Mantra
Contributor
Hey all! Firstly, apologies. I posted about this yesterday, but asked the post be deleted an hour or so later as I was able to get to the surgeon for advice and didn't want to waste your time here until I'd gotten that input. So what I will instead post is a summary of what has happened, the advice I have received, and the decision I am making. If anyone would like to discuss this, I am all ears. If not, I hope this data is of use to anyone else who might experience this to help them make their own informed choices.
SUMMARY:
I have had a significant knee injury on a boat on the 21 Dec. My wife and I have a five week dive trip to the Philippines planned on the 03 Jan. I have decided to delay the trip by a week, reduce it to four weeks, and modify diving ambitions appropriately.
INDIDENT:
On the 21 Dec, after a couple of night dives, and after I had de-kitted and changed back into normal clothing, I was crossing the deck of a dive boat when a combo of a wave and my feet being both in puddles of water caused my legs to slide out from under me. Landed on my tailbone, hard. Immediate pain and an inability to move my left leg much (toes could wiggle). When the boat was docked and the deck stabilized, I attempted to stand. I felt a pop in my knee - this was probably the point at which the ACL completely ruptured. I was in much less pain after that.
I didn't want to wait in an ER on a Saturday night on a full moon, because I knew I would be triaged very low. So we headed home. Aprox 2hrs later I was in bed, with the leg compressed, iced, and elevated.
Went to an after hours doctor on Sunday for a MRI referral. MRI'd yesterday (Monday) and the report was generated at once, as after looking at the knee I was treated as a priority patient. Luckily, one of my friends is a top sports ortho surgeon (signed sports celebrity pics galore on his office walls, etc) and he was kind enough to read the report right away, and to see me this morning, Tues, Christmas Eve.
ADVICE:
The ACL is a complete rupture, and there are two small meniscal tears. Some bone bruising etc. As far as ACL ruptures go, I'm lucky. Apparently the outer sheath is likely intact, which is why my knee has only moderate swelling. Side ligaments are OK. I'm feeling a bit unstable, but am able to walk with the leg bearing weight and can even balance on it with concentration. I've been on crutches and had the knee all braced up, just to clarify - as I'm being very cautious. But I will start to ease off now a little with that. Virtually no pain at all.
Given the stability I do have and the nature of the injury, the surgeon has advised that I will likely be walking OK in a fortnight, and that he feels my own comfort level should be my guide as I am not likely to further injure my knee by walking on or exercising it. He said if I could wait another week, he felt diving on the knee should be fine in relatively benign conditions, keeping an eye on what felt comfortable or not. I'm aware that frog kicks are likely to be quite impacted by this. He also made the point that at the end of the month of the trip I was likely to be much improved than at the start.
This was encouraging, and so I contacted DAN for further advice about the implications on DCS likelihood given that there is swelling, oedema, circulatory impacts and so on to the knee as it is. The advice there was that I am at an increased chance of getting a hit in this area, but it's pretty much anyone's guess as to what the increase might be given the dearth of data on diving and this injury type. I proposed the scenario of doing one dive per day at no more than 15m depth and staying well inside NDL limits. I plan to be very conservative, ice afterwards, etc. DAN were happy enough with that, and will continue their insurance coverage based on that understanding, and that if I do feel comfortable later in the trip ramping up the kind if diving I'm doing, I do it similarly sensibly.
MY DECISION:
I've been waiting all year for this trip, as has my wife and god knows we really need a holiday right now. What I definitely do not need is a DCS hit or to further injure myself in the Philippines. Weighing up these factors, I have decided to:
Delay the trip until circa the 10th of Jan (we have appropriate travel insurance covering injury etc) to heal up as much as possible beforehand. I will keep on anti infammatories, and ice etc very diligently. I will stay ambulatory, with a close eye on what is and is not comfortable to do.
For the first week of the trip, I will do no more than one shallow dive per day, very conservatively within NDLs. I'm aware that you can get hit in 10m of water completely undeserved etc, and that this is risk minimization only, but I consider this an acceptable risk. I will try to dive in as close to zero current as possible, and get a realistic idea of what my in-water abilities look like. I will ice after every dive.
I will adopt a similarly conservative approach to ramping up diving over the course of the month, bearing in mind that missing a dive is vastly preferable to getting bent. I don't envisage doing more than four dives per five day period as a hard limit, even if I feel more comfortable than that. And I will stay at or above 20m. And I will dive 32% nitrox where possible.
Weigh up the wisdom of ACL surgery later in the year.
CONCLUSION:
I promised TS&M I'd write this up when I heard from the surgeon! There you have it
I'm only too willing to listen to any and all advice. Things like getting up gangways to Bankas and so on I am happy to do on my butt if need be. I'm not too proud to face a bit of humiliation if it means not ruining my wife's trip, and if I can get wet here and there in the process, I will be very happy with that. I've had some very very memorable and pleasant shallow dives and am more than happy sticking to the tops of walls, etc.
We will have to re-plan the details of the trip from scratch. We originally wanted to do some deeper wreck stuff etc, but will re-orient the trip to more benign places. Thankfully, we both like muck and critters. I'm thinking we might revisit Moalboal, for example, as the bay there is shallow, has some good muck, and the house reefs in 5m or so have stuff like mandarinfish etc that I could hapily watch for hours. It's not the kind of diving we were ideally interested in doing again, but let's face it - a hell of a lot better than being grounded at home.
---------- Post added December 24th, 2013 at 02:10 PM ----------
Oh! And I will keep this thread updated with outcomes as I go, of course.
SUMMARY:
I have had a significant knee injury on a boat on the 21 Dec. My wife and I have a five week dive trip to the Philippines planned on the 03 Jan. I have decided to delay the trip by a week, reduce it to four weeks, and modify diving ambitions appropriately.
INDIDENT:
On the 21 Dec, after a couple of night dives, and after I had de-kitted and changed back into normal clothing, I was crossing the deck of a dive boat when a combo of a wave and my feet being both in puddles of water caused my legs to slide out from under me. Landed on my tailbone, hard. Immediate pain and an inability to move my left leg much (toes could wiggle). When the boat was docked and the deck stabilized, I attempted to stand. I felt a pop in my knee - this was probably the point at which the ACL completely ruptured. I was in much less pain after that.
I didn't want to wait in an ER on a Saturday night on a full moon, because I knew I would be triaged very low. So we headed home. Aprox 2hrs later I was in bed, with the leg compressed, iced, and elevated.
Went to an after hours doctor on Sunday for a MRI referral. MRI'd yesterday (Monday) and the report was generated at once, as after looking at the knee I was treated as a priority patient. Luckily, one of my friends is a top sports ortho surgeon (signed sports celebrity pics galore on his office walls, etc) and he was kind enough to read the report right away, and to see me this morning, Tues, Christmas Eve.
ADVICE:
The ACL is a complete rupture, and there are two small meniscal tears. Some bone bruising etc. As far as ACL ruptures go, I'm lucky. Apparently the outer sheath is likely intact, which is why my knee has only moderate swelling. Side ligaments are OK. I'm feeling a bit unstable, but am able to walk with the leg bearing weight and can even balance on it with concentration. I've been on crutches and had the knee all braced up, just to clarify - as I'm being very cautious. But I will start to ease off now a little with that. Virtually no pain at all.
Given the stability I do have and the nature of the injury, the surgeon has advised that I will likely be walking OK in a fortnight, and that he feels my own comfort level should be my guide as I am not likely to further injure my knee by walking on or exercising it. He said if I could wait another week, he felt diving on the knee should be fine in relatively benign conditions, keeping an eye on what felt comfortable or not. I'm aware that frog kicks are likely to be quite impacted by this. He also made the point that at the end of the month of the trip I was likely to be much improved than at the start.
This was encouraging, and so I contacted DAN for further advice about the implications on DCS likelihood given that there is swelling, oedema, circulatory impacts and so on to the knee as it is. The advice there was that I am at an increased chance of getting a hit in this area, but it's pretty much anyone's guess as to what the increase might be given the dearth of data on diving and this injury type. I proposed the scenario of doing one dive per day at no more than 15m depth and staying well inside NDL limits. I plan to be very conservative, ice afterwards, etc. DAN were happy enough with that, and will continue their insurance coverage based on that understanding, and that if I do feel comfortable later in the trip ramping up the kind if diving I'm doing, I do it similarly sensibly.
MY DECISION:
I've been waiting all year for this trip, as has my wife and god knows we really need a holiday right now. What I definitely do not need is a DCS hit or to further injure myself in the Philippines. Weighing up these factors, I have decided to:
Delay the trip until circa the 10th of Jan (we have appropriate travel insurance covering injury etc) to heal up as much as possible beforehand. I will keep on anti infammatories, and ice etc very diligently. I will stay ambulatory, with a close eye on what is and is not comfortable to do.
For the first week of the trip, I will do no more than one shallow dive per day, very conservatively within NDLs. I'm aware that you can get hit in 10m of water completely undeserved etc, and that this is risk minimization only, but I consider this an acceptable risk. I will try to dive in as close to zero current as possible, and get a realistic idea of what my in-water abilities look like. I will ice after every dive.
I will adopt a similarly conservative approach to ramping up diving over the course of the month, bearing in mind that missing a dive is vastly preferable to getting bent. I don't envisage doing more than four dives per five day period as a hard limit, even if I feel more comfortable than that. And I will stay at or above 20m. And I will dive 32% nitrox where possible.
Weigh up the wisdom of ACL surgery later in the year.
CONCLUSION:
I promised TS&M I'd write this up when I heard from the surgeon! There you have it
I'm only too willing to listen to any and all advice. Things like getting up gangways to Bankas and so on I am happy to do on my butt if need be. I'm not too proud to face a bit of humiliation if it means not ruining my wife's trip, and if I can get wet here and there in the process, I will be very happy with that. I've had some very very memorable and pleasant shallow dives and am more than happy sticking to the tops of walls, etc.We will have to re-plan the details of the trip from scratch. We originally wanted to do some deeper wreck stuff etc, but will re-orient the trip to more benign places. Thankfully, we both like muck and critters. I'm thinking we might revisit Moalboal, for example, as the bay there is shallow, has some good muck, and the house reefs in 5m or so have stuff like mandarinfish etc that I could hapily watch for hours. It's not the kind of diving we were ideally interested in doing again, but let's face it - a hell of a lot better than being grounded at home.
---------- Post added December 24th, 2013 at 02:10 PM ----------
Oh! And I will keep this thread updated with outcomes as I go, of course.
