On bended knee...

On the 14^th March this year I snapped a ligament in my knee. I was doing one of my favourite things ever… I was dancing! I had joined dance classes again just a few weeks prior after a prolonged sabbatical thanks to inflexible work commitments and a cervical cancer scare promising long periods of post-op convalescence, inter alia.  We were at the end of the class running through our contemporary routines… and my teacher had just told me how she had noticed an improvement in me already (music to my ears).

I leapt, landed on my left leg, and felt like it broke in half as I crashed to the floor and wailed like a banshee.  Heaven knows what the freemasons meeting in the hall’s adjoining room thought! I won’t tell you what my dance teacher said. Once I had finally caught my breath and realized my leg was intact and I could move again, I hobbled to my car and headed home.

Within about 24-48 hours my knee began to swell and I couldn’t straighten it completely. As I walked around, I could feel the instability in my knee as it threatened to pop out backwards and left from time to time.  My muscles surrounding the knee joint began guarding and very soon I could not get full extension of the joint as a result. My dance teacher referred me to a physiotherapist (Michelle) and I booked the earliest appointment I could.

Two consultations later, Michelle surmised that I had snapped my ACL (anterior cruciate ligament) and she referred me to an orthopaedic surgeon (OS) for possible surgical resolution, as this was not something that could heal spontaneously.

My first visit with the OS Michelle referred me to was, sadly, decidedly futile. He was a handsome and meticulously groomed young man with a pleasant demeanor, partner to a more senior OS renowned for his prowess with knees.  However, following my generously presented history and a brief physical examination, he could come up with no concrete diagnosis as there was still too much swelling and my other leg (the reference range for ‘normal’) indicated that I was relatively hypermobile to start off with.  The only way he could really see what was going on so deep inside my knee joint was by way of an MRI (magnetic resonance imaging), which costs a whack and is not covered by my medical aid. I was sent home with a prescription for anti-inflammatories and instructed to return in 2 weeks. 

I did so, more or less, and during the second consultation he called his partner in for an opinion. At the end of the meeting they told me that I had a decision to make… that they couldn’t confirm exactly what happened in my knee (not without an explicit MRI) but that they could perform an arthroscopy and during that procedure perform whatever repair work might be indicated which could translate into a long period of recovery and rehabilitation. Fifteen minutes later I was ushered out again, ready to make my 58km trip back home, still with a bad knee and more questions marks.  How could they leave me with the entire weight of this decision? Who would go the invasive route voluntarily unless someone told them, categorically, that there was no other way? Then there was the issue of money. Adorning several areas of the practice was signage emphasizing that this OS charged private rates and not medical aid rates, etc.  I was only on a hospital plan, so I first made enquiries with them about what was covered and the extent of coverage, and then emailed the OS to negotiate that he work within those limitations as far as possible. Well, he never even replied to my email – not even to this day. And, bottom line… he didn’t instill much confidence in me… or shall I say, confidence in him.

I put out feelers and spoke with people… even put a shout-out on my Facebook wall enquiring whom the best knee doctor in KZN was. I received a few responses, all different,  but then a now-accomplished physiotherapist who studied around the same time as I did at UCT got in touch with me and recommended a second opinion from an OS whose post-op patients he often treated. It was the best advice I got… this OS listened to me, confidently diagnosed my problem and told me exactly what needed to be done, unabashedly expounded on his knee know-how, and agreed to work within my hospital plan limitations.  I walked out of there knowing that this was the man I would let invade my limb whilst I was blissfully unaware, and fix it properly. I don’t think surgeons realize how PERSONAL an activity this is… and how important it is to make the patient feel like they’re going to be safe and everything’s going to be all right.

So, I had to schedule my operation for after a move to a new granny cottage on the 1^st of June because an indefinite but certainly prolonged period of incapacity was on the cards depending on what the arthroscopy revealed.

The move was hectic but I was blessed with assistance from a few friends, bless them. Then, two days into the new home, whilst cleaning shelves to fill them, I stumbled off a short step ladder, and as I stepped from my right to my left leg, my afflicted knee popped out again, I crashed to the floor, and tried to break the fall with my left arm with the result of dislocating my elbow!

I just lay on the floor whilst my mother went hysterical. Apparently, my arm looked alien. Most fortunately the landlords were at home (granny cottage is on their property) and they rushed me to Kingsway Hospital’s emergency unit. It took a good while before my elbow was relocated (or reduced, as they call it in medical circles) and recollection of the ordeal remains cloudy. I know that when I got there, they gave me some morphine. Then they wanted me to fill in forms and they needed X-rays to be done before reduction to ensure that there were no major fractures that would be exacerbated. Fortunately, I only had a minor fracture in my forearm, so they finally got on with it.

I remember looking away as I felt the Pethidine rush through my carotid artery hand-in-hand with Dormicum. I must have passed out for a little while as they titrated me back to consciousness. At least the elbow was in place again and I felt okay. They decided to keep me overnight.

I was discharged the next day with my double-sized arm in a bandaged half-cast of sorts complete with sling. My knee was twice its size and I could hardly walk on it. They sent me off with some Stilpayne and, quite frankly, I felt like they were pretty glad to free the bed I had occupied more than anything else.

It was now the day before I was to be admitted to Umhlanga Hospital for my scheduled knee op. I needed to let me surgeon know of the latest developments and did just that. His secretary called me back and said that ‘The Fly’ (my nickname for my surgeon) reckoned I should wait three weeks before I have my knee op as it was imperative that I was able to use crutches. I asked to speak to him and implored, “Please, Doctor! I can barely walk as it is! Three weeks… and then another long haul with the knee after that? I cannot bear the thought of prolonging this anymore than it needs to be. Who can afford to take so much time off work? Off Life?” He then asked me which arm it was, and seemed pleased that it was the arm on the same side of my leg. It was most important that my opposing side was the stronger one as far as the crutching was concerned. He conceded to us going ahead, and although it was by no means the easier route, it was the better one taking all things into account.

The rest is a bit of a blur thanks to oscillating states of medicated numbness or racking pain. When The Fly came to see me post-op, he said that it all went well with the ACL reconstruction (he used a graft from my hamstring). However, the arthroscopy had also revealed a full-depth tear of my meniscus, which meant that I was not going to be able to weight-bear on that leg for at least 6 weeks!

I thought my leg felt relatively good considering it had just been invaded, but the next day, about 18 hours after the procedure, the femoral block wore off and I nearly went through the roof. The intense pain, discomfort and general fear of what lay ahead rendered me an ungraceful, writhing, wailing kvetch looking only for her next fix. I couldn’t sleep as it was, and endured my last night in hospital with a lady next to me who snored so horribly loud, the deaf could hear it.  I remember telling the nurse that I would kill her!

In the hospital getting my surgical sites redressed.

A Series of Unfortunate Events that cost me an arm and a leg and silenced a lamb.

My arm after a week of Arnica tablets - the yellow is not iodine staining, but rather a fading bruise!

Finally discharged with my crutches (one of them a gutter crutch), I headed off home for what was to be one of the most challenging periods of my life, both physically and mentally. 

The infamous gutter crutch - bloody awful thing, but the only option  under my circumstances.

Bruising from my leg brace...

I am now just over 2 months post-op and walking again, albeit it tenderly. Although my arm looks normal, my elbow joint is still very traumatized and sensitive, and my range of motion disturbingly limited. My knee, however, is starting to look like a normal knee, and the weight bearing for 2 weeks has already improved the atrophied muscles, never mind my psyche and general disposition. The hell I have been through has left me feeling almost reborn and so incredibly grateful. I have tasted disability in a big way, but every day I reminded myself how fortunate I was that mine was only temporary. I don’t believe I have taken my body for granted before, but I am now more intrinsically aware of how precious it is to me and how blessed I am that most everything is working again. Everything else pales in comparison. And then, of course, I was also relieved that I was on a good hospital plan as well, else I would have been crippled financially with hospital bills tallying R80000! I could go on some more, but I shall leave that for another post.

There were many times I wished I could have asked someone if what I was feeling at any given time was normal. I wished I could have compared notes and received more reassurance during the trying phase. So, for this reason, if there is anyone out there who has suffered an injury (or set of injuries!) similar to mine, and wants to talk about it, I’d be happy to oblige.