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5.22.2009

Cro Cop Interview



Interesting look into the motivations of a seasoned professional like Mirko "Cro-Cop" Filipovic

5.13.2009

R.I.P. John Wynn

I met John in practice on the occasions he came over from Terre Haute. John was not a fantastic athlete but he had the heart of champion. It was always surprising training with John, he didn't wrestle like most teenagers, rather than trying to muscle his way through positions, he played with technique beyond his years. John competed in sport jiu-jitsu and even fought mixed martial arts. But John was more than fighter, he had a quiet humor and didn't have any quit in him. He was a good kid...no a good man, he will be missed as a friend, a team mate, and a brother.

5.12.2009

Physical Therapy: Learning to Walk Again

I'm suffering from arthrogenic muscle inhibition (AMI), which is hypothesized to be due to the loss of neuromuscular innervation supplied by nerves running along side the ACL (ref). After all knee surgeries the muscles of the leg surrounding the surgery site are "stunned" and can take weeks to recover. In the meantime I've got an immobilizer on to keep me from buckling my swollen knee and undoing all the good work already done on it. My question to this hypothesis is that since I didn't really have an ACL to start with, what nerves were destroyed in the surgery?
My first session of "real" PT started today. I'd finally gotten so that I could lift my leg mostly under its own power as well as getting me to flex and extend my knee. My physical therapist took a look at my "walk" and explained the proper method for using a single crutch, opposite and simultaneous with the injured extremity. He assessed my knee flexibility, not quite straight and only able to flex it to 72° by myself and 86° with assistance. My right knee is a good inch longer in circumference, too.
I was given several new exercises as well as continued my old ones:
  1. Kneecap Self Mobilizations (basically stretching the knee cap in the four cardinal directions to prevent adhesions from the patellar tendon graft) 2 sec hold x 5-10 reps, 2 sessions per day
  2. Extension stretch (letting gravity flatten my knee with the foot elevated) 1-5 minutes, 3 sessions daily
  3. Lying Knee Flexion (lying on your back trying to pull your foot to your butt) 1 second hold x 10 reps, 3 sessions per day
  4. Quadriceps Set (squashing a towel flat with the posterior surface of the knee) 5 sec hold x 10 reps, 3 sessions per day
  5. Leg Raise 10 sec hold x 10-20 reps, 2-3 sessions per day
  6. Seated Knee Flexion (sit on a table flex the knee) 10 sec hold x 10 reps, 2-3 sessions per day

5.10.2009

Saku HL

5.09.2009

Evan Tanner Power of One HL



RIP Evan

5.07.2009

This May Not Be As Easy As I Thought

Don't step with the bad leg!
Don't step with the bad leg!
Don't step with the bad leg!
Don't step with the bad leg!
Don't step with the bad leg!
Don't step with the bad leg!
Don't step with the bad leg!
Don't step with the bad leg!
Don't step with the bad leg!
But I did get a shower in today and my thigh got off the floor.

5.06.2009

Those Are Where EXACTLY

Stylin' my Jackson-Pratt DrainStylin' my Jackson-Pratt Drain
The drainage bulbs for the two Jackson-Pratt drains
I emptied my Jackson-Pratt drains after about four hours, then six hours later and they had pretty much slowed down the following morning when I was to report to the office to have the drains pulled. Just as Lan was about to get me packaged in the car, I heard a dripping sound on the floor as bright red synovial-diluted blood poured down my leg onto the carpet. One of the plungers on the drain had come loose while I had arranged my pants. I slapped my thumb over it and we managed to get me cleaned up in time. Just to make sure that I knew who was boss, I stubbed my toe as I hiked myself forward on my crutches, and my knee wiped the color from my face, the words from my lips, and made sweat sprout on my forehead. At the orthopedists office, the nurse stripped down the immobilizer, athletic wrap, Kerlex, and bandages on my knee to reveal my assaulted hinge joint.
Yeah those are WAY into the joint spaceYeah those are WAY into the joint space
Two drainage ports and the staples over the area where they took the patellar tendon segment
The nurse then removed the drains, carefully and slowly. I could feel the uncoiling drain dislodge within the joint, the burn as rubber tubing moved past raw flesh, and I turned a shade of light green. With the removal of the second drain I felt much better whether it was because I intellectually knew that yet one more foreign body had been removed or the relief from the insult of having something inside my knee joint.
After getting home I worked on my rehabilitation exercises which include knee flexion and extension as well as hip extensions. Extending the knee was simple, it'd been nearly in that position with immobilizer since that day before. Knee flexion with great effort my knee crept a little above horizontal, scant degrees of horizontal. As for hip extension, I strained to failure and my leg didn't even move.
I've got a lot of work to do...

5.05.2009

Bow Before the Impotent Agony of Knee the First

The night before surgery was like any night before a big tournament, I was ready to go, telling my body to slow down and my brain from running itself in circles. The weekend and day prior had been a frenzy of preparation to get the house clean, laundry done, and groceries stocked. With four refreshing hours of sleep I reported to the SurgiCenter at 7:45 AM and then went through the standard pre-operative preparation. I had my vitals taken, an IV was established, and they shaved my knee. The anesthesiologist made the fact that his nurse anesthetist was going to knock me out and breath for me sound mundane, while my orthopedic surgeon was pumped to start rearranging the internal geometry of my knee. A bag of ceftriaxone was hung along with some dexamethasone for nausea.
From my highly positive physical exam the plan was to visualize that I indeed was missing an ACL then clean out the meniscus rubble. My surgeon would then use a central piece of my patella tendon to replace my ACL, boring a hole through the bones proximal and distal to the joint. Shortly after chatting with my surgeon I was wheeled into the OR, the nurse anesthetist introduced herself and slapped some oxygen on my face.
I started waking up to someone really far away telling me not to fiddle with the oxygen in my nose. My right knee was a huge, uncoordinated, painful thing down at the end of the bed. As I regained a semblance of consciousness I pieced together that my surgery was done and that the annoying thing in my nose was a nasal cannula with oxygen. A shot of morphine and an antiemetic allowed me to down some ketorolac and hydrodone-acetaminophen. My pain got a lot better and I started to perk up, the nurse brought me something to drink and some toast. As the medications tenacious hold slipped away, they transferred me to the next level of recovery and brought my saintly girlfriend, Lan, to come talk to me. She showed me the arthroscopic pictures, evidence of the beating I had given my knee for the past decade. In my intoxicated state she also almost convinced me that we weren't dating.
Not a desirable region for a high coefficient of friction
Before picture, showing torn meniscus
A little high powered elbow grease
After picture, everything smoothed out

Getting me from the gurney to the easy chair demonstrated profoundly that my knee was impotently pissed off. The slightest vibration was nauseatingly painful but from my hip flexor down my leg hung like a limp noodle. With the added fortification of some cranberry juice and apple cinnamon muffin we attempted the next stage in the right knee saga, getting home. Fumbling against the vestiges of the anesthetic and gravity I was deposited in a wheel chair and moved out to the car, where I was able to prop myself unceremoniously in the back seat, my right knee like so much extra unwieldy baggage.
Yes there's a piece missingSomeone done put a patella tendon in there
Before picture, there's supposed to be an ACL between those two lines there
After picture, voilá a new ACL

At home Jarred had swung by with faux pansies and some milk shakes, and he helped get me inside. I had to figure out how to urinate again and will have to optimize the technique necessary to get the appropriate orifices over the correct waste receptacles with one leg that's a painful, rigid, brittle log. For the next 24 hours Lan watched over me. I spent the remainder of the day dreading having to move, but forcing myself to pump my calf to prevent a venous thrombosis (no thank you 6 months of warfarin). I drowsed in and out of consciousness as the stress, medications, and lack of sleep collided. We emptied the two Jackson-Pratt drains that drew a mixture of blood and synovial fluid from somewhere deep under the bulky immobilizer. Toward night I hopped up the stairs and with Lan's help got myself arranged in bed. I managed to sleep some more.

5.04.2009

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