By mid January 2014 I went back to see Dr K in Ottawa and I shared my very detailed pain log with him. I am not sure if he is a speed reader or not but he certainly didn't read too much of it, he commented that I had done some good rides while I was in Brazil but in my opinion they were not that good at all. In the past 2 years I have built up quite a pain tolerance and each ride I did in Brazil had a certain level of pain that I am sure the average Joe wouldn't be able to tolerate.
I was still experiencing significant pain inside and outside the knee joint. While riding my pain was mostly at the insertion of the Vasus Medialis Oblique (VMO) which is the tear drop Quad muscle that inserts into the inside of the knee. The pain was slightly underneath the VMO in the Medial Patella Retinaculum. I was experiencing even worse pain at all times at the medial joint line and just below it signalling possible meniscus disease or something else like damage to the medial femoral condyle articular cartilage, and some tendonitis at the pes anserine bursa which is where 3 hip tendons join and insert just below and inside the knee. Dr K offered me a diagnostic arthroscopy, basically another scope to have a look at what was going on and to correct any damage. The surgery was booked rather fast for January 25th, 2014 at Ottawa Riverside Hospital.
I drove to Ottawa the night before and checked in to a rather cheap hotel which my 'employer' uses for overnight medical stays in the Ottawa Region. The hotel was near the hospital and it was safe, clean but the air in that hotel was the driest I had ever experienced. I barely slept and after the little bit of sleep I got when I did wake up it felt as though my throat was glued closed. But I was in good spirit even if I was anxious and nervous for the surgery that day. I had faith in Dr K and his surgical skills so I tried not to worry.
By 3pm I woke up in the Recovery Room after my surgery, Dr. K had promised to come and see me briefly in the recovery room to tell me what he found. Apparently this isn't common practice in Ontario and sometimes the patient doesn't actually find out what happened until the follow-up about 10-14 days later but Dr K did indeed briefly come over to see me and he mentioned he found a complex tear to the posterior horn of my medial meniscus which he trimmed and he also resected a remnant plica (which Dr P had missed).
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| pre-op but in a good mood. The staff at Riverside Campus was super nice to me. |
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| Post Op and feeling queasy. |
I ended up throwing up pretty bad and I had the dry heaves the entire way back from Ottawa from the medication and anesthesia. My GF Roberta flew to Canada a few days later to assist with my recover effort as I was immobile and stuck at home in the middle of winter and I had a dog (Owen) to take care of. We had horrific weather in February of 2014 with record cold and snow. It seemed like it was snowing every other day. Without Roberta I am not sure what I would have done. She shovelled endless snow, walked Owen, fed him, got me ice, shovelled more, changed my bandages, shovelled more and made sure I was comfortable. She also learned to drive in the snow which proved to be a frightening experience for all but we survived and so did my CRV! But best of all she was the most amazing company which is half the battle as I am not one to sit around and watch TV all day, I am hardly a couch potato. Quite the opposite and I get bored very easily but Roberta is a talker and all you hear is nanana nanana nanana nanana all day and night so she kept me entertained nicely.
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| Roberta and Owen. This photo is priceless. |
I had the ultra sound and figured everything was fine and left the hospital against Roberta's wishes but as soon as I got home my cell phone rang and it was Belleville General Hospital saying I had a large blood clot and I needed to go back to Emergency ASAP. Five hours later I was leaving emergency with instructions to see my GP/Primary care nurse the next day. The emergency physician the night before had suggested serial ultra sounds as a course of action for the DVT (every 3-4 days) to monitor the clot, but my clinic was not so sure how to proceed. They referred me their local Internal Medicine Specialist named Dr J who they used as a consultant. He was adamant that I start an anticoagulation regime, to stop physical therapy, not swim and not fly anywhere for a minimum of 3-4 months. Roberta and I were not impressed by Dr J at all. (Roberta is a medical professional and a good judge of medical competency. She is very impressed with Dr K in Ottawa but not this guy). He was full of himself, arrogant, over weight and also wore clothes full of holes. We are not ones to judge but why would I want to be treated for a blood clot by a man who couldn't even dress himself like a professional that he is?
Blood Thinning
After consultation with a few other professionals and my Surgeon Dr K we decided to anti-coagulate after all. (go on blood thinning medication). The medication Dr J prescribed me did not require weekly blood tests to screen my INR levels - my bodies ability to clot blood. It was a single dose that I would take orally for 3 months but again, no flying, no physical therapy and no exercise. This was going to kill me!
Roberta had to go home to Brazil. With in a week of anticoagulation treatment I was experiencing significant joint pain all over my body particularly in my back and I had lost a lot of weight despite being docile at home. My back was so sore I could hardly walk or get out of bed every morning which proved difficult especially when I returned back to work. I was in agony, feeling down and not in good spirit over all. My knee was also feeling terrible even though the incisions were heeling nicely. Despite the pain I was rehabbing diligently and working hard 3-4 hours a day to do what I had to do and get better.
At around 3 weeks into anticoagulation my local GP recommended to see a colleague of hers from the University of Ottawa who specialized in Thrombosis to see about a medication change and also to inquire about flying as I had a previously booked a ticket to Brazil for mid-March. The Thrombosis specialist, Dr C was fantastic and she switched anticoagulation medication which didn't have joint or back pain as known side effects and she also gave me the all-clear to fly as I as already anti coagulated (my blood was thin), but I had to walk around the big jet every 40-60 minutes during the 10.5 hour flight down south. No problem. I even gained my weight back within 2 weeks of the medication change!
Prior to flying to Brazil I saw Dr K again and he was quite pleased with how my knee was heeling but I was concerned about the significant pain I was still experiencing, my inability to ride and also a rather bad catching inside my knee that had been present since the early days after my surgery some 8 weeks before. This was dismissed as crepitus and I was to keep doing what I was doing. He wanted me to get back on the bike asap to try to get that leg stronger. Tolerating what ever effort I could do. I wasn't too encouraged because this was causing significant pain. Fortunately I was able to do some light riding in Brazil during my two weeks and slowly ramped up when I came home. I am absolutely convinced that the cold weather here in Canada severely affects my knee and level of pain.
I started to cycle last spring the best I could but it was clear I was going to have significant issues and this disaster was on-going. My right knee almost exploded May 22nd while riding in cool, damp weather and my surgically repaired left knee never responded. Worst of all, I had to put my dog down in mid May as he was old, sick and really suffering. This absolutely destroyed me and it is an experience I never want to go through again. Owen was (and is) my best friend and I miss him dearly. There is not a day that goes by where I don't think of him. One of the legacies of Owen, I continue to walk as often as I can. I really miss walking him especially when I can't ride or do the other things I enjoy, I always had Owen to walk no matter what and now he is gone. I still go for my walks.
In June I raced the Surf N Turf the best I could, once again 1st place cyclist by 2.5 minutes and I did it on half a leg. By July I was off the bike completely because it just hurt too much to ride and I had developed pain almost everywhere in my knees especially in the quad tendons and hips. I couldn't cycle nor could I do anything else I enjoy - I did not have a good summer at all and it really affected me. Thankfully Roberta was here to spend the summer with me. Even though I missed cycling tremendously I encouraged Roberta to keep riding without me and she reluctantly did, cycling often with the local cycling club here in Belleville, a small club called the Belleville Chain Gang. Roberta's improvement on the bike in one short summer was remarkable and I am very proud of her!
In July I ended up buying an ACL/unloader brace to protect my knee and to enable me to move around a bit better and maybe play a bit of golf on flat courses. Although I didn't have an ACL injury, this brace is excellent in preventing a knee to over torque/hyper extend and as such I was able to hit some golf balls and get a bit of exercise. I was also swimming as much as I could but I hated swimming with a passion. Something that would change in the fall - I would learn to like it.
My brace also allowed me to successfully complete a physical fitness evaluation at work and with that I was able to remove medical employment limitations that threatened my career and allowedme to attempt a career leadership course in the fall at CFB Borden. I had been scheduled for this course over 3 years prior and they were really getting down my back to do it despite my injuries. Without the brace I would not have been able to complete this demanding course.
A month prior to starting my course I went to see Dr K in early August and he was very concerned about both my knees. He said he wouldn't be surprised if my right meniscus was also torn, due to the nature of my left knee injuries, favouring my leg for 2 years and also genetics. He ordered MRI's and I had them on August 16th. I got the results about 10 days later and the MRI report was not good.
- massive re-tear of medial meniscus, with a flap tear measuring 7mm X 3mm that was stuck in the inter condylar notch of my femur
- half-thickness lesion on the weight bearing medial femoral condyle
- trochlear dysplasia (rounded off instead of triangular groove - where the knee cap tracks)
- high and lateral patellas
- joint effusion (swelling)
I had basically been off cycling since early July, and in mid October I graduated from my 6-week leadership course. Roberta flew for my graduation and then we went to Miami for some deserved R&R afterwards. While I was there I rented a Specialized Road Bike and I did two flat rides of 70 and 50km though it still hurt. Not only were both of my knees messed up but I had also developed snapping hip syndrome in both hips.
PRP
In August I had inquired about a new unconventional treatment called Platelet Rich Plasma (PRP), which I had heard of before. Basically, my own blood is withdrawn, centrifuged and the platelet rich plasma (clear stuff in blood) is extracted and re-injected into the knee to a) cause a mild inflation to trigger and inflammatory response and b) inject thousands of growth factors into the joint for production of new cells (collagen). There was quite a wait and consultation process for PRP which I would receive in Kingston, ON in mid November. I was extremely sore for the first 14 days after PRP, not sore from the injections but sore where I was injured. Typical medial joint and retinaculum pain and pain under the patella. After 14 days the pain went away and I was feeling much better - I was walking without a limp and I was even able to do some indoor rides on my bike and not feeling too much pain afterwards (I was going easy though). This was the first positive news in this knee disaster in almost 2 years.
I went to Brazil and I was able to cycle quite a bit - about 1500km over 32 days which was fantastic. Not to the level of my racing days, not even close but better than most people would be able to do. I even schooled a few people. I was cycling with some pain during and after my rides but I felt it was manageable. If the pain was too much I didn't ride and took a day or two off.
While in Brazil I also had a fantastic bike fit, my second one in a year. The first fit was in Toronto from a former cyclist who had done some on-the-job training in bike fitting and received certification on a pro bike fit system called RETUL. I have learned that too many fitters today rely on these computer systems like RETUL to determine a fit and bike position. These fits are also extremely EXPENSIVE! RETUL is a useful 'tool' but it doesn't really take into consideration a persons flexibility or injury status. It places you into a position of pre-set, known cycling parameters for the average person. We all know everybody is different. Everyone has different flexibility, different leg lengths, limb length discrepancies, flexibility, injuries and as such I feel I was put into an extremely poor cycling and ergonomic position as a result of my RETUL fit and his lack of knowledge which severely loaded my knees and greatly contributed to the failing of my right knee in May.
The second bike fit, in Brazil was fantastic. The fitter, named Rogerio studied biomechanics in San Diego, California and was an experienced bike fitter. He had studied the methods of Dr. Andy Pruitt who is one of 2 or 3 world famous bike fitting Guru's. Dr Pruit actually designed the Specialized Body Geometry system and I happen to use those shoes whicth are fabulous. Rogerio doesn't use RETUL but his fitting methods are fantastic. During my bike fit he measured and observed that my flexibility was fantastic, better than most cyclists and this was certainly a result of all the hard recovery and rehab work I had done in the past 2 years. He took advantage of my flexibility, but best of all he also raised my seat 1.5 inches which greatly off-loaded my knee joints and also helped my hips to feel better. He put me into an excellent position and I actually looked like a racer again and I was instantly feeling much better on my bike. Not great... but enough that I could almost enjoy a ride with my GF or my friends... and solo too. I even documented my Brazilian cycling in high definition video and produced a short 17 minute film called Pedalar Brasil.
https://www.youtube.com/watch?v=Idh6e84nAKo
I returned to the brutal cold and harsh Canadian Winter on January 12th and plan to meet Roberta and her family for a cycling trip at the end of February. In Tucson... where this fiasco started. And apparently will continue. I have recently experienced a massive set back to where I was in July 2014.
I had PRP during the first week of February but it isn't working this time. I have pretty bad pain on the side and bottom part of my knee where I am weight bearing - probably massive damage to cartilage of the medial femoral condole. I can feel the torn meniscus fragment catching inside my knee. I have pretty bad medial retinaculim and quad pain as well. I can't ride and it now even hurts to walk and stand. I have booked another appointment with Dr K in Ottawa and possibly will seek a second opinion. I do have faith in Dr K, but it is time to address the pathology in my knees and do something. Not necessarily to put me back on the bike but to give me my quality of life back because now I have none. Two weeks in a row a friend called and asked me to go skiing. I can't. I can't play squash with my friends. I can't cross country ski, skate or play hockey. I can't go snow shoeing. All I can do is swim, and I can't even do that right now because I am sick.
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