Osteochondritis Dissecans (OCD of the Knee)

"Osteochondritis dissecans (OCD) is complete or incomplete separation of a portion of joint cartilage and underlying bone, usually involving the knee, associated with epiphyseal aseptic necrosis" which basically means that part (usually the end) of a bone dies a little bit. They think that it's caused from lack of blood supply or repetitive stress, and that there may be a genetic component.

In my case, the end of my femur (thigh bone) died a bit, and depending on the stage some pieces have either broken off or they're smashed up just hanging in there with the cartilage. The doctors aren't sure if the cartilage is in tact or damaged either. They can't really tell until they go in and look, but they think mine is stage 3. Here are the stages:

Stage I—Thickening of articular cartilage and low signal changes (stable)

Stage II—Articular cartilage breached, low-signal rim behind fragment indicating fibrous attachment (stable)

Stage III—Articular cartilage breached, high-signal changes behind fragment and underlying subchondral bone (unstable)

Stage IV—Loose body (unstable) (from http://www.aafp.org/afp/2000/0101/p151.html)

Mine may have been caused from doing gymnastics for 8 years, track, cheerleading, or marching band since they are all high impact. My dad and brother also had it. Back when my dad had it, they casted his legs. For my brother, they drilled into his bone to restore the blood flow to the dead bone which is usually successful for teenagers. The doctors say mine probably started in late elementary school or middle school since that's when I remember my knees beginning to hurt. 

An MRI of my left knee from the side. The arrow is pointing to the crack in the bone, and the fluid building up around it.

MRI of my left leg. The top two parts are the bottom of my femur, and the bottom part is my tibia. This if the view of if you were to "slice the leg like a loaf of bread" in the middle/top part of me knee according to the doctor. The circled part is the damaged area. 

X-rays of both knees bent, from behind. This is my left knee compared to my right. the darker area on the left is the damaged part when compared to the healthier right knee. 

There were many different surgery options, some involving some pretty cool science. One doctor wanted to clear out the dead bone on my femur (thigh bone) then take part of my tibia (shin bone) and screw it into the femur. If the cartilage is damaged, he was going to take some of my cells and send them to a lab in Boston to grow more of my own cartilage, then put my new cartilage back in my knee. 

The other doctor (the one I'm going with) wants to clear out the dead bone, then replace it with a synthetic "plug" that will fit into the space he clears out. My healthy bone and cartilage around it will eventually take over the degradable plug and kind of eat it up, replacing it with healthy bone and cartilage. I can't find much online about it because I'm not sure of the exact name of the plug. I'm going with this procedure because they should only have to open my knee 1 time instead of what could be potentially 3 times. They also won't have to take part of my tibia out, which I think would hurt as much as the femur part. 

So...that's the plan for what's happening during surgery tomorrow. I'm trying to just pray and relax, but I'm still quite a bit nervous. Hopefully it all goes well.  

For more info about osteochondritis dissecans:

This website has a quick description of it (and the definition from above): http://www.medicalnewstoday.com/articles/166764.php  

This one is from the Mayo Clinic and is more detailed: 
http://www.mayoclinic.com/health/osteochondritis-dissecans/DS00741

And this one has current research about osteochondritis dissecans:
http://www.osteochondritisdissecans.org/

A New Job and Bad Knees and Surgery, Oh My!

It's been a while since I've posted on my old blog (over 2 years!), so I decided to make a new one. Mostly because I don't use the email address associated with the old one, and I can't figure out a way to completely switch it to my new email address. Anyway...

SO much has happened since then. I became an aunt (twice!). I met a prince charming :) I traveled to Europe, Los Angeles, Chicago, Siesta Key, Harrisburg, Montgomery, and went on a cruise. We unfortunately had to put our oldest dog, Teddy down, and we have now added a turtle to all of our pets. There have been many weddings, sadly a few funerals, and some friends and family now have new babies in their families. I finished my grad school classes, survived 6 months of fieldwork, graduated and earned my Master's of Occupational Therapy, studied like crazy and passed my NBCOT exam to become board-certified, became a licensed occupational therapist in Ohio, and got a job! Or almost got a job. I lost the job the day after accepting it due to a random knee injury. Because of my knee, I'll be having quite a bit of free time, so I figured I'd start writing a little bit again in a new blog.

Everyone who came to my hooding ceremony a day before graduation

My sweet little nephews, John (23 months) and James (2 months) 

Kevin and I on the cruise 

After all of the stress and chaos of grad school and boards, life started to finally calm down. I applied for a bunch of jobs, and one was my dream job; a position in pediatric acute care at the exact hospital I want to work at. I was initially told they typically like a bit more experience for that position, so I wasn't incredibly hopeful about it, but there was still a little bit of my heart going "You never know! Maybe they will call!" A few days later I received that call to set up an interview!! I was a nervous wreck for the interview because it meant so much to me.

I interviewed on a Tuesday (4/9), and thought it went pretty well, but wasn't quite sure. I absolutely loved all of the OTs and manager that I met, and the tour of the hospital was phenomenal. I felt like I really fit in there, and could see myself enjoying working there so much. Two days before the interview, I felt some pain in my knee while I was getting into bed, and I thought it was weird but not too crazy since both of my knees have always hurt for as long as I can remember. Two days after the interview (4/11) , I was sitting on the ground playing with my nephews. I went to stand up and could barely put any weight on my left leg because it hurt so terribly. Here is how the next week went:

Friday 4/12: Doctor Appointment and X-rays. Dr. #1 says it's either osteochondritis dissecans or a torn meniscus and orders an MRI. He tells me to brace it and walk on it.
Monday 4/15: MRI. I got to sit up in a dentist-like chair and just stick my leg in a little tube, which everyone told me I was lucky about since I didn't have to have my head in the machine. My butt went completely numb from sitting for so long, causing me to wiggle around a little, but luckily it didn't compromise the MRI.
Tuesday 4/16: Appointment with Doctor #1. Dr. #1 says it's definitely osteochondritis dissecans, that he's 50/50 on if I should have surgery, and that he wouldn't get surgery if he were me. He also talked about a patient who knits her own socks for about 10 minutes of my appointment, then (thankfully) referred me to a doctor that specializes in cartilage repair because he said he just had no idea what to do for me. My mom came with me to this appointment and she referes to him as the "nutty professor" now.
Wednesday 4/17: Got the Job! The hospital I applied to offered me the position, and I was THRILLED, but very scared about the whole knee thing. I asked them if I could think about it, hoping that I wouldn't need knee surgery since I had another doctor appointment coming up. I really wanted to just jump up and down screaming with excitement and immediately accept it though.
Thursday 4/18: Accepted the Job! After calling a few professional mentors/friends that I trust and asking their opinion on if I should accept it after hurting my knee, everyone said go for it since I wasn't sure what was going to happen with the knee anyway and since I really wanted the position. I called and accepted it, and was beyond excited but still so nervous about the knee.
Friday 4/19: Appointment with Doctor #2: The more specialized doctor said I definitely need surgery, and explained how he'd do it. Kevin came with me for a second set of ears, and gave his stamp of approval. Kevin knows exactly what kinds of questions to ask, and always makes sure he understands absolutely everything clearly, so it was comforting having him there to make sure we really understood what was going on.This doctor was definitely more knowledgable than the first, and explained everything better.

After finding out that I would definitely need surgery, I called the HR person and my future manager to explain what had happened. I had accepted the job because I initially thought I would be able to wear a brace and work for a while. I could have tried to work a few weeks, secured the job, then scheduled the surgery, but it was getting more and more painful to walk and I just couldn't do that knowing they urgently needed someone to start as soon as possible and that I'd immediately need quite a bit of time off. I am honestly not even sure if I would have made it through orientation because I'm limping so much, and I definitely wouldn't have been able to be on my feet all day in such a fast-paced setting. As much as it stinks that I don't have the job now, I'm glad I was honest with them. The HR person said she'd try to work with me when I'm all recovered, so hopefully another opportunity will come up!

Yesterday, I went to an appointment with Doctor #3 that I originally didn't think I'd be able to go to, because yesterday was supposed to be my first day of work. Doctor #3 did knee surgery on my younger brother when he was in high school 6-7 years ago, and my parents loved him and really wanted me to see what he had to say. Doctor #3 is incredibly nice, and actually listened. I am very picky with doctors, and it's tough to find doctors who really listen to what you have to say. My dad came with me to this appointment, and really likes him. I've been concerned about my right knee as well since they've both always hurt the same amount until this random left thing happened, and Doctor #3 is the first one who said he'd like to do an MRI of the right too. The other doctors were very dismissive and practically ignored my concerns with the right knee, which is incredibly frustrating. My gut keeps saying to get it checked out too. We're all hoping it's just normal aches and pains and not osteochondritis in both.

I ended up choosing Doctor #3 (this sounds like a weird dating game now) for a few reasons. He seems like he genuinely cares, he's one of the best knee surgeons in the country according to some online research, his surgery sounded less extensive than other options, and he listened about my right knee. Also, we know a lot of family friends who have had him do surgery on their knees in addition to my brother's knee, so we ended up going with him. He could fit me in this week, and surgery is scheduled for tomorrow.

I'm hoping everything goes smoothly and is complication free, and that I recover quickly. I'm incredibly anxious over having surgery, and scared for the pain that I'll likely be in after. I'm also terrified of waking up in the middle of it. I know that many other people have way more severe, complex surgeries though, so I should be thankful that it's arthroscopic. The plan after surgery is:

Six weeks of non-weight bearing and using crutches
Six weeks  of very careful walking, being cautious with stairs, and gradually increasing the weight I put on my left leg
At the 12 week mark I'll start slightly more intensive physical therapy

Which brings me back to why I'm beginning to blog again. Six weeks of using crutches with my upper body strength (or lack thereof) will probably mean I won't be doing much physical activity. Since I'm used to being pretty busy and active, I'm trying to come up with new ways of occupying my time, and this is one of them.