How to Train a Runner: Preop

Part One: Get your knee fixed.

My initial appointment with Dr. Werner* (who gave me permission to use his name, as I only have complimentary things to say about him, cause he is awesome) could have easily been an advertisement for the benefits of yoga. After the pleasantries of introduction, my knees are both tested for strength and flexibility. My right knee bends perfectly. Oh? You’d like me to bend my knee and put it to my right shoulder? My left knee, the “bad” knee, can do the same thing. Dr. Werner and team of experts are surprised by my range of motion. He is impressed that my knee shows no outward sign of breakdown. After the x-ray and MRI, he also verifies that I do not have arthritis or mild osteoporosis under my knee caps which is “typical for a female of your age.” No kidding? That’s why I do yoga!

 I tell the team my story: I was in a car accident years ago in which my car rolled over multiple times at high speed. After that, I started experiencing sharp knee pain, but due to a distracting head injury, I wasn’t aware of the significance. I kept doing yoga for years and found Fixed Firm Posture to be the most challenging, and one that took 5 years after the accident to do. I demonstrate the posture for the team. Dr. Werner is concerned, as this posture looks like it would damage the knees. I am sitting in between my legs, hips on the floor, and can lower my upper body down to the table, grab both elbows. All the while, my knees are on the table.

Over the years I consulted Physical Therapists and Chiropractors telling them about my knee pain. “It’s the IT-Band” they’d advise me. “You just need to stretch it.” At this point, Dr. Werner adds, “You do stretch. You do yoga regularly.” I smile. I like Dr. Werner.

He continues manipulating my bad knee and finds the trouble zone. One push in and BAM! Pain! “Yes, that’s it,” I inform him. He keeps doing things to the knee, eliciting a pain response.

“Dara, based on your story and my assessment, I agree that there may be something wrong with your knee. I would like to do an MRI.” I feel validated. After years of being told that “it’s probably nothing,” here it is! Something!

One Magnetic Resonance Imaging trip, listening to Jack Johnson by headset, admiring a tropical island scene painted on the ceiling, and a whirling machine later, I am back in Dr. Werner’s office. One thing was determined by the MRI. I have “fat pad impingement.” Most likely due to my accident, the fat pad under my knee enlarged and started suppressing the internal structures of the knee.

“Dara, I believe that you may have a meniscocapsular separation. It was not determined by the MRI. Your symptoms and history lead me to believe this. The only way to determine this is through an arthroscopic procedure. If this is what you have, we can fix it. We won’t know without going in. There is a chance that we may go in and find nothing.”
            I interrupt confidently, “Yes, but you will find something.”

“I have to advise you of this possibility.”

“Okay but you will find something.” I smile.

“Given the fact that your knee is now affecting your life, I would advise surgery. I would not recommend surgery if I didn’t believe there was a good reason. I believe we can help you.”

I am on board! Dr. Werner informs me of the surgical expectations. Either (1) I go in and they find nothing wrong. I wake up with a small incision site, go home, and continue on as I have been. Or (2) I wake up and am in a solid knee brace (which I now look at as a shackle), which means they found something and fixed it. After surgery, if I am in the knee brace, I will be non-weight bearing for 2 weeks, partial for 6 weeks, and then full-weight bearing. I will require physical therapy and am provided with a prescription for pain medication.

            “Listen Dr. Werner,” I state to my rock-star orthopedic surgeon, “I have questions for you.” I then demonstrate various postures to determine if I will be able to do certain one-legged yoga postures if I have the assistance of a ballet bar. I receive approval for some of them and encouragement for others: such as postures where I am locking my knee. “When can I go in the hot room?”  He says I can go in after my wounds are healed, so 5-6 days.

Surgery Day:

I am ready for this! Heck, I am a nurse! I have made my apartment easier to maneuver around: putting rugs away, repositioning furniture, creating a therapy table with lotions and healing balms. I have my prescription for pain medication which I have no intention of using. I also have reinforcements coming: Nick is flying out to help me for the first four days and will be replaced by my adopted sister, Romy. Already have the okay from Dr. Werner for yoga. I am good to go.
       I am a terrible patient. I am nervous and feel disempowered being a patient, so I ask questions about everything. When a nurse comes in to put in an IV, I am convinced it is not in the right spot. “Let me flush it myself,” I demand… It is in the right spot.
        Dr. Werner comes in and again runs over the game plan, advising once more that there is a chance they will find nothing. I look at him and state again, “but we will find something.”
“If we do find something, you will wake up in recovery with a knee brace on.”
            Dr. Werner is replaced by an eccentric anesthetist who makes me nervous. After questioning him about his professionalism and conduct, he says enthusiastically, “let’s calm you down a bit.” Midazolam is pushed. My anxiety is quickly replaced by euphoria. I start laughing. I laugh all the way into the surgical suite. I laugh into unconsciousness.
            I wake up with the knee brace.
            Pain....woozy...clouds.. nausea.. My friend drives me home and another friend meets me at the house so I will not be alone.
           What did Dr. Werner find? Fat pad impingement, which he shaved off. How embarrassing! And yes, a meniscocapsular separation.
           Why Dr. Werner is a rock star: a meniscocapsular separation is a RARE avulsion injury caused by trauma or force. After further research, I found out that only 3% of meniscocapsular separations are found on MRI. And most chronic separations (which is what I had) are never found. Yet, he found it! Go Dr. Werner!
          On my follow-up appointment with Dr. Werner, he shows me video footage of the internal aspects of my knee and provides me with photos. “See, this is what a knee is supposed to look like…and this is what yours looks like.” Instead of my meniscus looking like a pancake from behind, it looks like cotton candy. And there is a huge gap every time they shift the meniscus. “I didn’t realize how bad it would be when I went to the back of the knee. This is probably one of the worst knees I have seen, and I hope to never see another like it." I am so pleased with his statement! He shows me photos of how he fixed my knee. It looks like I have nautical rope in my knee. I encourage him to use my knee for a research paper.