100% and Two Months Out

I took the dog for a long bike ride today. About eight miles. And my knee was just fine. And as I sit here and write from the comfy of my chair, the knee isn't swollen. My legs don't ache. And I don't feel like I overextended myself. Woo-hoo! I think I can fairly say that I am truly healed. No complaints in the knee department. In fact, I even found myself climbing in and out of a sports car and a low-riding sedan several times this week. I simply had to put full weight on my right knee to get in and out. And no problem! Full recovery in 8 weeks.That's the message if you are facing open knee arthrotomy surgery. If all goes well--as I believe it has in my case--then you'll be pretty much back to normal by six weeks and fully recovered by eight.

My next appointment with my onc doc is in March. He will probably take another MRI to see if the PVNS has returned. I'm certain that the tumor behind my knee is alive and well. I can feel it daily...but it isn't hurting enough to warrant a posterior knee surgery...I, er, hope.

And just where have I been?

Buried in Life. But that's a relatively good thing.

On the Appendage Front (Let's see...if I face the closet and twist my right leg so that it's pointing at the bathroom door I can accurately say "All's quiet on the western front." And if you don't get that pun, then it's back to school for you.

--I think I can honestly say my knee is 98% healed from the operation. I only feel a little uneasy on stairs...and my rusty pogo stick.

--I have been feeling the remaining tumor in the back of my knee. It throbs several times during the day. It's not painful...just annoying. I hope this isn't beginning of the

--I took the dog for a run alongside my bike. Yes, I was pedaling and she ran alongside. (Or were you thinking it was the other way around?) And no one got hurt! My knee didn't even balk a bit. I'm now gearing up for the 5.5 mile ride into work. I wanna start exercising again!

--My scar continues to itch. And it's kinda raised up. Weird. My daughter and I decided to draw on it last weekend. We turned it into a centipede with numerous legs and feet and big eyes, antennas, etc. As I bent my knee it almost looked like it was crawling! Then we had a very serious conversation about how centipedes have many legs and feet but no hands. "How do we know that their feet aren't actually hands...or that every other leg is really a hand?" I know: deeeeeeep. But you're not really following this, are you? You're still thinking about my intentionally drawing on my scar, aren't you? Maybe I'll do it again and share photos. It's quite therapeutic, really.

--Yes, I still owe you photos of my healing scar. I know. I know. Will you ever forgive me?

--I also wanna add some more cartoons. Stay 'tooned.

--That's it for now. I need to go pack for another business trip. Hopefully, I will have absolutely NOTHING to say about my knee as it will serve me well as I dash through the airports.

All better?

So I haven't written for a few days because my knee hasn't been on my mind. It hasn't been an imposition. Dare I say it? Is it just about healed?

I took the dog for a lovely long walk in the rain over the weekend. We must have walked a good two or three miles. And I felt fine. Granted, I pilfered oranges three times for sustenance. I do love this time of year when navel oranges are deliciously ripe and just begging to be picked from the trees along these suburban sidewalks.

I traveled to LA today. Flew on a small jet, which meant I had to climb stairs to get in and out. And, at one point, I found myself hauling my bags and bod into an SUV. My knee was all for it. Even walked to the end of a pier to catch the late afternoon sun and take in a whiff of the clean ocean air. A perfect break from the preceding business meeting. At no point did my knee speak up. (Yes, yes, we know that my knee is shy...per my previous "knee therapy" post, which--apparently--only amused me. But that's OK. I may be the only person reading my own blog.)

I've been tracking my scar healing and will have some new photos to share soon. I know you can't wait for them. Like a car wreck, right? Can't look, but you will.

So all seems relatively well in my knee world for now.

All in all, I'm feeling fortunate to have healed so quickly.

This post is written six weeks after surgery.

The real story

Here’s what really happened in physical therapy:

1) I learned that I should avoid limping. It creates problems. I should take my time and focus on limp-free ambulation. Otherwise, I could be creating future back problems and such. Interesting.

2) Massaging the scar will help separate it from the injuries beneath the skin and is likely to encourage the scar to disappear altogether.

3) I’m at 80% mobility compared to my other knee. Not bad.

4) It’s natural for me to feel more confident going UP stairs than DOWN. That’s because one has more control going up and less going down. The physical therapist encouraged me to use the stairs—but carefully and slowly to build up my strength.

5) She told me that there is less pressure on my knee if it is straight…so I was encouraged to put my leg out straight when seated at my desk at work. (I was trying to get a prescription out of her for me to put my feet up on the desk. She was only slightly amused.)

6) Lastly, she introduced me to a fun exercise. She gave me a big rubber band that I'm to slip into the door jam. I then sit in front of the closed door and pull against the band to build up strength around my knee. I’m sorry, but that one makes me laugh.

Therapy for my knee

There was no shaman. No masseuse. Alas, physical therapy was held in an average windowless office with the usual protocol. The therapist had friendly pictures of well-adjusted joints lining the bookshelves: bookshelves stocked with a common assortment of self-help books: “Listening to your Inner Meniscus,” “Positive Discipline for the Wayward Patella,” and “When Good Knees Go Bad.” The therapist was warm and welcoming as she ushered my knee to the couch. She lit a candle, dimmed the lights, and we settled onto the long couch with the obligatory box of Kleenex alongside. We waited for the questioning to begin. The therapist opened her notebook, adjusted her glasses, and clicked her pen. She began slowly: “So…” she said, carefully measuring each word, “how long have you..uh...been feeling this way?” We were dumbfounded. Um. Since December 18, we wanted to answer: when one of your colleagues slipped a knife into us and removed a tumor. But we thought that might sound a bit snarky. So silence followed. She tried again with: “Is there a history of this in your family?” Again I knew not what to say. PVNS strikes one in a million people. The likelihood was slim. “On a scale from one to ten, how bad would you say you feel today?” I waited patiently for my knee to respond. The therapist waited, too. Nothing. My knee said nothing. Not a thing. I could only hear the steady rhythm of the second-hand on my watch…tick-tocking, marking each passing, fruitless moment. My knee simply refused to speak. I then realized that therapy for a knee is pointless. I just knew I’d have to find another path toward femero-pateller self-actualization.

First PT tomorrow

Don't know what to expect. I really do think my knee has bounced back pretty quickly. Very little discomfort now. But I suspect that I don't have my full range of motion back...and for this they will send me to a physical therapist who will tell me in tones of great profundity "to bend my knee more frequently." I will nod my head enthusiastically and thoughtfully, as if pondering a grand new and bold thought. Yes, I suspect I'll be told to do a handful of exercises in repetitions of something and then I'll be sent on my way. And for this I will be skipping out of work tomorrow morning?! OK, not skipping. I hear you. If I were skipping I wouldn't be going to PT in the first place. Let's just say my expectations are low, but I'll be going to my HMO's new flagship hospital for the PT. I hope I get a therapist who believes that a full body massage is the quickest way to heal a knee. Or perhaps this new facility has a shaman who can dangle a gold coin on a red thread over my knee, mumble jibberish at my whole leg, and then scare out all the bad mojo?

Actually I'll just be happy to get good parking.

I'll let you know how it goes.

General N.S. Thaddick

As I believe I wrote in a previous post, this fellow is my favorite companion for surgery. I used to worry that he'd leave me with a really bad hangover--or worse!--but I've come to realize he's actually quite good. With him around, I was oblivious to the surgery.

I commend him to you.

Note: Yes, I'm aware that I am trying extra hard to make light of PVNS. And, yes, my sense of humor is sophomoric. And, yes, I plan to continue with the bad puns and silly drawings. Oh, and if you don't lighten up, I swear I'll post the hi-res image of my gory knee surgery.*

* That sentence was written for the self-serious sorts who are trolling the web for Important Information. If you appreciate a good knock-knock joke, then you can stay and I'll stop making threats.

OMG! Be careful what you ask for.

I confessed to my doctor that I was eager to see a photo or two of my surgery. I most vaguely remember another doctor in the operating room with a fancy camera. Why I remember this as I was being dosed up with the general anesthesia is beyond me. So here it is: a photo of my knee operation. I've spared you the gory hi-res photo by putting a little Adobe Photoshop filter on the picture. I'm kind of in shock right now. But I share this with you because it certainly helps us "see" what was removed. I assume it's the blob at the end of the pliers. No wonder my knee was locking up!

I will post the gory hi-res image if I receive a groundswell of requests in the comments...but I betcha that won't happen!

Meanwhile, know that I am healing well. My limp was just about gone this morning. In the afternoon I started to bob a little, but not too bad.

I think my next post will have a more pleasant cartoon. In fact, this post just made me think of one. Pardon me while I step away for a moment to go draw something silly.

The long ride home

I have just returned from a little vacation in the wine country. My knee got a workout, which I'll describe in greater detail later. Meanwhile, as I tried to keep my daughter amused on the long ride home, I found myself amusing myself more. Her initial response to this song was "Muh-UH-thurrrrrr!" with a perfect pre-teen roll of the eyes. But she was game: she tried to sing the song with me. Aside from the clapping challenge inherent in the song, calling this condition by its complete and formal name was the real trick. Listening to my daughter attempt to sing it was the highlight of my day. I heard such things as "Piggy mental viggle single isis." I was in stitches. Again...if you know what I mean.

This song, by the way, is being sung by Bingo himself (a special thanks to his supportive agents at CAA for lending his talents).

I did it...

...and I'm writing you from my comfy chair. Not a gurney (which I keep wanting to spell Guernsey, which would be an entirely different ride).

I summoned my courage, stretched my leg, and I found that I have more bend in my knee than just a week ago. I put a little lotion on the scar to keep it nice and flexible. Then I snuck out the back door and with great and quiet glee I went to my long neglected, but much-loved bike. As if to dramatically underscore the moment, I literally had to wipe the cobwebs off. A perfect composition by a perfectly talented spider destroyed with a wave of my hand. I backed the bike off the porch, wheeled it out the gate, adjusted the seat, and then carefuly sat down on it. And after quickly assessing the risk, I took off. I opted for the highest gears so I didn't have to pedal as much, and I did find I favored my good knee for the heavy pedaling, but--oh, lah!--what a joy it was to float across the top of the pavement. What a thoroughly different way to travel: no limping, no bobbing, no hobbling--and QUICK! What a joyous way to celebrate my month out of surgery.

At first the knee was stiff. A moment of doubt crossed my mind. But then, half way down the block, the knee loosened up, as if to say, Oh, alright already, I get it, we're gonna start doing THIS stuff again. As I rounded the block, headed towards home, my knee had (dog metaphor coming up) rolled-over, legs-in-the-air, vulnerable-belly-pointed-skyward given in. I was comfortably pedaling. However, I could tell that my thigh muscles were now bickering. So...I can tell that it's not just my knee that's gonna need a re-introduction to full-out mobility.

And, no, Hubby was not trailing behind me begging me to rethink this exercise. This was my solo victory lap. I'm actually kinda giddy about it. I can imagine that I'll be able to start riding to work again and--perhaps--undo some of the damage the holidays did to my diet.

P.S. Can cows get PVNS? Or is this little affliction reserved for the mammals who can laugh at themselves? I know, I know. "Laughing Cow." But that's just cheese. Don't think for a minute that a cow ever stopped to ponder "Bergson's Taxonomy of Comedic Principles." (Highly recommended reading for those of you who need to understand why people laugh at you.) Upshot: 90% of laughter is derision, 5% is incongruity and surprise, and 3% is something called automatism, which is something about the organic becoming oddly mechanical...kind of like watching the Rockettes. And, yes, I've neglected a dangling 2% here, but that's your cue to laugh at me with 90% derision. Now back to PVNS and cows: They've got bigger joints than I do: perfect breeding ground for this insidious little disease, don't you think? I suspect I know why I haven't heard of other animals with PVNS: Because cows can't use crutches. If they can't get up to get milked, they're probably shot. Glad my regimen only involved a slight filet-ing of the knee. Listen, Doc, trust me. I can get up and around. Really I can. Now put down that .35!

One more thing: I do not plan to put myself into another analogy with a cow any time soon.

One month out

Tomorrow marks one month since my surgery. To celebrate I think I'll get on my bike and make one small, ever-so-careful victory lap around my neighborhood. My hubby will be running behind me the whole time yelling, "Are you CRAZY?!" Afterall, I've been babying this knee for a WHOLE month and a bike ride is wickedly dangerous, right? Nope. I don't think so. I'm gonna give it a try. Stay tuned and I'll let you know how it goes...whether I write from my comfy chair or a hospital gurney.

By the way, I had quite a breakthrough moment in my recovery yesterday. Ladies, you'll appreciate this: I wore heels all day. I stopped wearing my flats and braved the dizzying heights of my two-inch work heels. I'm not particularly tall (Read between the lines. She's saying she's downright short), so I kind of miss being able to at least look a person in the chin. The flats were appropriate when I was so shaky, but I'm feeling pretty stable these days. Well, you know what I mean. My KNEE is pretty stable...stable enough to shove my foot into an elevated pointy-toed shoe-vice and trust my knee to respect the situation. In fact, I heard myself proudly announcing to a friend the other day that I haven't fallen over once in the last month. Now, under normal circumstances this would be a less than stellar achievement. But given the surgery, the crutches, the Vicodin, and the assorted blankets, computer cords, and odds and ends that often clutter the floor between me and the master bathroom, why it's simply a miracle I haven't face-planted at least once. May I always have the good fortune to be vertical when I want and, er, horizontal when I want, too. (I'm not sure diagonal is ever a good thing.)

Is there a circus in my knee?

Well, my knee was mighty stiff when I woke up this morning, but after I got going, I hardly noticed it. But there's a strange sensation behind the kneecap now...where the tumor was. It's like something's back there and is moving around. It's something, but I don't know what. I'm not too worried yet. I'm gonna wait this out and see if it becomes problematic...or if it's just the inside of my knee rearranging itself to adapt to no tumor. Or maybe something else is going on in there?

I wonder how long the tumors have been in my leg? Do they grow quickly or slowly?

I'll have another MRI in a couple of months. It'll be interesting to see what it shows.

By the way, I can't think of a clown that didn't creep me out. Clowns...tumors...seems appropriate. I hope I haven't offended any Americans of Clown Descent. Like the current Administration.

So I walk like a Penguin. What of it?

My hubby, who has been ultra-attentive during my recuperation, finally made fun of me this evening as I walked in the door from work. Yes, I still have a limp. And toward the end of the day when I've got my computer bag and purse on my right shoulder hovering over my surgicalized knee, my evening limp is worse than my morning limp. In fact, when I first get up in the morning now, my first thought is NOT about my wounded knee. I get up, head for the bathroom, and only after my fifth step now do I realize that: Oh, yeah, I had knee surgery almost a month ago and my knee is stiff and woe is me. As the day progresses my knee can get a little ornery if I'm doing too much walking or--as I did yesterday--try to climb stairs. So by the end of the day my knee is at its weakest and my limp takes on a wobble. Like a penguin, I guess. Like an extra tipsy penguin. Hubby was at the dinner table as I came in tonight. And as I entered the dining room he started bobbing his head back and forth like a lovesick cockatiel. I suppose he was mimicking the rhythm of my new gait, but--frankly--at that moment I was not the silliest person in the room.

And my co-workers seem to enjoy charting my progress, too. Everyday someone says, "Your limp isn't as bad now." So I guess that's proof that I'm healing...or mastering the fine art of a graceful limp. An aunt of mine said that a limp is "distinguished." While I appreciate her attempt to console me while I bob around, I think her analysis would be more apt for some mysterious European viscount...not this suburban mother from San Jose.

Thanks, Mary. Thanks, Walt.

When asked why the limp, I find myself explaining that I just had surgery to remove a benign tumour. I'm careful to say "benign" right up front lest I see undue concern cross my friend's face...which makes me awfully embarrassed and uncomfortable. I cut through the awkward explanation by calling this thing "PVNS. That's Pigmented Villonodular Synovitis Expealidocious." Somehow PVNS is a lot more fun with the Disneyfication.

About my scar...

I'm still waiting for my surgery pics. I just can't wait to see the gooey red tumour that was the instigator of my current imposition. Meanwhile, I focus my attention on the care and maintenance of my scar. I'm taking lo-res pictures every few days with my Treo's camera to chart the scar's healing. Weird hobby, isn't it? Even weirder that I'm gonna post it here for you to see and admire...or wince at. I have shown the scar to my daughter a couple of times and the last time she said, "You just show it to me so that you can see my face get all puckery, don't you?" Puckery is the word she uses to describe sour things. Anyway, I bet you've got a some weird hobbies, too. You just keep it to yourself. If only I were so discreet.

So here is a picture of my knee at 18 days post-op. My onc doc thinks it's healing perfectly. I suppose I agree. No secondary complications, but I'm certain that's because I was was extra careful with it the first two weeks. I made sure that it was always clean. I changed the dressing on it regularly (with clean hands) and, after about 4 days post-op, I gently washed it with a hospital-supplied anti-bacterial soap. So I was certain that it had every opportunity to heal without complications. You'll note that there are some bruisy dimples around the scar. That's where the sutures were applied. My sutures are self-absorbing, supposedly. I suspect that as I actually absorb them, the dimples will disappear and the skin'll flatten out. We'll see.

OK, so are you ready for the next picture?

This one is 24 days after surgery. That's today. I'm not seeing much difference between a week ago and today's picture...other than the two little marks in the upper left corner of my knee. Those two marks are from the bandages that were applied over the incision by the hospital. When I first changed the dressing (what am I...a turkey?), the surgical tape took some of my skin with it. ADVICE: If you're reading this pre-op, moisten your bandages a little before removing them.

I also see there is less bruising around the knee.

The scar is starting to itch a little these days and I'm starting to get these little shocks of electricity. The knee gets a tiny internal zap. Doesn't hurt. It's just weird. Hubby thinks that my knee nerves are waking up. (What do knee nerves dream when they are asleep?) Oddly, my knee is a little numb on the right side. I remember that this happened with other surgeries I've had. It's kind of like Novacaine numbness...only it takes months to wear off.

Well, that's enough of this drivel for now. Surely you have more important things to do than read about some silly lady's scar. Off you go now.

Me and my limbs

Whatta week. I went back to work last Thursday and woke up on Friday morning with a grumpy knee. Being up and about at work--walking around so much, driving to and back, etc.--took its toll. But on the whole, I'm glad I went in. But on Friday, I decided to stay home in the morning to rest my knee before going in. Then one heck of a storm rolled through the Bay Area. Good God, we had wind and rain! Real weather. We Californians rarely get such stuff. My poor daughter was scared. She tucked herself between her bed and the wall while the wailing winds and big gloppy raindrops pummeled the house. And, naturally, as the winds blew in a rare northern gust, our big old spruce tree out front was ripped at. Little branches starting landing on the house. My kid cowered under her bed. Then a big wind whipped up and three BIG branches came crashing down on the house...on the very wall where my child was shivering in fear. Yow. She was fine. Daddy calmly removed her to the warm comfort of the family room. (It's much nicer to huddle together in fear anyway.) The house wasn't perforated. Nothing was damaged...except for a gutter. Oh, and I suppose the old spruce tree is now suffering some sort of post-traumatic stress. Think of it...poor thing. One day you're a fine tall spruce tree, enjoying your position as the grand elder tree in the neighborhood and the next you're suffering from an assortment of ripped limbs and you're all tousled. Very disconcerting, I'm sure. And, naturally, I can't help but draw an analogy of such sudden physical trauma to one's diagnosis and surgery for PVNS. Yeah, I know. It's a stretch, but I do think that as I recover from my surgery, I have an empathetic compatriot in my big old spruce tree right now. We're insulted by injury.

After the diagnosis

I had my surgery on 12/18/07. The worst part of the surgery--as always--was the anticipation. I worked myself up worrying about it and preparing for the lack of mobility. But when the time came, the surgery was quick. I was in the hospital at 7am and out by 1pm. I don't remember much about it. Uh, I suppose that's cuz I chose general anesthesia, which I highly recommend when it's an option. I've had other surgeries when I could smell, hear, and see things happening to me that I really shouldn't have. So I gladly wussed out and chose a general. The days of toughing it out are definitely behind me.

Anyway, Hubby drove me home in the afternoon. I was woozy and sleeping on and off (best sleep I'd had in a long while). And, most importantly, that very evening I was able to get myself into the bathroom for the necessities via crutches. OK, so it was a most ungraceful visit, but I was surprised that I was able to even get up after the surgery. I was more mobile than I thought I would be.

Hubby helped me keep the knee well iced 24/7...and by 12/20 I was starting to enjoy the guilt-free rest imposed by the surgery. Thank God for NetFlix and a tall stack of unread books. I caught up on some great entertainment made extra delicious under the influence of a little prescribed Vicodin. Ice, movies, books, and a little TLC have surely helped me heal quickly. I was on crutches for about five days. On Christmas Day I started limping about with one crutch. By New Year's I was pretty mobile. No crutches but I walked like Frankenstein. Or John Wayne after a really long ride. Naturally I practiced both walks to silly perfection. Small animals and young children scattered in fear.

I have more to say about recovery and the details that I will write about in the next post. For now, though, I think a picture's worth a thousand words; so I share my single incision on the front of my right knee ten days after surgery. It looks more painful than it is. (What? You'd rather have had the thousand words?)

The doc pulled out one of the two nodular tumors from behind my kneecap (or "patella" as those of us who are now way too versed in knee anatomy call it). The tumor removed was the largest and the one that was making my knee lock up. Lab tests confirm that it was (in doctor-language): "consistent with a diagnosis of PVNS."

I remember, btw, a doctor-photographer in the operating room. I asked my onc doc about this and he says pictures were indeed taken of my knee during the surgery. So...because I have a morbid or mechanical curiosity or both...I've asked to get copies of the photos. I'm very curious to see what that tumor that created all this fuss actually looked like. I should get the photos within the next two weeks, which I will joyfully share with you. I am certain those photos will be even more "attractive" than today's.

And by the way, a shout out to "kimberleesblog.blogspot.com" The documentation of her struggles with PVNS have been a source of great interest and encouragement to me. There really do seem to be so few PVNS stories on the Web. And, believe me, I know! I must have spent 60 hours scouring the Internet for first-person accounts of this disease. Kimberleesblog is not only a joy to read (if only to learn about her accidentally transexual cat), but very candid in describing her full range of physical and emotional feelings with PVNS. Thank you "TallGall." My blog will always be but a shadow of yours. I write merely to present another POV re PVNS. :)

Here's how it started

About the PVNS: I was on the phone, sitting in my comfy chair. I lifted my right leg up onto the ottoman in front of the chair and I suddenly couldn't bend it. Way weird. I realized that my right leg had frozen in a bend. Very freaky. I was just about to go to the emergency room when the leg unfroze...just as suddenly as it had frozen. I called my doctor, got a referral to Orthopedics, and got an x-ray. It didn't show a thing. So I pressured the doc to keep looking a little more for the reason (I suspected a meniscus tear or something from a run-in with an aggressive German Shepherd who lunged at me while I was biking a few months back). The doc ordered an MRI...and THAT showed weirdness going on in my knee joint. But the doc looked at the MRI and said he hadn't seen anything like this in 16 years of practice...and referred me to an oncologist. What?!? Isn't that the kind of doctor who deals with the Big C? That freaked me out. But then the doc pointed to a little mole on his neck (a real treat...ya shoulda been there) and said that a musculoskeletal oncologist treats benign and not-so-benign growths...just like this mole on his neck. I resisted the urge to tell HIM to take the oncologist appointment but spent the next two weeks scouring the web about knee problems. I went into my appointment sure that I either had a sarcoma of the knee or PVNS. And, dang, the onc doc diagnosed it as nodular PVNS.

So that's the beginning the story. I'll tell ya about surgery in the next post.

Recovering from PVNS

Hi. OK, anyone out there dealing with PVNS? You know, the joint thing: Pigmented Villonodular Synovitis. It apparently affects 1.8 people in a million, so I'm figuring that there are over a million Americans with this nasty little disease mucking up your lives, too. There don't seem to be many sites that let us chat together about this and our experiences...so let me be among the first.

I'll share more of my story tomorrow.

Meanwhile, lemme know if you're one in a million, will ya?