningful. But somehow, verbally recounting status details even for just those blog-opposed few is strangely draining for me. I don't really mind discussions about the mechanics of it all (the surgery itself is rather fascinating if you can stomach the details) and I do appreciate the fact that anyone even cares enough to want to know how I'm doing. But honestly I'd rather write about my physical and emotional status once every few days than talk about it at all ever. I guess I just don't want to make this whole situation any more a part of my daily existence than it already is. Writing also forces me to provide a more thoughtfully considered evaluation of my condition and, perhaps just as important, how well I am (or am not) dealing with it.

The other main reason for these posts is that I hope to provide someone else who has an ACL injury (and what would necessarily be a lot of reading time on their hands) with key information and an insider perspective on the experience. The doctors will tell you what will happen after surgery. And they might even tell you that it’s going to hurt (“This will likely be the single most painful event of your life”, I was told by one surgeon). But what they won’t discuss with you is how all of this might make you feel at any given point during the journey. If you do happen to have an ACL injury, or know someone who does, one of the most important things to keep in mind is that every injury is distinct. Every recovery is unique.

Your mileage may vary.

The day before surgery, Doctor Stone pointed to a woman hopping on a small trampoline as we walked through his PT facility. “Three weeks”, he said with a hint of pride in his voice. She did appear to be a little hesitant about the safety of the trampoline therapy, but still, there she was, three weeks post-op with the same surgery I was going to have and she was hopping around like part of a circus act. Sure, I could get on the trampoline now, in the middle of week 10, but at week 3 I was still rocking back and forth in a corner, sucking my thumb and incoherently muttering something about my “boo boo”. It has since occurred to me that the term “ACL reconstruction” is not nearly definitive enough to make accurate predictions about recovery. There are two other significant factors to consider:

1.) How much collateral damage was done in the process of tearing the ACL?
2.) How does your body respond to injury, and especially that of surgery?

With respect to damage, if you are somehow able to tear the ACL with minimal additional strain on the knee (and it is possible if you hit it just right) then you will probably fair much better in recovery. I regularly hear or read about people who have torn their ACL and then finished the karate class, or played the rest of the game, or walked around for weeks before finally going to see a doctor. The moment I was injured I was instantly and dramatically debilitated. It felt like a bomb had gone off inside my knee. There was no opportunity to "play through the pain". In the midst of my pre-op investigation phase I talked to a local guy who tore his ACL playing indoor soccer, but then put off the surgery so he could hike part of the John Muir trail first. “Well, I wore a brace”, he noted as if that explanation was going to be nearly enough to get my head to stop spinning at the thought of it. I was three weeks into pre-op PT at that point and brace or no brace I was still barely able to walk through the neighborhood grocery store. Over the mountains and through the woods was definitely out of the question for me. Clearly, although the general diagnosis was the same, we did not have the same injury.

The other element of recovery has to do with the body’s unique response to the trauma - of the initial injury and then later of the surgery itself. I had the same surgeon, and exactly the same surgical method and materials as trampoline woman, so it was as close to a controlled study as I was likely to get without some research funding. But somehow the function of my knee did not recover at all the way hers did. Ten weeks, dozens of fully committed PT sessions, and countless compression wraps and ice packs since surgery and although the entry wounds are now well healed scars, my knee still retains hints of a freshly insulted joint - still somewhat awkwardly swollen and distorted. When I broke my collar bone at twelve years old (sliding off the top bunk in my sleep if you must know) it began healing itself within days, surrounding the break with an aggressive accumulation of bone tissue the size of a golf ball. I realize now that while this may be a preferable bodily response to a broken bone, it’s probably not ideal for joint injury.

With all of this in mind, I’ve found it helpful – to some extent even necessary – to consider the published rehab schedules and other people’s stories of recovery for what they are – single data points (just like this one) that make up a small part of the bigger picture. I’m beginning to accept that my recovery is uniquely and entirely my own. The successes, failures, and schedules of others, while interesting, are not mine in any real sense. As I wrap my head around this concept, the stress of comparison is removed from the equation. And only then am I able to successfully focus on what really matters.

Day 67

“Where have you been?”, you’re probably not really asking. Well if you hypothetically must know, I’ve been waiting. Waiting for some significant event to occur on this project. Surely, one would think, there would eventually be some clear indication of progress or sudden improvement in my condition - an event transpired, a milestone reached. In short, something worth writing about. Right?

But as seventeen days have gone by since my last post, I am now beginning to realize that I have officially entered the slow burn part of this process where progress cannot be measured on a daily basis – maybe not even weekly. It’s not that I’m not improving, it’s just that I am now doing so at the same hypnotizing pace as my insurance company’s claim processing effort. My progress has been so slow in fact that phrases like “probably permanent” and “as good as it’s going to get” are beginning to creep into my subconscious.

In general things are going well, although when I walk my knee now sometimes snaps and cracks like a mouthful of pop-rocks and occasionally when I bump it just right I involuntarily drive my fingernails deep into the nearest solid object. I’m still regularly reminded of the sciatic nerve but even when I do feel it, the pain is mostly mild. In fact, my knee is almost pain free at this point unless I run it up against either end of the range of motion where things quickly turn excruciating. Before the injury my range was about minus 7 to 150 degrees - essentially, from slightly hyper-extended to a full heel to butt bend. Typically I now have about 5-125 degrees available, but with a generous bit of teeth grinding and profanity I can push it to about 0-140. In PT it can be pushed adequately into hyper-extension. But if I’m not regularly moving it to the limits, even the typical range rapidly tightens up.

Functionally, the last few weeks have actually been excellent. I’m still doing thirty minutes every day on the bike, now at 60 rpm and with moderate resistance – enough to make me sweat for the first time in well over a hundred days. Last weekend I strolled around for hours with my family and a couple thousand other fish fans at the Monterey Bay Aquarium. And I voluntarily hiked to the car afterwards, which turned out to be a mere eight or ten blocks away, the natural result of my resourceful father’s determined search for free parking. The next day I went swimming. We’re not talking laps or anything but just the act of aimlessly swimming around was amazingly fulfilling. It was the first time since Christmas day that I had felt almost uninjured, almost normal again. And yesterday I walked my oldest daughter home from first grade. There are no words that would nearly begin to describe what it means to me to once again be able to make that little trip.


I also had another session at the Stone Clinic PT facility yesterday. The new trick on the rehab agenda: Squats. Sensing my need for reassurance of progress, Thor, the maharishi of PT, pointed out that this is the first time I have been even close to physically ready for the squat. He suggested that we are all born with an innate sense of perfect squat form. (A premise you’d be inclined to agree with if you’ve ever seen the common squat stance of a two year old, feet firmly planted on the floor, butt hovering within an inch of the ground.) But somehow as we age we begin to lose our form – as well as our natural ability to cry our eyes out and laugh uncontrollably in the same five minutes, but that’s getting a bit off topic. If you were somehow able to convince an average adult to perform a squat, you would undoubtedly see their knees immediately start forward as they initiated the descent. Their butt would remain centered under the torso until the bottom of the movement where they would begin to resemble the lesser known yoga stance, “pooping dog”. Giving equal time to the other popular domesticated pooper, Thor also refers to this as “cat box-ing”.

With this in mind I called on my inner toddler as I retrained myself in proper squat form. And I tried to stay focused on Thor’s squat form rules:
1.) Feet comfortably shoulder width apart, angled out 30 degrees.
2.) Knees over ankles throughout the movement.
3.) Send the butt out first. – This is really the key to the squat. As soon as the butt goes backward the head moves forward to balance compensate. This gets things going in the right direction and allows the descent to occur while the lower half of the legs remain reasonably vertical, thereby minimizing the potentially damaging sheer forces experienced by the knees.

After a few trial runs I was able to get very close to a full squat (butt lower than the knees) before shooting pain across the front of my kneecap sent me tumbling to the floor. I’ve still got plenty of work to do, but my newly found squatting abilities were both surprising and encouraging.

I guess the short of it all is that my knee is slowly getting better. Even if too slowly. I am both tremendously tired of being injured and also quite confident that things will be much better next month, and even better still the month after that. And as it's been from the beginning, that belief alone is still plenty enough to keep me going.

Day 50

Here’s a bit of recovery wisdom that I've recently derived: One of the main reasons that you want to rehab as soon as possible after ACL (or any other immobilizing) surgery is that the longer you remain bio-mechanically altered, the more likely you are to injure something else.

Last week’s diagnosis of my recently instigated knee pain:
Sciatic nerve damage.

The determination was based on a quick exam and a few physical tests administered by Thor, comic book legend and trusted PT guru. I know nerve damage sounds nasty but given the alternatives the nerve is by far the best choice. If not the nerve, then the source of pain would have probably been one of the repaired elements of my knee (the ACL graft or sutured meniscus). If either of those had been compromised, it would be highly unlikely for the situation to somehow self-resolve. As such, I was more than happy to buy the nerve damage story. In general, you know things are a bit desperate when you are rooting for nerve damage.

It's now just ten days later and while the pain is not gone, it is already quite a lot better. The relatively quick improvement matches the initial diagnosis and is a good indication that the source was not the graft or the meniscus. Definitely good news.

So how did this happen? Well in my case the theory goes like this:

3 Easy Steps to Sciatic Nerve Damage
1.) Do not straighten or fully use the knee for a few months. This will help to make the nerve shorter and less flexible.
2.) Ice the knee into a deep freeze.
3.) Stand up and fully straighten the knee into hyper-extension – be sure to bend forward at the waist to induce maximum stress on the nerve.

Although it was enough to force me back onto crutches, I’m off them again now and as mentioned, the pain is definitely better. This is especially promising given the fact that I recently gave up Advil, the last of my pain medications.

I had been taking 200 mg of ibuprophin (via Advil) every 4 hours for nearly 5 weeks (beginning the day my supply of Toradol ran out). For the first few days after the nerve diagnosis, however, I doubled the doses to 400 mg every 4 hours. Into the third day of elevated doses I was opening my mail when my eyes suddenly obtained free-agency status. Within seconds my left eye was looking at the ceiling and my right was angled toward the floor. I stumbled to the couch and squeezed my forehead between my hands trying to correct the internal corkscrew effect until it finally subsided after a few very long minutes. By then I had sworn off everything from Advil to fast-food, squinting, nail-biting, illegal u-turns, littering, loitering, loud music, internet porn, new episodes of LOST, and anything else I could think of that might have caused the disorientation. I haven't touched the Advil since.

Going off pain medication is a bit like jumping into a mountain lake. It might be ok or it might be bone-chillingly cold. But you won’t really know until it’s too late to undo what you’ve done to find out. Thankfully, the post-Advil period has so far been quite tolerable. I just have to keep reminding myself that the newly identified aches and pains at this point are not likely an indication of lost progress, but rather the result of once again accurately feeling everything as it really is.

Yesterday I was back on a Stone Clinic PT table where I confessed to Thor that my lower back was still not entirely right. He worked my back a bit and then targeted a new area, the Psoas, a hip flexor muscle that you never even knew you had. Thor calls it the “Filet Mignon of the human body” and in accordance with what is apparently a strict personal policy of full-disclosure, he said that if we were ever stranded after a plane crash in the Andes, that’s the part he would take first. A distracting bit of information I now wish I could manage to forget. In any case, digging into my abdomen to “relieve” the tension in the psoas was a none too pleasant endeavor in itself but it definitely did seem to help afterwards.

The PT session focused primarily on the sciatic, the aforementioned filet, and on obtaining full extension (the latter of which I had been successfully getting to at home for the past couple of days with the help of my wife who is understandably somewhat hesitant to push on my knee). Afterwards I asked Thor about the sports brace that he had previously suggested. The bottom line was that he highly recommends one if I am going to engage in sports during the first year post-op. A quick internet search when I got home led me to this excerpt from about.com regarding ACL knee braces…
“The problem with knee braces? While they may help support the knee when low forces are applied, these forces would not be expected to cause injury to the reconstructed ACL. However, a force that is high enough to disrupt the reconstructed ACL would not be effectively stabilized by the knee brace.”
Similar comments can be found here on the ACL Solutions website: http://www.aclsolutions.com/faq_07.php

Given the opposing opinions, the fact that I already have the bulky post-surgery issued brace, and my general lack of intention to join a pro sports team this year, I think I may have a difficult time justifying a sports brace.

Left: Lightweight state of the art custom fitted brace available in a dozen colors.
Right: Brace worn by Joe Namath in the 1968 season prior to Superbowl III.

At this point I’ve abandoned the regularly scheduled formal PT sessions, although I’m working daily at home and will continue to follow up at the Stone Clinic as needed over the rest of the year. I’m spinning 30 minutes every night on the bike (mounted in a trainer, and at a blazing 40 rpm, but hey, it’s something). I’m still not getting to full extension when I walk but I am getting closer. Overall, I’m quite thankful and pleased to report that despite the recent setbacks, things do seem to be back on track once again.