What follows is a sort of journal, a record of the strange little adventure I’ve been going through of late. See, I had a wee procedure to fix an old problem, and it’s become…well, it’s been a bit of an odyssey. Please enjoy (although I’d warn those with weaker constitutions to maybe skip this one. Y’been told.) Without further ado, here are the five things I’ve learned about knee surgery.
The sooner you see the doctor, the better
My knee troubles began when I was a young 20-something. I was hit from behind playing ice hockey. My right knee went out sideways, rather than back along the hinge as nature intended. It hurt quite a bit, but I just wrapped it in an ACE bandage, iced it, etc. I was young and probably under-insured. Mostly, though, I didn’t want to bother. “Probably nothing” I told myself. That is, until I started having discomfort. It felt at times like I needed the joint to ‘pop.’ You know how sometimes it feels good to crack your knuckles or your back? Like that. Sort of a dull ache and stiffness. I would sometimes lie on the floor and have a friend pull my leg out from my body until I felt (and sometimes heard) a gentle crack. Then I felt better for a while. As I aged, it started turning into an ‘old man knee’ which would react negatively to the weather changes and such. I discovered that the older I got, the more pain I’d experience after playing hockey, paintball, or soccer. Sometimes I could barely make it up the stairs. Two procedures, and a scary infection later, I wish I’d gone to the doctor right away. Might’ve been expensive, but would’ve saved time and money in the long run.
Your body is a crazy, autonomous, self-protection machine
The main problem was that a bit of scar tissue from my initial injury (or perhaps a bit of bone or tendon) had broken free inside the flesh within my knee. My body decided to encapsulate it in a cyst. The cyst grew over time, until it became the size of a peach pit. This, more than anything, was the cause of most of my discomfort. Imagine having a Lemonhead candy in your knee, only it’s wrapped in layers of raw bacon and wet tissue paper. Gross, yes. But that’s what your body does to protect itself. It’s akin to an oyster creating a pearl around a grain of sand, if the oyster was a fan of David Lynch films. This bodily reaction is all well and good, until it gets in the way of flexing your knee or pushes down on your patellar tendon or expands and contracts in response to barometric pressure. Then it becomes troublesome. And, jumping ahead a bit, it turns out that for years I harbored a sub-dermal infection in the knee after my first procedure. (SURPRISE! It’s MRSA! Seriously, this could’ve ended up with me doing a great Long John Silver cosplay.) This infection stayed trapped in the knee cavity for years. In other words, my body basically threw up a force field around the nastiness, keeping it from spreading throughout my body…until we inadvertently released the monster.
Even nurses get grossed out
My first outpatient procedure was almost ten years ago. They went in and, unable to remove the entire cyst, sort of cut it down a bit. Trimmed the proverbial hedge. The problem was that the sutured wound became infected. They took out the stitches and gave me topical antibiotic cream and antibiotic pills. Should’ve cleared it right up. It didn’t. WARNING: we’re now getting to the part where you weak-stomached types might want to skip ahead. When the wound finally healed, it left a little ‘vent’ of sorts. This was disgusting, as now and then enough fluid would build up inside the joint that it would express itself. On one hand, it meant that the juice in my knee never reached critical, painful levels…but it also meant that it never truly healed, and had the added annoyance of being irritating and embarrassing. I’d stand up from kneeling to tie my kids’ shoes and there’s be a wet spot on my knee. Yuck. And the cyst was still in there, so when I did get down on my knees, at just the right angle, it was like having a marble sewn inside your pants leg right at the knee. Awkward and unpleasant. Finally, I’d had enough and went to my current doctor, who also specializes in sport medicine. He went in and basically performed the same procedure that I’d had before. Sewed me back up. And, you guessed it: more infection. The knee had been swollen and sort of red for a few days, and I was getting concerned. Then my shin got sort of pink. Finally, the Monday after my procedure (I’d gone in the previous Thursday) I awoke to find my knee a bloody mess. Literally, I’d ruptured, and spilled blood out of my dressing and down my leg. When I went to clean it up and re-dress, with every small bit of pressure I put on the wound, fresh blood poured out. It was like my knee was a water balloon full of blood, water, and pus. I called the doc, and he got me in fairly quickly. Opened me up, flushed out all the nastiness with saline, swabbed it, and packed the wound with medicated gauze. Here’s how that works: he opens a jar containing the gauze. The strip is about 1/4 to ½ of an inch wide and a foot or so long. He takes the forceps and slowly crams it all into the wound. Then he covers it with dry gauze padding, wraps it with more gauze, and puts an ACE bandage over all of it. One of the two nurses that have assisted every time I’ve been to the doctor has told me how hard it is to keep her breakfast down during my visits, first the cutting-out of the mass and cyst (the stuff looked like chewed-up watermelon bubble gum as he pulled more and more out) and then the stuffing of the raw, open hole in my knee with gauze. I, on the other hand, found it fascinating to watch. I had my phone in my hand at one point, and he asked “taking a video?” I told him that I was Tweeting, but damn if that wasn’t a good idea. But it was too late by that point. The good stuff was over.
The pain actually isn’t the worst part…
The most difficult hurdle of this whole situation has been my feeling of helplessness and immobility. The healing process mandates that I keep my leg as straight as possible at all times…even during sleep. You know how difficult that is? Do you realize how many times a night you instinctively pull your knees up, fetal-style? I also have the tendency to cross my legs under one another, like a figure-four. Every time I’d start to move too much, I’d wake myself up in alarm. It makes for restless nights. And maybe it’s the stress or it’s the antibiotics, but I’ve had some interesting dreams. Stress dreams about my knee exploding or blood soaking through the sheets, enough so that I wake up and have to feel the wrapping to make sure all is well. The doctor also told me to keep weight off the knee, and recommended a cane. “Not only does it help keep the weight off, it forces you to keep your leg straight.” Great. But fucking cumbersome. Have you ever tried to get a laptop bag, cane, and cup of coffee out of your car while keeping your leg as straight as possible? It’s like a hilarious one-man game of Twister. And stairs? Fuck stairs, man. But then there’s the whole ‘propping my leg on a chair at work.’ My job primarily involves sitting at a desk, looking at a monitor. No problem. But when you have to torque your upper body almost 90 degrees to accommodate your gimp leg, it gets old really fast. And showering? Good luck. You’re told to keep your dressings dry. Holding a leg out of the shower doesn’t help that much, as water tends to run all the way down your body no matter whether it hits your head or your torso, following gravity and the surface tension of your skin; water doesn’t give a shit if there’s some gauze and tape in the way, it just wants to flow down. I’ve taken to encasing the knee in Saran Wrap, holding it out (basically standing on one leg) and hoping for the best. And your muscles do strange things. Because I am working so hard to keep my right leg straight while walking and sitting, it’s like I’m constantly flexing it. (Try this: stick your leg out in front of you, keeping it as straight as possible. Good. Now, hold it like that all day.) The downside is that when you do get a chance to relax, you sometimes have cramps. Like, bad ones in the arch of your foot. Or maybe just twitchy spasms in your thigh. And the other (left, in my case) leg sometimes feels like it’s carrying around most of your (in my case) 197 pounds all by itself. So when you ask it to go up the stairs once more, it sometimes says “No. No more. Let’s stay right here.” Hard to argue, Mr. Leg. I didn’t really need to go to the bathroom anyway.
…but there is quite a bit of pain, too
Ain’t gonna lie. There were some really excruciating moments in this little adventure. The initial procedure a few weeks ago was no fun; yes, I received a shot to numb the knee to begin with. But even that part sucks. They stick a needle waaaaaay deep into the place where he’s gonna do the cuttin’. And then he adjusts locations and sticks you again. Doesn’t take long, but damn, it’ll take your breath away that first time he jabs you. And here’s a fun little tidbit about me: I apparently have a very high tolerance for painkillers, especially lidocaine and novocaine. This means that after the doctor numbed me and started cutting, he had to administer more shots. Every time he’d go to expand the incision, starting at about an inch and then going wider to get at more of the pulp, I’d feel it. He’d stop and dose me again. Tedious. But the really bad part came when, after my first infection-solving gauze-pack, I went in to have the gauze replaced. Watching him pull a foot of bloody bandage out of my knee like a flesh-and-blood tape dispenser was surreal, but more uncomfortable than painful. Replacing the gauze with new, fresh stuff, however…ouch. He started shoving some in and saw me flinch. “Want me to numb it?” he asked. “Nah, just do it. Go.” So we’re clear: this means that I was able to feel everything as he grabbed my skin with a pair of pincers and then slowly, inch by inch, fed a strip of medicine-infused cloth through the red maw below my kneecap and into the cavity within.
You’re gritting your teeth right now, aren’t you? Yeah. That’s pretty much all you can do. Stare at the ceiling, grip the edges of the table tightly, and clench that jaw. But there’s good news. The pain afterwards is minimal. No ongoing sharp pains. And the times when I do feel a twinge or ache, I simply pop a couple of Advil. So no super-powered painkillers or narcotics. No danger of becoming Greg House.
Now it’s just a waiting game. Waiting for this thing to heal. Every time the doc or I change dressings, we remove a bit more of the stuffing. And day-by-day, the wound starts to close and heal. The antibiotics seem to have cleared up the infection. No more MRSA. (I’ll keep taking the pills, though, until the damn thing is fully healed.) Yet, I know that there’s still work to be done. My right leg is going to have to learn how to bend at the knee, slowly and gently stretching the new skin and scar tissue. Plus, there’s sure to be a bit of muscle atrophy (although my left leg should be able to do single-leg squats by now, as much work as it’s doing.) But after all is said and done, I should be right as rain by the end of the summer.
Just in time for hockey season.