Process of Illumination

Since my ACL reconstruction on Aug 21 things have been a bit like the mountains around here: rocky. Everything was great for about three weeks, then I had PT one Friday morning and the knee blew up, culminating in a second surgery on Oct 19. While I would love to have such a simple scapegoat—some bad therapy or massage or, worst of all, a bad physical therapist—it seems that I was fated to struggle.

Aug 22–Sept 14 had me progressing at an above-average rate. Nothing amazing, but better than many recoveries. My extension and flexion (how close my heel comes to my butt) were improving each week, and my strength was returning like refugees to a war-torn homeland: the landscape was familiar... changed for the worse, but familiar. On Sept 14 I went into PT and had some swelling—normal, certainly, for 3.5 weeks out of surgery—and a stiffer than usual knee cap. We did the routine things that day as well as some massage around the knee cap trying to loosen it up. Next day my knee was extremely stiff and the swelling increased. My extension and flexion regressed to where one would expect to be several days out of surgery, not several weeks.

Weeks 4–8 were downright depressing. I would fight and fight for 1 or 2 degrees of extension and the stiffness and swelling would knock me right back. Fears crept in: Are we pushing too hard? Are we not pushing hard enough? Is my body rejecting the allograft? That would fucking suck. Am I not doing enough at home? My surgeon and I booked a second surgery for Oct 18. We weren't sure what the surgery was for ... making sure the ACL was solid, I guess, seeing if it was infected, maybe. Whatever. It was comforting to know in early October that if my struggles persisted for several weeks more there might be a silver bullet.

But there are no silver bullets in physiology. Every 3 seconds you take off your 200m time requires weeks of training, and lifting in the months prior just to make sure your body could even shave any time off. Every 3 degrees of extension or flexion I gained required weeks of stretching, patience, and pain.

Oct 15, three days before surgery #2, I met with the surgeon and it happened to be a good day. In the up-and-down wave of my recovery he caught me on the upswing, marked by slight gains in extension/flexion and a decrease in swelling. We called off the surgery.

Friday Oct 19 I had a regularly scheduled PT session and the 24 hours prior had been the hardest since surgery. I called in "sick" to work on Thursday, but I wasn't sick, I was nearly incapacitated, immobile. Then Friday morning my knee capsule was bigger than a softball. My PT said he couldn't do anything and called in the PT center's physician's assistant to evaluate the knee. They called my surgeon—caught him scrubbing in, minutes from being unavailable—and he advised to drain the knee, have the fluid sent to the lab. "That is a big syringe," I said to the PT and the PA. "Better to have the RV than the Pinto I guess."

Twenty minutes and two syringefuls (110 cc's) later we had some fluid in our hands and I had a lot less in my knee. Went home. PA called: "By the way, you can't eat anything starting right now in case you need surgery." "Okay." Awesome. It's 10 a.m. and I've eaten cereal and coffee. Later the PA calls ... Lab report says the white blood cell count is very high in the fluid, they suspect infection. Instructed to report to the hospital at 5:00.

Surgery finally starts at 8:30 or 9:00. I&D, irrigate & drain. Knee-related fears being not assuaged at all (It is the allograft. Will I have to start over? Fuck. Fuck fuck fuck fuck shit), my only comfort was the promise of a new Vicodin prescription and, if I was lucky, some ice chips and a snack as soon as I came to. Surgery went fine and they cleaned out the knee, checked on the graft. Everything seemed okay except the white blood cell count from the drain sample.

But lab cultures never replicated a bacterial infection from the blood samples drawn over the course of three weeks. Apparently microbacterial science, in the year of our Lord 2007, is an imperfect science. Yesterday's chat with Alex, a PT student:

11:02 PM me: knee's ok

11:00 PM infection might've been, might not've been

they're not really sure

apparently that field of medical science has not yet been perfected

I'm like isn't it 2007?

11:01 PM but -- getting better now, slowly but surely

11:02 PM Alex: haha

true

unfortunately the big money is not researching microbacteria stuff

me: where is the big money?

11:03 PM Alex: anti-depressants, fat burners and male erectile dysfunction

So I was on antibiotics for a 3.5 weeks. Better to treat a possible infection than not treat an imperceptible infection.

The last 5 1/2 weeks have yielded steady improvement with a slight plateau in the last week. I'm hitting the YMCA 5–6 times a week, PT now down to once a week. Just began introducing cardio to my routine, did some speed ladder–like exercises, slideboard, and lunges. Good shit.

I am optimistic now.