Elbow Update: I am hardware free!

I went to a massage appointment today, mostly to get the crud out of my muscles. I picked up a bug recently, and was left pretty sore everywhere by it. But I had the CMT work on my left arm as well (not around the elbow, but all the muscles around it), and my shoulder. By the time she was done, I had more comfortable movement in my arm in a long time.

So, I fired off an email to my orthopedist, letting him know that I had really good range-of-motion, and that the massage really opened it up. I also asked if I could start going without the brace, as I didn't think it was making much of a difference right now. About 30 minutes later... I got his blessing to remove it.


Yep! I am hardware-free! While I have it if needed, I am working slowly to get my arm back to its norm, and hope to never wear it again. I still need to wait on major strength work until I get cleared on the 11th, but this is a significant step forward for me. My mobility is really good. With increased range-of-motion, I started feeding myself with my left arm again this week (Thankfully! Try using chopsticks with your non-dominant hand!), which has improved my muscle tone a bit, and my arm is no longer shaky when I hold something.The back of my arm is still tight near the elbow, but I suspect that will improve as well. Muscle-mass... um, yeah... there isn't any right now. Once given permission, I will be doing some serious strength training again, to get that back. My poor right arm has been a victim of overuse syndrome, so I am sure that will improve as well.

Marching onward! I will be back on my bike soon! And working more hands-on in EMS again. :-)

An MRI... and good news

Last Friday, I contacted my orthopedist, because I was concerned about some things with my elbow. These were:

• Could not bend my elbow more than 90 degrees without pain (I have been doing exercises per my orthopedist for mobility, not strength). I wasn't sure if the pain was due to the tendon tear, or due to it needing to be stretched.
• An odd "ache" that had started, with no known reason
• No major improvement since I saw him on January 11th.

 During my last visit, he offered the opportunity to MRI my elbow if I had increased pain, or no major improvement within a few weeks. So, after sending my email to him on Friday morning, I was surprised to get a phone call from him in the afternoon.He decided it was a good time to get that MRI done. He sent off the request, and gave me the number to call to followup ASAP. So, after getting off the phone with him, I did just that. I left a message for the MRI scheduler, figuring I'd hear something in a week. I did mention in the message that my doc had just put the request in for an ASAP MRI.

Surprise! I got a call 20 minutes later. And an even bigger surprise... an appointment at 5:30pm that night. I took it.

I showed up, and was taken to the MRI trailer. I've had 3 other MRI's, so this one wasn't a concern. Some people have real issues with the noise and the claustrophobic feeling the tube can cause. I've actually found the sound almost soothing. I know... I'm wierd. You can't have magnetic metal at all in the MRI tube. I removed my glasses, elbow brace, put my keys and ID on the counter next to my brace and glasses. Hearing protection was given to me, and I was placed in a modified "Superman" pose, prone (on my stomach), with my left arm straight out past my head, my arm locked into a tube with wedges placed inside (stuffing material) for the machine to do its magic on and scan my arm. My head was cocked to the right a bit, with my right arm bent and under my head. I had a pillow also. The scan was expected to take 30-40 minutes.

Initially, it wasn't a problem. About 20 minutes in, my deltoid and biceps muscles (shoulder and upper arm) began to cramp and spasm. I tried to not move, and succeeded for a while, but after 10 minutes, the pain from the spasms was too great, and I couldn't help it. MRI's are very sensitive to movement. So the last 2 scans didn't come out. They needed to be repeated. I mentioned to the tech what was going on, and I had two choices... hold still no matter what, or come back another day after taking a prescribed muscle relaxer. I thought about it for a minute, and decided to just get through it. I did a little repositioning of my head, and rubbed the muscles for a second, then tucked my head down and went somewhere else for the next 10 minutes. Where did I go? I went to the beach; walking on the wet sand at the water's edge in Huntington Beach in my mind. Great trick I learned years ago when dealing with pain. Doesn't always work, but most of the time. But the pain was mounting...

I was just about to say I couldn't do it any longer, when the tech announced he was done, and he got the last two scans. Whew! He pulled me out of the tube, and initially I couldn't make my left arm work. It was like a limp noodle. Started wriggling my fingers, then wrist, and finally could get my shoulder to cooperate enough that I sat up. It still didn't want to move much. And a good part of my shoulder had actually gone numb. Got my brace back on after a few minutes, and then was escorted back into the medical center, where I then left to go home.

I sat in my car for several minutes before leaving. My shoulder was twitching and cramping constantly. It plain HURT. But, the scan was done, and I hoped it would tell what the orthopedist and I wanted to know: How bad was the carnage in my elbow?

When I got home, I emailed my orthopedist to let him know the scan was done. He emailed back to me that he would check on it first thing Monday morning. I took some pain meds and went to bed.

Sure enough, on Monday, I got an email from him around 8:40am.The MRI confirmed the fracture in the bone spur, and I have a helluva contusion (bad bruise) on the triceps tendon, BUT THERE IS NOT A TENDON TEAR! WOO HOO! YEE HAW!!! We emailed back and forth a bit, with him warning me to "behave myself" (in other words, don't be working EMS directly - still supervisory only). Of course! I want this to heal NOW.

So, I can deal with a fracture. Bones heal eventually (usually). This is a bone spur, so it might not behave. If it doesn't there are options. So, I am still allowed out of the brace for minor range-of-motion exercises, and to shower. That's it. No lifting, tugging, or pulling on the arm (Not that I have anyway... I've been good.). My next appointment is on 2/11/10. Here's hoping it is healed by then.

An exercise in patience, as healing continues

Just a quick update.

I am continuing to do what my orthopedist has told me to do, including brief forays out of the brace while at home to reduce stiffness. Mild movement only. But I am able to get my arm to bend to 90 degrees now without pain. Anything further, and it hurts. I have to remind myself that it was just 3 weeks ago that I got hurt, and that I really need to be patient with my healing. 3 weeks to go...

Disasters and Individual Readiness

January happens to be one of the "on-call" months for my DMAT. About a week before each on-call month, I go through my 72 hour pack and my main gear bag, making sure that anything I "borrowed" from it was put back in, any foods that need to be replaced are, and that everything is in good shape. I potentially have to live out of my 72 hour bag. It has food, my medical gear, first aid kit, change of clothes, stuff to keep me busy, some survival gear, etc. And my gear bag is replacement clothing, sleeping bag, sleeping pad, pillow, spare bag (Things expand while on deployment! I swear!), MREs, and more.

I had begun this process, then got hurt. On December 31, I called my unit commander to advise him I would not be deployable for 6 weeks. I think that hurt worse than the injury. I joined DMAT to provide medical care during disasters. I made the decision to join the team right after 9/11 (I had heard about them during my EMT recert class), and I've been with them ever since. I've deployed since in 2004, and 2008, with wildland fire medical and CalMAT thrown in in-between. Even when the orthopedist told me the news, I had not immediately thought it would take me out of deployment availabiltiy, but that realization hit a few moments later.

This week, as hopefully all of you are aware, a 7.0 earthquake hit in Haiti, a few miles from Port-Au-Prince. Casualty estimates are 50,000 to possibly 500,000. That's just the dead. Injured? Try 4 or 5 times that. Illness, infection, rescue/recovery/rebuilding injuries will increase that. And the hospitals and clinics are destroyed. This is a first for DMATs. We have historically worked US missions, although some teams have gone to US territories, such as Guam, and American Samoa. Teams landed in Port-Au-Prince today, along with DMORT (Disaster Mortuary Response Team), IMSuRT (International Medical Surgical Response Team), and more. My team is on standby, although not first out the door for this mission. The medical response for this mission will be prolonged. The magnitude of this disaster is almost surreal. 3 million people are homeless. Malaria, Dengue, HIV/AIDS, Hepatitis B, and TB are endemic in Haiti.

I was asked last night "how broken I was", by one of my teammates. A few want me to deploy with the team, but I can't. Part of my readiness is assessing my capability. I am an EMT. Yes, I am also the Electronic Medical Record expert on the team, but I am first and foremost an EMT. I can't do that work right now. And I need to let my elbow heal, so that I can continue to be a responder, for the team, for my company, and for my employer. This is my livelihood at stake right now. Back in July, I had to make the same decision when I had my knee worked on. Each of us has a responsibility to ensure that we are capable of performing our work. And to assess ourselves and determine that we are not putting our team or partners at risk due to illness or injury. I don't want to do something that will make my arm worse, and potentially send me to the O.R., when I can potentially avoid it by allowing my arm to heal. And I don't want to risk the safety of my team.

Besides, there will always be more deployments. And I suspect multiple deployments to Haiti.

Elbow update

I went back in this afternoon for another round of x-rays, and time to chat with the orthopedist. Although he requested an "in-splint" x-ray, the brace covered the area to be seen, so I needed to remove it for a good shot.

This is a print of the x-ray (I need to remember to bring my camera with me next time), cropped:

The text was added by me. You can see where the bone spur I have tore away from the bone (That was the initial injury on 12/28/09). Additionally, if you look at that bone spur, you can see a break in it. That was what happened 24 hours after the initial injury at the gym, when I slung my backpack on my back. Worse injury, in other words. This shot was actually taken on 12/31/09.

So, today's film shows that the bone spur hasn't moved. Which means it is still a partial tear only, and should heal on its own. But, with my propensity to shred things really well, cautious optimism is the term of the day. No surgery now, thankfully! Hopefully never. When the doc checked it out, and had me pull up with my forearm against his hand with my arm bent at about 90 degrees, it still hurt like hell. Extension is good, though, which bodes well also that it isn't torn horribly.

At this point, I am still to keep it in the brace, but I can remove it for very passive exercises when I am at home (and still for showering, thankfully). Otherwise, it stays braced. Even while sleeping. No lifting with my left arm at all. This will continue for another 5 weeks. Any increase in pain, "pop", or no improvement over the next few weeks will send me to have an MRI. But not for now. And yes, I am still banned off my bike.

Thank you to everyone for all your well wishes while I deal with this injury. Your thoughts and prayers are very appreciated.

Las Vegas Trip

Last Wednesday, I took off for Las Vegas, to attend the 2010 Consumer Electronics Show. Aside from the show, my family lives there, so it affords me the opportunity to visit them as well, which I always love. The drive out there was actually quite nice. I didn't see the sun until I got onto highway 58 and up the hill a bit. As many in California know, in winter, northern and central CA are either fogged in, or it is rainy. Once up the hill, the sun was out and the temperature jumped from 44 to 60 degrees. It was comfortable.

I got there in about 10 hours, taking a few breaks along the way to rest my arm a bit. I was pretty sore when I got to the RV that I stay in. Typically, I bring the SUV for around town transportation, and my father brings his RV for the show. This year, he also brought his own truck. His RV is really comfortable. I happened to arrive near sunset, and fired off a few shots:

The show itself was fun. I wasn't very impressed my first day there, but Friday and Saturday, I got to play with a lot of cool stuff. And Thursday night, I attended a fun party, that also had a lot of great stuff to see. Some of this years swag was fun, but less companies were offering it. I didn't win anything (that I know of at this point), but I still entered the freebie contests as I found them. I reviewed a few items for publication, and will be doing more soon, including some headphones that are semi-custom in fit. And inexpensive!

Thursday night, I happened to witness a medical issue that occurred in a casino. I watched it from start to finish, since they had EMTs there. I was walking by as the casino EMTs arrived. It was interesting to watch how they handled a patient having a stroke while playing blackjack. They provided excellent care for the patient, who was tranferred over to Clark County fire paramedics, and transported to a local hospital for further treatment.

Friday after the show, I needed to rest. I did gamble a little (Hey, I have to pay my Vegas visitor's fee, right?), but got some dinner and went back to the RV. My arm was pretty sore after being down by my side most of Thursday and Friday, and being protective of it, so people didn't smack into it (The show floor was VERY busy). Some booths are extremely popular, and resemble mosh pits for the freebies given out.

Saturday evening, I got to spend time with my family, enjoying a really good dinner that was cooked by my sister-in-law, Paula (I want that recipe for the rice!). It didn't last nearly long enough, and soon I had to head back to the RV to get some sleep before leaving the next morning.

Yesterday's trip went quickly. I basically drove straight through, stopping only to get food and for some "brief relief". Took today off, just to kick back, but also because I have a doctor's appointment this afternoon to get more x-rays on my elbow, and chat with the orthopedist to make sure that my injury is stable and doesn't need surgery. I will let everyone know later today...

Working EMS as a supervisor

While I am a supervisor as one of the owners of a BLS provider, I am usually a "hands on" supervisor. I am not the type to stand back and not have direct patient contact. Unfortunately, with my triceps tendon injury, and my arm in the brace at a 45 degree angle, there isn't a lot I can do, EMS-wise, except to supervise. So, I've decided to turn lemons into lemonade, and hone my supervisory skills during this time.

While I did assess one patient who has diabetes with a minor hypoglycemia issue, he self-treated while we watched him. But if he had gone to the ground, I knew I would not have been able to drop him in a controlled manner, to avoid injuring him and myself. Thankfully, the two EMTs I was supervising were right there as well and would have been in a capacity to care for this patient. After that, I stepped back and let them handle all the patient care for the duration of the shift. I need to really work on being only a supervisor for the next several weeks. And keep my hands in my pockets. :-)

On the injury front, the brace has done wonders to stop the spasms in my triceps muscle. I do have a fair amount of upper arm soreness, but I think that is due to sleeping positions and from holding my arm in a protective posture (which I am correcting and learning to relax while walking and sitting). And the soreness is in the biceps muscle, which is uninjured. The brace slips a little, so I need to re-adjust it occasionally, but it is infinitely more comfortable than a cast. The pain is down to a level that I hardly notice it any longer. Except when I bonked it a bit last night. I am going back to the gym today, but to work on my cycle time (stationary bike only - I am absolutely not allowed on my MTB), and work on lower body and core strengthening.

Uh oh... what did I do now?

I've gone back to the gym lately, more as a result of the weather not being very conducive to riding my bike lately. But I realized I was also losing muscle mass since my knee surgery in July. I just haven't needed to really USE my muscles much. The last time I really had to lift a patient was back in October. So, I needed to get back into a good muscle building regime, along with some good cardio.

I like mixed cardio/weights in a workout, not isolating to one or the other, when I am in the gym. Part of this is to break up the monotony, but I think (for me) that I get more out of my workouts when I do this. I'm not a body builder, nor am I a long distance runner. I am simply someone trying to lose weight, to build some muscle, and generally feel and look better. That said, sometimes I do just use the bike, or the elliptical, but I never just do weights.

Two days ago, I was at the gym, and had moved from the elliptical to a 30 minute weight session. Worked on the legs, and the back, and went to work on the biceps, triceps, and lats. I have a 3-way method on the lat pull-down machine for this. Standard lat pull down behind the neck, forward, and then I work the triceps using the same machine, but with my hands close to the center of the bar, elbows close to the body, and just bring the bar down so my arms are at a 90 degree angle, then up again, not moving the upper arms from my body (so the triceps are forced to work). No problem, right?

Set the machine for 40 pounds. First two exercises went off without a hitch. Then I moved to the triceps. First 4 felt good, then something went "pop!" in my elbow, and I felt a tearing sensation. I stopped right then. Checked out my arm, and moved it. Moved ok. No real pain. Dropped the weight to 30 pounds. 3 pull downs later, the pain returned. OK. I stopped the exercise altogether. This was going to be the end of my workout time anyway, so I went home, and iced my elbow.

Yesterday, I woke up, and my elbow felt ok. Pushing down hurt a bit, but not bad. I went to work, and finished out my day without a problem. Not that a keyboard really works out your arms a lot, mind you. Got home, and was pulling my backpack out of the back seat like a normally do, and went to sling it over my left shoulder, when WHAM! Sudden, searing pain in my elbow! 10 times worse that at the gym. I think they could hear me yell a few streets away from my apartment complex. I know one of my roommates did. Damn that hurt!

I closed up my car, and went immediately into my apartment, grabbed the ice pack in my freezer (A zip-loc bag full of peas - works great), and iced my elbow. This time, the pain didn't subside. And my elbow was feeling hot. Crap! After 45 minutes of icing it, I had some improvement, and could move it a bit without pain, but putting pressure, even typing, hurt. I spent most of last night before bed icing it off and on, fired off a message to one of my docs, letting him know what happened, and went to bed.

I didn't sleep much last night. Positions that didn't allow my muscles to completely rest were uncomfortable (read: painful). I am still waiting for an answer from my doc. I hope he is in this week. If not, I may have to call in and get an urgent care appointment. I don't know if I just tore some old scar tissue in my elbow (from years of bowling), if this is a new injury, or a combination of the two. I can move my elbow this morning, but it still feels warm, and pushing down on things hurts (I can type again with my left hand, as long as I rest my arm while doing it.). I've also started back on some non-steroidal meds (started those last night), hoping the combination of NSAIDs and icing will calm this down. Based on the improvement since yesterday, I am hopeful that I didn't tear anything major, but since I am dealing with ligaments and tendons that don't heal normally, I do have to be careful. EMS-wise, I am not working until Saturday, and if I had to work, I could right now. Might not be the happiest EMT around, but my arm does work.

In the meantime, I am going to work more on strength in other parts of my body, riding, and other cardio. I do have MTB season starting soon, and I plan on participating this year.

Infection Control and an update on Jackson-Pratt

The antibiotic I am on is really making a big difference. Its knocking out the infection really well. My knee hasn't felt this good in a while. Mobility is much better, pain is down to almost nothng, swelling down, and redness is gone. My surgeon made an interesting comment when he was checking it last Friday, "Hey, its starting to look like a knee again!"  I've been 100% on the antibiotic. Even have an alarm that wakes me up at midnight to take it. Haven't missed a dose yet.

Last Friday, 5 days after I visited the E.R., my surgeon and I sat down to make a decision about the drain. It was at a point where we needed to decide if the drain was causing the fluid to continue, or if the drain needed to stay in longer because my knee needed more time to heal. But since it was already the cause of the infection, it would probably mean I would either be on antibiotics until it came out, or I would end up sick again.

So, the drain was removed. The surgeon started putting together everything he needed to pull the drain as well as to cover the hole left over and provide good compression. While he was doing that, I asked him if I could get a release to work EMS again. He asked me, "Will you be careful?", with a tone that was a little comical, but that implied he was serious and not joking. "Yes, I will be.", was my response. And I meant it. I don't want to go through this again, not that my work in EMS did this to me.

Remember how I mentioned the joy of it going in? Taking it out was without anesthetic. Not that I think the anesthetic would have worked, since infected tissue doesn't anesthetize very well. He takes a 4x4 and places it on my knee right where the drain came out of my skin. I mentioned to him that I accidently tugged on the drain line the day before, which gave me a taste of what this was going to feel like... ugh. But, I wanted it out like no tomorrow.

"Are you ready?", he asked. "As ready as I'll ever be..." Only took a minute, but yeah... it hurt. Sometimes they do, sometimes they don't when they are removed. Since it was infected already, the tissue was pretty tender. Yeah, I watched the whole thing. I also got to take a good look at the drain (the portion that stayed under the skin for over 2 weeks). It didn't have holes. It had rails, made of a flexible plastic, along the sides. The suction pulls the fluid into the rails, and it comes out the tubing. Really interesting, actually.

So, I ended up with a bulk dressing again. Lots of 4x4s over the hole left where the drain came out, and a bulky pad over that, wrapped up with a gauze wrap and and ace wrap over that. In this case, the "bulk" of the dressing is to provide pressure on my knee to discourage fluid from accumulating again. I took the rest of the day off of doing anything, and went home to be kind to my knee. With the drain out, the pain level dropped instantly. Still tender, but not painful except a few twinges once in a while. I did fax my work release over (Yes, he gave it to me) to the Rivercats, so I could work there again. I've really missed it a lot.

On the EMS front, Saturday, I worked a triathlon, then went to a football game and worked there. Saturday night, I worked a shift for another EMT at the ballpark. Sunday, I worked another triathlon. It was really hot both days. Yeah, I jumped in with both feet. But it felt really good to be hands-on with patients again, and I needed to get tired again doing some good physical work. My sleep hasn't been very good lately, due to the pain from the surgery, the drain, the infection, and more. I slept really well the last two nights. I know mentally I've missed the work. I didn't realize that I physically did as well.

Uh Oh...

For the last few days, I noticed an increase in the amount of fluid coming off my knee through the surgical drain. Obviously, it shouldn't increase, but decrease. Saturday evening, my knee was sore, but I thought it was from moving the scar tissue around, since I was walking more. I iced it, and it did feel a bit better. Went to bed...

Yesterday, my knee looked good in the morning. Still more sore than it had been, though. Even doing my quad exercises hurt more. Went to breakfast with my roommates, and to Walmart. Walking through the store, I noticed my knee seemed more swollen and painful. Finished there, and went home. Iced my knee right off the bat. It didn't improve the pain and swelling much though. And about an hour after, I started getting chills. I very unjustly blamed my roommates for my freezing, as the thermostat was at 67 degrees (They both said they didn't change it).

So, I pretty much took it easy the rest of the day, hunkering down in my bed under the covers. I did get up when my business partner Steve returned gear he used during an event, and I was pretty sweaty when we were offloading gear.

So, last night, I decided to ice my knee more directly that through the ace wrap. Took it off, and immediately realized it wasn't an overuse problem...

 

You can see the redness and swelling in this picture. Sorry the quality is so poor.

Uh oh... My knee was red, hot, and swollen, as well as being painful. I pressed on some of the area that seemed more swollen, and realized there was fluid in there, even with the drain in. I pressed on the skin, and 10cc of fluid came out within a minute. It was obviously an infection. I did ice it, which didn't do anything. Knee was still as hot after I iced it as before. Checked my temp, which was 100.3. Bleh. Rewrapped it, made

A trip to the ER was in store, which I did do. Sent a message to my surgeon also, so he knew what was going on. Ended up with I.V. antibiotics, and a 10-day supply of oral antibiotics. Got home about 12:45 this morning. Thankfully, they cut me loose rather than having me take up space in a bed in the hospital. Got home and promptly fell into a coma until my alarm went off reminding me to take my next dose of antibiotic. My knee is less painful and less swollen this morning, which is a good indicator that the bug causing this is sensitive to the antibiotic, a real good thing. I have a planned appointment with a P.A. in the orthopedics department this morning, which is now also an ER followup appointment.

A Week with Jackson-Pratt

OK, well, "A week with a surgical drain tube and suction device sticking out of my leg"... sure does sound less poetic than the title of this post, doesn't it?

As I reported in a previous post last Tuesday, I had the surgical drain implanted. Since then, it has been doing its job: keeping the fluid from building back up in the tissues. It has allowed the dermal layer (the layer under your skin) to lay down to the tissues underneath, and to begin the process of permantly adhering to those tissues. Literally overnight, the color of my skin around the suture line improved, showing that perfusion of the tissues was happening again. This is really good! Healing happens when blood supply is returned to tissues. Otherwise, it is very possible that a section of the skin might have not survived, or would have taken a very long time to heal. It has also had a nice secondary effect... the fluid that was building in my lower leg since the first surgery was also removed via gravity and suction. I kept my leg elevated most of the week to encourage it to drain. It was a little disconcerting when the amount of fluid removed increased, but it made sense.

My surgeon has kept close tabs on me during this last week. We have used a form of telemedicine to do this. Simply, I email him status updates daily, along with a link to pictures of my leg that I place on my domain. You can see these at http://www.portable-essentials.com/pics/knee if you wish. Warning: They aren't pretty. He then replies to my email, with any changes he wants me to make, or lets me know to continue doing what I am doing. And he answers any questions I have. I've been very impressed by his care and caring. Even this week, he is on vacation; however, he is continuing to read my email, and saw me this morning in clinic. He could have passed this off to someone else to deal with this week, but he didn't. For those of you who remember when my late husband Rory ruptured his patellar tendon, it was this doctor that was able to repair it so that Rory was able to continue to walk, until a few days before his death. He is very well respected, and I fully understand why.

On to this morning's appointment... things look good. Everything is healing, and the dermal layers are staying down. The drain is still putting out fluid, and although was briefly clotted off Saturday and Sunday, I was able to get it unclotted so it worked again. Took a bit of work, but it seems to be behaving again. With any luck, it might be out on Wednesday this week. This is a day-by-day thing, with no set date for it to be removed. This is just a plan at this point. Every day it is in, though, my risk of developing an infection is there. So the faster my body stops producing fluid around my knee, the better. If it comes out too soon, then fluid will build up again, and another drain will need to be placed. It wasn't fun the first time. I'd much rather not have to do that again. If I have to, of course I will, but lets hope I don't.

Knee pic

This is what my knee looks like with the Jackson-Pratt surgical drain in place:

And yes, it hurts.

Surgery Part Deux is over

The surgical drain is in. And I am back home. Drove there, and drove back on my own.

I got to my orthopedic surgeon's office this morning, and needed to wait a little while. Not a big deal, but it ratcheted up my apprehension level a bit. I *really did not* want to go through with this. I was hoping all night that the fluid would just disappear, but I knew it wasn't going to happen. When I woke up this morning, I knew I was going to end up with the drain. I just didn't want it. I can't imagine anyone that would.

The doctor came in, and we chatted for a few minutes while he checked out my knee. We talked about the blister that popped up Saturday under a steri-strip, as well as part of the suture line not looking real well. The skin just isn't perfusing (getting needed oxygen) very well, due to the fluid underneath not allowing the tissues to heal together and form those all-important new blood vessels. After our discussion, it was evident that the drain needed to be placed, if anything to allow the tissues to heal properly. He thinks I blew the internal sutures the first time I bent my knee. Not that I did anything wrong. The tissues just wouldn't hold the sutures. Fluid accumulation probably contributed to this as well. The problems I am having aren't uncommon for this surgery, but still disappointing.

There are a few types of drains used for wounds. And I had some questions before we got started:

1. What type of drain was he going to use?
2. What about antibiotics while the drain is in place?
3. What about culturing the fluid still in my leg?

The surgical drain is (as I was hoping) a Jackson-Pratt (JP) drain. This is a "closed" drain, with a bulb on the end to maintain suction on the area being drained. This type of drain is safer than "open" drains, which allow more opportunity for bacteria enter the wound. Here is a picture of a JP before it is placed where it is needed:

The end of the drain has a trocar (a large needle). You can see it in the picture above. They come in different sizes. I think a 7FR was used for mine. The white ends of the tubes are the end that stays in the wound where the fluid is. Only one tube is used for each drain. I only have one drain (thankfully).

!!! WARNING... THE REST OF THIS IS PRETTY GRAPHIC... WARNING !!!

The surgeon prepped my knee with sterilizing solution, a large area, well past where he was working. Situation normal... always go farther than you need. He then started numbing up my knee, starting above my kneecap. Used a fair amount of lidocaine. He then numbed the area below my knee where I have little feeling from the accident. Some fluid started coming out from the anesthetic needle hole below my kneecap. Gave the anesthetic a few minutes to take effect, tested to make sure it was numb...

...and then he took the trocar and went in from below my knee. Didn't hurt at first, but then he went through an area that wasn't numb. OUCH! Took less than a minute, but wow that hurt! He continued to thread it through the tissues. Then he went through the skin above my kneecap where he had numbed up initially. A little bit of positioning of the drain line with it pulled completely in through the entrance wound, and it was attached to the suction bulb. Yep! Fluid started coming out.

He extended the drain with more tubing to make my dealing with it easier. Yep... still working. Covered the entrance wound with tegaderm, covered the exit wound where the drain line comes out of my leg with xeroform (antibiotic/petroleum jelly gauze) and tegaderm (clear plastic dressing). The picture above shows it covered, with some fluid coming out. He covered the blister with some xeroform as well to get it to heal, the suture line with gauze, and then covered my leg with Kerlix (a type of fluffy gauze roll), and ace wraps over that.

We were talking while he was doing this, and joked about the patient table I was on (He really likes that table! But it has very little padding. Almost like sitting/laying on a backboard with a folded towel on it), and I learned more about this type of drain. I have to admit, it was pretty interesting to watch him put this in. I've taken drains out of people before, but never saw one put in. I would rather have seen it put in on someone else, but it was still interesting!

I need to empty the bulb periodically, and then squeeze it to maintain suction. No antibiotics right now. The fluid coming out looked just like it has all along. No signs of infection, except possibly the small area on the suture line and blister. That is managed with triple antibiotic ointment (like Neosporin). If I start showing signs of infection, then he will prescribe at that time. I am back on "house arrest" until my next appointment, early next week. With any luck, the drain will be removed them (if my leg isn't putting out more than a few drops of fluid at that point). I did refill my pain meds in case I need them. Got my leg elevated also. As I am typing this, the lidocaine is wearing off... we'll see how it is in a little while.

Surgery Part Deux is tomorrow

There wasn't supposed to be a part 2.

I should have been well on my way to getting back to normal. Movement-wise, I am doing well, but the fluid is still on my knee. Seems to have stabilized, but it is still there. So, barring a miracle of the fluid going away overnight, I will be back in a procedure room tomorrow, more than likely having a drain put in my leg.

I haven't done anything wrong. I've followed exactly what I was told. Yes, I have been a good patient. I stayed a couch potato for over a week, with one brief foray for food, and one movie (with my leg propped up at the theatre!). I didn't even lift any medical gear during that first week post-op.

Why is this happening? I don't know. But it has to end.

More info tomorrow.

Frustration

I wonder if I did the right thing at this point in having the surgery. After all of this, half of the fluid aspirated off yesterday is back today. I just can't believe this! I had the surgery to STOP this from happening, not to make it worse!

Surgery Update

OK. Sutures came out today. Well, it was actually one LONG suture. The P.A. that pulled it was duly impressed at how large the incision was, since most bursectomies (removal of bursa) are much smaller. The white steri-strips will fall off in the next few days. There are two areas that still need to heal in a little more, but it looks good, scar-wise.



He also noted the large amount of fluid that had accumulated. We agreed it needed aspiration (thank you!). So, he got all the stuff together, numbed up the location he was going to put the needle into (It is the same general area I used before as well, which is numb already), and went ahead and started aspirating the fluid off. This is OUTSIDE THE KNEE, everyone! He used a 30cc syringe, and pulled off one, two, three syringes full, plus another 22cc. Total 112cc removed! It was almost a record for him (115cc is his record). I had guessed yesterday that there was about 100cc, so I was close on my guess. Last Friday, when I emailed my surgeon, I told him more than 40cc, but more swelling has gone down, so the fluid was more evident. The fluid looked just like it should, no sign or smell of infection. Hopefully, the fluid wont come back, since that was why I went through this surgery in the first place. Bandaid placed over the aspiration site. The picture was taken after the sutures were out and the fluid pulled off. I am using a pad on the area where the fluid probably originated at, putting pressure on that area, to try and convince the area to not fill in again, and an ace wrap for compression.


I came home, and immediately iced my knee again. It was a bit sore from the suture removal and aspiration, so I figured it was a good idea.

 

(Comparison of my knees)

So, I am off the crutches (yes!), and am allowed to use a stationary cycle (yes! yes!), and exercise at the gym. No regular bike riding for at least 3 more weeks (sigh...). Once the skin heals a little more, I will be able to bend my knee more than 90 degrees, but not yet. I may need to wait up to 10 days. I can shower again, too! In terms of EMS work, I can supervise, and do some work, but no kneeling on that knee. So, I will stay a supervisor for a few more weeks. I really want patient contact again, and I miss my work at the ballpark, but need to let my body heal first.

Back to the grind

Well, this week, I started back to work, but from home. Worked Monday-Wednesday at home, with my leg elevated. Once the over throbbing went away, I began to keep it propped up, just not resting on the floor like normal. That worked well. Well enough, that I decided to try and work at my normal cubicle. Since there is a fair amount of walking involved to actually get to my desk, I drove to work, rather than taking light rail in as I normally do. Still using my crutches for distances, although at home I am walking around without them. I have my leg propped up on a box of all things! Tried propping it up on my desk, but it isn't very comfortable:

You can actually see my wrapped knee through the blue jeans. Might try some different things.In the meantime, my office chair broke. It had a crack in it when I acquired it over a year ago, and seems to have decided that now is the time to commit suicide. Bad timing. So now, I am scrounging to find another one. Budget woes are apparently hampering our ability to order needed things, such as something to sit on.

I have been feeling what I think is "suture pull" for the past few days. As tissue begins to heal, with sutures in place, the whole area feels like it is being tugged on. Hard to know for sure, since the feeling is not quite normal. Been doing the quad set exercises that apparently were supposed to have been included with my post-op instructions, but were not. I know them anyway, so its not a biggie for me. Even sitting at my desk I do them. I have noticed there appears to be fluid accumulation around my knee, right around the suture site, going up the medial side of my knee and over the kneecap. I sure hope it is just post-op, and not the seroma back again. I'd be "extremely disappointed" if this was all for nothing, except making it worse. So, I've been wrapping the ace wrap tighter than it was wrapped post-op, hoping to convince my body to absorb the fluid back. Hope it works...


Trying to see when I can ditch the crutches. I have to admit, when walking distances, it is more comfortable than walking without.

In the meantime, I am going back to EMS in a supervisory capacity for a few weeks. No kneeling for me for a while... got to be a compliant patient. Got several new EMTs, and I don't want them working without good supervision.

Post-op Day 6

Well, I spent yesterday as a couch potato again. I knew that going to the movie would extract a price, and it did. When I went to bed Saturday, I needed to take the vicodin for pain control, and keep my leg up (which I've been doing). But, I couldn't sleep. It just hurt. Ended up taking more meds 4 hours later. Finally got a couple hours sleep, then got up, went out to the couch, propped my leg up, and watched the TdF final stage (Distraction does wonders for pain control!). That was a great finish! Right after the end of the race, I dropped off to sleep on the couch.

I woke up some 3 hours later. Felt a lot better at that point.

Take-Home Message: A drugged sleep is no substitute for the real thing!

But I knew I needed to keep my leg up. So, most of the day, except for necessary moments, I stayed on the couch with my leg up. Had some swelling in my foot and ankle again (a minor post-op problem), so keeping it up was important. Around 6:00pm, I sat up, and started using the recliner function in my couch and pillows to keep my leg up, but to actually sit up, and not be lying down.

Today, I woke up after getting some sleep last night. Got back to work today, but working from home, since I need to keep my leg up still. Can't really do that well at my desk. Might try to get in to work later this week, but that is a *maybe* at this point. The plan is to work from home this week, and get back to my desk next week.

Been checking my wound, and I noticed bruising that was starting to resolve. Guess I didn't see it before. Still sore, but nowhere near as painful as it was last week. Looks good.

Yesterday and today, I've been walking around the house without my crutches, which is nice, but outside I am using the crutches. But I am feeling a lot more confident walking, and hope to ditch the crutches entirely by the end of this week or early next week (With the surgeon's permission, of course!). As I put in my previous post, I moved to the forearm crutches, which are vastly more comfortable than underarm crutches.

Cleo is still guarding me...

Can you see the look on her face???... "You will NOT move!"

I am not a patient patient, but I am trying to be...

Post-op Day 4

Took a good look at my knee today, and changed the dressings under the ace wraps. It doesn't look bad:

The yellow xeroform is where the suture line is. Pretty large incision. The blue lines are (I think) landmark lines that the surgeon used. My knee is still swollen, but looks good. No sign of infection (always a good thing!). No, my leg wasn't hanging down. It was propped up on the pillows, and I took an overhead picture.

Started doing some quad muscle tightening today. Not a lot, but a start.

I am on crutches, although I ditched the underarm crutches in favor of my old forearm crutches. My roommate dug them out of my garage for me. Since I am weight-bearing, why not? They are WAY MORE COMFORTABLE! Haven't used them in a long time (For a few weeks after I rolled my ankle in 1999, prior to that 1992-1993 when I was between ankle reconstructions, and after the 2nd one in 1993), but I am, at this point, very glad I didn't get rid of them. Every time I get up to walk, it is not comfortable (read: painful), but after several steps, it is ok (read: tolerable).

I finally got stir-crazy enough to need to go out and DO something. So, I decided to go see Harry Potter and the Half-Blood Prince. I've wanted to see it since it came out, and decided that my mental well-being needed to take a little priority. So, I made sure I had no narcotics in my system, grabbed a pillow for my leg, and drove to the local theatre to watch the movie. Went to the first showing, figuring that there would be less people there than any other time on a Saturday. Not really, but I managed to score a seat along the "disabled" seating that allowed me to prop up my leg on the seat next to it (That God for those new connected seats that the armrests swing up and away!). For the next 2 and 1/2 hours, I de-stressed. BTW, the movie is good!

Went directly home, and got my leg back UP. Stayed that way for a few hours. Went back out briefly to get some fresh veggies for dinner. Made a killer salad later, and had some mushroom ravioli (really yummy!). Good dinner.

Well, no deed goes unpunished. My increased activity has taken a bit of a toll. Pain is a good reminder. Ended up taking more vicodin for pain control. Something tells me I will spend all day tomorrow with my leg up.

Post-op Day 2

Well, today started rough, but ended easier. I didn't get much sleep last night. Even with the pain meds, my leg HURT all night. Turning over made it worse. I am not used to sleeping on my back, and to keep my leg elevated, I need to do just that. Bleh.

So, I got up and out to the living room. Propped my leg up, and took a few vicodin. Promptly dropped off to sleep. When I woke up, it was over 2 hours later, and I was feeling a bit better. A little sleep does wonders. A few hours later, I got washed up, and made a short trip to the store (Yeah, I know...) to get groceries I desperately needed. I used the little electric cart at the market. Sure got a few looks from people that know me, but no one said a word. Got home, put my leg back up, took more meds, and stayed that way most of the day.

The day is ending much as it started. Heading to bed to rest. I hope.

Post-op Day 1

Most of the surgical meds are out of my system now. Thinking a lot clearer, but I feel like crap. Been taking the vicodin since about 10:00pm last night. Sometime around 2:00am or so, the local anesthetic wore off that had been used on my knee. Pain started ramping up at that point. Hurts more on the medial side. I wonder what the surgeon found over there. When I left the hospital, pain was about 2-3. Today... 6-7, with occasional spikes higher.

Never got an answer about putting weight on my foot or not, so I am non-weight bearing until I hear from the surgeon.

Today is definitely a kick-back and take the meds day.

I am so appreciative of my friends that got me over to the surgery center, and got me home after. Not sure what I said on the way home... I remember a traffic issue on the way home, perhaps an accident (not that we were involved in). Thank you, Steve, Donald, and Penny!

Op Day

Surgery seemed to go well. Not sure why, but I was given a general anesthetic at some point. Hopefully I will find out soon. I'm wiped out. Gonna sleep.

Surgery

Yep. (Warning, what follows is a bit graphic)

Last week, I sent an email to my orthopedist, 'fessing up that I had aspirated fluid that was accumulating outside my knee. Did it by what is called needle aspiration (syringe and needle), following good aseptic technique each time. Not once, or twice, but three times. But, doing this is essentially playing russian roulette, risking infection each time. And the problem wasn't going away. In fact, when I was on my bike, it got worse (presumably due to pedaling). So, we chatted back and forth by email, and he let me know that the only way to fix this permanently at this point is surgery. Not on the inside of my knee, folk. On the outside.

What has happened is that a pocket developed, probably due to a shearing force when I hit the ground that tore away the tissue layer that holds the skin to the underlying tissues. There is an area below my knee that feels "rope-like". This is more than likely the tissue that sheared away. A "pseudomembrane" has formed in its place that is holding the fluid in that area, since the body likes to fill in voids with fluid. The surgeon will go in and open up this pocket, clean up the mess I made (like that rope-like stuff), check on the side of my knee for damage (its been getting progressively more sore since I started bicycling again), repair anything that needs it, and essentially attempt to "tack down" the underside of the skin to the tissue below with absorbable sutures, to keep the pocket from re-forming. If that last item can't be done, then I will be stuck with a drain in my leg for a few weeks (not a fun prospect). Needless to say, I am voting for the suturing.

This surgery will keep me out of commission EMS-wise, for a few weeks. Two weeks of VERY LIGHT duty (Think nothing to supervisory only), followed by a few weeks of ramping up to normal activity. I need to give the tissues a chance to really adhere to each other. Day job-wise, it means I am probably going to be working at home for a week or two, after a few days off for healing and pain control.

I went in and saw the orthopedic surgeon last Friday. Got all the pre-op stuff out of the way already. So, when is all this happening? Next Tuesday, July 21st.

June is here already

Wow... I can't believe 5 months have gone by so quickly! It seems like it was January yesterday.

I am doing ok. Still dealing with the effects of my bike crash on Cinco de Mayo. The fluid on my knee (called a seroma) is keeping me from riding, which bugs me to no end. I may start riding anyway. But I have a trip coming up to New York City on June 6th (Really on June 7th, but the flight technically takes off at 11:59 June 6th... yeah, a real red eye flight!) to man a booth for my day job for the State of CA. The bruising is all gone, by the way. Allergies are driving me nutty lately. But that's what I get for being outside all the time! :-)

I am working madly to get everything together for this conference in NYC. Its gonna keep me busy this week!

EMS work is keeping me busy. Baseball season has started, so I am working EMS at Raley Field now, too. First On Scene EMS is also busy!

Not what I wanted to hear

Five weeks ago, I rolled my ankle. Not doing anything incredible; I was just reaching for something across my bed of all things. Didn't seem that bad, but it hurt. I treated it with the usual formula (RICE):

• Rest
• Ice
• Compression
• Elevation

It improved relatively quickly. However, a couple of weeks ago, it really began to ache, up into my fibula (One of the bones in the lower leg). My thought was, "maybe you have a stress fracture". So, I got in touch with my old podiatrist by email. Didn't hear back, so when I went to pick up some meds from the pharmacy, I stopped by. Talked with him briefly when he passed by me in the hallway heading somewhere else. Got an appointment, and got some x-rays taken.

Flash-forward to today. I saw him, and we chatted about my ankle, while he found the area of what we call "point tenderness" that was the worst. It wasn't in the bone. The pain I was feeling was "referred pain" (pain that starts somewhere else), probably due to the previous nerve damage in my ankle. Its that nerve damage that allows me to walk on a potentially severely injured ankle without screaming. The pain was clearly in an area of soft tissue (Non-bone). I was figuring he would offer a few options, one of which was injecting it with a cortisone drug to get it to calm down.

Nope. He dropped a bombshell on me. He told me that I need surgery AGAIN to essentially reconstruct the ligaments. Either I overstretched the repair I had in 1993 (and previously in 1992 which didn't take), or I tore it out (I had the extensor tendon from my ring toe harvested in 1993 to recreate the anterior talofibular (ATF), posterior talofibular (PTF), and calcaneal ligaments. Took months before I was allowed to put my foot to the floor after that one, and a year before it was ok to walk without support (Most of the time, I was in a "fracture walker", a removable cast that looks like a ski boot). This time around, it will take cadaveric ligament grafts to fix. Hmmm. Not real thrilled about that, but my tissue isn't usable. And two months non-weight bearing, along with another 2 months in a fracture walker. Hmmm. Thats four months directly out of commission, in terms of EMS work. Ugh.

I don't have to do it immediately, but it does need to be done. My ankle will dictate more than anything when I have to get it done, but I am thinking next summer might be a possibility. In the meantime, the doctor built up the outer edges of my boot inserts to keep me from turning my ankle while walking. He wanted me to be in a fracture walker again, but after we talked, my work boots are a good support for it (just about as rigid on side-to-side movement). I have to be able to work. At least right now.

Padded lampposts to protect texters?

In yet another one of those, "Why are they doing this?" moments, somewhere in London, England, lampposts are being padded to PROTECT PEOPLE WHO ARE WALKING AND TEXTING USING THEIR CELLPHONES. Here is the article from ITN:

-----
Padding to protect pedestrians

People who have been injured while walking and texting on their cell phones may be in luck.

A London street is experimenting with padded lampposts to protect those not paying attention from banging into them, ITN reports.

A study conducted by 118 118, a phone directory service, found that one in 10 people has been hurt while focusing on their cell phone instead of where they were walking, ITN reports.

The test lampposts will be given a trial run in London’s East End on Brick Lane. If the trial is successful it will be rolled out in Birmingham, Manchester and Liverpool.

The survey found that almost two thirds of respondents lost peripheral vision while texting, and more than a quarter wanted lines on the pavement to create routes for texters to walk while using their phones.

The study claims that 68,000 people were injured in the U.K. last year while chatting or texting on their cell phone, Infomatics reports.

118 118 will provide the padding, and in return will be allowed to advertise on them.
-----

OK... Here's my take on it... Stupid people should not text and walk at the same time. Sit down and send your message!

The Danger of iPods and other MP3 players

I saw this on another site a few minutes ago. The New South Wales Police Dept (Yes, in Australia) has embarked on an interesting campaign to remind people to be aware when listening to music on headphones. I especially like the body outline.

Post CES: Lots of great stuff...

... and a sore knee to finish it off.

I got a lot of cool swag at the show. The usual promo stuff, pens and the like. A lot of USB drives, including a few 1GB models. Tshirts (not many, these appear to be out of fashion now). Some product, including WeatherDirect, a cellular emergency power system, a cellular extender, a speaker for MP3's, headphones (3 different types), and a Jawbone (it is a Bluetooth headset given out to ANYONE presenting and abandoning their old BT headset to the folk handing it out). Pics to be taken soon, and I will post them at that time.

My knee on the other hand may have been aggravated by the 9+ hour ride home (My bad for wanting my Jeep in Las Vegas). Dunno, but it started getting seriously sore on Wednesday during the show. Sore enough that by the time I left a party Wed night, I seriously considered dipping into a more potent painkiller that I brought for my elbow (Which did surprisingly well, probably because I didn't carry anything with my left hand for long.). By Thursday night, I was in a lot of pain. Ice packs and pain meds got me through the night, and I was able to drive home yesterday. Again, by the end of the trip, I hurt BAD. I am still sitting here taking it easy today, going through the swag. Tomorrow will also be a "take it easy" day.

A little history: I had a problem with knee pain as a teenager and young adult. Had knee arthroscopy in 1986, which showed my knee in good shape. The lateral collateral ligament on the outside of the knee was WAY too short, and it was lengthened in that surgery. My knee has been in good shape until last Wed... overuse? Underexercise? Dunno... but I have to get it feeling better ASAP.

CES was a blast, however! I love going every year... even if I end up hurting.

Addendum: After speaking with several people at my work, it appears a bug might have been the culprit for my knee pain. When I got sick earlier in the week, it may have been the start of a virus that finished out nailing my knee. On the 15th, it was fine again, like nothing had happened.