Surgery Day! Jingles appreciated!

Linden16

Greenie

Surgery Day! Jingles welcome :)

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PostWed May 25, 2016 9:52 am 

Morning! Today's the big day   I had to travel into a different province (Alberta) in order to have this surgery by one of the only surgeons in North America qualified to do this procedure. I left on the Greyhound bus at 11:50 PM, slept the entire way on the bus and arrived at Banff Mineral Springs Hospital at 8:30 AM. The hospital is a very small, almost boutique-like place. Very quiet, bright and everyone is lovely. My nurse, Ken, is very kind and even though my IV catheter was tricky to place, he has tons of patience. My room is a two-bed ground level room with a gorgeous view of biking/hiking trails. Each bed has their own hilarious TV, and there's free wifi as well. I checked in and was given a "Management of Post Surgical Pain" booklet that was put together by Dr Hiemstra's clinic, Banff Sports Medicine Group. We went over all my paperwork and everything was correct and complete.

I had to gown up and scrub my operative leg (Left) from mid-thigh to the bottom of my foot with a hibitane scrub for 5 minutes, and then mark my leg with a YES.

Now I'm just watching Love It Or List It while I wait. I am going into surgery around 12:30 or so. So a couple hours to kill still.

Dr Hiemstra just came in and had a quick chat. She's such a wonderful individual. So kind and genuine. She has one patient before me, who has also crazy lax patellas, so it will be a couple hours before I go in. She asked me about my right knee that's been giving me trouble and said she needs to do the left one first as she isn't sure exactly how it will do, and only wants to do surgery once on each knee, so the left one will teach her how to deal with it. I have never felt so comfortable with a surgeon before, even though I am nervous for the outcome.


Don't Forget What Makes You Strong

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Countdown..12 days till Knee-gate

So I am now 12 days away from my MPFL &LPFL reconstruction, & grade IV chrondoplasty. I'm quite nervous about the post-surgical rehab as 5 weeks post-op from my initial MPFL repair in 2008 I suffered 3 lumbar herniated discs with an annular tear. This was all caused by me not being allowed to put weight onto my left leg, and the uneven load bearing caused scoliosis and then disc ruptures.

I am much better for day-to-day activities now with my spine, but I still cant bend forwards or backwards without severe pain. Since the initial herniations after knee surgery, I have had 3 open decompressions (debriding of the herniated disc material)  and one complete bilateral lumbar rhizotomy. (electical burning of the nerves at all 6 lumbar levels that's performed as a pain management treatment)

After the first knee surgery (and each spine surgery as well) I developed severe adhesions (scar tissue) that prevented me from achieving any range-of-motion. It's called a "frozen knee" and literally is exactly how it sounds - the scar tissue grows around the surgical sites and freezes all flexion of the joint. It gets worse the longer you have to make the joint stay immobile for healing purposes after surgery. Typically the scar tissue has to be manually ripped apart by forcing the joint to bend past the range where the motion is available. These are called "manipulations" and are either done in the PT office or under anesthetic by your ortho surgeon. When I had my knee surgery in 08, I needed 6 manipulations in order to get my knee to bend 90 degrees, and none of them were performed under anesthesia. I was never offered that option, If you're wondering how it feels to have scar tissue ripped apart, I can say it is the most painful thing I have ever experienced in my life. And I have major spine issues, have torn my ureters apart during a routine diagnostic kidney scope, and have had kidney stones.  It's absolutely brutal.

Anyways, I am hoping this time I don't develop those adhesions, but I  am prepared for it as in all 4 of my surgical procedures I have had the same result. I remember for example during my 3rd lumbar decompression surgery rehab, I was stuck at bending over nearly 90 degrees at the waist, I couldnt stand straight up because of the scar tissue formation. It was awful.

Today my good knee (the right leg) is still swollen and painful since yesterday, It's been subluxing  a lot this past week and is right now more painful than my bad (left) knee.

Theres not enough ice in the world....

So I suppose an update was long overdue. Sorry for the delay, I have been impatiently awaiting my MPFLr + LPFLr surgery in Banff with Dr. Hiemstra. Now it's less than two weeks away and I am terrified! Let's just say that the last MPFL repair (tightening of my own MPFL, not a reconstruction with donor grafts) was pretty rotten and I swore I would never have another knee surgery again. Look how long that lasted hey?

Anyways, I have finally found the right patellar stabilizing brace after several years of trying all different ones. most of them are fabric, and pull on. I found that my patella would just glide around underneath and never sat in the opening the way the braces were designed for. The new brace I have, is excellent. it actually holds my patella in place and prevents it from moving around during regular activities like sitting, walking, driving etc. I still sublux frequently but not nearly as often as before. The brace is called a DonJoy Reaction. Don Joy is one of the top 3 orthodic companies in NA and their quality is amazing. I am very happy with mine!

So one week after I saw Dr. Hiemstra for my consult in January, I dislocated my right (good) knee, and since then it has been unstable as well. She had clinically diagnosed me with Ehlers Danlos Syndrome (hypermobility) due to my 7/9 Beighton score, history of GERD, very elastic skin, and slow healing of scars. I routinely get subluxations in my right shoulder, left hip, both elbows, both knees,  and my TMJ's. There is no genetic test for EDS, however my neice who is 10 has hypermobility in her joints as well and other symptoms. This diagnosis finally makes everything a little clearer for me. It's why my hip pops out of joint when I put on pants, or hang from monkey bars. My ligaments are all very lax and don't hold my bones in their joints as normal peoples do.

So, my surgery is performed on May 25 in Banff Mineral Springs Hospital, and I am to stay two extra nights. Most patients leave the same day or the morning after if they require further pain control, but because I am going alone, taking the Greyhound there and back (8 hour drive each way from Kamloops) Dr. Hiemstra wanted to keep me for a little longer to be sure I was ok before I left.

Did I post these photos yet? Banff Sports Med Clinic (where Dr Hiemstra practices) has a couple walls of photos sent in by all the professional athletes they have helped get back to sport. Inspiring. 

She told me due to the nature of my repair, riding horses after the surgery is absolutely out of the question as it will cause the grafts to stretch out again and ruin the surgery like I did the first time. I should have stopped riding back then but I didn't, and hence the failed MPFL repair. It is likely she will have to reconstruct my right knee as well once I have recovered from the left one, as it's already unstable. Dang...these are not fun surgeries to recover from. ACL and TKR (Total Knee Replacement) are much more rehab-friendly, they are up walking within 24-48 hours, fully weight bearing and allowed to bend the knee. With this procedure, I am non-wt bearing for 3 weeks and locked straight in an immobiliser (the Ossur Rehab brace) until I see Dr. Hughes (my local, regular sports medicine orthopedic surgeon) on Jun 20th.

Thanks for reading and I will be more active as the day is getting closer!

(on a side note, I was in for a steroid injection for my shoulder with Dr. Hughes a month ago, and it had no effect. Still cannot throw the ball, or sleep on my right shoulder. It's been that way for over a year now. I've fallen on it off of horses multiple times and had my AC joint separated now at least 4 times in 6 years, but he isn't sure why I have prolonged trouble as there isn't any pathology in it.)

Hey guys, I promised to write when I had something to write about, and I am glad to tell you that day has finally arrived. I really hope none of you were holding your breath, because, well..for obvious reasons, and also they say breathing is good for stress.

So I am sitting here on a Greyhound bus on my way to Banff. Random right? Not really, but a little, insomuch as it's January and I don't partake in winter sporting activities, unless you count drinking in the lounge above a curling rink to support my cousins while they play. I think that may actually count. Anyways. The Greyhound bus. Did you know they have free WiFi on these things? I think I'm sold, the wifi might make up for the dude in the row next to me taking :secret"selfies for the past hour, wearing a white TapOut hoodie with no shirt underneath, adjusting the height of his zipper, waxing his hair, and wearing mirrored RayBans. INSIDE THE BUS. it's like a (bus) crash, you don't want to stare but you can't tear your eyes away....it's been over an hour now and he's probably taken over a hundred photos. And he's at least 35. How long do I have to sit here and take this? the bus ride is nearly 6 hours. Somebody shoot me. I'll give you half a ham sandwich and a movie-sized roll of Junior Mints?

So, the knee, right. I forgot for a second there. You guys are good little distractors. A few weeks ago I got a brace from a local podiatrist/orthopedic bracing office.It was an Osseur neoprene brace with a keyhole patella opening and some metal stabilizing bars on the lateral and medial aspects. within 4 days the femur aspect of the neoprene had stretched out to nearly flapping state because I had to keep pulling it up so that my patella would centre inside the hole. I had a hell of a time getting the company to take it back for a full refund as they thought my leg had atrophied. It has, it's 1.5 cm smaller at the thigh than my right leg (35 cm on the left, 36.5 on the right, measured 7 inches above the top edge of the patella) The problem with pull-on knee braces is that they force your kneecap to sit within the designated area, and for those whose patella's sit high or low in relation to the surrounding anatomy, it is very painful to have outside forces artificially push or pull your kneecap out of alignment in order to conform to a certain ideal. Keep in mind these braces are suposed to hel stabilize the patella from tracking abnormally laterally, and in my case, medially, now factor in a brace forcing it to shift distally (downwards) because the brace is designed for a knee that's "normal" and sitting where it should in most of the general population. Not fun. Frustrating, actually.

So I found a brace at RowMac in Kamloops called the DonJoy Reaction brace that isn't a pull-on, it's a strap on. (Anyone who snickered at that gets to take a 2-minute minor) . The beauty of this brace is that you center your patella in the opening, and then secure the straps to tighten it around your leg after that. It stays with your patella, and is never slipping or for forcing your patella into a position that is unnatural for your own anatomy. It's wonderful and lightweight. The only thing is that mine is Lime JELL-O green because the office didn't have any other colours, and I didn't want to wait to i
order anything else in. This is the only brace that keeps y knee in place somewhat. All the other braces made from neoprene or nylon or fabric just kind of let my patella slide around underneath and were completely ineffective. This brace actually works somewhat. Nothing keeps my knee from shifting around but I feel pretty confident I won't get a full blown sublux while wearing this brace. Pretty cool!

I am almost in Banff now, and I'm pretty nervous to see Dr. Hiemstra tomorrow. Scott Hughes, my regular orthopedic surgeon, the guy who referred me to Dr H, has been great. He has been honest with me that my issues are beyond his scope as a surgeon and if it were him, he would want to go to Dr. H, and quickly. So, he bumped me up ahead in the waiting list, which I am so grateful for..as this hasn't been an easy thing to come to terms with. His receptionist and I didn't get along at first, I think she thought I was a pain in the ass as I wanted to get a second opinion (this was all prior to him discovering my patellar instability and he thought I had an ACL Tear) and she threatened to cancel all my appts if I persued a second opinion. Once they realized I was right, it was my mpfl insufficiency and patellar instability, shes been an angel ever since. lol.

Many people have been very casual in saying "So obviously you're not planning on riding any more right? I mean, lets not be stupid, you've been lucky up until now" and things like "So are you planning on riding any more or are you going to smarten up now?" Things like that. Of course these types of off-the-cuff remarks come from family and friends that don't ride, and have no idea what my life has been like, or the sacrifices I have made for my riding career. I even had one person say to me "You're not planning on riding anymore are you?" I am not sure what is worse, those comments, or the people who say things like "Chin up! I'm sure once your leg heals you'll be back in the saddle again!" or "Don't worry, you can ride side saddle!" or "Have you considered driving?" or "You'll ride again, if it's meant to be". There's a third category, a particularly painful one, the people who have said "Don't be so upset, it's just riding." and "At least you still have two legs, you'll find a new hobby."


Bus just arrived in Banff. Off I go!

Hey guys :) The tattoo of a Phoenix I had put onto my shoulder seems utterly fitting these days. When everything seems to be burning down, as always, new opportunities manage to rise out of the ashes. Or so I hope. What would the alternative be?

I suppose I should start at the beginning with this knee stuff. 

Some of you might remember I dislocated my knee in 2002, while working at a veterinary clinic. I tore my Medial Patellar-Femoral Ligament (the ligament that keeps your kneecap from being pulled out of alignment to the outside) and since that first trauma, it would go out (sublux) spontaneously from regular activity until I got it repaired in 2007. I waited so long because I was travelling and working with Leslie and didn't want to take time off from that, and riding, and training. In 2007 I was living in the US for a few years already and attending ASU and so could spare some months to recover. Dr Yaccobucci in AZ did an MPFL repair (used my own ligament, just tightened it and reattached it) and a Lateral Retinacular Release (severed the opposing ligament on the outside that was pulling the kneecap off center to the outside). He also cleaned up some torn cartilage. The recovery was unbelievably devastating. I had only 5 PT sessions and used them all for manual manipulation to break up surgical adhesions after being locked in an immobilizer for 4 weeks post op and the leg healing straight. 

Now, you guys know I have a very high pain tolerance. I mean, I broke my back in three places and kept riding for a week before I even went in for radiographs. I didn't even take tylenol. I have had 3 back surgeries, multiple procedures...

And this knee recovery is THE WORST EXPERIENCE I have ever had in my life. I start to get anxious just remembering it. I promised myself no matter what, I would NEVER do it again. 

Well, because The surgical site happened to be on the inside of the knee, exactly where our dressage saddles contact our kneecap, and my doctors never told me I had "Ligament Laxity" to a very high degree, I have ruined the repair over the past 8 years by continuing to ride. 

The saddles, constantly pushing against the knee, have overstretched the ligament, and now, as there is no ligament on the outside (it was severed during the first surgery) my kneecap has no lateral structures to keep it stable. It is now a "floating patella".

Since the surgery in 2007, and after I recovered (took 14 months to get back 100% ROM and strength) it was completely perfect. Never swelled, never hurt, never felt unstable. EVER! it was wonderful! I was so pleased. 

Last year, Around October, it subluxed and reduced on its own, was swollen and sore for 24 ours and then was fine. I didn't worry too much because I couldn't manually push my kneecap out of place like I could before the repair. Then, This summer, it went out again. I found this time, that the mobility of the kneecap was again to the point where I could dislocate my knee laterally (to the outside) 100%. My heart basically sank at that moment. I went to my GP and she got me a consult to my Ortho Dr, Scott Hughes, who I had already been seen for my right shoulder in the summer and was awaiting an MRI for pain and loss of motion (long history). 

After I got the appointment scheduled, D'Jango ran into me, my left leg (the bad one) and knocked the knee out. The kneecap dislocated medially (to the inside) and I ended up so painful I had to use crutches for 3 weeks. It felt like it was freezing with bending motion, worze with load bearing, especially going downstairs. It never felt that painful, EVER, before the first surgery. 

When I saw him, he and I decided I would pay for my own MRI ( I didn't want to wait) and we would tentatively schedule a MPFL Reconstruction because of my Ligament Laxity (obviously my lax ligaments were no good if they would stretch out again). and he could do the surgery. It was pretty devastating for me, I did not tell him my knee is what caused all my spine problems (my discs herniated 5 weeks post op in 2008) or that since I saw him for my shoulder I broke my back). I also didn't think to tell him the kneecap was dislocating medially. Why Would I? I didn't think it was a big deal. 

So, here's a tidbit of juiciness, Scott is a wonderful guy, very good bedside manner, excellent references. (And hello, handsome!) but his receptionist, OMG. Since day one, she's been rude to me. Short, cranky, disinterested. I asked my GP to send me to Robert McCormack, head of UBC Orthopedics, and a world renowned knee surgeon. I was recommended my several high performance athletes (friends) to see him as a second opinion as he is the Team Canada surgeon. Well, Receptionist gets wind of this and phones me to tell me if I go see anyone else, she "will cancel all my appointments with Dr. Hughes". WHOA. apparently I have no right to get a second opinion about my career ending, major surgery?! wtf. so I cancelled my second opinion because it took me months to get into Dr Hughes already. 

After my MRI, I saw Dr Hughes to go over it and book surgery.. (2 weeks ago) This time  I showed him how my knee could dislocate from my fingers pushing it both ways, laterally and medially. He was shocked..basically said the MPFL repair would not work. And why would it? I never thought of that, Of course tightening the ligament on the inside would just pull the kneecap off the rails (aka trochlear groove)to the inside. Damnit. I didn't tell him about his receptionist's threats or attitude. Or my spine or anything. We just started thinking about possible procedures that could be done. There isn't a set "flow sheet" to this type of problem. There aren't enough of us medial dislocators to have the protocol set in stone. I suggested a Trochleoplasty (deepening the Trochlear Groove) and he said that the outcomes from that procedure are absolutely awful, they all cause pain, arthritis, and patients are worse off than before the procedure, comfort wise. He left to look at my radiographs, and was back 5 minutes later, saying it may be a good idea. What?! Also said I might be looking at a "Tibial Tuberal Ostoeotomy with Distal Transfer" which is a fancy way of saying cutting the part of my Femur that has the patellar tendon attached and reattaching it at a lower spot on my leg so that my patella sits lower and will advance into the trochlear groove sooner during flexion. My patella sits very high, higher than it should, so that's partially why it subluxes so easily. 

So, because he isn't a Patellar Femoral specialist, and he said only 1% of patellar instability patients sublux medially, he needs to send me to another specialist. His friend, Laurie Hiemstra of Banff Sport Medicine. 

So, He sent the referral, I had to go get a new set of special view radiographs for her, and am now waiting for a consultation appointment. In Banff. 5 hours away. In the winter. 

Oh, here's a cute little video,

Update Long Overdue

Hey everyone - This is so long overdue - Bug was sold back in the end of September which is why I haven't been posting. It was a very difficult thing for me as I was promised she would not be for sale, ever. So, I apologize for not getting to you sooner but I was just wallowing there for a bit.

Also, Remember how I had a major knee repair (patellar realignment) doe in Christmas of 2007 when I lived in Phoenix? Turns out I shouldn't have kept riding, and because I didn't listen to the doctors, I ruined the repair. The way we use our leg on a horse, and where our leg contacts the saddle, is where the repair was done. And, by riding, I have overstretched the ligament that was secured on the inside in order to keep my patella from subluxating to the outside, to the point of my kneecap now "flapping in the breeze". There is nothing keeping it centered in it's groove and it constantly subluxates in and out, all day long.

To peel the onion even further, my recurring lumbar spine problems that have sidelined me multiple problems, required surgeries, injections, and left me with chronic pain, all happened due to my knee. The first disc herniations occurred 5 weeks post-op from my knee surgery, likely because I was non-weight bearing on my bad leg, and that put so much pressure on the right side of my body, that my discs herniated out of the left side of my spinal column. I can already feel my back getting much worse now, just in the past 2 months that my knee has started subluxating again and I have a distinct limp.

So, I guess what I am trying to say is, I just had 3 doctors tell me I need to not ride any more once they sort out what to do with my knee this time. (that's another post).

What is the point of all this struggling to keep the dream alive only to keep being shot down at every turn? Oy.

Thank you for your support.This blog is now my Knee Blog, as apparently I am a very rare (1%!) case and one for the research journals. Go me.

Love,Jamie

Oh, PD Don't watch this short vid if you're squeamish

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