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Author Topic: Jak's Pre Op Diary  (Read 3517 times)

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Offline FindnNemo91

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Jak's Pre Op Diary
« on: May 02, 2009, 12:20:12 AM »
I just thought that  I would start one of these things. PLus, its a new experience for me.

Heres how yesterday started...
I called the doc after school. I FINALLY got a hold of the scheduling lady. She asked me when I wanted it done and I said as soon as possible. I heard a slight pause and then she said how about next friday the 8th? I was in total shock. I didnt no they could schedule that soon. I was like, yea, ok, that sounds good. and then i asked, so they are doing the lateral release and is it an MPFL recon/repair or imbrication? and she said ummm...there is nothing about the mpfl, but it looks like they are gonna do a TTT and chondroplasty. and right there was another shcok. i was only expecting "minor" surgery-the lateral release and chondroplasty. So, then we scheduled the pre op visit which is tuesday, the 5th. after i hung up with her, reality started to set in, but i wasnt scared. i told my coach who was not thrilled because there are only 2 weeks left in the season. but i told him that i was in so much pain, that i didnt want to delay the surgery anymore (little did i know).

so today: i was at school, during our morning break and my mum called me and said, the surgery has been delayed till the 15th because your new doc doesnt take our insurance. i kinda wanted to cry because i had been mentally preparing myself for friday. and now i will have to restart next week. and plus i misunderstood her. i am going to a "real" hospital for the TTT not the free standing outpatient place. and i was like, omg...im not gonna have the doctor, that has done 1500 of these surgeries? what if the new doc screws it up? so then when i got home, she told me that my doc was gonna go to the hospital and do the surgery. i was SOOOOOOOOO happy, because i feel like i can trust him (hes done plenty, and plus he did Kevin Loves knees: for those of u who dont know who that is, he went to my school and graduated in 07 and now plays in the NBA.)

so right now: im writing this to yall. and i need to go get dressed for practice and prepare myself to tell the team all over again, that my surgery is not for another week and that i can try to help them into the playoffs. hope all goes well.

some questions for those that have had the TTT...
 1. how bad is the pain when u wake up?
 2. did u get sick from the anesthesia?
 3. how long were you on crutches? and after that in a brace?
 4. does an iv hurt?
 5. was it open or arthroscopic or does it depend?

thanks so much guys,
yall have gotten me through some tough times!!!

jak
TTT/Lateral Release/Chondroplasty: May 15th, 2009
Brostrom Reconstruction: Oct 16th, 2009

  ~United States Army~
Wheeled Vehicle Mechanic

Offline FindnNemo91

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Re: Jak's Pre Op Diary
« Reply #1 on: May 02, 2009, 12:23:32 AM »
i figured for the ones who dont know me that i would post my history, since the start of my knee pain. (thanks to the kneeguru for helping me out with this one!)

I am currently 17 years old (born 1991) and female.

I was very sporting as a child, and played softball (catcher) and later roller hockey (goalie). I had no problems with my knees until 1999, when I was eight years old.

My history is as follows:

In 1999 when I was eight years old, I started to get pain in my left knee. It was brought on only when undertaking strenuous activity. The pain was experienced all over the knee. I was given a provisional diagnosis of 'tendinitis'.

In 2001, when I was ten, I was playing a game of softball, in the position of catcher and wearing catchers shin/knee pads. I missed a catch and the ball struck me over the region of the kneecap. I estimate this was at about 55 mph. I could not walk at all immediately after the injury because of a feeling of instability, and it was also painful to bear weight on the leg. I had to stop playing and was transported to the ER. There was no numbness from the injury, only from the big bag of ice, but the knee was very sensitive to touch at the time of the injury. It was just like I wanted no one to touch it. It was from 1 inch above my knee to one inch below it.

At the ER an X-ray was taken and I was told that there was no bone break. My foot and ankle started to swell the day after the injury and a small bruise came out on the kneecap. I had to use crutches for a week and slowly started back into softball a week later. (no running, no catcher, just throwing). My knee settled down after getting back to normal, and I just experienced some aches from being in a catcher's position during the game.

A year and a half or so later I was hit on the knee again, in the same position during a game, but this time the symptoms were not so bad. I wore a ACE patellar stabilizer brace after the game (but needed no crutches).

By the time I was twelve, I had started playing roller hockey in VA and suffered no major injury while playing this sport. However, in 2003 I fell of my bicycle trying to go off a ramp, and the bike landed on my left leg (the bad one). A lump came up on my calf - about the size of a half orange. My mother brought my crutches as I could not bear ANY weight and I could not even pick my foot up - I had to drag my foot on the ground. I was on crutches for about one week Then I had softball tryouts. I tried not to focus on the pain and they went pretty well.

I moved to Florida in March of 2005, where I continued roller hockey. I had no injuries. After roller hockey, I had to start wearing a brace. I started wearing a brace because my knee began to have a low grade continuous ache in it and was relieved by nothing else that I tried. I also got it for basketball and the ache would have made that impossible. I suffered no injuries from basketball.

I arrived in Oregon on Dec. 7, 2005. Things have become much worse since this move. There was a lot of emotional stress before, during, and after the move. I did not want to move, although I kinda liked driving across the US. I started at this time to experience numbness in the left leg, usually from the knee down, mainly in the ankle and foot and toes. My foot and ankle and toes felt continuously swollen, although they were not. I went to my first doctor, a GP, in Oregon in Aug of 2006 and she ordered an MRI after the X-ray showed a higher than normal patella. The MRI did not show this - the MRI was apparently "perfect.". I went back to a different doctor, a different GP, and he told me that I have ITBFS and generalized ligament laxity. He did a bunch of tests. I was having a lot of pain over the IT Band, and had had it there for a couple months. I went to another doctor, a different GP, because of the continuous pain, and he told me that along with the ITBFS and GLL, that I also had chondromalacia. He gave me a script for physiotherapy. I also went to an OS, and he told me that I only had ITBS. He also gave me a script for physiotherapy.

My band had a trip that was from May 19-22. We were marching in the Victoria Day Parade. The parade was two miles long. To prepare for this, I had to see if I could walk two miles. I went to the gym and walked on the treadmill for a quarter of a mile and had to stop because of the pain. The next day I paid for it. I could not walk. I spent the next three days at home on the couch icing and heating. I got some crutches and was on them for five weeks because of the tremendous amount of pain. I went to Canada, but I did not march, just watched.  I started physiotherapy after I returned.

The physiotherapist gave me a list of different exercises, and told me to do them two times a day. I followed this regime. She was very alarmed at my symptoms and how much pain I was in. I tried the TENS unit, which made the pain so much worse. After each session of physiotherapy, I would have a flareup that would last about 3-4 hours. I only had five sessions of PT, because my physiotherapist said that by the 5th session, I should have had at least a slight improvement. The physiotherapy made it worse. During physiotherapy, I was on crutches, and she told me to stay on them. When I started physiotherapy my therapist did a lot of work on my back. She said that I was sensitive in a lot of the places that connect to the knee. She told me that my spine was compressed. She also told me that I have scoliosis, but not a major case of it. She started out by what she said as "the easiest exercises." I think that my ROM was 120 (full) but I know that I have lost some now. (I used to be able to touch my heel to my buttocks, but now I am about two inches from it with severe pain at that point.)

I am now 15 (2007) and am in almost continual pain. I am on amitryptaline, prescribed by my Pain Management doctor, which does not seem to have made any real difference to the pain, although I do manage to sleep through the night. I am seeing a pain management doctor. Her nurse practitioner told me to come back as needed. She had written on her notes that she wanted to try DMSO and Neurontin, but my mum does not want me to take these as she feels that they will only benefit the pharmaceutical company. She feels my pain is due to emotional stress. She wants me to play softball this fall, and I do too. The pain management doctor wants me to see a pain psychologist.

Currently I experience the pain all around the knee, but it is sometimes more severe in the calf area. I feel as if I have enough pain for ten people. I often feel numbness in the calf area. My toes, feet and ankles often feel generally weak and are frequently numb. My left leg goes numb if I cross my legs. The skin on my left leg sometimes burns and is blotchyish purple in color. The discoloration is usually only in the calf but it can also spread to the foot. The discoloration comes and goes. My "bad" leg is almost always colder than the good one. My left leg kinda feels sweaty and is sometimes shiner than the right. There is no difference in hairiness. The toenails on the "bad" leg seems slightly longer than the "good" leg. (not much of a difference though)

I recently had an MRI scan of my lumbar spine to rule out a herniated disc.

I do not go to the pain management doctor any more. My mum feels I should tough out the pain, and do some exercises the PT had initially told me to do – with the hope of playing softball this fall. I now wear a stabilizer brace whenever I go out the house, and sometimes if the pain is severe I wear it in the house, too. The brace does not help with the pain – it just gives me a sense of stability. I also have a Cho-Pat Dual Action Strap, but it does not help at all. I have to have it in the perfect place, and if not it causes more pain. I am currently trying to get an immobilizer. It is hard to do everyday things like taking a shower or putting dishes away in the lower cabinets.


TTT/Lateral Release/Chondroplasty: May 15th, 2009
Brostrom Reconstruction: Oct 16th, 2009

  ~United States Army~
Wheeled Vehicle Mechanic

Offline Silkncardcrafts

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Re: Jak's Pre Op Diary
« Reply #2 on: May 03, 2009, 02:54:30 AM »
Hi Jak,

I find your history and background very interesting. It sounds like you've never really had the right care.

It seems very strange that the surgeon has changed his mind on what surgery he wants to do. Why is that ?

After you've had your surgery I would encourage you to go and see a sports and exercise medicine doctor or Psyiatrist which they are often called in the U.S. They will be able to guide you through your rehab better in terms of returning to sport. I have been seeing one for over 7 years and makes a massive difference. What part of Canada are you in ?

It must be hard your Mum saying that you just need to tough out the pain. I think that might be part of the problem. Hope you don't mind me saying, my Mum has been the same.



11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline FindnNemo91

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Re: Jak's Pre Op Diary
« Reply #3 on: May 03, 2009, 06:34:51 PM »
Hi.

Yea, the road of tryin to get a diagnosis was long and difficult. I was so happy when i got a referral to this new doc and he told me exactly what was wrong and that he could fix it. it was a load off my shoulders. i honestly dont know why he changed his mind about the procedure. maybe he looked back into the file and saw that the TTT was better? (his assistant did do most of the consultation. he was only there for about 10 minutes.) i guess there are too many "maybes" to really answer that question. Do you know if i do pt with the ppl that did my surgery? or do they let me pick my own place? My regular doctor(not my OS) is a sports med. doc, so should i continue to see him after the surgery? my mum was kinda difficult to deal with at first, cuz all the docs kept tellin us that there was nothin wrong and she just felt totally useless. its been a hard situation for years and hopefully this will help.

o...and im not in canada. I am in oregon (close enough tho :)

thanks so much,
jak
TTT/Lateral Release/Chondroplasty: May 15th, 2009
Brostrom Reconstruction: Oct 16th, 2009

  ~United States Army~
Wheeled Vehicle Mechanic

Offline fraud_ninja

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Re: Jak's Pre Op Diary
« Reply #4 on: May 03, 2009, 07:16:09 PM »
Jak,

I want to offer a word of caution before your surgery.  Please find out why the OS is now electing to do a TTT.  Also, do research and make sure your OS specializes in patella problems.  This is very important.

I know that you are very into sports and love playing softball.  The TTT is a big enough surgery that if it is not done right, you might not be able to play softball ever again.  So, please please please do some research and make sure your OS has made the right decision.  If your OS does not specialize in knees, then consider finding one that does.  Keep in mind that just because an OS suggests a surgery, does not mean that they are the most qualified to perform the surgery.

Once you have done your research and know that this is the right surgery with the OS, then here are some answers to your questions:
1.) It is pretty painful after you wake up, but they will do a good job in the recovery room of giving you the right pain meds to help with that.
2.) I do get sick from anesthesia.  It depends on the person. 
3.) I have had four TTT's.  #1 was brace and crutches for 6 weeks.  #2 was brace and crutches for 5 weeks.  #3 was crutches for 3 weeks and brace for 6.  #4 was crutches for 4 weeks and brace for 7.  It depends on the surgeon and on the particular recovery.
4.) IV's are not bad, just do not "think" about it too much.  I found it helped to have a conversation with my mom who was there with me...I did not notice the pain of the IV going in.
5.) A TTT pretty much has to be done open.

But, as I stated above...PLEASE do some research and make sure this is the right surgery for you.  Once you have the surgery there is no going back and it can often make the situation worse.  This was the case for me.  My first two TTT's made my knees 20 times worse and I certainly wished I had never had the surgery. 
12/26/02 LR R
10/26/06 TTT R
1/25/07 TTT L
12/17/07 TTT revision, MPFL recon R
2/7/08 TTT revision, MPFL recon L
3/24/08 screw removal R
4/30/08 screw removal L

Knees are fixed, training for a triathalon.

9/21/09- Right ankle reconstruction

Offline FindnNemo91

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Re: Jak's Pre Op Diary
« Reply #5 on: May 03, 2009, 07:57:18 PM »
Hi fraud_ninja:

thank u so much for answering my questions. now to answer urs: my doc does specialize in knees/patella problems. hes done a lot of these surgeries and for now, i totally trust him. (we will see if that holds true after the surgery:) I do realize that if the surgery isnt done right i might not play again, but if i dont risk it i prolly wont play anyways. i have done the research and i hope that its the best for me. i have my pre op appt on the 5th (tuesday) so i will ask all my questions and then write back to yall about what he said.

thanks again,
jak
TTT/Lateral Release/Chondroplasty: May 15th, 2009
Brostrom Reconstruction: Oct 16th, 2009

  ~United States Army~
Wheeled Vehicle Mechanic

Offline Silkncardcrafts

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Re: Jak's Pre Op Diary
« Reply #6 on: May 04, 2009, 04:04:26 AM »
Hi Jak,

I totally agree with Fraud Ninja. You need to do the research and make sure it is the right type of surgery for you.

In regards to physio I would get a recommendation from your surgeon about a PT that specialises in patella problems. It can make a massive difference. I would really urge you to see your sports medicine doctor after your surgery to monitor your rehab. Make sure they closely liaise with your surgeon. My sports physician works very closely with my knee surgeon and it makes a massive difference.

It must be hard with your Mum. Mine was exactly the same, but sometimes made matters worse. I am so glad that I pay my own bills as I don't have to put up with her rubbish now. Can just make my own decisions.

Hope this helps.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline FindnNemo91

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Re: Jak's Pre Op Diary
« Reply #7 on: May 04, 2009, 04:26:46 AM »
hi again...

i have looked over and over at it. its kinda hard for me to completely understand if its the right surgery, but from what i can gather, it appears as if would benefit me. i have the pre op appt with the surgeon on tuesday so i will make sure that he thinks this would be in my best interest.

thanks so much!
jak
TTT/Lateral Release/Chondroplasty: May 15th, 2009
Brostrom Reconstruction: Oct 16th, 2009

  ~United States Army~
Wheeled Vehicle Mechanic

Offline fraud_ninja

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Re: Jak's Pre Op Diary
« Reply #8 on: May 04, 2009, 06:23:47 AM »
Jak,

Here are some things to ask your OS to make sure this is the right surgery for you:
1.) Ask about the type of TTT he intends to do.  You have mentioned previously that you have patella alta.  If this is the case then it should be addressed in the TTT.  I had patella alta and it was not addressed in my first TTT's...hence the revisions.
2.) Ask about rotational issues...the rotation of your tibias and femurs can play a large role in the alignment of the patella.
3.) Ask about other structures such as the trochlear groove.
4.) Ask why your OS changed his mind from the MPFL recon.
5.) Ask the OS how many TTT's he does in a given year.

If your OS cannot give a solid answer for each of these questions, then you ought to consider getting an OS that is more specialized.  Its so important to do this up front, especially since you are an athlete.  Take it from me, 4 TTT's are not fun at all.

Signed, The Ninja
12/26/02 LR R
10/26/06 TTT R
1/25/07 TTT L
12/17/07 TTT revision, MPFL recon R
2/7/08 TTT revision, MPFL recon L
3/24/08 screw removal R
4/30/08 screw removal L

Knees are fixed, training for a triathalon.

9/21/09- Right ankle reconstruction

Offline FindnNemo91

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Re: Jak's Pre Op Diary
« Reply #9 on: May 05, 2009, 03:25:04 AM »
thank u for the questions to ask.

my preop appt is tmw morn, so i will ask the questions and then update yall when i get home.

everyone has been really helpful...thx so much.

jak
TTT/Lateral Release/Chondroplasty: May 15th, 2009
Brostrom Reconstruction: Oct 16th, 2009

  ~United States Army~
Wheeled Vehicle Mechanic

Offline Silkncardcrafts

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Re: Jak's Pre Op Diary
« Reply #10 on: May 05, 2009, 05:05:46 AM »
Hi Jak,

I would definitely be asking lots of questions. You need to make sure it is the right type of surgery.

Unfortunately I've never been able to return to sport at this stage and has been really hard to accept.

Last year I had a trochleoplasty as my trochlear groove was very shallow. In the operation it was deepened and has made a massive difference.

I am also concerned that your OS changed his mind about the type of surgery he wants to now do.

Good luck and let us know how you go.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline FindnNemo91

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Re: Jak's Pre Op Diary
« Reply #11 on: May 05, 2009, 05:20:38 AM »
should i ask about the trochlear grove?

i guess i will make a big list of questions. the lady that i talked to on the phone when i scheduled it that when they actually "open me up" thats when they will decided if additional things will be done.

but i will definitely ask about that.

thanks,
jak
TTT/Lateral Release/Chondroplasty: May 15th, 2009
Brostrom Reconstruction: Oct 16th, 2009

  ~United States Army~
Wheeled Vehicle Mechanic

Offline Silkncardcrafts

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Re: Jak's Pre Op Diary
« Reply #12 on: May 05, 2009, 07:45:24 AM »
Hi Jak,

Definitely ask about the trochlear groove. If it is not addressed and you have a problem you could continue to have problems.

They should have a pretty good idea before they go in to do the operation.

Good luck with your appointment.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline FindnNemo91

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Re: Jak's Pre Op Diary
« Reply #13 on: May 05, 2009, 08:48:23 PM »
so here is what they said at the pre op appt...

modified Hauser procedure with a lateral release
possible chondroplasty
NWB for 4-6 weeks (at 2 weeks they will unlock the brace and let me bend a little)
he does 4-6 TTTs a month (they said that it is the most common procedure at their practice)
they said they would remove the screws if they become bothersome
i am gonna be icing 30 on 30 off. (the machine has a 30 min timer built in so i dont have to worry about timing. and they told me to ice whenever i am not asleep)

thats basically about it.
i wrote down to ask about the trochlear groove but must have overlooked it at the appt. (you know how you get when u start to get nervous)

thanks alot
jak
TTT/Lateral Release/Chondroplasty: May 15th, 2009
Brostrom Reconstruction: Oct 16th, 2009

  ~United States Army~
Wheeled Vehicle Mechanic

Offline fraud_ninja

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Re: Jak's Pre Op Diary
« Reply #14 on: May 05, 2009, 09:04:22 PM »
Did you find out why your OS switched to the TTT?

It cannot be stressed enough to do your research and ask the questions.  You have to advocate for yourself here...do not assume anything.

12/26/02 LR R
10/26/06 TTT R
1/25/07 TTT L
12/17/07 TTT revision, MPFL recon R
2/7/08 TTT revision, MPFL recon L
3/24/08 screw removal R
4/30/08 screw removal L

Knees are fixed, training for a triathalon.

9/21/09- Right ankle reconstruction















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