Complete ACL rupture two weeks before dive holiday

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I don't think you are being a bloody fool at all. My biggest fear would be managing dive gear on the pitching deck of a boat; wherever possible, if it were me, I'd see if I could don my gear and doff it IN the water.

Absolutely. I normally dive off RIBs here where you can kit up seated and just back roll in after without standing in between. On the Bangkas in the PI where it is usually a giant stride, I plan on doing exactly this. And staying seated while the boat is moving. Where possible.

"ACL repairs are regarded as optional in sedentary patients or those who are putting minimal stress on the knee. I'm not sure how much impact this will have on frog kicking; the ACL primarily limits knee extension, which is not really an issue with frog kicking." If I can keep my frog kick so close to the injury time, I will be a happy man. I will post an update on this.

"I'm not at all sure you need to put such strict limits on yourself on your trip, but if you have negotiated that with DAN, it's important to follow the rules you have agreed upon. There are certainly theoretical concerns about increased DCS risk in areas of acute injury, but to my knowledge, there are no studies quantifying what that risk IS." DAN, as always, have been excellent and this is exactly what they have said. I will ease in cautiously and just step it up conservatively within my comfort levels and make sure DAN signs off on it. The nearest chamber to us will likely be Cebu, which is a fairly long trip to get to. And DAN did advise that they haven't had their upgrade yet, so the chamber itself could be better. Anyway, trip isn't cancelled altogether and I'm feeling really happy with that.

Merry Christmas, all!
 
Questions?

What happens if a current kicks up during the dive?

What happens if a down current sweeps you over a reef?

What happens if the seas kick up while you are under? Large surf and the ladder is jumping out of the sea?

What if something happens to your buddy and she requires towing back to the boat!

You are putting both you and your buddy at risk. You said you have insurance use it and cancel the trip. The PI will be there next year. It ain't worth it IMHO.
 
one point i want to note... u can live without an acl..
my doctor tells me that many sprinters that dun have torn acl.. they choose to do menicus damage repair surgery only.

that was an option given to me by my doctor. as my main concern is that when i walk ... i was having very sharp pain on my knee... when your daily life is affected then get it fix. that was caused by my menicus damages.. as i mention.. mine was quite extensive...

talk to the doctor more... ask all question that comes up... that is what they are they for... i grind my doctor so much that he think i was an real athlete concern about my sporting future!

rest well... know yourself and make the right decision...
 
So I'm managing to walk OK at the moment which is encouraging. In terms of surgery - I would strongly like to regain full strength, but will see how I go with stability etc in a couple of months. My surgeon did advise that surgery was optional, and given that downhill skiing, tennis, squash etc are not on my must-do list that living without the acl might be a course of action, given the lengthy rehab time after surgery. In addition to the usual transplants, he has also done a large number of LARS reconstructions, which apparently has a much better recovery time, etc, etc.

Anyway, Doubler:

Questions?

What happens if a current kicks up during the dive?

What happens if a down current sweeps you over a reef?

What happens if the seas kick up while you are under? Large surf and the ladder is jumping out of the sea?

What if something happens to your buddy and she requires towing back to the boat!

You are putting both you and your buddy at risk. You said you have insurance use it and cancel the trip. The PI will be there next year. It ain't worth it IMHO.

Firstly, I REALLY appreciate the questions and being challenged on this. Thank you!

I've already discussed with her my own reservations around my ability to assist my buddy should we have problems, and I insist on having a third diver present. The plan already is to pay for a private guide on all dives, even shore/house reef type ones, and to make sure that guide understands that I'm expecting them to keep close and be ready for a rescue if either of us has issues. Not ideal, but an additional margin of safety. In terms of those specific scenarios, please understand that this is purely a thought experiment. I will really need to see how I go in the water to be better able to answer these. If it turns out I don't feel confident, well, honestly I'd rather be sitting on a beach watching my wife dive than sitting at home watching television. I can live with that. I can also live with sitting out more dives than I make, diving only when conditions and forecasts are benign, etc. However your point, of course, is that the best laid plans can go to hell, etc, and you're right. So, assuming I'm competent with a strong flutter kick from the hip (a straight line movement that the ACL should not greatly impact, but which I would consider a non-negotiable in terms of basic fitness to dive):

If the current can't be managed, I'd do what I would if caught in a current that I thought posed a risk at any other time. I'd thumb the dive, shoot a DSMB, and ascend normally with a stop.

Erk. But, I guess ditto to the above. Inflate, kick away from the wall (or crawl sideways along it or whatever). Get out of the current, re-establish buoyancy, calculate if new stops are needed if unplanned depths were hit, check how gas management is looking, and ascend super conservatively, extending stops where possible.

This one alarms me. I can see problems here. But with typical banka construction (these are terrible boats in big seas anyway - not like a RIB or larger dive boat - the sort of seas you are describing here they really, really try to avoid. I saw one take damage in about a 1.5m swell) I would try to hand my gear up on a rise, grab on to the ladder with both hands and at the least my good foot on a rise, and use moments when I was in the water to try to move up a rung and cling on when heaved out of the water. Crew would usually assist all exists even in calm conditions anyway, holding the tank valve etc. But I confess this is not a pleasant scenario as I'm seeing bits breaking off the boat too.

Again, if I can't manage a straight-leg kick with decent power I don't think I have much business being in the water anyway. Assisting my buddy back onto the boat, or pulling an unconscious buddy up onto dry land on a shore dive or whatever would really depend on how well I heal as to my abilities. Also, third safety diver/guide. Posing a risk to my buddy is something I take VERY seriously, and it's right you should mention it.

So those were interesting thought experiments. I guess I am encouraged by the mobility I am already gaining, but will really have to see how I go in the water before I have any idea how limited my diving is likely to be in two weeks.

I will definitely sit out dives if it looks like conditions will be choppy, and the local crews do seem to be well able to judge if wind is likely to pick up, etc, during the day. Mobility just on the boat itself is a real concern for me in that situation anyway. I don't want to be on a terribly unsteady deck full stop.
 
Mantra. Great on you. I would also rather sit on a beach with my leg up as well if I can dive...

One thing I want to add and hope u remember is that as you walk more... U will sense that it take more out of you .. Your muscles on the thighs and calf will feel really tight. A good massage will take care of that...

Maybe you can plan that when u go off on this 'maybe' diving holiday... :)
 
Mantra I give you kudos for thinking about what you are doing in advance as many people don't. I also understand putting down hard earned cash for a trip and planning it for a year and getting injured a couple of weeks before. Been there done that. If third diver was a friend and someone I dove with on a regular basis that would be one thing, to hire a guide as a fall back safety position that is something else. Something else to think about what if something terrible where to happen and your wife, through no fault of her own, couldn't help you, can she live with the guilt that she is probably going to feel. If you are worried about DCS and you plan on keeping shallow, and you plan on shortened dive times, and one dive a day, icing the knee after each dive, (how does icing affect blood flow and off gassing) is this really a dive vacation or a I'm a going any way because I spent the money vacation. If it where a hiking vacation what would you do? Think about getting a Pegasus unit for emergency propulsion.
 
Mantra I give you kudos for thinking about what you are doing in advance as many people don't. I also understand putting down hard earned cash for a trip and planning it for a year and getting injured a couple of weeks before. Been there done that. If third diver was a friend and someone I dove with on a regular basis that would be one thing, to hire a guide as a fall back safety position that is something else. Something else to think about what if something terrible where to happen and your wife, through no fault of her own, couldn't help you, can she live with the guilt that she is probably going to feel. If you are worried about DCS and you plan on keeping shallow, and you plan on shortened dive times, and one dive a day, icing the knee after each dive, (how does icing affect blood flow and off gassing) is this really a dive vacation or a I'm a going any way because I spent the money vacation. If it where a hiking vacation what would you do? Think about getting a Pegasus unit for emergency propulsion.

Hey man, thanks again. I will be frank about why I'm so motivated here in part. It's not about money. It's more that my wife and I have had brutal years with work, and need a sanity break. There's something about putting distance between home and an island somewhere, spending the days in the water and the sun doing physical things (diving just helps you be so present in the moment, you know?) etc. This has been a good wake up call for that, actually. Both of us believe that life is too precious to spend it living for the weekend, and it seems we've both been doing that on a broader scale, so we need to tweak how well our personal values are aligning with the life we are actually creating. So ultimately that's no better a motivation than worrying about money in terms of the wisdom of it, but there's the truth of it.

Agree about an unknown third diver being less than ideal. No likelihood that a guide in those areas is rescue trained etc etc. But at least they will be comfortable in the water and have air and extra hands and a heads-up that we are relying on them as more than a critter spotter. Ideal? Nope.

I'm going to reread my deco for divers once the Xmas rush here dies down. But based on the advice I've been given, I'm not super concerned that with these proposed profiles I'm painting a target on my back for DCS. I mean, it should ALWAYS be a major consideration in planning a dive, and I just have to be really conservative right now for the reasons you mention.

I will ask DAN about the wisdom of icing. I hadn't fully thought through the circulatory impacts - although am aware that circulation is already an issue in this part of the body. Thanks.

I really do appreciate you helping me think things through better. I totally get where you are coming from, and hope I'd do the same for a friend.

For me, yeah, it's still a dive vacation. It's still something I can enjoy way more than being at home. For me a shallow easy dive is still a very wonderful thing, especially somewhere like this. And knowing my wife is getting to dive as much as SHE wants, even if I'm sitting most of them out, will give me a lot of comfort too. She deserves that, and would do the same for me in a heartbeat. And I get it that emotional reasoning has no place here, but this whole thing is an exercise in trying to find a sensible middle way now I guess.

And I'm encouraged by the fact that if I don't do anything stupid early, I will likely be much better at the end of the trip than I was at the start, so quality of activity should be gently sloping up the whole time.

Hellhole: massages. Massages and mango shakes. You betcha ;)
 
Again, the ACL primarily limits knee extension. It's not going to limit the force that the quads can put across the knee joint. My guess is that a garden-variety flutter kick will be just as strong as ever. The ACL is going to be stressed mostly when the patient is twisting while bearing weight, which is why my concern about the pitching boat deck.

The knee is a peculiar joint, because unlike many others, it has no real reason to want to stay together. The two major bones (tibia and femur) have flat ends that articulate on one another; the joint is stable because of four ligaments that hold it together, but even more, because of the strength of the muscles that cross the joint. The two collateral ligaments are crucial, because if one of them is completely ruptured, the two bones don't even rock back and forth on one another normally. The cruciates are there to limit extension and twisting, and the knee joint is stable without them, but won't withstand as much stress in particular directions. One can make up quite a bit with very strong thigh muscles, so exercises to strengthen the quads and hamstrings will help the patient with any kind of knee instability.

I think doom and gloom scenarios where the OP is unable to rescue his wife are a bit over the top, actually. What's far more likely is that he will try to move around on a boat, stress the knee further, and damage either the cartilage or one of the ligaments critical to the stability of the joint.
 
I just though that maybe getting a soft knee brace for sport will be good... So that if kinda of keep the knee from making the sideways movements that puts a lot of pressure on the menicus... It's bad already... Dun need to make it worst...

Once again.... Rest well from now
 
I'm only too willing to listen to any and all advice.

Shallow dives with a rich Nitrox mixture and a scooter and a couple of strong guys to take your gear, and a lift on the boat so you don't need to try to stabilize yourself on the ladder.

flots.
 
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