Rap My Knuckes and Jump for Joy, I Got a Clean Bill of Health from Dr. McCoy
Actually it was from Dr. Phat, my orthopedic doctor and surgeon here in Ho Chi Minh City, née Sai Gon. And I should qualify clean bill of health. He is more than satisfied with my recovery from surgery thus far, terming it – and I quote – amazing. I guess it’s not common for folks who suffer a complete tear of their quadriceps tendon to be back at work full time three weeks after surgery, and walking around unaided even before that.
Yay me. And here’s some blatant SEO: fuck yeah.
He said there was no reason for me to come back to see him, unless I developed problems of some sort in the future, but he doesn’t foresee any. Or, of course, if I bust something else on my body involving bones or muscles. Being the klutz that I am, this is not entirely beyond the realm of probability.
But does that mean my leg is healed? That “it’s all better?” as I’m asked frequently? No, not at all. I still walk with a slight limp; most people wouldn’t even notice it, although it becomes more pronounced throughout the day if I’m walking and or standing a lot. While I can walk both up stairs and down now, I still need a railing to hold onto to walk down. This isn’t out of fear of my leg buckling – which still occasionally happens – but simply because my muscles still aren’t strong enough.
Walking up stairs I can do without a railing for one flight of stairs; if there is two, there had better be a railing or a wall to brace against. At the end of a Saturday or Sunday in which I normally teach six hours a day and often times eight, my leg, could it verbally express itself, would say: “Yo, dude, screw them stairs and screw you if you expect me to do down them. Unless the building is on fire, we’re taking the elevator, champ.”
And my leg does express itself frequently through its individual component parts; it is almost constantly sore, to one degree or another. Use my leg too much on any given day, and my Frankenstein quadriceps tendon lets me know, using even more colorful language than that evidenced above. Plus the rest of my muscles in my leg suffer degrees of fatigue and soreness. My calf is pretty much always sore, all day, all the time. The IT band in my right leg often weighs in at the end of the day to let me know that it is indeed done for the day, and could use a good stretching. Needless to say my hamstring and quadriceps muscles also frequently have things to say, although not as much as the rest of the lot.
My right leg and I have frequent conversations these days.
I’m still looking at months of physical rehabilitation before “it’s all better.” It will be a least a year or so, in total, before I can walk normally without thinking about it, before my level of muscle (re)development matches that of my left leg – hooray for bilateral symmetry. As Dr. Phat said, the only thing left now is physical therapy, i.e., exercise, and lots of it.
And as you can see, bilateral symmetry – I don’t have it. The muscles in my injured leg are still noticeably underdeveloped compared to my good leg — although I am standing a bit of an angle compared to the mirror; my Franken patella isn’t that much higher than the one in my good leg. But it is higher, because my quadricep and tendon have shortened, as discussed below.
Furthermore, in the interests of posterity and future sufferers of ruptured quadriceps tendons, I’ve done the unthinkable and posted a picture of my pasty white self in my underwear on the Internet. At least I’ve spared you from having to look at my junk in the process. And frankly that smiley icon is considerably bigger than it needs to be. Add this to my list of things I never thought I’d do or experience – like tearing my quadriceps tendon.
So When Does the Surgical Incision Stop Itching?
The short answer? Years, but then I expected that. Even now, more than three months after the surgery, sometimes the surgical incision site itches. The lengthwise incision minimizes damage to the nerves beneath the skin, avoiding any major ones, but still there is some unavoidable damage – a small price to pay in the long run for the ability to walk again, trust me.
Furthermore, as anyone who has ever dealt with deep scar tissue knows, it takes a long time to … settle down, for lack of a better term. There is some residual healing that takes months; nerve regeneration considerably longer. Plus the resulting scar tissue from a huge incision like this is … sticky, for lack of a better term. Especially where a joint is involved, it doesn’t want to slide and move smoothly with the tissue around it, and it takes a long time to sort itself out.
This is one of several reasons why physical therapy is critical; if the leg is immobile too long, that scar tissue can actually hinder range of motion. I swear, early on in physical therapy, I could feel the scar tissue underneath the skin tugging at the tissue beneath it. My imagination, you say … perhaps.
So yeah, the long and the short of it is I have roughly a circle of skin about an inch or so in diameter on my knee that is numb, and yet sometimes the flesh around it itches. I scratch, rub my knee and life goes on.
When I asked Dr. Phat about this and when I could expect it to subside, he said “years.” Then he looked up at me with a slightly alarmed look on his face, like it just occurred to him that this wasn’t exactly a bedside-mannerly thing to say.
I smiled and said I expected as much. I had maxillofacial surgery when I was 18 to correct my mandibular prognathism – a fancy way of saying I had my underbite fixed. It wasn’t pronounced at all – I didn’t look like Baron Von Ünderbheit or anything – just a matter of a few millimeters, but I probably would have lost most of my teeth by now if I hadn’t had it corrected. Follow those links if you want to learn more.
The surgery involves cutting out hunks of jawbone, but at the same time avoiding severing a major facial nerve that runs through the jaw bone. Some numbness is unavoidable, as the surgeon has to handle and move the nerve as he cuts through the bone. To this day, some two decades later, I still don’t have complete feeling in a small patch beneath my lower lip. And to this day there is still some phantom itching in this area as the nerves continue their long regenerative process.
Dr. Phat was actually pretty interested in my surgery and recovery from that, asking specific questions about how my jaw was now, the feeling in my lip, etc. But then I suppose that’s kinda his thing. One of his raisons d’etre, as it were.
“Actually Your Quadriceps Tendon is Shorter”
There’s one more thing about this long recovery from a torn quadriceps tendon and the subsequent surgery. As I began to walk again without the aid of a crutch and brace about a month or so ago, I came to have the feeling that my leg was just ever so slightly shorter than the other one — a matter of a millimeter or two, maybe. Also, I noticed that my right foot seems to point a few degrees more laterally to the right, or to the outside, when I walk.
I assumed that these things were probably a combination of my imagination and the fact that my muscles had atrophied so much during six weeks of immobility outside of therapeutic exercises. But I asked Dr. Phat about it, and he said that actually the quadriceps muscle and tendon shortens during recovery when it’s immobile (just take a luck at those ugly legs in the picture above). After all, that’s why it takes so long to recover one’s range of motion.
So perhaps, at least temporarily, my leg could be a millimeter or two shorter than the other one.
As for my foot being in a slightly different position during my walking stride, that is also possible. It may just be a matter of weakened muscles, but as Dr. Phat explained, when surgeons put people’s bits back together, they do their best to put them back the way they were before, but it’s never quite the same.
This I know, too. Nothing is ever the same after a severe orthopedic injury. My junior year in high school I tore the syndesmosis tissue where the tibia and fibia meet at the base of my right leg. A few years before that, I had torn up that same ankle – torn ligaments, bone chips and whatnot. It was literally years before my right ankle ever felt normal, and to this day, it can’t take abuse like my left ankle. A slight sprain or twist that I could walk off in a few minutes on my left ankle means a few days of soreness for my right ankle.
Then there is the dislocated AC joint in my shoulder (again, on my right side; that side of my body is all sorts of messed up) that I’ve been living with for the past decade or so (knobby mountain bike tires and slick rock is a potentially bad combination).
So there you go. If you’re reading this because you’ve ruptured your quadriceps tendon and want to know what you’re in for, you’ve got a long road ahead, my friend. A long, difficult, frustrating road. But I’m here to tell you to hang in there, listen to your doctor, listen to your physical therapist, don’t skip out on your exercises – not if you want to walk again anytime soon – and you will be walking, riding a bike and even running again. But it will be a matter of months.
Did I mention that I jogged the other day? It was only across the physical therapy room at the hospital, and with little baby steps — but those were metaphorical giant leaps. Fuck yeah! Take that, random uncaring universe. Or karma. Once again, sorry Larry.