Finally Approved

Finally, I got approval to have the ACI surgery. Dan Gates, called today and he had spoken with Genzyme and the procedure has been approved. That takes my stress level down a notch or does it? The surgery date hasn't been set but I should be getting that set up this week.This comes at the perfect time since I am getting ready to move.

My knee has been hurting for the past five days, even doing my leg stretches and ice haven't helped. I am doing 4lb weights with at home pt and riding my stationary bike frequently. Unfortunately, that pizza seemed to have made the 2lbs lost reappear. I guess now its a juice diet before surgery.

Even though, my knee was hurting I managed to watch my nephew, Tanner play baseball. Last night, he made his pitching debut, well since two years ago and done great. His team won by a score of 10-6 in the district 8 Allstar Tournament.

Last night was the premiere of the Twilight Saga: Eclipse. My sister snagged us tickets to the 1am showing at the local theater. I know what you are thinking, 1am! Isn't that late? well not for me since I sleep at day and up all night. I blame it on nearly a decade of EMS or am I half vampire? Regardless, it is well worth it as 7 million people watched the opening night. It still surprises me that most people that watch the movies, have never read the books. They don't know what they are missing.

With that I will close, not much with the knee, other than the usual. Just wanted to share that the denial was overturned and soon I shall be cloned. Can't wait for that movie to come out, Loo: cloned!

Feeling Good

I have written several posts this week, that were pure genius. Unfortunately, my BlackBerry didn't post them, so I have had to track down a computer to keep you guys informed. I'm sorry you couldn't read those posts but genius can't be repeated. And I can't remember what the heck it was that I wrote, so hopefully, this will work.
This week has actually been fantastic! It has to be the summer weather but my knee has given me a couple days to get out and enjoy myself. Don't get me wrong the pain is still there but is tolerable. I caught a couple softball games and meet up with some old friends, whom I haven't seen in years. I was able to stand for about an hour before the knee said, excuse me,Loo but you have bone ends rubbing together, take it easy.
The next day I paid for all the excitement, with edema and pain that forced me to stay in the house, with my best friends, ice pack and elevation. Saturday, my niece and I went to Nashville to watch the NPF softball team the Tn Diamonds, play the USSSA Pride. We got to meet all the players, who were gracious enough to sign autographs and get their pictures taken with hundreds of young, silly band wearing, girls. Some ice and rest after I got home and I was good to go.

I reached down recently, and I think I found some muscle mass building up around my knee. Could that be? I am exercising at home and feeling really good, I had lost two pounds but that was before I cooked a pizza.
I have contacted Cigna multiple times and still they are useless to talk to, insisting that my physician needs to call them. So, still no surgery date. Come on people, pain here.

I have a new friend, who is having knee surgery in July, quite different from mine but a very interesting story. She is an EMT and so we share in the family of EMS. I'm glad someone out there understands the sarcasm, in this blog. I wish her the best of luck and look forward to hearing more about her progress.
I'm also searching for new career options, so any ideas would be appreciated.

denied again

I finally found out the source of the delay of surgery, it is Cigna. They have denied me again, this time citing insufficient evidence to demonstrate the safety and/or effectiveness of autologous chondrocyte transplantation in the treatment of lesions of the patella. Go tell that to the people walking around, pain free, after ACI. It appears, I will have to send them a not so nice letter, this comes after they flaked on a peer to peer session, with Dr Looney. If you are unaware Cigna, the longer someone waits who has no/decreased cartilage, the greater the chances are of developing osteoarthritis and further bone damage.Thus, leading to total/partial knee replacements. At 26 years old I am not a candidate for knee replacement nor do I wanna be. There I got that out of the way.Dr. Looney is still confident that the surgery will be approved and I am optimistic as well.
I must say my Physical Therapy is going great. I am still seeing improvements in muscle tone and swelling. I still have some pain from the lateral release but full flexion and extension. The pain under my kneecap has improved slighty, which is great, I'll take slight.

I'm going to use this post to congratulate my nephew, Tanner, and his team for winning the City Championship!!! He had the only homerun in the contest, hitting the scoreboard in centerfield. Congratulations!!! Orioles!!!

While watching the game, I wondered if I would be able to participate in competitive sports again.Or if it was wise to even entertain the thought? I love sports and am a big proponent of women's sports in particular, yes, i'm leaning towards another blog, so stay tuned. Anyway, I know Dara Torres, had this same surgery, so I am interested to see how she does. Yes, she is a swimmer, so the knee isn't taking a pounding like running or basketball would. I haven't come across any other athletes who have had ACI, some have had microfracture, with mixed results. Perhaps, its time to sit on the sidelines or coach. I guess I'll have 18 months to figure that one out.

I plan on putting some pictures on here soon, that is if I can figure it out. Now i'm going to write a letter to Cigna.

Greater Detail

Its time I explained my diagnoses in even greater detail. I try to document my journey, with humor, honesty, and emotion and to tell it in such a way that everyone can understand. So here goes:
When I had my first knee surgery in September of 2009, I was 25 years old and in great health. My preoperative diagnosis was left knee pain, possible medial meniscus tear. My postoperative diagnosis: chondral defect left patella, grade 3 defect medial femoral condyle.
The procedures: Medial Femoral condyle chondroplasty,
Abrasion arthroplasty and microfracture of the patella.
I had grade 2 change of the central trochlea region of the patellafemoral joint. Grade 4 change along the medial aspect of the patella at the junction between the medial and lateral facet. This measured 1cm x 12 mm.
My patella tracked well, so a lateral release wasn't done. I had no plica or suprapatellar adhesions or synovitis. I had no meniscal tear and no chondral injury laterally. The femoral condyle defect was 2cm x 5mm.
Now, are you confused? Me too! But don't worry, I'll explain it all.

A chondral defect is a lesion of the hyaline cartilage. Imagine eating chicken leg, the gristle at the end, is the hyaline cartilage.I had to throw that in for all you chicken eaters! lol! Chondroplasty reshapes the articular cartilage, while abrasion arthroplasty penetrates the tissue beneath the articular cartilage. This activates cells to form fibrocartilage. Which is less strong.
The microfracture is tiny fractures made in the bone to create clots and activate stem cells to grow new cartilage. This procedure was invented by Dr. Richard Steadman of the Steadman- Hawkins Clinic in Vail, Colorado. So says google.
My surgeon, Dr Colin Looney, did a fellowship at the Steadman-Hawkins Clinic. I am very confident with his skills.

I know I've thrown a bunch of words out, but I like to know the details and figure some of the people reading this, feel the same.

when

I went for my preop and to see Dr. Looney today. Not much to do considering nothing has changed in a month. Good news to report on the lateral release, my kneecap has loosened up tremendously. For a kneecap that is a good thing. I still have swelling, pain, and heat but is easily managed with rest, ice, and elevation.
Carticel is still being ridiculous or Cigna, not for sure which one exactly. Carticel is saying they need pre- authorization before they can start growing the cells and Cigna has already sent me a pre-authorization letter. Plus, the surgery center says they scheduled the surgery when the hot the pre-auth. Such fun, I'm fairly sure nothing is simple with me.
We are shooting for surgery on June 22nd but myself and Dr Looney feel it will be the first part of July before everything is in place.
Until then I will be sitting on the couch, watching the womens college world series, waiting to be called up to play. Tn actually has a pro fastpitch softball team, currently based in Nashville. Eight bucks a ticket behind home plate! Next year, season tickets for me!
I also am done with physical therapy. Yahoo! I've been in pain since the last session.
With that said, I will continue pt at home and focus on weightloss. Its extremely important to be in decent shape before surgery, to help yourself out. I mean damn, I have gained over the last 2 surgeries, leg dimples. Gack! And back tits. Double gack!
Just forget about that last sentence, don't close your eyes just call your shrink.
I didn't really ask many questions today, seeing as we are in holding mode right now. So Carticel, Cigna we are waiting and ready to go. I would like to not have the knee of a 70 year old anymore.

Postponed

I received a call today from Dan Gates, at Vanderbilt Bone and Joint. My surgery for next week, has been postponed until June 22nd, tentatively. He got a call from Genzyme group, that my cells were not ready. Bummer! I am so ready to get this over with and start the healing process, towards a normal life, again.
Carticel, the lab that grows the chondrocytes must have 12-14 million cells per vial, to make an attempt at implantation. This requires four to right weeks to achieve, I'm at four weeks now. Also, a delay in the surgery center seems to have trickled down to Genzyme, as they have an insurance approval they go through as well. Even though, my insurance has already approved the procedure. Yes, I know very confusing and frustrating as I told Dan, a couple more weeks to get my tan on.
Not only work on my tan but use my biggest loser training for weight lose and muscle growth.
I may be the only person, who wants surgery at the heighth of vacation season. I'm in a bit of a time crunch with insurance, I only have it for a few months and my pt lasts about 70 weeks. Plus additional surgery to take care of osteotomy.
I wonder when I receive my Foley catheter, if they will notice my farmer tan? Gack!
I wonder since my surgery is postponed, if Andrea, will come knocking on my door and drag me back to pt? I still haven't recovered from yesterday's workout. The stabbing pain is gone but now the entire knee aches. All that equals another night of sleeplessness. Sigh! With a home computer and all my free time, I could solve the worlds problems.
I do have something to look forward to this week. The Womens College World Series. I am a fastpitch softball freak! So with games starting tomorrow and ending the 9th, I'll be content with my new job as a TV watcher instead of attending the games.
I guess I will close this depressing post, and do my at home physical therapy.

Last Chance Workout

Today was my last physical therapy session at Top Rehab before the "big surgery". In exactly one week I will be cut open, or as my there year old niece says, " they cutting your knee off".
Well I hope not but I'm sure it will feel that way, I'm even considering a tattoo of my surgery scar. Kat Von D, are you available? I'm broke so could you do it for free? I mentioned the tattoo to Andrea, so she drew a smiley face on my knee, using two of the scope scars as eyes.
It is so simplistic, yet unique maybe I shouldn't wash my leg, seeing as how I have an Andi original.
All of my range of motion tests were great, so no more wall slides. Yahoo! Whatever those things do? After measurements, I could feel a different energy in the air. As if, jillian Michaels, had entered the room, when Andrea told me to get on the treadmill. Omg! This time I turned the fan on myself, as she dialed up 2mph at 7% incline. Now to most that isn't much but to someone with a bum knee and who has been sedentary for months, it is.
I walked my five minutes, then five more on "ole Rusty". Then, something new! Already? This is outrageous, I'm still delicate. Sniff!, snort!
No use trying to talk my way out of it, Jillian, I mean Andrea, put a harness around me.
Yes, a harness, like something a mule would wear. Actually, I was attached to a weight machine and had to walk until the weights pulled me back, like a YoYo. If you watch the biggest loser you will know what I'm talking about. Jillian, will drag behind the contestants, holding a rope as they pull her. I know sounds like a porno, not that I would know.
I did fairly well on this exercise, minus a couple times when walking sideways. Apparently, I'm still weak, I didn't know you could lose teeth at pt.
Within the first fifteen minutes of physical therapy, I had already worked up a sweat and lost five pounds. As a matter of fact, my shorts tried to make an escape during marching and kicking. Its a good thing I drank a protein shake before my workout, ahem pt session. I really enjoyed it, I have missed sweating. No crude jokes please! I wish I could have had lateral release a few months back. My pain has decreased enough that I can go outside and be a little more active. And with that said since the "last chance workout" today, I've had stabbing pains in the medial aspect of my knee. Go figure.