Patrick T. Magee's Blog

Heading in for fourth knee surgery in 14 months, whew

2010-08-03T19:50:00.000-07:00

This last one was totally my fault. Four weeks after last surgery I slipped while crawling on an obsticle course in the pool with the kids. Not even the compression ice or 2400mg of Ibu a day for 5 days was enough to calm it down. Here's the compression ice wrap I use FYI:

Here are some key lessons learned this time around:
1) It takes 4-6 weeks for miniscus to fully recover from surgery.
2) The quad shuts down if there is swelling in the knee, which can lead to atrophy if you don't do specific excercises to keep them active. See PT for details.
3) Taking lots of Ibu is a mixed bag: in my case the swelling and pain was worse when I stopped taking it as it was masking pain that my body was using as a signal to warn me something was wrong.
4) I had a tough time recovering from the propofol anesthesia given me for this last surgery. Serously affected my concentration for weeks. Apparently there was a recall just after my surgery on June 3rd, 2010, but the doc says they examined all the propofol they used and didn't see any of the stainless steel particulate matter floating around. I hope they are right, because I had some serious health problems after the surgery that I haven't been able to explain.
5) surgery sucks!

Post surgery compllications

2010-06-10T22:16:00.000-07:00

About 3 weeks after surgery, my right knee started bleeding internally as shown in this picture:

It took over 2 months for the bleeding to stop. The doctor was just about to schedule another surgery to go back in and cauterize the blood vessals. While I was battling this, I caught a strange flu bug in July that the ER doc thought could be swine flu, so he gave me Tamiflu, even though the swab came back negative for Swine flu. OMG. Within two hours of taking Tamiflu, I was laying flat on my back unable to move thinking this is the worst flu I've ever had. Two days later I learned I didn't have Swine flu and should stop taking the Tamiflu. When my muscles began to recover, I realized that the immobilization was caused by the Tamiflu. 3 days later, I stood up from sitting in a chair, turned, and tore the miniscus in my left knee. It took six months of PT and 2 knee surgeries to recover from the Tamiflu. More on this nightmare saga later.

BTW, the thing that finally stopped the internal bleeding was compressed ice packs followed by wearing a neoprene wrap. Ace bandages just weren't strong enough. Thanks a ton to the ProClub PT staff (Susan in particular) for getting me started on this. The ultra important take-away on this is that doctors / surgeons may know how to do surgery, but they may not know how to help you recover from the surgery.

Knee Surgery Post-mortem

2009-05-22T16:54:00.000-07:00

I’ve always been one to avoid x-rays and surgery. I now have a crater in my knee cartilage because of that reluctance. I’m writing this blog entry in hope that others can avoid these “pit” falls. With Ironman Coeur d’Alene now out of the question, consider this my non-race report.

While cruising along at a 7mpm pace during the 2004 Seattle Half Marathon, something gave out in my right knee at mile 11. I was immediately reduced to a walk and thought I was finished. After 5+ minutes of walking, I did a test jog and it didn’t hurt too badly so I sort of limped the rest of the way. When I reached the stadium, all inspired by the cheering crowds, I went into a full sprint for the last 100 yards. I mention this because I shouldn’t have been able to run at all with a meniscus tear. But this tear was unique. When the torn meniscus was out of position, I was in pain. When it slipped back out of the way, I was semi-ok. Don’t know what caused the tear except that I was massively dehydrated. I didn’t know much about nutrition at the time, and was running hard trying to break 1:40. Sometimes the body finds a way to slow us down when it must to avoid even greater damage.

When the doctor examined me, the miniscus was behaving itself during the visit, so it wasn’t apparent that it had been torn. He offered to do an x-ray but I declined. Bad move. Two years earlier I had seen him for chronic knee pain. His exam revealed no structural issues, and he recommended physical therapy first. We would follow up with additional procedures if the PT wasn’t effective. PT did the trick. So it seemed that if it worked once, it would work again, and it did, but this time it took longer. The only difference was that I couldn’t kick a soccer ball with the side of my foot for over a year without a sharp pain. There was no other indication that I had an injury until Ironman Canada 2007.

Having completed 2 half Ironman’s in the 2 months prior with no sign of trouble. I was off to a great start in Penticton , but 40 miles into the bike, my right knee started aching as I was climbing Richter Pass. I began pedaling with just my left leg, but by the time I reached the top, it hurt so bad I couldn’t even do that. The pain was bad, so I thought I was done.

The mystery was that simply stretching my quads out for a few minutes on the ground caused the pain to dissipate enough that I was able to resume cycling with both legs - for a while, and then I had to stretch again. Given the information obtained from surgery today (pictures below), I have a possible explanation - inflammation is what was triggering the meniscus to move out of position. Stretching helped move it back into position. When I got to my special needs pack and took 2 Ibuprofen, this reduced the swelling enough that the meniscus didn’t pop out and irritate the cartilage, and no further stretching was necessary.

When participating in a race or training, there are times when you should tough it out; and others when you should back off and opt for a close medical evaluation. Hopefully someday I’ll be wise enough to know the difference. This case was very difficult for the doctor to diagnose because the symptoms were only present when the knee was inflamed, which wasn’t the case during my examinations. It was also tough because the damage occurred very gradually over time, and I didn’t associate the arthritic pain that began years later to the original injury until the recent MRI. Based on the location, amount of pain I experienced, recovery time and effort, I'm fairly confident the injury occured during the Seattle HM in 2004.

The MRI wasn’t even done for this injury. It was for prepatellar bursitis triggered by wrestling with our kids on my knees. After 3 months of swelling, draining 100 cc’s of fluid, and 2 cortisone shots, it finally stopped swelling 1 week prior to surgery. My guess is that scar tissue from previous injuries made it susceptible to swelling, so I decided to have the bursa removed while having the meniscus repaired, even though the swelling finally stopped. The perpetallar bursa only serves to reduce friction between the knee-cap and the skin. In most cases it grows back in about a year.

I’ll be doing 10 minute bike rides on the trainer in two days, and probably cycling outdoors in a week, but Ironman Coeur d’Alene in June is now out of the question. I haven’t trained in over 2 months. Putting my knee under an IM load without proper preparation in this circumstance doesn’t make sense. If work isn’t too crazy, I hope to be there for the swim and to cheer on my friends.