A Bit More About i-Balance

It’s been a really long time since I’ve posted an update, but Angela’s good news has inspired me to touch base. I will make this brief.

I had a follow-up visit with my surgeon in December, one year exactly after my second HTO and almost two years after my first (how is this possible??). The bone growth, alignment and muscle regeneration all looked good on the x-rays. My surgeon said I was the “poster child” for HTO surgery. Well, I’ve always been a high achiever, so you can imagine how happy that made me :-) More importantly, what I walked away feeling was really grateful that my surgeon did such a great job and that I didn’t experience any complications.

The x-rays confirmed what I was already experiencing, which was close to what I would call a 100% recovery. I’ve been able to run and jump around since October. Admittedly, I waited a while to really push myself with running. Instead, I did regular yoga and strength training classes so that I could really build up my muscles before putting that kind of pressure on my knees and shins. In mid-November, I ran three consecutive miles for the first time in a long while and it felt like a real victory.

Here are some of the x-rays, showing how the bone has grown over the bone graft and around the supportive wedge. You’ll also see an illustration of the implant, which explains why there is still a gap on the x-ray at the outer most edge of my knee. That’s where the wedge is and will remain until the end of time.

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Iris’ Story: Post-Surgery

It’s hard to believe it’s been only about 5 months since I met Iris in person (click here to read our first meeting). She was a sweet lady and we connected right away because we knew both of us struggled with the same problem from having bowed legs. From then on she went through two surgeries and currently is in recovery process. I know she’s been through lots of pain and physical therapy that requires patience, time and energy. Without further ado, here is the story and photos forwarded from her this morning. Although I went through HTO myself, I was amazed to see her photos! Congratulations, Iris! I am so happy for you!

I was fortunate enough to discover this blog and eventually met Dr. K and NACG in May. After my first appointment with Dr. K, I scheduled for my first tibial osteotomy surgery to correct my left leg in July. Nine weeks later, I had my second tibial osteotomy surgery done on my right leg. From two surgeries, Dr. K corrected 8.5 degree on my left leg and 9.0 degree on my right leg. In addition, he also corrected my uneven legs. Prior to the surgery my left leg was slightly longer than my right one. Although these 2 surgeries were identical, my experience were very different.

(I) First Surgery – Left leg
I decided to have my left leg operated first because the pain from the inner left knee was much more severe. Also, my left leg looked more bowed than my right leg at the time. The anesthesiologist decided to give me the general anesthesia with block. After all the pre-op work, I was pushed to the surgery room and the doctor asked me to inhale something and then I went unconscious. The surgery went well and I didn’t have any complication with the anesthesia at first. After I was almost awake from the recovery room, the hospital staff took me to my room, where I stayed one night. I had a big meal after the surgery and was able to get up with a walker to go to the bathroom. The pain level was not too bad for the first 8 hours because the block was still working. However, by midnight I was in so much pain that I had to call nurse every few hours to give me more pain medications (Morphine shots and Percocet). In the next morning, I started feeling very dizzy. I threw up a few times and felt sick in my stomach. Despite the nausea, the pain level was manageable. Dr. K visited me early in the morning and told me that the surgery was a big “A+”. I was relieved to hear that and a few hours later, they discharged me from the hospital.

On the way home to my sister’s house, I started throwing up like crazy. I threw up and thew up the whole 40 minutes of the drive. I was told that this was a side effect for someone who went through general anesthesia. Out of the whole surgery I think this drive was most awful than anything.

During the first week after surgery, my left leg was extremely bruised and swollen. The hospital gave me a “Polar Care Ice Cube” machine to wrap around the operated area and I used it for 24 hours for the first 3 days. However, on the 4th day I noticed that the hose on the machine was leaking around my knee, and I was supposed to keep the operated area dry until the stitches were out, so I stopped using the machine and I didn’t ice the operated area until after I met Nurse Stacey on the 8th day to take out the stitches. This was a big mistake on my part. My leg continued to be much more bruised and swollen than it should be for next few weeks so my advice to future HTO patients: keep icing your operated leg for the first 7 days non-stop.

My recovery on my left leg was very painful and slow due to (1) excess swelling and bruise (2) my age. I was very dedicated to work on all the exercises that physical therapist provided for me, however, my progress has been pitifully slow, especially with bending. As of today, my left leg is 15 weeks post-surgery and I can only bend up to 135 degree “after” warm up the leg. Without warm up the leg, I can only bend up to around 95 degree.

I visited Dr. K on the 4th week post surgery and at the time, the x-ray looked fine, so I started weight bearing after the appointment. I started putting light weight on my left leg with two crutches for one week, then down to one crutch for another week and was totally crutch-free by the 7th week. Also, since I had my left leg operated first, I was able to drive by the 5th week.

(II) Second Surgery – Right leg
I decided to have my second surgery done nine weeks after the first surgery. Everything was similar to my first surgery except for the method of anesthesia. After reviewing my chart and discussing about my side-effect from last time, the anesthesiologist decided to use a different kind of general anesthesia, hoping that I would have less side-effect after surgery. However, this was not the case. I developed a slight fever after the surgery and started vomiting. I could not eat, drink, talk, or even get up to go to the washroom. Since my good leg (left) was only operated nine weeks ago, it was not strong enough to carry my full body weight up so I could not use the walker to go to the washroom. The nurse had to give me the bed pan when I needed to go, and eventually ordered a commode for me on the bedside. Fortunately I also brought some adult diapers with me and that helped a lot. I continued to use adult diapers after I was discharged from the hospital since I was just too weak to get up.

The pain level on my second surgery for my right leg was also more intense. Since I kept throwing up, the nurse/doctor had to change to a different kind of pain medication. They suspected that I was allergic to Morphine so they stopped giving me the Morphine shots. Percocet, which worked like a gem last time, no longer worked. They finally changed to Dilaudid which seems to calm my pain slowly.

Also, since my leg was covered with the brace after surgery, I developed some rashes on the back of my thigh. The nurse suspected that I might be allergic to the material on the brace or the metal in the brace. It’s interesting that I didn’t have any of the allergic reaction from the brace on my first surgery.

Dr. K visited me the morning after the second surgery. He was very pleased with the surgery and the fact that my legs are finally “even” length. Since my correction is larger than many of other patients, he encouraged me to be more aggressive on the exercise afterward. I asked him why the pain level was so much more severe this time but he didn’t have an answer. He said my x-ray looked great and he couldn’t be more pleased with the result. By the middle of the day, my fever had dropped and my pain level had stabilized so they discharged me from the hospital.

Despite all the drama that I went through with my second surgery (right leg), my recovery was rather speedy. I had no problem with bending at all and as of today, 6 weeks post-surgery, I can bend up to 170 degrees without warm up on my right leg. I really think that few days of non-icing on my left leg made the whole difference. As Nurse Stacey told me during my second post-up appointment: “bruise and swelling will keep your range of motion away. Your number one goal in the first few week after surgery is to get the swelling down. Once the swelling is down, the bending will come back itself.”

With my right leg I started weight bearing on my 22nd day post surgery (beginning of 4th week). I was eager to get back to my routine so I forced myself to walk without crutches on the 5th week. I was limping but was crutch-free. On the 6th week, I was able to walk without limping and I started driving at the same time.

(III) After surgery
I am now 15 weeks post-surgery for my left leg and 6 weeks post-surgery for my right leg. I can walk fine now but the knees still feel stiff. I continue to work on the exercises that physical therapist ordered me and started stationary biking as well. My legs still get swollen at the end of the day so I raise them up and ice them for half an hour each. For the readers who are interested in having the HTO surgeries done on both legs, I recommend to have two surgeries spread out a little bit. It was extremely difficult to get around without an “able” leg. Also, since I was an out of town patient, I stayed in Washington DC for 4 weeks after my first surgery before I flew home; for my second surgery I stayed there for 3 weeks.

A few observations after surgery:
(a) So far my scars are pretty noticeable. My left leg’s scar is around 3.5 inches where as my right leg’s scar is around 2.8 inches.
(b) I am about 1.3 cm taller.
(c) My knees often feel like 10 degrees hotter than the rest of my body temperature after the surgery. This is normal according to Dr. K.
(d) I still have numbness and some bruises around my leg even after 15 weeks of surgery. This is normal according to Dr. K as well.
(e) Because I cannot bend my knees and I like to sleep on my side, I have a hard time getting good sleep. This is normal according to Nurse Stacey.
At the end of the journey I want to say thanks to Dr. K and to NACG. Without them, I never dreamed to have such surgery in my life time. I am proud to say that I am finally “Not A Cow Girl”!

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Cindy’s Story

I met Cindy, from the southwest U.S., through this blog couple months ago. She had an appointment with an orthopedic surgeon who performs tibial osteotomy referred by Arthrex representative. Arthrex is a manufacturing company of I-Balance. She kindly sent me her experience of meeting with the doctor and physical therapy sessions which was recommended by her doctor before she decides to have the tibial osteotomy surgery. Thank you, Cindy, for sending me your story and letting me share it with the readers of this blog. Here is her story.

Growing up, I too share the same psychological effects.   So, I will fast forward to the present and focus on the physical pain.  I started to develop pain around the knees a few years ago, usually after running or walking for a long period of time.   The pain occurred around the kneecaps, especially in the inner sides of my knees.  Finding NACG blog, I scheduled an appointment with an orthopedic surgeon.  After reviewing my x-rays, he said I was born that way and suggested orthopedic soles.  Upset, I reached out to NACG for help and advice.  Arthrex referred me to a surgeon from a respectable orthopedic clinic in my area familiar with HTO.  After his assistant looked at my legs and x-rays (from the first surgeon), she had me take a full-length x-ray for the doctor (hip to feet).  When the doctor came in, he looked at the new x-ray and my legs, bending and twisting them, asking if it hurt and where it hurt.  Within minutes he told me I had tibial varum.  He showed me on the x-ray where he would cut a wedge in the tibias to correct the alignments.  It would require 4 weeks on crutches with no weight bearing after each surgery; he would only do one at a time.  This sounded similar to NACG’s blog so I figured I was on the right track.  My right leg is 6 degrees off and my left leg is 5 degrees off.  When standing, my legs look very similar to NACG pre-op.  

However, he suggested PT first for 6 weeks, twice a week.  Maybe after PT, I will come back happy and not want surgery.  Given the psychological impact and the continued worsening of the pain over the years, I said I’m aware of what’s required for HTO and that I want to move forward with it.  He said he would be happy to do the surgery but continued to suggest PT first.   Since muscle strengthening would help with recovery, I agreed.  My follow-up is in early August. 

After 5 weeks of PT, my pain (around the kneecaps and inner sides of the knees) is actually worse than before.  It ranges from a sudden sharp, burning sensation to a dull pain that lasts for a while.  It can happen whether I’m standing for a few minutes, walking around the office, sitting, driving, or going up or down stairs – basically at any time.  My therapist continues to suggest that I stick with PT long-term rather than surgery, even after telling me PT will alleviate the pain, not eliminate the pain.  Since the pain continues to worsen, I know that HTO is the better solution; young and active, I don’t want this to slow me down.  
I will keep NACG posted on my follow-up appointment and will provide pictures later.  Please know you’re not alone and there is a solution.  If there are any questions, I am happy to help. 
 Thank you, NACG – I don’t know what I would have done if you didn’t share your story and experience with us.  You give me hope and courage.  

Iris’ Surgery

Iris left her first comment on this blog in March this year and flew to DC for her first appointment with Dr.K in May. I met up with her for lunch after her appointment and a few days later she sent me her story which is posted on the blog (click here to read more).

She moved forward with her plan of having a tibial osteotomy with Dr.K and she had her first surgery in July. The surgery was successful and she got the stitches out last week. Dr.K didn’t recommend her flying since flying could cause blood clogging. Fortunately Iris’ sister lives close to DC so she’s been staying with her sister.

I will update the progress of her recovery on this blog and hopefully share some photos very soon.

Good News

I have a great news to share! One of the readers of this blog had a tibial osteotomy surgery about a week ago to correct her bowed legs with Dr.K and the surgery was successful. Now she is recovering much faster than I did – she can already bend her knee close to 90 degrees which took me almost a month! I am truly excited for her speedy recovery. She has requested that she stays anonymous so I won’t post any photos of her legs but I wanted to share the good news with everyone!

Iris’ First Appointment with Dr.K

Iris flew 700 miles for her first appointment with Dr.Klimkiewicz last Wednesday night and she wrote me her experience of meeting with Dr.K so I could share her story with all the readers who visit this blog. I am so happy for her that she saw the hope to correct her legs and wish her the best of luck for the journey. I also thank her for sharing her story on this blog. Thank you so much, Iris!

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My battle with my bowed legs started on one hot spring afternoon when I was 11 years old.  My 6 grade teacher, Mrs. C, asked us to stand up and stand still for a physical examination.  When she approached to me, she pointed to my legs and said: “stand up still and put your knees together”.  I whispered softly to her: “Mrs. C., I am standing up still.”  The truth is despite my best effort I was not able to put my knees together like other kids.  I knew I was different then.

Over the years I’ve learned to accept a few nick names from my classmates such as frog-legged lady, O-legged girl, horse-riding girl and countless stares on my legs.  Laughed by others in the swimming pool, I also gave up my chance to be in senior swim team in high school.  My legs continue to be more bowed as I get older and I started developing pains on my knees and legs.  Eventually I gave up my love for running, biking, swimming, and hiking.

Determined to fix my legs, I’ve visited chiropractors, yoga instructors, and orthopedic surgeons and had purchased other devices that claimed it can fix my bowed legs. Needless to say, none of the devices and exercises doctors recommended worked and my legs are still bowed. Then one day while searching internet I found the “Not A Cow Girl” blog.  Seeing how NACG recovered from her surgery gave me a hope to correct my deformed legs.  I immediately called Georgetown University hospital to schedule an appointment with Dr. K.

I was very nervous about the upcoming appointment because of all the rejections that I received from other doctors in the past.  The night before the appointment I prayed to God for his help to guide me through the process and I sincerely hope Dr. K would consider my physical pain and would agree on doing the surgery for me.

My appointment with Dr. K was at 9:00 am but I arrived bright early at 7:15 am.  The orthopedic department wasn’t even open at that time so I just walked around the campus for a while until the office was open.  Since I was the first time patient, I was asked to fill out some paperwork.  Then the medical assistant asked me to take some X-rays on my knees.  Afterwards I sat and waited in the waiting room.   As I was sitting in the waiting room, someone called my name and asked me to change to surgical gown.  I changed and waited nervously in the room.  Dr. K came in to the room with a big, bright smile.  He listened carefully about my condition, asked me to lie down on the bed, and examined my knees and legs carefully.  He pressed at several locations to get an idea on where exactly my knees and legs were hurting and told me that I have several options: one is to schedule a 6 week physical therapy by doing some exercises and see if my condition would improve; two is to have the I-Balance HTO surgery.  As bowed as my legs are, the I-Balance HTO surgery would definitely align my body and help easing my knee pains and legs cramps.  We came to a conclusion that surgery would be my best option.  My next step is to come up with the date that I can do the surgery.  Dr. K said that since I am from out of town, he will help me to schedule a surgery date that works for me.  I am so thankful that he sees my problem and is willing to help me resolve the pains that I’ve carried on for so long.  I almost cried leaving the orthopedic office.

Since the initial appointment, I have talked to my boss and family members and came up with the range of dates that I am open for surgery.  I will have my surgery on the week of 7/11 with exact date still not finalized.  I am so looking forward to the surgery date.  At least I can finally see the light at the end of the tunnel and I thank “Not A Cow Girl” for all your help from finding the right doctor.  Thank you so much, Not A Cow Girl.  I hope someday I can be a “Not A Cow Girl” too!

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Meeting with Iris

Iris, who lives 700 miles from Washington DC had her first appointment with Dr.K this week. It was my pleasure meeting her and it definitely brightened my day. During her appointment, Dr.K gave her a website address that has detailed information on orthopaedic surgery including ACL, tibial osteotomy, knee replacement, etc. Here is a link to the website and hope this would be a useful information if you are considering a tibial osteotomy surgery.

X-Ray taken last week on April 26, 2011

Time flies. It also mends scars and grows new bones. It has been 6 months and 2 weeks since the first surgery and 2 months and 3 weeks since the second surgery to correct my bowed legs. I always felt self-conscious about the shape of my legs since I was a teenager so it was a great news that the surgery would make my bowed legs straight, fix the knee pains, and prevent arthritis in the future as well. The level of pain I had on my legs before the surgery was not too serious. I experienced dull pains on the outside of my legs below the knees only after long walks, jogging, and snowboarding for hours and I was concerned that the pain was getting more noticeable as I get older. As I mentioned in my previous posts, both my grandma and mom suffered from severe arthritis on their legs. My grandma had knee-replacement surgery and my mom had arthroscopic surgery.

Dr. Klimkiewicz (Dr. K) who operated tibial osteotomy using ibalance system is a wonderful surgeon who puts his patients’ needs on priority. For me he was the perfect surgeon because he didn’t judge the need for the surgery with the existing conditions but saw the benefits I would have in the future from the surgery.

Last week, I had my second follow-up appointment with Dr. K and he was excited to see the progress on my legs. He told me I should be able to start running by early July and encouraged me to be more aggressive with exercises (stationary bike and elliptical) to strengthen the legs. Below is a x-ray of my legs taken during the appointment. The gap on my right leg looks cloudy which means new bone is filling in. The screws look faint but they are there – you can click on the picture to enlarge it.

X-ray taken on April 26, 2011

5 Months Two Weeks Post-Surgery (R) and 7 Weeks 3 Days Post-Surgery (L)

It has been 5 months and two weeks since the first surgery on my right leg and sometimes it’s hard to believe I was lying down on operation table almost a half a year ago. During the recovery after my first surgery I realized the surgery was much more complicating than I had imagined. I intentionally did not think about all the details such as pain level and rehab process prior to the surgery. I was just determined to have a surgery and willing to go through anything the surgery entails.

I had told my husband many times that it was harder than I expected after the first surgery. First four weeks felt like four months. There was progress but I couldn’t see any progress myself since I couldn’t put any weight down for first four weeks.

After the second surgery, rehab was much easier and time went by faster because I knew what to expect. Since some of the readers and friends of this blog are planning to have a bowleg correction surgery (tibial osteotomy with iBalance system) I thought it might be helpful to post some details and challenges I experienced during first few days after the surgery. (I emailed some of these details to a friend in Salt Lake City, Utah a few weeks ago already and thought others could benefit from reading this information as well)

First, there was a mandatory pre-op test (blood test, medical history, paper work, etc) one week before the surgery (The pre-op test for the second surgery was done on the day of the surgery because it was a continued surgery from the first one and most information had not changed since the first pre-op test). Also they had mailed me a letter of information on how to prepare for the surgery. I was not allowed to take aspirin, herbal medicine, fish-oil based supplements for 15 days prior to the surgery. On the night before the surgery, I wasn’t allowed to eat or drink after midnight. I showered with anti-bacterial soap in the morning on the day of the surgery and put clean and comfortable clothes as the instruction sheet suggested. I think it could have been more comfortable if I wore a long skirt instead of sweatpants. I couldn’t bend my knees so it was hard to put pants on. I could have struggled less during the check-out if I brought a long skirt which I can put on from my head. Also I packed a few things for my stay at the hospital – toiletries, my favorite podcast, phone and headsets.

My surgery was scheduled for 11am and I was told to check in two hours before the surgery. Once I checked in and confirmed insurance information with the office I was guided to a surgery waiting room where my husband stayed with me. I changed into patient clothes then for about an hour I was interviewed by couple medical students, residents, interns, nurses and anesthesiologists before the surgery. Some of them interviewed me for the paper work and some of them examined my legs. They all asked me same questions over and over again. Around 11am my surgeon, Dr. Klimkiewicz, came by and marked the knee with a pen he was about to operate on.

Few minutes later, the anesthesiologist gave me IV and nurse did blood test to confirm I wasn’t pregnant. Then one of the medical students put a surgical cap on my head and took me to the operation room. In the operation room about 6 people – nurses, anesthesiologists, residents, etc, were standing by the table to greet(?) me. I wondered if they were standing to hide saws and other scary operation equipments. I lied down on the operation table and surprisingly it felt warm and comfortable. The doctors and nurses all spoke softly with low tone of voice and I felt relaxed and not scared at all. It seemed everything was prepared before I walked in and they were waiting for me to fall asleep.

Few seconds later I heard a nurse’s voice. I was in the recovery room. The surgery was already done. It felt like less than 10 seconds since I lied down on the operation table. I felt heavy pain below my right knee but it was bearable. The pain felt like a burn. Once I was 80% awake they moved me to my room and my husband was waiting for me. I slept mostly after the surgery. I would open my eyes for ~30 minutes then dozed off. I was able to go to the bathroom and use the toilet with the nurse’s help. She had to sit me down on the toilet (I was able to sit myself after the second surgery). The main care-taking point for the nurse was controlling my pain and preventing falls. It’s very important not to fall or slip during the recovery. Next day I felt very nauseous. Two physical therapists visited and gave me a quick training on how to walk with one leg using the crutches. I wish I had refused to do this physical therapy because it made me even more nauseous and I ended up throwing up. After the second surgery, when the physical therapist came to train me again, I just told him I didn’t want to do it because of what happened before and he understood. Some medical staff, especially physical therapists, like pushing patients and it’s absolutely right to tell them what I don’t want to do.

On the way home (about 3-4 miles from the hospital) I felt sick (nausea and dizziness mostly) and threw up a few times in the car. By the way while I was in the hospital I couldn’t eat anything except graham crackers because of nausea. It would be a good idea to bring biscuits or crackers because I was so hungry after the surgery but couldn’t eat anything except graham crackers due to nausea.

For the first week after the surgery I didn’t take shower not necessarily because of the pain but the leg felt so heavy and I couldn’t move my leg unless I moved it with my hands. First two-three days I slept most of the day and I didn’t get up except for the bathroom and my husband had to help me sit on the toilet for first two days after the surgery.

On the 4th and 5th day I ventured out to the living room on my crutches. I was able to go to the bathroom alone and walk around in the house to get used to the crutches. My leg still left like it was burning but not as intensely as right after the surgery. On the 6th day I took a sit-down shower on a small step stool inside the bathtub. It was challenging – I wrapped my leg with a kitchen garbage bag and tied around my thigh and ankle in order to keep the water away. On the 7th day, I went back to work and next day I went to the hospital to get the stitches out. During this appointment I only met with a nurse, not with Dr.K. Now thinking back I really needed to take 2 weeks off instead of 1 week from work, especially for the first surgery.

I started to put gentle weight on my right leg during 5th week post-surgery. 5~8 weeks post surgery was exciting time because I made the most progress during that time. Once I started to put weight on my leg, everything became so much easier. I was down to one crutch during the 6th week then by the 7th week I was crutch-free. From then it took me little longer (2 weeks) to be able to walk without limping. The recovery speed after the second surgery has been much faster. It has been 7 weeks and four days since the surgery and I’ve been off the crutches for three weeks and walking short distances without limping. I am able to stand for at least two hours without feeling too uncomfortable. I’m still taking two tablets of Percocet a day (I used to take 8-10 Percocets in addition to 4 tablets of oxycotine a day during the first week after the surgery)

Below is a slideshow of photos taken this evening. My left leg gets little more swollen at night and I use ice pack for an hour before I go to bed almost everyday.

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Six Weeks and Three Days Post-Surgery on Left Leg

Dear all visitors and friends to Not a Cowgirl blog,

I started this blog 4 days after my second surgery. I was 95% immobile. I didn’t get out of my bed unless I had to go to the bathroom or sit on the couch to change the view. I spent a lot of time watching movies and writing drafts for this blog during the first week after the surgery. Now the end of the journey I started in the spring last year is in sight. I plan to continue this blog until I am 100% pain free and able to do my favorite sports – snowboarding and biking. Also I want to continue until I get everything off my chest from having bowed legs, especially as a woman. My close friends didn’t understand and even made fun of me when I mentioned that I wanted to correct my bowed legs. I knew my parents would be too worried if I go through a surgery that involves cutting the bone and breaking the legs so nobody in my family knew I had a surgery until one week later. Two people knew – my husband and a close friend. I told my co-workers I was getting a preventive surgery for arthritis, which was true.

I hope the visitors and friends who visit this blog find some sort of comfort as well as the information you need. Feel free to leave detailed questions or comments. I would be more than happy to help.

Below are the pictures my husband took a few minutes ago. You can tell my left leg is still little swollen. I’m glad to see I am growing little muscle on the inner calve on my right leg. Hope everyone has a peaceful week.

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