*There are a couple of post-surgery incision photos in this article. They aren’t bloody and I don’t think they are too bad, but if you have a weak constitution, maybe you should skip this article. Fair warning.
-Greg
A few weeks ago, I took a big fall while hiking and seriously damaged my knee. I wrote about what happened and my need for an upcoming surgery requiring the cancellation of a couple classes.
I haven’t provided any further updates, so I thought I would fill you all in on what’s been going on in the last couple weeks.
On the initial appointment with the surgeon, he diagnosed a torn quadriceps tendon by physical exam. He anticipated that there would be more damage inside my knee and scheduled an MRI for the following week. He also set me up with a preliminary surgery date because the quad tendon needed surgical repair regardless of what else they found on the MRI.
The MRI gave us good and bad news. The good news was that all of my ligaments inside my injured knee were intact and functional. I had two small meniscus tears. We made the decision not to repair those at this time. The doc thought that would make the recovery significantly more difficult if he added the meniscus repair to the quad tendon repair. He also thought there was a good chance that due to the small size of the meniscus tears, a surgical repair may not ever be needed.
The bad news was that the quadriceps tendon was very badly torn. The quad tendon is at the top of the knee and attaches all four of the quadriceps muscles to the kneecap. See the photo below for details.
The MRI showed my quadriceps tendon was approximately 95% ruptured. Take a look at the photo below of my knee just before the surgery. See the darker-colored indented horizontal line just above my kneecap? That’s the tear. The quadriceps muscles were completely torn off the kneecap except for a tiny strand of muscle still attached at the outer edge of the quad.
I asked the nurse to do a proper fade on my shaved leg hair before the surgery. I don’t think she found the request as humorous as I did.
The surgery ended up being somewhat difficult. Part of my quad muscles had retracted about five inches up into my leg. The surgeon had to open me up, find the retracted muscles and tendons, then pull them down to my knee cap. He drilled two holes in the top of my kneecap and anchored all the tissue with sutures. They closed the incision with staples and wrapped everything up with a bandage, compression stocking, ice pack, and brace. They gave me instructions not to take anything off or get things wet for a week.
I tried to obey the instructions, but the bandages started slipping off after three days. I opened everything up and re-dressed the wound. Here’s what it looked like at three days.
Day 3
At day seven, I had my first checkup and got the staples removed. I was also allowed to take a real shower for the first time. The evaluation was good. Everything was still holding up well and there was no infection. I had a bunch of swelling and bruising even a full week after the surgery.
After 7 days
Replacing the staples with steri-strips
The side of my knee showing the swelling. My calf is pretty big and the swollen knee makes it look tiny.
Still a bunch of bruising even a week after the surgery
As I write this, it’s been 10 days since my surgery. The surgeon told me that most folks used crutches for about two weeks, but that I could put weight on it and walk as soon as I could tolerate it. I never used the crutches they gave me. I’ve been using a cane on uneven ground and getting along pretty well without it on flat floors.
The only thing that can harm the healing now is bending the leg before the tendons properly reattach to the knee cap. The doctor said he’s seen patients re-tear the tendon especially if they have strong quadriceps muscles. That was his biggest worry with me.
Walking is fine, but I have to keep it locked in a steel brace and immobilized in the straight position for at least three weeks. Wearing the brace full time is tedious. It’s especially bad when I’m sleeping. I’m surviving.
I’ve been trying to walk as much as possible. I find my tolerance is somewhere around 1.5 miles a day. I did a 2.5 mile day and woke up several times in absolute agony that night. It’s driving me crazy because since I’ve retired I’ve made it a practice to walk about four miles a day in addition to my weight workouts. I didn’t realize how much I liked my daily walks. Hobbling a mile or so a day isn’t quite the same.
I did make it to the gym yesterday for my first machine-based upper body weight workout since the surgery. I’m glad I can start back doing that again.
I was surprised by two things after the surgery. The first is how much it hurt. I’ve had several pretty nasty surgeries in my life. This one hurt the most. At 10 days out I’m still using occasional opiates especially when things start really hurting at night. For all my other surgeries, I was off the opiates within a couple days.
The other thing that surprised me was that despite the pain, I’ve been pretty mobile. I was worried that I’d be really laid up, but I’ve been able to hobble around since day one. Getting in and out of bed has been challenging, as has sitting on the toilet, but I’ve figured out how to do everything with minimal pain. Right now the most vexing thing is trying to put on my shoe when I can’t bend my knee or lift my heel off the ground. I haven’t quite succumbed to the temptation of buying Crocs, but I’ve been thinking about it.
While I’m unhappy I had to cancel my classes in Georgia, it was the right call. I’ll probably still be in the locked brace and unable to bend the knee. I don’t think I would have been able to stand all day or demonstrate any of the techniques I would have to teach. I have a class for my armed school teachers and a shotgun class at the end of September. I should be out of the locked brace and able to move a little better by then. If my recovery continues at this rate, I don’t anticipate needing to cancel any more classes this year.
Look forward to another more interesting article about the surgery in a couple weeks. As I was preparing for the surgery, I had lots of friends contact me asking me if I needed any help. Any of you who know me recognize I’m pretty independent and don’t like to inconvenience my friends if I can avoid it. Not only did I have to deal with my personal recovery, but I also bought a house three weeks ago and had to figure out how to pack up all my stuff and move with a bum knee as well. It was posing quite the challenge.
As I was preparing for my surgery, I read the following quote in the book Die Wise by Stephen Jenkinson:
“You can consider it an affliction. Or, you can consider it an assignment.”
This book is on an entirely different intellectual level. If you deal with death as a vocation or are anticipating your own passing, this one should be in your library.
I certainly had an affliction with my torn quad tendon, but that isn’t the only affliction I’m facing. I still have metastatic stage four prostate cancer. I’m exploring treatment options, but at this stage of the game if I chose to do all of the treatments offered to me, I’d still only have a 29% five-year survival rate. Considering that I’m not going to do some of the treatments because of the serious reduction in quality of life, my time here may be a bit shorter than that.
I bring this up because the next place my cancer is going to spread is to my bones. I’m likely to have a lot of painful bone fractures in the next few years as the cancer spreads.
I’m single, have no kids, no serious romantic relationships, and no close family. In the worst case scenario when my cancer spreads more, I may have to take care of myself despite all those broken bones. Taking care of myself following my knee injury is good practice for doing that. I chose to embrace Jenkinson’s idea of the “assignment.” My assignment was going to be learning how to completely master taking care of my daily activities alone despite a serious injury. Framing the assignment as a challenge rather than an “affliction” altered how I looked at the shitty situation I was in.
I made it my assignment to completely manage my surgery and recovery on my own without any physical assistance at all from friends. That included packing up and moving to my new house as well. I’m not completely recovered yet, but I’m through the worst parts. I did it all completely on my own without even using friends for a ride to and from the hospital. I didn’t tell any of my friends who offered assistance that I was doing this. Sorry, amigos. I was working on my assignment and couldn’t take you up on your generous offers. This assignment taught me quite a bit.
I plan to write an article about how I managed this surgical procedure, recovery, and move without any assistance soon. Look forward to it in the next couple weeks. Until then, I’m doing well and will see you all in a class soon.
The ultimate get-well card for my recovery. Thank you Nathalie!
