Saturday, January 20, 2007


Everyone told me how your post-partum body is never quite the same, and I knew that having twins would exacerbate it. I expected a thickened waist (check), some extra pounds (now non-check, thanks to the breastfed-twins-miracle-diet), sagging (check), scars (check), and stretch marks (also check, but fading). I miss my pre-pregnancy, pre-infertility self, but I'm working to get as close to it as I can, and progress is being made. I may not ever get back to where I was, but I can live with, even be proud of, the things that time and effort won't cure.

What I did not anticipate was that I'd be looking at surgery less than six months after the birth of the girls, but after my consult with the orthopedic surgeon, that's exactly what's going to happen.

It started thirteen years ago, with a skiing accident on my senior-year spring break ski trip. I was an advanced-novice skier, so not terribly skilled, but it could have happened to anyone -- a hockey stop, an ice patch, a too-tight binding that didn't release. My ski went one way, my knee another, the rest of me a third, and suddenly I was rolling around howling in the snow. I turned out to have partial tears of my ACL and MCL and a reasonable amount of damage to my knee cartilage. The meniscus was surgically repaired, but the ligaments weren't fixable; completely torn ligaments get replaced, but you can't sew up partial tears, so you go through physical therapy to strengthen the leg and adapt to a slightly looser knee.

I did well after surgery, and the knee didn't give me much more trouble after that. In fact, the last three years or so saw it in the best shape since the accident, as I took up weightlifting and built up my quads enough to compensate for the looseness. Then, infertility happened, and things began to go haywire. I gained a massive amount of weight (5 lbs with the letrozole cycle, 15 lbs during the six weeks of estrogen therapy, and 5 more with the Clomid cycle), and developed a bad case of the awfuckits -- it seemed pointless to exercise when I was helplessly gaining weight from the hormones, not to mention that I was just generally sad and depressed.

Happily, I got pregnant, but almost immediately developed severe OHSS; by the time that cleared up enough to permit exercise, I was at the end of the first trimester, fighting constant fatigue, and developing an irritable uterus. I got put on restricted activity after a bleeding episode at 26 weeks, then strict bedrest when preterm labor hit at 32 weeks, and by the time the babies were born at 36 weeks, I was weak as a kitten. I gained 30 lbs in those last four weeks, for a total of nearly 60, and I could barely walk or get out of my chair -- I was so huge and heavy and swollen, and everything below my chin hurt like fire.

I didn't work out that there was a knee-specific problem until the babies were about ten days old. By that time, the massive fluid retention had gone away, and I was beginning to feel like myself again. Then one day, I was half-reclined on the bed nursing, with my legs out in front of me, and when I pulled my left leg up to support the baby on that side, it hurt. The knee felt way too loose, and there was pain at the back of it, and I knew in that moment that there was more cartilage damage. At the advice of my OB, I waited until two months after the delivery to see an orthopod. By that time, the looseness had resolved some, but the pain was still there, so I was sent for an MRI. While it didn't show a meniscus tear, it did show a cyst, which means that there's about a 98% chance that there is a tear, obscured from MRI by the scarring from my previous surgery. The doctor's opinion is that it's the result of my preexisting looseness plus the ligament relaxation of pregnancy, exacerbated by the overall muscle weakness and the large rapid weight gain.

Meniscus tears don't usually fix themselves, especially not the kind that usually are responsible for cysts. I knew that from my previous surgery, and so I've been suspicious almost since the birth that surgery was somewhere ahead of me. I thought at some length about whether to fix it now or wait until later, as there are arguments on both sides and eventually concluded that now would be the best choice. I don't think there is ever a *good* time to have knee surgery when one is the parent of young twins, but I think it's probably easier when they are of limited mobility. Too, I hope to have more children, possibly including another set of twins if we have to go the infertility route, and so it may be five to ten years before I have no children requiring either constant carrying or constant chasing. The doctor says the damage will only worsen over time, particularly with another pregnancy, but that if we fix it now, the next pregnancy may not start any new damage. Plus, there's a lot of stuff I'd like to be able to do over the next couple years, like kneeling by the tub to bathe the girls, sitting indian-style on the floor with them, or squatting down to tie shoelaces, that I currently can't reliably do.

So, I'm scheduled for arthroscopic surgery on February 28th. They won't know how extensive the damage is until they are looking at it, so at this point, I don't know how involved a surgery it will be, or how slowly I will recover. The greater likelihood is that they will simply remove the damaged portion of the meniscus. While this further increases my risk for arthritis down the road, it is a much easier recovery; I'll be able to bear weight on it within just a few days, and won't require much in the way of physical therapy. If there are tears that can be repaired, I'm looking at four to six weeks on crutches plus substantial PT, but I'm somewhat less likely to be troubled by it in the future.

G will be able to take off work and help me for the first few days, and if I have the easier surgery, I should be able to manage the babies solo when he goes back to work on Monday. If it goes the other way, well, I'm not exactly sure how it's going to work. At this point, the babies are not really rolling over much (though I know that may change in a month), so my current theory is that we can all just camp out in the co-sleeper and the bed for a while. Later, I might be able to work something out for moving the babies around the house using the sling, but I'm still at a loss as to how I'm going to get the three of us out to physical therapy sessions.

Uncharacteristically for me, I'm choosing not to worry about it right now -- it'll work out somehow if and when it becomes a problem, and I've got better things to waste my worrying energy on. That's an attitude I never could manage to take in my pre-motherhood life, and I'm still somewhat surprised at the new roll-with-the-punches me. I guess that's a fair trade for a few bits of knee cartilage.


Nico said...

Sorry about the knee. Does seem like now is the right time to take care of it though.

Roll with the punches sounds like a great way to go through life!

Eva said...

What a thing to deal with while babes are so young, but sounds like you are right in that it will only get harder. And what a great attitude yo have about it. I also think I've become a bit more flexible and adaptable about things... how can we not with 2 infants in our homes?