2 Weeks Post Op

Just a quick update since I'm on my phone. Aside from falling on my bad leg quite badly the other day when I slipped, my leg has been healing well.

The swelling has gone down almost totally and the wound is healing nicely. Here is a photo! I shall update with more details when I get home.

The Maci Surgery

I'm now three days post-op and I'm finally feeling up for typing.

On the day of the operation I got to the hospital bright and early at 6am and was the first person to get whisked away to get all my pre-op checks done - blood pressure, weight, any previous medical problems. Everything went really well and before I knew it I was waiting to be wheeled into surgery.

The last time I went into the operating theatre I was kind of waiting around in there for a while they chatted and fiddled with stuff. This time was completely different - I was wheeled in, moved onto the table and they had the drip in before I knew it. The anesthetist mentioned that the Device Technology guy said I had very thirsty cells and that I was probably sick and tired of needles and blood by now. I had time to mention something about vampire and needles before I got really really dizzy and gave in to the general. I was asleep much faster than last time.

Waking up was a little different to the last time I'd woken up in recovery. For one thing, there was no gentle wake up and happy chatting with the nurses. The first thing I was aware of was the pain in my leg. I was in so much pain that I woke up in tears - I remember the nurses asking if I was in pain or if I was relieved to have it over. I tried to mumble pain, but I was still really, really out of it. I also woke up with a migraine, so I kept trying to clutch my head. They gave me morphine for the pain and when it didn't fade away enough, they gave me 50mg of tramadol - which really knocked the pain on it's head.

Eventually they moved me up to my room where I stayed for the next 24 hours or so. It was pretty hellish. Whoever tells you that the post-op pain isn't bad is a liar. The pain is bad and it only gets worse if you're unlucky enough to have to go to the bathroom. I won't go into the details of trying to get me from my bed to the toilet, but it was embarassing and insanely painful.

The nurses kept me on a pretty strong regime of alternating drugs - mostly Endone and a mix of codeine, paracetamol and ibuprofen. To be honest though, although the drugs took the edge off they didn't do a lot for the bulk of the pain. Although there was a reason for that.

My surgeon came to see me around 9am the next day to check up on me and see how I was going. The surgery had gone really well - the legion was just as big and ugly as the last time he'd seen it and took up around 40% of my weight bearing area. The matrix patch had gone in well and as long as I kept of my knee for 6 weeks, he thought it would take really well. I mentioned that I was in a lot of pain and he mentioned that although they'd given me a local in my leg, it might not have been enough to dull the pain enough.

After he left the physio came in and taught me how to use my crutches properly. He also gave me some simple exercises to do, to hopefully keep my leg muscles semi-workable while I kept off it.

Then I got discharged and came back to my patents place - where I am now. I'm still taking a lot of pain killers as the pain was pretty bad for the first two days, but I'm feeling a lot better today. The Endone is giving me crazy CRAZY ass dreams. The most vivid and crazy that I've ever had. But other than that, I'm doing okay. It's really hard to get around on crutches and I spent most of my time lying on the couch like a lump, but I'm feeling better.

So, for those of you who are going in for MACI surgery - be prepared for post-op pain. You're going to be uncomfortable and it's going to really hurt...but you'll get through it. Each day things get better and easier. Just stay off your leg and don't try to move it!! Use the straps on the leg brace to move your legs around and keep it relaxed.

Other than that, I'll check in soon to let you all know how I'm going! I'm hoping to have 90 degrees of flexation in my knee by the end of the week, so we'll see how it goes!!

Eeeek!

So, my MACI surgery is Tomorrow morning - I'm the first one up for surgery and have been told to get to the hospital by 6am (eeeek!) as my surgery will start at around 7.30am.

I get a delightful meeting with my anaesthetist first up to discuss what he'll be doing and the risks. This is the part where I tell him how scared of needles I am and ask if e can put the drip into my hand vein instead of into my arm. I'm not sure why but I hate having drips stuck into my arm - really, really freaks me out. You can imagine how good I am with blood being taken.

I've had bad experienced with anaesthetic in the past - nothing too horrible really. The first time I was under general to get my wisdom teeth out, I woke up unable to remember how to swallow and unable to see clearly - everything was a complete blur. I was, understandably, freaked out. The last time I was under, I was fine when I woke up, but when they put they anaesthetic in I felt an intense burning feeling in my arm. Nothing too bad.

Anyway, I've had a few discussions with the hospital and they seemed very concerned about the risk of infection post-op. I've been told to make sure I do not cut or hurt my leg (especially around my knee) between now and the operation. I'm to shower before the operation but I'm not to shave my leg at all - in case I cut it.

I imagine getting a golden staff infection in my knee would be a pretty horrific experience. I mean, golden staff getting down to the bone would probably land me back in hospital for a very long time while they try to fight it off. But that won't happen.

I'm nervous...but I'll be fine. I'll see you guys after the op and let you know how everything went!!

Waiting, waiting...

My knee has been killing me for the past few days - aching and throbbing and the like. I spent most of last night curled up on the couch with pain killers and antiinflammatories. Clearly I've been using my knee too much - what with all the walking I do.

Anyway, I have my MACI operation in a week and 2 days. I'm nervous and excited about that. I know it will be a slow recovery and I know that I'm going to be in pain immediately after the operation...but hopefully this is going to fix my knee.

I've been getting prepared for a while now - doing core strengthening exercises and trying to increase my flexibility. I'm planning on reorganising my apartment a little bit too, so it's easier for me to get around with crutches. Oh, and I have a shower stool - sounds lame, but a few of the people I've talked to on forums have reccomended them as standing is not your friend.

It's really only hit home recently how little I will be able to do after I have the MACI surgery. I mean, I'm on crutches for 6 weeks and I won't be able to put any pressure on my knee. So, no standing on my bad knee for 6 weeks. That means I won't be able to cook or clean or washup. I'm going to be lazing around the house doing nothing.

Which isn't all bad...although I will be in pain and my leg will probably turn to jelly!!

My Arthroscopy!

Arthroscopy

I had my first round of surgery in July 2011 - it was a fairly simple knee arthroscopy.The surgeon would go in via keyhole surgery and pull out the rogue bits of cartilage that had detached from my knee, clean up the defect and trim off the ragged edges and take a sample of cartilage for some medical facility to grow.

I'm not really a fan of surgery. I'm not really a fan of hospitals. I'm not really a fan of anything that might bring me into contact with needles or injections...yeah, I'm ever so slightly phobic when it comes to needles. I wish that I wasn't but try as I might I have never been able to properly get over my irrational fear of needles.

Needless to say, I was pretty nervous when the day of my surgery rolled around. I was undergoing the procedure at the Mater Private Hospital in Brisbane - which is quite close to my house. My husband was working on the day, so my mother very kindly offered to come down and drop me off at the hospital and take me home afterwards.

Now, the Mater Private Hospital is pretty amazing. The waiting rooms are welcoming and...well...opulant. I don't think too many public hospitals have nice plush leather seats for patients to wait in. Nor do I think they give you fluffy white robes, warmed towels and hot face clothes before they bring you in for the procedure. The staff were also very friendly and very helpful. I felt a lot more at ease then I had expected to.

The aneasthetist was really great - he chatted about what he would do and what had happened to me the last time I went under general. He explained how I would feel when I woke up and what I could and could not do. He was also pretty understanding when I mentioned me fear of needles and he was nice enough to offer to put the drip into my hand instead of my arm.

Now, everything happened really fast. I have memories of having to wait a really long time for my operation when I had last been in hospital, but this time I had barely sat down in one waiting room before they were whisking me into a wheelchair and carting me off to another room. In total I spent time in 3 different waiting rooms before they finally wheeled me into theatre.

The operation went well and I woke up in reovery feeling remarkably well. I was feeling a little bit of pain and pressure in my knee, but the discomfort was minimal. I really didn't have to wait all that long before Dr. Astori came to speak to me. The operation had gone well and he'd managed to get all the loose bits out and clean up the lesion. However (and he gave me some photos) the lesion was much bigger than he had thought.

We discussed the second stage of the surgery, but unfortunately even though the lesion was so big, I couldn't get the second round of surgery done until early december - only because that was when I had six weeks of holidays scedhualed and I couldn't afford to take off any more time.

The recovery from the arthroscopy was okay - my knee was really swollen and insanely bruised, but it didn't hurt too much. I made quick progress with my physiotherapy and now, around 5 months later, I my knee is pretty  much normal again - same flexibility and just as capable of bearing weight.

An Orthopaedic Surgeon to the rescue!

Getting a referral to an Orthopaedic Surgeon (OS) and being able to put a name to what was wrong with me was both a relief and yet another thing to scare me. For one thing, I now had the ability to type my ailment's name into Google and to go to town seeing just how bad things were for me. The problem was that I had no idea exactly how bad the defect in my knee was.

I knew from exhaustive internet searches that OCD's have a scale that measures...well...how much damage has been done to the knee. I was hoping that mine wasn't that bad, but as my local GP hadn't known much about it and my OS appointment was still a little while away, I could really only guess.

Stage 1. Cartilage begins to weaken
Stage 2. Cartilage begins to fragment
Stage 3. The cartilage has fragmented but hadn't come away from the bone.
Stage 4. The cartilage has separated from the bone and is loose in the knee.

I read about the usual symptoms of OCD and had trouble matching them up to my own problems because most pages talked about a slow onset or about a nasty accident causing them. Mine has happened while I slept and I'd had no slow build up of symptoms. I did find one website here that gave a pretty good description of what I was going through.

I could especially relate with misdiagnosis and with sitting in a doctor's office saying, "See? There was something wrong with me knee!"

My OS referral was to a surgeon called Dr. Ivan Astori and he turned out to be someone who was able to give me the answers that doctors couldn't. He was able to explain exactly what was wrong with me, what may have caused it and what my options were to have my knee fixed.

My first appointment was good. By then I was in tears each day with my knee. It was constantly swollen and I had a very noticeable limp. Not so much from the pain (although it hurt) but because my knee wouldn't bend properly and whenever I put my full weight on it; it felt horrible.

After much prodding and poking and looking at X-rays and MRIs, Dr. Astori gave it to me straight. I had a large OCD lesion in my knee that looked to be around 2x2cm - making it quite significant. The reason my knee wouldn't bend properly and the pain I was feeling was because I had 'knee mice' running around in my knee. 'Knee Mice' being the loose bits of bone and cartilage that had fragmented away from the bottom of my femur. They were getting stuck in my joint and causing me pain.

So, the surgery he recommended had two part to it. Firstly, he wanted to do an arthroscopy on my knee and pull out the fragments that were hurting me, as well as clean up the lesion in my knee. This, he said, would get rid of most of my pain, swelling and discomfort.

The second thing he wanted to do was MACI surgery - which involved him taking a sample of my cartilage, and it being cloned/grown in a lab. Then these cells that were lab-grown would be re-implanted back into my knee. It was open knee surgery, it would leave me with a big scar and it was expensive... Oh, and it would mean spending 6 weeks on crutches and a 12-18 month recovery period with a lot of Physio. Terrific! However, Dr. Astori believed that due to the size of the lesion, that it was my only option if I didn't want to get Osteoarthritis down the track.

                  

So off I went with some information brochures about knee arthroscopies and MACI surgery, an appointment for an MRI and a feeling that things were going to get a lot worse before they got better.

Finding A Doctor

The first doctor I went to after I hurt my knee was puzzled by my symptoms. 

Yes, my knee has swollen - but not too much. I was struggling to bend my knee properly though. Almost from the minute that I hurt my knee, I lost flexibility in it and the longer it went on the harder it got to bend my knee to any great degree.


Yes, my knee was hurting - but I couldn't exactly say where. I had two spots on my knee that seemed to have these round little lumps under them. Both of the lumps would pop out from under my knee cap or slide back under if I touched them. They were excruciating to touch - I almost passed out when I first pressed down hard on one.  

Other than that though, I was vague with my symptoms. My knee was aching and it hurt a little when I stepped on it- but nothing too bad. It felt a little tight and I didn't want to put my full weight on it because it...well...it just didn't feel right.

Doctor #1 said that she thought I'd possibly done something to the meniscus in my knee or that it was possibly a mild ACL strain. The fact that I had just woken up with my knee like this and that I couldn't remember hearing a snapping sound, meant that she really had no idea exactly what was wrong with me. She gave me anti-inflammatory pills, an X-ray referral and some pain killers and told me to take it easy for a week and then come back and see her.

The X-rays, when I got them, came back with a report that said that there was no sign or a break, fracture or dislocation. However, when I looked at the X-ray there was pretty obviously something wrong to me. There was a chunk missing from the bottom of my femur. The missing notch was pretty big too - it looked like it was at least as big as my thumbnail.

A week later (more than a week, if I'm honest) and I went to my normal doctor in West End, instead of the other doctor. My regular doctor didn't seem to think that it was an ACL injury and instead told me that it was possibly soft tissue damage or possibly some minor meniscus damage that should have healed up by now. He implied that I was making it up and that he didn't think there was anything wrong with me because my symptoms didn't match anything.

He referred me to Qscan for an CT-Scan and  told me to take it easy for a week and take some pain killers if I needed them.  I decided I needed a new doctor.

I went to get my CT scan and got told when I got there that although the CT scan would be bulk billed, it wasn't going to show any injuries that the doctor was looking for. They recommended I get an MRI, which would cost me $300. Unfortunately I couldn't afford it, so I went ahead and got the CT scan.


Luckily, the person who wrote the report for my scans was better than whoever wrote the X-ray report. They saw the chunk missing from my knee and several other bits floating around in my knee. They correctly stated that I had an OCD lesion in my knee and that there were several fragments floating freely in my knee.


When I went back to see a new doctor, she read the report and did some reading herself told me that I had an Osteochondral Defect in my knee - something which was quite rare in women of my age who don't engage in high impact sports. She explained that reason that the other doctors hadn't picked up on it was because OCD's usually happen to men who play sport  and was especially common in football players. 


There was nothing that she could do for me, she explained, other than give me more medication to handle the swelling and the pain. In the meantime, she gave me a referral to see an orthopedic surgeon and informed me that depending on how bad the lesion was, I would probably need at least one round of surgery to clear it up.


Not a happy start to my 2011.

I’m starting this blog to share my story with other people who might find themselves in the same situation as me. There is a lot of information about OCD on the net, but not a lot of it really tells people what is wrong with them and what symptoms to look out for! Let alone what you can do to get help.

My name is Lena and this year I found out that I have a 2x2cm Osteochrondral defect in my left medial femoral subchondral. Sounds crazy-complicated doesn’t it? It’s not -  basically, I have a massive gaping crater in my knee – specifically, I have a crater on the bottom of my femur. Chunks of cartilage and little bits of bone have come away from my knee.

You’ll see the terms ‘OCD’ ‘Osteochondritis Dessicans’ and ‘Osteochondral Defect’ thrown around a lot in this blog. Sorry about that, but if you’re here then you’re probably here because you have OCD yourself or you know someone who does.

 I’m currently one month away from having MACI surgery to fix the defect and now seems like a good time to reflect on how this started!

Things fall apart...

I’d always had a bad left knee. As a child I’d been heavily involved in competitive sport – much of it high impact like sprinting, hurdling, triple jump and netball – so in retrospect it was no surprise that I’d damaged my knee at some stage.

I remember that I first hurt my knee when I was around 12 years old. I was skateboarding down a hill and I fell off. Although I wasn’t seriously hurt, or even slightly injured, my knee felt oddly tight. I didn’t think much of it and almost immediately went back to doing sport again, but within a few days my knee was swollen and almost too sore to walk on. The doctor thought I’d damaged my cruciate ligament and he prescribed rest.

A few months later and my knee seemed to go back normal. Well…almost. It would slightly lock up and give way on the odd occasion and if I did too much sport it would ache slightly and swell. But hey, I was a kid and I ignored it and kept on doing what I did best – sport.

Fast forward a few years later when I was in my final year of high school. Unexpectedly and seemingly without any reason other than me stumbling awkwardly down some stairs, my left knee swelled up to the size of a rockmelon and began to seriously hurt when I put pressure on it. My mother took me to a doctor after work and he gave me some anti-inflammatories and pain killers and told me to keep off it. He also said that I should get an X-ray and sent me on my way.

The swelling went down overnight and the pain vanished within a few days. I never got that X-ray – and it’s something which I have now come to regret.

I’m now 26 years old and my problems have come back with a vengeance. I’m not overly sporty, but until these problems started back in January I was swimming 1.5km a day and going to the gym every second day.  Everything changed one morning in January when I woke up and my knee felt wrong.

I didn’t have an accident. I didn’t fall over or bang my knee or have some sort of sport-related incident. I just woke up and my knee was swollen, stiff and was having problems moving. It didn’t hurt initially; it just felt like it was ‘out’. I felt like my knee needed to click back into place.

I did make one critical mistake on that day – I underestimated what was wrong with me. My knee had been bad for years – catching and feeling ‘out’ from time to time, but always it went back to normal. Not this time though. I remember kneeling on the floor to pick up my cat and putting weight on my knee…and then I remember pain.

I couldn’t tell you if my knee made a cracking sound (although I think it did) I just remember pain shooting up from my knee in this haze of red. I think I almost passed out from pain, and I know I certainly spent a long time laying on the round cursing and carrying on.

That was the start of this long, painful journey that I’ve been on, and the first step in one of the most confusing and frustrating periods of my life.