Walking seems to be better. I can walk without a crutch decent enough, I think, but still using one crutch to try to make sure the gait is normal.
Woke up with the knee feeling stiff, which makes the first bunch of steps of the day have an awkward gait (knee not extending all the way).
2nd PT visit went well. Was able to do the stationary bike, flexion up to 121 degrees. Extension *feels* like it's almost there, but it isn't. It's better than the original visit for sure.
Did range-of-motion exercises (heel slides and the towel-assisted terminal knee extensions) before bed. Also did a prone hangs for about 5-6 mins with a 5lbs ankle weight! Didn't feel too brutal, so things must be improving.
Wednesday, September 30, 2009
Tuesday, September 29, 2009
Week 3, day 2
Slept poorly!
I think the knee got inflamed from all the exercises and the walking. Even though I iced it before bed, I woke up in the middle of the night with the knee aching and not feeling comfortable. It felt warmer than the other knee (inflammation) and I couldn't get in a comfortable position to fall asleep. I popped an ibuprofen. Not sure if that helped, because I only feel asleep some 2 hours later.
Hope this won't happen again tonight.
On the bright side, showered standing up like a normal person!
Needing to use only one crutch is a big boon, as it frees a hand to carry stuff. This is essential (coffee and water at work, stuff at home).
Night update:
Did all the exercises, once after work and range-of-motion exercises 2nd time before bed. Prone hangs with a 2.5 lbs ankle weight at the end of the night.
I think the knee got inflamed from all the exercises and the walking. Even though I iced it before bed, I woke up in the middle of the night with the knee aching and not feeling comfortable. It felt warmer than the other knee (inflammation) and I couldn't get in a comfortable position to fall asleep. I popped an ibuprofen. Not sure if that helped, because I only feel asleep some 2 hours later.
Hope this won't happen again tonight.
On the bright side, showered standing up like a normal person!
Needing to use only one crutch is a big boon, as it frees a hand to carry stuff. This is essential (coffee and water at work, stuff at home).
Night update:
Did all the exercises, once after work and range-of-motion exercises 2nd time before bed. Prone hangs with a 2.5 lbs ankle weight at the end of the night.
Monday, September 28, 2009
Week 3, day 1: Evening
The PT assigned the following exercises to be done on a daily basis:
* static quads (5 sec hold), 30 reps, 2x day
* towel-assisted terminal knee extension (10 sec hold, see *A below), 10 reps, 2x day
* active-assisted heel slides (10 sec hold), 10 reps, 2-3x day
* straight leg raises, no weight, 3 sets of 15 reps, 1x day
* side leg raises, no weight, 3 sets of 15 reps, 1x day
* heel raises, 3 sets of 15 reps, 1x a day
* calf stretches, gently (twice, 30 second holds for all stretches)
* towel-assisted hamstring stretches (see *B below), gently
* prone hangs (to straighten), no weight now, but 3-5 lbs later, 3-5 minutes, 2x day
I did all of these before bed! (Obviously, things that are 2x day I did only once)
Let's hope I can follow this schedule every day.
The PT said to do strength (leg raises) every day until we start adding ankle weights, at which point the strength exercises will be done every other day.
Time to ice the knee and hit the hay!
... p.s.:
detail on exercises:
*A - sit on the floor, leg straight, place a towel or belt around the foot. Pull the foot towards myself, lifting it slightly, while pushing the knee down like a quad set.
*B - lay on my back, leg straight, place a towel or belt around the foot. Raise the leg, keeping it straight, pulling towel to assist until a stretch is felt.
* static quads (5 sec hold), 30 reps, 2x day
* towel-assisted terminal knee extension (10 sec hold, see *A below), 10 reps, 2x day
* active-assisted heel slides (10 sec hold), 10 reps, 2-3x day
* straight leg raises, no weight, 3 sets of 15 reps, 1x day
* side leg raises, no weight, 3 sets of 15 reps, 1x day
* heel raises, 3 sets of 15 reps, 1x a day
* calf stretches, gently (twice, 30 second holds for all stretches)
* towel-assisted hamstring stretches (see *B below), gently
* prone hangs (to straighten), no weight now, but 3-5 lbs later, 3-5 minutes, 2x day
I did all of these before bed! (Obviously, things that are 2x day I did only once)
Let's hope I can follow this schedule every day.
The PT said to do strength (leg raises) every day until we start adding ankle weights, at which point the strength exercises will be done every other day.
Time to ice the knee and hit the hay!
... p.s.:
detail on exercises:
*A - sit on the floor, leg straight, place a towel or belt around the foot. Pull the foot towards myself, lifting it slightly, while pushing the knee down like a quad set.
*B - lay on my back, leg straight, place a towel or belt around the foot. Raise the leg, keeping it straight, pulling towel to assist until a stretch is felt.
Week 3, day 1: First PT appointment
First visit to my PT today. Things are looking good. Still some good strength in quads and hips. Hamstring ain't half bad either. Hurray pre-habilitation! The quad lag that worried me is just a little and is small enough that we are starting on straight leg raises right away. Apparently, the lag is not due to lack of strength, but more due to swelling/fluid interfering with muscle activation and that fluid also getting in the way of movement.
Cold extension 4 deg, flexion 103.
I tried walking with one crutch in the office and did pretty well! So gonna use one crutch for two days (until next PT appointment), while trying to make sure I have proper gait. I was actually able to do some walking with no crutches, but I have a limp. The one crutch makes a huge difference. Gotta concentrate on keeping the knee straight, hitting with the heel and toeing-off with my toes.
The plan is to re-evaluate my walking Wednesday and see if I can go to no crutches. If not Wednesday, then hopefully Friday.
Going to keep going to the PT three times a week for the next two weeks. Then we'll scale it down if things are looking good.
Exercises for home include heel slides, towel-assisted knee straightening/quad set, straight leg raises, side leg raises, heel raises, prone hangs. Also light hamstring stretches and light calf stretches.
The electrical muscle stimulation and ice at the end of the PT visit was brutal. OK, I turned it up to a brutal level, and had to turn it down a few notches. Between the pain/discomfort of extending the knee (my heel was propped up) and the electro-stim intensity, it was not a comfortable last 10 minutes. However, it is all good for me!
Cold extension 4 deg, flexion 103.
I tried walking with one crutch in the office and did pretty well! So gonna use one crutch for two days (until next PT appointment), while trying to make sure I have proper gait. I was actually able to do some walking with no crutches, but I have a limp. The one crutch makes a huge difference. Gotta concentrate on keeping the knee straight, hitting with the heel and toeing-off with my toes.
The plan is to re-evaluate my walking Wednesday and see if I can go to no crutches. If not Wednesday, then hopefully Friday.
Going to keep going to the PT three times a week for the next two weeks. Then we'll scale it down if things are looking good.
Exercises for home include heel slides, towel-assisted knee straightening/quad set, straight leg raises, side leg raises, heel raises, prone hangs. Also light hamstring stretches and light calf stretches.
The electrical muscle stimulation and ice at the end of the PT visit was brutal. OK, I turned it up to a brutal level, and had to turn it down a few notches. Between the pain/discomfort of extending the knee (my heel was propped up) and the electro-stim intensity, it was not a comfortable last 10 minutes. However, it is all good for me!
Week 3, day 1: Morning
Woke up, waiting for a ride to work.
Starting to put weight on the right foot and it feels weird! Clearly, weaning off crutches won't be instant here. Going to start with two today, putting more weight on the foot. My leg feels like it will give out easy. The first couple of steps felt strange on the foot.
At work, keeping my heel propped up on a little heater pad, or top of a neighbor's computer, trying to keep the knee in extension as much as I can tolerate.
Starting to put weight on the right foot and it feels weird! Clearly, weaning off crutches won't be instant here. Going to start with two today, putting more weight on the foot. My leg feels like it will give out easy. The first couple of steps felt strange on the foot.
At work, keeping my heel propped up on a little heater pad, or top of a neighbor's computer, trying to keep the knee in extension as much as I can tolerate.
Sunday, September 27, 2009
Week 2, day 7: Evening
Last day of CPM. Got about good 4 hours in it today.
Exercises:
2x knee straightening, going to try to get one more set in before bed (like I did last night).
Some quad sets, maybe 10-15 reps, but they just don't feel strong.
I've been more or less dropping the ball on the quad sets. I hope that the PT will check my form and give me specific instructions (how many sets and reps per day). That will make it easier to follow.
So, first day of PT tomorrow, looking forward to it! Also re-learning how to walk starts tomorrow.
Night update: did one more knee straightening set, then did about 5 mins worth of prone hangs. Damn those hurt too. Couldn't do a whole 5 min hang in one go, and this is without any weight on the ankle.
Exercises:
2x knee straightening, going to try to get one more set in before bed (like I did last night).
Some quad sets, maybe 10-15 reps, but they just don't feel strong.
I've been more or less dropping the ball on the quad sets. I hope that the PT will check my form and give me specific instructions (how many sets and reps per day). That will make it easier to follow.
So, first day of PT tomorrow, looking forward to it! Also re-learning how to walk starts tomorrow.
Night update: did one more knee straightening set, then did about 5 mins worth of prone hangs. Damn those hurt too. Couldn't do a whole 5 min hang in one go, and this is without any weight on the ankle.
Saturday, September 26, 2009
Week 2, day 6: Evening
Slept much better without the brace! Hurray comfort.
Got outside again today, got driven around in my Miata by my friend. Incidentally, he also did the car justice and we experienced some nice G's. My crutches didn't fly out, so that's cool too!
Occasional ache comes and goes in the knee. About to risk it by going to a friend-of-a-friend's party in Somerville. I bet money the apartment will be on the stairs of the 3rd floor of a narrow, steep staircase with no railings. Still, I'm just going to try to be really careful.
Exercises:
Did two 2x of knee extension (sit down, straighten out leg, push knee/thigh down). 10 seconds each. This exercise works much better on the flat floor than the couch (too much room for error). I got the bottom of my knee to start feeling the carpet, so I definitely made a degree or two improvement tonight.
Oh by the way, DAMN it's painful to do! I tried to push it down to a pain threshold, the kind where I swear out loud. I almost got a tear in my eye going by the 9th rep. But hey, I got a few degrees out of looks like, hope it stays that way.
I also attempted another set of quad sets, but I think I may be doing them wrong. Am I supposed to put a towel under the knee to have something to push against? I think so, I'll look it up later.
Bad news: maybe due to the extra extension, I now have noticeable quad lag! OMG weak! Looking at it, it's gotta be about 5-7 degrees. I think it's because I have added several degrees extension, and probably because my quads keep getting weaker anyway.
It's really weird to have quad lag that's so noticeable! I sit there and it's like I can't do anything about that. I tighten the quads, but it's not enough.
Physical therapy cat says:
Hoping I can get another set of knee straightening and quad setting in before bed.
Also, my right leg is noticeably thinner than the left leg. It looks weird.
Got outside again today, got driven around in my Miata by my friend. Incidentally, he also did the car justice and we experienced some nice G's. My crutches didn't fly out, so that's cool too!
Occasional ache comes and goes in the knee. About to risk it by going to a friend-of-a-friend's party in Somerville. I bet money the apartment will be on the stairs of the 3rd floor of a narrow, steep staircase with no railings. Still, I'm just going to try to be really careful.
Exercises:
Did two 2x of knee extension (sit down, straighten out leg, push knee/thigh down). 10 seconds each. This exercise works much better on the flat floor than the couch (too much room for error). I got the bottom of my knee to start feeling the carpet, so I definitely made a degree or two improvement tonight.
Oh by the way, DAMN it's painful to do! I tried to push it down to a pain threshold, the kind where I swear out loud. I almost got a tear in my eye going by the 9th rep. But hey, I got a few degrees out of looks like, hope it stays that way.
I also attempted another set of quad sets, but I think I may be doing them wrong. Am I supposed to put a towel under the knee to have something to push against? I think so, I'll look it up later.
Bad news: maybe due to the extra extension, I now have noticeable quad lag! OMG weak! Looking at it, it's gotta be about 5-7 degrees. I think it's because I have added several degrees extension, and probably because my quads keep getting weaker anyway.
It's really weird to have quad lag that's so noticeable! I sit there and it's like I can't do anything about that. I tighten the quads, but it's not enough.
Physical therapy cat says:
Hoping I can get another set of knee straightening and quad setting in before bed.
Also, my right leg is noticeably thinner than the left leg. It looks weird.
Friday, September 25, 2009
Week 2, day 5: Doctor Followup
Today was the first follow-up with my orthopedic surgeon.
He said that my knee is looking great. The steri-strips are going to fall off on their own and the stitches are buried deep inside and will not need to be taken out. He did mention earlier that the steri-strips can get wet, but I am going to stop wrapping my knee in saran wrap.
I asked the burning questions: when am I going off crutches and when am I driving?
So, I am getting off the crutches starting Monday, using the protocol of two crutches, then one crutch then zero until I can walk without crutches.
I cannot drive until I cannot walk without crutches. The time to learn to walk again is anywhere from 1 to 2 weeks, so I am looking at one more week of not driving (boo!).
I must work on getting terminal knee extension. Towel under heel and all that good stuff. Prone hangs. I'm gonna get this baby straight.
The surgeon showed me intraoperative pictures. I am going to post those later. Those were cool! All my meniscuses are clean as a whistle. I can see the new ACL.
I'm only now wearing the brace while walking and not during sleep! Hurray! Sleep without brace FTMFW.
Physical therapy starts Monday. The doctor wrote a script for the PT, which includes no hamstring strength until Nov 14th.
I asked the doctor which tendons he took. He said he took the semitendinosus and gracilis tendons. He said since it's the tendons and not muscle, they will regenerate and I will have full strength of my hamstrings back. w00t!
I asked the doctor about what I felt was the poor fitment of the brace. He said that I should cut off one of the tightening straps that's right over the incision and just use the large tightening straps. Also, he explained that the function of the brace is three-fold: 1) to protect me in case of a fall, 2) to signal to others that I'm injured (VERY interesting! Didn't think of this!), and 3) to make it awkward to move around, to force me to be more careful. I can understand point #3: basically, while the brace is on, I know I should be careful not to twist or do anything stupid that may jeopardize the ACL.
One thing that he mentioned is that because the ACL surgery has advanced so much and is now less painful, people are inclined to try to be more active than they can be. Hence, the one function of the brace to remind me that I am still healing.
I only should continue the CPM machine use until Monday (I'll see if I can get it picked up Monday night).
The icing regimen is just once a day, after physical therapy or before going to sleep.
So!
I am a bit disappointed that I can't drive for another week. I hope it only takes one week (or less!) for me to learn to walk.
Time to get that knee extension back. Terminal knee extension exercises (towel under heel, push knee down) 10 repititions of count to 10, 3 times a day.
He said that my knee is looking great. The steri-strips are going to fall off on their own and the stitches are buried deep inside and will not need to be taken out. He did mention earlier that the steri-strips can get wet, but I am going to stop wrapping my knee in saran wrap.
I asked the burning questions: when am I going off crutches and when am I driving?
So, I am getting off the crutches starting Monday, using the protocol of two crutches, then one crutch then zero until I can walk without crutches.
I cannot drive until I cannot walk without crutches. The time to learn to walk again is anywhere from 1 to 2 weeks, so I am looking at one more week of not driving (boo!).
I must work on getting terminal knee extension. Towel under heel and all that good stuff. Prone hangs. I'm gonna get this baby straight.
The surgeon showed me intraoperative pictures. I am going to post those later. Those were cool! All my meniscuses are clean as a whistle. I can see the new ACL.
I'm only now wearing the brace while walking and not during sleep! Hurray! Sleep without brace FTMFW.
Physical therapy starts Monday. The doctor wrote a script for the PT, which includes no hamstring strength until Nov 14th.
I asked the doctor which tendons he took. He said he took the semitendinosus and gracilis tendons. He said since it's the tendons and not muscle, they will regenerate and I will have full strength of my hamstrings back. w00t!
I asked the doctor about what I felt was the poor fitment of the brace. He said that I should cut off one of the tightening straps that's right over the incision and just use the large tightening straps. Also, he explained that the function of the brace is three-fold: 1) to protect me in case of a fall, 2) to signal to others that I'm injured (VERY interesting! Didn't think of this!), and 3) to make it awkward to move around, to force me to be more careful. I can understand point #3: basically, while the brace is on, I know I should be careful not to twist or do anything stupid that may jeopardize the ACL.
One thing that he mentioned is that because the ACL surgery has advanced so much and is now less painful, people are inclined to try to be more active than they can be. Hence, the one function of the brace to remind me that I am still healing.
I only should continue the CPM machine use until Monday (I'll see if I can get it picked up Monday night).
The icing regimen is just once a day, after physical therapy or before going to sleep.
So!
I am a bit disappointed that I can't drive for another week. I hope it only takes one week (or less!) for me to learn to walk.
Time to get that knee extension back. Terminal knee extension exercises (towel under heel, push knee down) 10 repititions of count to 10, 3 times a day.
Week 2, day 5: Morning
Slept right thru my alarm. Oops! Slept decently well. Had the top strap of the calf portion looser on the brace, so it could move around up and down, rubbing less against my incision site.
Going to see the Dr soon! Will post details on what happened in the followup visit.
Going to see the Dr soon! Will post details on what happened in the followup visit.
Thursday, September 24, 2009
Week 2, day 4: Afternoon
Couldn't sleep worth anything. Readjusted the brace three times at 5am, made a bathroom trip. Between everything, that seemed to work and slept until 10am.
Accidentally put weight on the ACL leg AGAIN today. Twice, once was just a bit more than touchdown weight, so not too bad, but 2nd time was like a good amount of weight. Not full body weight, but probably a good half. Crap. Hope that doesn't mess anything up.
Accidentally put weight on the ACL leg AGAIN today. Twice, once was just a bit more than touchdown weight, so not too bad, but 2nd time was like a good amount of weight. Not full body weight, but probably a good half. Crap. Hope that doesn't mess anything up.
Wednesday, September 23, 2009
Week 2, day 3
Another quiet day in the CPM machine.
The knee seems to be less swollen and there's less bruising. The inflamed hot spot to the left of the kneecap is not hot anymore, just barely warmer. Feeling some random aches inside though. Popping a 200mg ibuprofen every 4-6 hours.
Icing nowhere near as frequently now, just like about 2-3 times in the morning, maybe another 1-2 times after. Forgot to do my quad sets earlier today, will do those soon.
My right thing really is looking considerably skinnier. It's really weird. I haven't seen it so skinny since before college.
The knee seems to be less swollen and there's less bruising. The inflamed hot spot to the left of the kneecap is not hot anymore, just barely warmer. Feeling some random aches inside though. Popping a 200mg ibuprofen every 4-6 hours.
Icing nowhere near as frequently now, just like about 2-3 times in the morning, maybe another 1-2 times after. Forgot to do my quad sets earlier today, will do those soon.
My right thing really is looking considerably skinnier. It's really weird. I haven't seen it so skinny since before college.
Week 2, day 2: Evening
My sister came over to visit this afternoon. I suggested we go somewhere, because I've been inside the house since the surgery and I needed to get the heck out. I was starting to get sick of spending all this time on my couch.
It was real nice to go outside! F this couch! It was warm and cloudy out. Fitting into the passenger seat was no problem, as I have about 90-95 deg flexion easy now. I moved the seat all the way back and that gave me enough room to flex the leg in.
We drove up to pick up my dry cleaning (been hanging out there for 2 weeks now) and grab some dinner with some beers.
Speaking of beer, I had my first post-op beer Sunday, after I decided to stop taking Percocet. It was a Weyerbacher Slam Dunkel. I followed that up with a Victory Prima Pils. Mmm mmm delicious!
Crutching around for a short distance was fine, from car to restaurant and such--seemed easy enough. However, I did have a stumble where I put more than touch-down bearing weight on my right foot! I lost my balance a little getting out of the car and put about quarter weight or something like that on the right leg. It was certainly not full weight, but it was more than touch down as well. I hope that didn't mess anything up. This is the only such incident so far. I was more careful after that. (And this was before the beers too!)
We decided to take a stroll down the nearby mall, to kill some time before a movie. So I ambulated over a half mile on crutches. Holy arm workout! I'm going to be feeling *sore* tomorrow! I sweat easy and so I had a wet shirt by the time we got to the other end of the mall. My shoulders were certainly not used to this either and my arms were yelling "wtf are you doing buddy?!" And I still had to make my way back! After that, I wasn't feeling a movie.
We decided to go to Starbucks instead and just relax, so my sister took an initiative (as usual) to take some pictures of my sweaty self. So here I am, after over a half mile of crutching:
Yeah, I sweated a lot:
We saw a funny label on one of the machines:
I can't imagine doing 6 weeks of non-weight bearing, as is the case in many knee surgeries that require meniscus-related procedures. I have 3 more days before the follow-up with the surgeon, where I will hopefully get to drop my crutches.
Finally, my sister mentioned an interesting tidbit that happened in the pre-operation room on the day of the surgery. When the surgeon walked in, I had a list of questions prepared to ask. This was moments before I got the "six pack of beer" IV injection and was carted off. I was told that I'd have the opportunity to ask the Dr questions before the operation, so this was it. According to my sister, when the surgeon saw me clutching a paper with a list of questions, he gave one of the nurses a "here we go, what's he got here?" kinda look. As in "can you believe he has a list there" type of look. Just a funny tidbit.
It was real nice to go outside! F this couch! It was warm and cloudy out. Fitting into the passenger seat was no problem, as I have about 90-95 deg flexion easy now. I moved the seat all the way back and that gave me enough room to flex the leg in.
We drove up to pick up my dry cleaning (been hanging out there for 2 weeks now) and grab some dinner with some beers.
Speaking of beer, I had my first post-op beer Sunday, after I decided to stop taking Percocet. It was a Weyerbacher Slam Dunkel. I followed that up with a Victory Prima Pils. Mmm mmm delicious!
Crutching around for a short distance was fine, from car to restaurant and such--seemed easy enough. However, I did have a stumble where I put more than touch-down bearing weight on my right foot! I lost my balance a little getting out of the car and put about quarter weight or something like that on the right leg. It was certainly not full weight, but it was more than touch down as well. I hope that didn't mess anything up. This is the only such incident so far. I was more careful after that. (And this was before the beers too!)
We decided to take a stroll down the nearby mall, to kill some time before a movie. So I ambulated over a half mile on crutches. Holy arm workout! I'm going to be feeling *sore* tomorrow! I sweat easy and so I had a wet shirt by the time we got to the other end of the mall. My shoulders were certainly not used to this either and my arms were yelling "wtf are you doing buddy?!" And I still had to make my way back! After that, I wasn't feeling a movie.
We decided to go to Starbucks instead and just relax, so my sister took an initiative (as usual) to take some pictures of my sweaty self. So here I am, after over a half mile of crutching:
Yeah, I sweated a lot:
We saw a funny label on one of the machines:
I can't imagine doing 6 weeks of non-weight bearing, as is the case in many knee surgeries that require meniscus-related procedures. I have 3 more days before the follow-up with the surgeon, where I will hopefully get to drop my crutches.
Finally, my sister mentioned an interesting tidbit that happened in the pre-operation room on the day of the surgery. When the surgeon walked in, I had a list of questions prepared to ask. This was moments before I got the "six pack of beer" IV injection and was carted off. I was told that I'd have the opportunity to ask the Dr questions before the operation, so this was it. According to my sister, when the surgeon saw me clutching a paper with a list of questions, he gave one of the nurses a "here we go, what's he got here?" kinda look. As in "can you believe he has a list there" type of look. Just a funny tidbit.
Tuesday, September 22, 2009
Week 2, day 2: Morning
Slept better yet. Seemed to have found a better position for the brace. When I am up and crutching around, however, the foam still rubs on top of the incision. Unpleasant!
Can't wait to get off the crutches! I really hope that with the Friday's visit to the orthopedic surgeon, I'll be cleared to wean off them. I do feel car-ready (even now), as I have full ankle control and I have enough flex, it seems, to punch the brake pedal and blip the throttle on downshifts. I noticed that the car-unreadiness that I felt before was after a 30 min icing session, where some of my calf was ice cold and not quite ready for flexing.
No painkillers last night either, only took two Motrins before bed. Pain level was low, so hurray. Still got pretty brutal looking bruising on the knee. As long as that's normal, I don't care, it's just not pretty to look at.
Can't wait to get off the crutches! I really hope that with the Friday's visit to the orthopedic surgeon, I'll be cleared to wean off them. I do feel car-ready (even now), as I have full ankle control and I have enough flex, it seems, to punch the brake pedal and blip the throttle on downshifts. I noticed that the car-unreadiness that I felt before was after a 30 min icing session, where some of my calf was ice cold and not quite ready for flexing.
No painkillers last night either, only took two Motrins before bed. Pain level was low, so hurray. Still got pretty brutal looking bruising on the knee. As long as that's normal, I don't care, it's just not pretty to look at.
Monday, September 21, 2009
Week 2, day 1
It's been a week since surgery. The swelling has come down a good amount and the knee feels better overall. Of course, compared to my left knee, the right knee is still pretty darn swollen.
Last night was the first night without Percocet. I had a hard time falling asleep, I felt hyper/not tired. This was probably due to me sleeping in until 11:30am on Sunday. I can't seem to get the brace on just quite right. The edge of the upper portion of the calf sleeve is right around an incision site, and so it has the potential to rub right against it. I woke up in the middle of the night with my hamstring sore at the top of the tibia. I rolled over a few times and the soreness seemed to move into the upper portion of the hamstrings. The knee was throbbing. I would say about 5/10 pain scale between everything. The brace felt awkward.
I got up at 7am and took two 200mg Advils with a bunch of water. At about 7:30, the pain seemed to sort itself out and it was much more tolerable. I then felt around the hinges of the ACL brace and they seemed to be a good half-inch below the knee hinge point. I looked at the brace and it slid down over the course of the night. I realigned the brace, this time going a bit higher on the calf (still trying to center the brace hinge with the knee). I tightened the calf straps much more. It seemed less painful to do that now (again, because there is that incision site under the top strap of the calf) and I tried to spread the tightening force by making the main wrap-around foam part as tight as I could (before tightening it more with the strap). This seemed to do the trick. I went back to sleep and woke up at 10:30am, much better slept. I ignored my 9am alarm. Working from home today, but I can afford to sleep in.
So technically, last night could argue for not dropping Percs. However, I'll try one more night, with a more careful brace fitment, and some ibuprofen before bed. Let's see what happens.
Quads.
So the quads on the right side are noticeably smaller. I wrote earlier that I had 0 quad lag, but I think that's wishful thinking. I must have around 1-2 degrees quad lag (nothing major like 10 degrees though1), as the heel definitely lags a touch when I fit the leg. I think it has actually gotten a touch worse since Saturday, but that could just be my imagination.
I read this interesting article that basically states that muscle atrophy and failure of voluntary muscle activation explains 85% loss of the quadriceps strength. Specifically, "[analysis] revealed that failure of voluntary activation contributed nearly twice as much as atrophy did to the loss of quadriceps strength."
So basically, my muscles are there, they are not just being activated.
Last night was the first night without Percocet. I had a hard time falling asleep, I felt hyper/not tired. This was probably due to me sleeping in until 11:30am on Sunday. I can't seem to get the brace on just quite right. The edge of the upper portion of the calf sleeve is right around an incision site, and so it has the potential to rub right against it. I woke up in the middle of the night with my hamstring sore at the top of the tibia. I rolled over a few times and the soreness seemed to move into the upper portion of the hamstrings. The knee was throbbing. I would say about 5/10 pain scale between everything. The brace felt awkward.
I got up at 7am and took two 200mg Advils with a bunch of water. At about 7:30, the pain seemed to sort itself out and it was much more tolerable. I then felt around the hinges of the ACL brace and they seemed to be a good half-inch below the knee hinge point. I looked at the brace and it slid down over the course of the night. I realigned the brace, this time going a bit higher on the calf (still trying to center the brace hinge with the knee). I tightened the calf straps much more. It seemed less painful to do that now (again, because there is that incision site under the top strap of the calf) and I tried to spread the tightening force by making the main wrap-around foam part as tight as I could (before tightening it more with the strap). This seemed to do the trick. I went back to sleep and woke up at 10:30am, much better slept. I ignored my 9am alarm. Working from home today, but I can afford to sleep in.
So technically, last night could argue for not dropping Percs. However, I'll try one more night, with a more careful brace fitment, and some ibuprofen before bed. Let's see what happens.
Quads.
So the quads on the right side are noticeably smaller. I wrote earlier that I had 0 quad lag, but I think that's wishful thinking. I must have around 1-2 degrees quad lag (nothing major like 10 degrees though1), as the heel definitely lags a touch when I fit the leg. I think it has actually gotten a touch worse since Saturday, but that could just be my imagination.
I read this interesting article that basically states that muscle atrophy and failure of voluntary muscle activation explains 85% loss of the quadriceps strength. Specifically, "[analysis] revealed that failure of voluntary activation contributed nearly twice as much as atrophy did to the loss of quadriceps strength."
So basically, my muscles are there, they are not just being activated.
Sunday, September 20, 2009
Week 1, day 7
Woke up with the knee feeling better than ever, flexed itself more easily with less stiffness. Still took a Perc overnight, debating dropping that entirely now.
Another day of ice and CPM.
Another day of ice and CPM.
Saturday, September 19, 2009
Week 1, day 6: Morning
Slept better than most night I'd say, though not as careful with the foot propping up on a pillow or the sleeping position otherwise. Had some fluid swelling mostly on the bottom left side of the knee, closer to the thigh.
No significant pain while sleeping, though the top of the brace is right against the 1.5"-long hamstring incision, so it's creating some friction pressure/discomfort there. I think that's the biggest source of pain (and that's more like burning/irritation, rather than pain). At least it's rubbing against the steri-strips and not the wound itself.
Took the Motrin ibuprofen (200mg), that should be OK getting me through the day.
Into the ice machine and CPM machine!
Also, all the bruising on the knee is really coming through becoming quite visible now! Looks like someone bludgeoned my knee.
I can see why driving is unadvised for a while. Tapping my foot to the music in the CPM machine is not quite as controlled as it needs to be. Whoa definitely weird! (This seemed easier to do yesterday though?)
No significant pain while sleeping, though the top of the brace is right against the 1.5"-long hamstring incision, so it's creating some friction pressure/discomfort there. I think that's the biggest source of pain (and that's more like burning/irritation, rather than pain). At least it's rubbing against the steri-strips and not the wound itself.
Took the Motrin ibuprofen (200mg), that should be OK getting me through the day.
Into the ice machine and CPM machine!
Also, all the bruising on the knee is really coming through becoming quite visible now! Looks like someone bludgeoned my knee.
I can see why driving is unadvised for a while. Tapping my foot to the music in the CPM machine is not quite as controlled as it needs to be. Whoa definitely weird! (This seemed easier to do yesterday though?)
Friday, September 18, 2009
Week 1, day 5: Evening
Pain management: feeling pretty good. No narcotics all day today, only took a Percocet just now before bed (just in case something starts throbbing in the middle of the night). Took a Motrin in the morning and the evening and that took off a little ache in the knee.
Been icing with Game Ready pretty much all day (about 10 hrs each day since the surgery). Been following the medium pressure 30 min ice, 30 min off cycle. Definitely notice a decrease in swelling after the first icing session of the day.
5-10 minutes after icing, I can feel the swollen areas get warm to touch. By 30 minutes, they feel pretty hot. That's kinda weird, but that also explains why cryotherapy helps. Yesterday my hot areas (towards the center of the body, left of the patella) seemed to get hot quicker after icing than today. Hopefully, this means that the swelling is going down.
Spent about 8-9 hours in the CPM today (lost count). It took a touch more effort/pain to hit 110 deg on the CPM today (and I'm not sure if it actually went all the way there... but it was 100+), maybe because I haven't been setting it to 110 for a few days now and also because the Percocet wore off.
Did three sets of static quads (12 reps each, holding about 10 seconds) throughout the day. Also followed up with a bit of a straight leg raise, while locking the knee out. So it's kinda like a static quad, but with a bit of a raise of the heel. It does take some effort to lock the knee, but it happens, and I think I should be good for proper straight leg raises now. It seems that by now I have very little to no "quad lag".
Feel a little lazy just icing and CPMing and quad settings all day long. Could I be doing more? Should I be doing more? If nothing else, I am at least definitely following the Dr's orders. The follow-up visit is in a week, Sep 25.
Been icing with Game Ready pretty much all day (about 10 hrs each day since the surgery). Been following the medium pressure 30 min ice, 30 min off cycle. Definitely notice a decrease in swelling after the first icing session of the day.
5-10 minutes after icing, I can feel the swollen areas get warm to touch. By 30 minutes, they feel pretty hot. That's kinda weird, but that also explains why cryotherapy helps. Yesterday my hot areas (towards the center of the body, left of the patella) seemed to get hot quicker after icing than today. Hopefully, this means that the swelling is going down.
Spent about 8-9 hours in the CPM today (lost count). It took a touch more effort/pain to hit 110 deg on the CPM today (and I'm not sure if it actually went all the way there... but it was 100+), maybe because I haven't been setting it to 110 for a few days now and also because the Percocet wore off.
Did three sets of static quads (12 reps each, holding about 10 seconds) throughout the day. Also followed up with a bit of a straight leg raise, while locking the knee out. So it's kinda like a static quad, but with a bit of a raise of the heel. It does take some effort to lock the knee, but it happens, and I think I should be good for proper straight leg raises now. It seems that by now I have very little to no "quad lag".
Feel a little lazy just icing and CPMing and quad settings all day long. Could I be doing more? Should I be doing more? If nothing else, I am at least definitely following the Dr's orders. The follow-up visit is in a week, Sep 25.
Week 1, day 5: Morning
Woke up with the knee feeling better/less swollen than most days so far. Slept better. Took only one Perc for the night. This morning, going to skip Percs and see whether the pain kicks in. Took a Motrin IB as a substitute.
I managed to take a decent shower with some saran wrap around the brace and a Home Depot 5-gal bucket as a shower seat. It was a complicated orchestration of steps, but seems like it should do the job fine for now.
One benefit of the 5-gal bucket is that, unlike a proper shower chair, it moves around the tub some, which compensates for the fixed showerhead.
I managed to take a decent shower with some saran wrap around the brace and a Home Depot 5-gal bucket as a shower seat. It was a complicated orchestration of steps, but seems like it should do the job fine for now.
One benefit of the 5-gal bucket is that, unlike a proper shower chair, it moves around the tub some, which compensates for the fixed showerhead.
Thursday, September 17, 2009
Week 1, day 4: Afternoon
In between the 30-minute ice cycles with the ice machine, I attempted to do some quad sets against a heel propped on the side of the couch. I guess this would be the real quad sets, trying to get that heel lifted up, attempting to keep the knee locked. They are hard! I did a set of 15 earlier and then another set just now, and I barely have enough strength to keep that knee locked.
Going to spend another 8+ hours in the CPM today, but today going to do more quad sets. I realized that tightening the quad muscle on the CPM machine at the 0 position is not quite the same as doing a proper quad set with the knee fully extended.
I can definitely feel the hamstring graft when I mistakenly bend a bit too far forward and cause a hamstring stretch. Ow!
The knee is looking a touch less swollen now, and the surgical incision sites look not quite so gross in daylight.
Will attempt to consume fewer Percs today. Will attempt two in the morning and two before bed. Yesterday, I did two morning, one afternoon and two before bed.
Going to spend another 8+ hours in the CPM today, but today going to do more quad sets. I realized that tightening the quad muscle on the CPM machine at the 0 position is not quite the same as doing a proper quad set with the knee fully extended.
I can definitely feel the hamstring graft when I mistakenly bend a bit too far forward and cause a hamstring stretch. Ow!
The knee is looking a touch less swollen now, and the surgical incision sites look not quite so gross in daylight.
Will attempt to consume fewer Percs today. Will attempt two in the morning and two before bed. Yesterday, I did two morning, one afternoon and two before bed.
Week 1, day 4: Morning and outer dressing removal
Woke up feeling better this morning, the knee didn't feel quite as swollen. Went downstairs for another day of CPM and ice.
Last night, took off the outside dressing, leaving only the steri-strips. It looks gross. Before, sock removed, dressing removed (the longer incision on the top of the photo is the hamstring graft site), a side-view of the removed dressing.
Last night, took off the outside dressing, leaving only the steri-strips. It looks gross. Before, sock removed, dressing removed (the longer incision on the top of the photo is the hamstring graft site), a side-view of the removed dressing.
Wednesday, September 16, 2009
Week 1, day 3: Afternoon
After the morning Percs, breakfast and plenty of icing really helped out the comfort of the knee. Feeling much better than when I woke up.
Strapped in the CPM machine for a good 6 hours today, trying to do quad sets as the machine comes down. Probably doing about 8-10 static quads per hour or two.
I get to take off the outer dressing today. I expect the result to look well nasty.
Strapped in the CPM machine for a good 6 hours today, trying to do quad sets as the machine comes down. Probably doing about 8-10 static quads per hour or two.
I get to take off the outer dressing today. I expect the result to look well nasty.
Week 1, day 3: Morning
Slept so-so. Went to bed at 1:30, woke up at 6:30 for a bathroom break, then got up at about 8:30. Was sleeping on my left side with a pillow in between, trying to keep the swollen knee elevated above the heart.
The brace feels strange. Perhaps it's the swelling and it's pushing down on the knee a bit too much, but it just doesn't feel that comfortable or freely-mobile.
Woke up with more swelling (not measured, just by feel) and more stiffness this morning. Back in the CPM machine now and icing.
Popped another two Percs. I think I still need them, but yesterday I at least managed a 10mg less dose (only took it 3 times yesterday).
Hope the swelling goes down soon.
The brace feels strange. Perhaps it's the swelling and it's pushing down on the knee a bit too much, but it just doesn't feel that comfortable or freely-mobile.
Woke up with more swelling (not measured, just by feel) and more stiffness this morning. Back in the CPM machine now and icing.
Popped another two Percs. I think I still need them, but yesterday I at least managed a 10mg less dose (only took it 3 times yesterday).
Hope the swelling goes down soon.
Tuesday, September 15, 2009
Pre-surgery: physical therapy pre-hab
When I found out I had a torn ACL, a week after the injury, I began attending physical therapy, 1.5 weeks after the injury, for the duration of 2.5 weeks before the surgery.
A friend of mine had an ACL tear and he alerted me of the importance of pre-surgery PT. His surgeon said he didn't have to do anything in particular leading up to the surgery and said that it was OK to wait two months. Over that time, his tendons and ligaments tensed up from the lack of the range of motion (the bundled-up torn ACL restricting that motion). After the surgery, my friend's physical therapist had to spend 1.5 months forcibly stretching out his knee. He was also on crutches for longer than necessary.
I e-mailed my surgeon the same day I found out it was an ACL tear, asking about the pre-hab. My surgeon agreed that pre-hab would be great and quickly forwarded a script to the PT office that I've been going to.
When I got the 2nd opinion on my ACL tear surgery, it was from a highly-recommended surgeon. This surgeon immediately told me that getting the full knee extension back as soon as possible was important (pre-surgery).
In the light of this information, it strikes me that the surgeon that my hapless two-months-of-no-PT friend had is not that good of a surgeon. So now you know folks, do pre-habiliation PT before your surgery.
As far as my own pre-hab physical therapy goes, I've already been attending an excellent local PT office for an running overuse knee injury. So, I've actually ended up having a good amount of quad strength built up as a result of doing the PT for that. This already put me in a favorable position for recovery.
We worked on getting my knee flexion and extension back. I started with 107 degrees flexion on my first visit and ended up with full flexion (something like 147 deg) in several days of doing heel slide exercises. I also recovered a bunch of knee extension via towel pulls and hanging my knee off the bed with ankle weights on it. I almost got to zero extension (perhaps bits of ACL still in there preventing from me being able to fully lock my knee).
I also was surprised to find that, post-tear, I lost some quad strength. At first, it took me some effort to do 2-lbs straight leg lifts, whereas I was up to 7-8 lbs pre-injury. I could also definitely feel my left leg having much more quad strength than my injured right leg. I progressed back up to 6 lbs in 2.5 weeks. I also performed balancing exercises, ball squats and a bunch of other good stuff.
I hope that all of this pre-hab poised me for a quick recovery. F that, I want a phenomenal recovery. I got a stronger-than-stock ACL now, and I am coming back stronger than ever!
A friend of mine had an ACL tear and he alerted me of the importance of pre-surgery PT. His surgeon said he didn't have to do anything in particular leading up to the surgery and said that it was OK to wait two months. Over that time, his tendons and ligaments tensed up from the lack of the range of motion (the bundled-up torn ACL restricting that motion). After the surgery, my friend's physical therapist had to spend 1.5 months forcibly stretching out his knee. He was also on crutches for longer than necessary.
I e-mailed my surgeon the same day I found out it was an ACL tear, asking about the pre-hab. My surgeon agreed that pre-hab would be great and quickly forwarded a script to the PT office that I've been going to.
When I got the 2nd opinion on my ACL tear surgery, it was from a highly-recommended surgeon. This surgeon immediately told me that getting the full knee extension back as soon as possible was important (pre-surgery).
In the light of this information, it strikes me that the surgeon that my hapless two-months-of-no-PT friend had is not that good of a surgeon. So now you know folks, do pre-habiliation PT before your surgery.
As far as my own pre-hab physical therapy goes, I've already been attending an excellent local PT office for an running overuse knee injury. So, I've actually ended up having a good amount of quad strength built up as a result of doing the PT for that. This already put me in a favorable position for recovery.
We worked on getting my knee flexion and extension back. I started with 107 degrees flexion on my first visit and ended up with full flexion (something like 147 deg) in several days of doing heel slide exercises. I also recovered a bunch of knee extension via towel pulls and hanging my knee off the bed with ankle weights on it. I almost got to zero extension (perhaps bits of ACL still in there preventing from me being able to fully lock my knee).
I also was surprised to find that, post-tear, I lost some quad strength. At first, it took me some effort to do 2-lbs straight leg lifts, whereas I was up to 7-8 lbs pre-injury. I could also definitely feel my left leg having much more quad strength than my injured right leg. I progressed back up to 6 lbs in 2.5 weeks. I also performed balancing exercises, ball squats and a bunch of other good stuff.
I hope that all of this pre-hab poised me for a quick recovery. F that, I want a phenomenal recovery. I got a stronger-than-stock ACL now, and I am coming back stronger than ever!
Recovery schedule
These are the recovery milestones we are shooting for. Obviously, subject to change based on PT results and doctor eval, but everything goes well, we are looking at:
2009
Sep 28 (2 weeks) Off crutches: also start PT.
Oct 26 (6 weeks) Back to the gym: stationary bike, elliptical, weights, etc.
Dec 7 (12 weeks) Running.
2010
Mar 1 (24 weeks) Back to sport: full recovery.
2009
Sep 28 (2 weeks) Off crutches: also start PT.
Oct 26 (6 weeks) Back to the gym: stationary bike, elliptical, weights, etc.
Dec 7 (12 weeks) Running.
2010
Mar 1 (24 weeks) Back to sport: full recovery.
Week 1, day 2: Evening
Spending my 8th hour in the CPM and the ice machine. Family came over to visit from 11am until 6:30. Stuffed with delicious food.
The surgeon called to follow up. I gave him a rundown of everything I've been doing. He said that the CPM is just to keep the knee moving and doesn't really need to go past 90 degrees. So the script is to ice, CPM and quad until I see the doctor in about 10 days.
Restocked on ice and threw some water bottles in the freezer. Looking to keep the icing to the max and keeping the CPM going.
So, life on the couch, with the laptop. I'm definitely going to need to work from home next week, maybe even start earlier than I planned, since the boredom is probably going to get the best of me.
On the bright side, I have several friends dropping by for lunch and dinner over the next 10 days!
The surgeon called to follow up. I gave him a rundown of everything I've been doing. He said that the CPM is just to keep the knee moving and doesn't really need to go past 90 degrees. So the script is to ice, CPM and quad until I see the doctor in about 10 days.
Restocked on ice and threw some water bottles in the freezer. Looking to keep the icing to the max and keeping the CPM going.
So, life on the couch, with the laptop. I'm definitely going to need to work from home next week, maybe even start earlier than I planned, since the boredom is probably going to get the best of me.
On the bright side, I have several friends dropping by for lunch and dinner over the next 10 days!
Week 1, day 2: Morning after surgery
Woke up, too early, but with no pain, really. Managed to sleep the whole night on my left side, with a pillow between my legs to ensure that the right knee stayed elevated above the heart.
I got a call from the hospital recovery staff nurse this morning. I told her I have no pain (so the Percs must be working) and she suggested to stay on a regular Percocet schedule for today. No other problems.
As I'm laying in my bed with my knee propped up, I am experiencing a little pain/some discomfort as the knee extends.
Waiting for the Dr's call. Going to make my way downstairs soon and get into the CPM.
I got a call from the hospital recovery staff nurse this morning. I told her I have no pain (so the Percs must be working) and she suggested to stay on a regular Percocet schedule for today. No other problems.
As I'm laying in my bed with my knee propped up, I am experiencing a little pain/some discomfort as the knee extends.
Waiting for the Dr's call. Going to make my way downstairs soon and get into the CPM.
Week 1, day 1: Rehab
When I got home around 5pm, I strapped myself into the CPM machine and had my sister help me get the Game Ready system going, with the articulated knee wrap. I put the ice machine on medium pressure and that seemed comfortable enough.
I did CPM for about 5 hours. I was able to quickly get to 60 and 80 degrees flexion. I left it at that, while letting the Game Ready ice/compress for 30 minutes and then take a break for 30 minutes.
I got to 110 degrees flexion without pain, and it seemed as though I didn't have to force it. Of course, this is a CPM machine on my couch, so a heel slide may tell a different story. My surgeon said that my hamstring will be sore, making the heel slides a little tricky.
I spent 5 hours in the CPM machine, though the dr only recommended 2-4 hrs. I was icing/compressing half the time (30 min on / 30 min off cycle). At some point I realized that I should be doing quad sets (static quads) on the 0 position of the CPM machine, while pushing the middle my kneecap down a bit. So I would do one quad set a minute or so. I ended up doing only about 30-40, but I hope that it will make a difference.
I popped a Percocet at 7pm and then again at midnight, before bed.
However, I then stayed up and used the Game Ready straight knee wrap to ice/compress for another 2 hours (same 30 min cycle). I also realized that I haven't been doing anything to get knee extension, so I ended up resting the heel (and heel/calf) on a pillow. This also kept it elevated above the heart. I had to alternate between a heel and a heel/calf because heel-support only was getting a touch too painful at times.
I attempted straight leg raises, and they seemed to be OK! I had the straight knee ice wrap on, granted, and haven't attempted that in a brace, but I did 3 sets of 15 and it seemed alright. I could feel my quad working a bit.
4 minutes until the Game Ready shuts off and then I'm going to sleep in the brace only. I could've slept in the Game Ready (but I don't know if I would've fallen alseep), but I think the safety of the post-op brace is worth not having the knee iced for the duration of my sleep.
The knee is still swollen, but I feel like I am making good progress on the day of the surgery. My surgeon calls tomorrow and we'll see if I'm on the right track.
I did CPM for about 5 hours. I was able to quickly get to 60 and 80 degrees flexion. I left it at that, while letting the Game Ready ice/compress for 30 minutes and then take a break for 30 minutes.
I got to 110 degrees flexion without pain, and it seemed as though I didn't have to force it. Of course, this is a CPM machine on my couch, so a heel slide may tell a different story. My surgeon said that my hamstring will be sore, making the heel slides a little tricky.
I spent 5 hours in the CPM machine, though the dr only recommended 2-4 hrs. I was icing/compressing half the time (30 min on / 30 min off cycle). At some point I realized that I should be doing quad sets (static quads) on the 0 position of the CPM machine, while pushing the middle my kneecap down a bit. So I would do one quad set a minute or so. I ended up doing only about 30-40, but I hope that it will make a difference.
I popped a Percocet at 7pm and then again at midnight, before bed.
However, I then stayed up and used the Game Ready straight knee wrap to ice/compress for another 2 hours (same 30 min cycle). I also realized that I haven't been doing anything to get knee extension, so I ended up resting the heel (and heel/calf) on a pillow. This also kept it elevated above the heart. I had to alternate between a heel and a heel/calf because heel-support only was getting a touch too painful at times.
I attempted straight leg raises, and they seemed to be OK! I had the straight knee ice wrap on, granted, and haven't attempted that in a brace, but I did 3 sets of 15 and it seemed alright. I could feel my quad working a bit.
4 minutes until the Game Ready shuts off and then I'm going to sleep in the brace only. I could've slept in the Game Ready (but I don't know if I would've fallen alseep), but I think the safety of the post-op brace is worth not having the knee iced for the duration of my sleep.
The knee is still swollen, but I feel like I am making good progress on the day of the surgery. My surgeon calls tomorrow and we'll see if I'm on the right track.
Week 1, day 1: Surgery
The surgery went great! My sister is the best and helped me out immensely today and yesterday. She also took a bunch of pictures of me, so I could embarrass myself in front of all the Internets. I also have a newfound appreciation for all the medical staff. Big ups!
About 1.5 hrs before the scheduled surgery time (of 11am), I was called into the pre-op room and asked to change into a gown and put on these nifty non-slip socks. I've come to appreciate these socks on crutches.
After signing some more papers, the pre-op person (not a nurse? maybe a nurse?) called up an anesthesiologist. This was me, waiting:
The pre-op person explained to me the entire process. IV, signing papers, talking to the anesthesiologist team, talking to the doctor, the "two glasses of wine" relaxing injection, the operation and then the two phases of recovery.
After a little while in the pre-op room, I did begin getting nervous and was looking forward to the "two glasses of wine." When the time came to inject that, the anesthesiologist joked that it was more like a six-pack of beer. (We then joked about what kind of beer it would be.) This stuff worked pretty well and pretty much instantly gave me that "happy yay!!!" feeling. Thumbs up!
I have great veins, as per the anesthesiologist. Hence, she used a 16 gauge needle, in my hand. Damn, 16 gauge is the gauge of speaker wire! (that I often run here and there)
A rep from an orthotics company came over and fit my knee brace to me. It's a Bledsoe OR Post-Op Knee Brace. It's a pretty nifty brace in that it has pretty simple controls for extension and knee flexion limits, as well as a locking mechanism.
This picture shows a touch much leg, so close your eyes, lest you be blinded by the pasty whiteness:
Of course, I had to test drive it:
An assistant to the surgeon came out, for some Q&A. This was when the correct knee was marked and I ended upt having to ask the surgeon whether they mark the correct knee.
Having had only 5-6 hours of sleep, the tiredness began hitting me, but I was ready to rock:
The "six pack of beer" injection took place, my the surgeon, the rest of the team and the interns observing the surgery all gathered round. They carted my jolly self off to the op room.
I remember helping them transferring myself over on the operating table, complying with a "move just a bit over" request and then, bam, I was out.
Post-operation, I woke up in the recovery room, phase I, my knee sore and hurting a darn good amount. Even though there was a tube inserted down my throat, but my throat wasn't (and still isn't) sore.
The surgeon gave me two Percocets (the painkiller prescribed to me) and then gave me an IV painkiller. The pain didn't seem to be coming down sufficiently fast over 15 minutes, so a little more painkiller was administered over IV. This seemed to do the trick enough to make the pain closer to tolerable.
I was then discharged into recovery room II. At this point, the pain became tolerable. I had my CryoCuff ice machine on and the nurse refreshed the water. My sister was called back in and the taking of the photos resumed. Horns up!
I brought my own crutches (the ones I got with the ER visit) and the nurse in the recovery room went over the crutching with me. Even though I've already done some crutching a month ago, this time it is ever so important not to put weight on the right leg (against the doctor's orders).
The nurse was very helpful in readjusting the crutches and showing me proper sitting down and getting up technique.
To finish it off on a grosser note, here's an artsy shot with some blood in the IV tube:
After this was removed, I was wheel chaired out to my awesome yellow hatchback and my sister drove me home, while blasting my favorite tunes. It was a beautiful 75 degree day out.
About 1.5 hrs before the scheduled surgery time (of 11am), I was called into the pre-op room and asked to change into a gown and put on these nifty non-slip socks. I've come to appreciate these socks on crutches.
After signing some more papers, the pre-op person (not a nurse? maybe a nurse?) called up an anesthesiologist. This was me, waiting:
The pre-op person explained to me the entire process. IV, signing papers, talking to the anesthesiologist team, talking to the doctor, the "two glasses of wine" relaxing injection, the operation and then the two phases of recovery.
After a little while in the pre-op room, I did begin getting nervous and was looking forward to the "two glasses of wine." When the time came to inject that, the anesthesiologist joked that it was more like a six-pack of beer. (We then joked about what kind of beer it would be.) This stuff worked pretty well and pretty much instantly gave me that "happy yay!!!" feeling. Thumbs up!
I have great veins, as per the anesthesiologist. Hence, she used a 16 gauge needle, in my hand. Damn, 16 gauge is the gauge of speaker wire! (that I often run here and there)
A rep from an orthotics company came over and fit my knee brace to me. It's a Bledsoe OR Post-Op Knee Brace. It's a pretty nifty brace in that it has pretty simple controls for extension and knee flexion limits, as well as a locking mechanism.
This picture shows a touch much leg, so close your eyes, lest you be blinded by the pasty whiteness:
Of course, I had to test drive it:
An assistant to the surgeon came out, for some Q&A. This was when the correct knee was marked and I ended upt having to ask the surgeon whether they mark the correct knee.
Having had only 5-6 hours of sleep, the tiredness began hitting me, but I was ready to rock:
The "six pack of beer" injection took place, my the surgeon, the rest of the team and the interns observing the surgery all gathered round. They carted my jolly self off to the op room.
I remember helping them transferring myself over on the operating table, complying with a "move just a bit over" request and then, bam, I was out.
Post-operation, I woke up in the recovery room, phase I, my knee sore and hurting a darn good amount. Even though there was a tube inserted down my throat, but my throat wasn't (and still isn't) sore.
The surgeon gave me two Percocets (the painkiller prescribed to me) and then gave me an IV painkiller. The pain didn't seem to be coming down sufficiently fast over 15 minutes, so a little more painkiller was administered over IV. This seemed to do the trick enough to make the pain closer to tolerable.
I was then discharged into recovery room II. At this point, the pain became tolerable. I had my CryoCuff ice machine on and the nurse refreshed the water. My sister was called back in and the taking of the photos resumed. Horns up!
I brought my own crutches (the ones I got with the ER visit) and the nurse in the recovery room went over the crutching with me. Even though I've already done some crutching a month ago, this time it is ever so important not to put weight on the right leg (against the doctor's orders).
The nurse was very helpful in readjusting the crutches and showing me proper sitting down and getting up technique.
To finish it off on a grosser note, here's an artsy shot with some blood in the IV tube:
After this was removed, I was wheel chaired out to my awesome yellow hatchback and my sister drove me home, while blasting my favorite tunes. It was a beautiful 75 degree day out.
Monday, September 14, 2009
In the waiting room pre-surgery
Waiting at the Shapiro Clinical Center of the Beth Israel Deaconess Medical Center. Actually feeling nervous now. T minus 2 hours.
TV is showing Regis and Kelly--it feels like anesthesia for your brain.
Planning on asking the doctor a bunch of questions, mostly about rehab, but also about whether they will mark the correct knee. I bet he will be pleased with that question.
TV is showing Regis and Kelly--it feels like anesthesia for your brain.
Planning on asking the doctor a bunch of questions, mostly about rehab, but also about whether they will mark the correct knee. I bet he will be pleased with that question.
The night before the surgery
The surgery is tomorrow at 11am. My room is cleaned, with lots more space for crutching. My sister is helping me out immensely, especially tomorrow, driving me back from the surgery and helping me set up my daytime continuous passive motion (CPM) machine and ice machine setup.
I'm feeling a touch nervous, maybe a touch anxious, but the anxiety hasn't really hit me yet. I think I will be plenty sleepy tomorrow, as I'm getting less than 6 hrs of sleep before. This may be a good thing for anesthesia, though it probably makes no difference.
I decided to start the drink-nothing eat-nothing protocol just a little bit earlier, at 9:30pm, instead of midnight, just in case.
My sister will pick me up in my yellow Protege5. That is nice, because I love that car and it's one of those familiar things that will feel like home right away. I'm going to set up a favorite album ready to play for the way back. In a way, I am looking forward to getting into that car and sailing away home, to good music.
I don't know how I'll react to the pain (and how much pain there will be). Will I be cranky? I hope not.
Oh yeah, and paid a little too much for a 60-capsule set of 50mg Colace. Given that you're supposed to take 1-3 capsules daily, 60 count is definitely overkill. (Though I just jinxed it).
I'm feeling a touch nervous, maybe a touch anxious, but the anxiety hasn't really hit me yet. I think I will be plenty sleepy tomorrow, as I'm getting less than 6 hrs of sleep before. This may be a good thing for anesthesia, though it probably makes no difference.
I decided to start the drink-nothing eat-nothing protocol just a little bit earlier, at 9:30pm, instead of midnight, just in case.
My sister will pick me up in my yellow Protege5. That is nice, because I love that car and it's one of those familiar things that will feel like home right away. I'm going to set up a favorite album ready to play for the way back. In a way, I am looking forward to getting into that car and sailing away home, to good music.
I don't know how I'll react to the pain (and how much pain there will be). Will I be cranky? I hope not.
Oh yeah, and paid a little too much for a 60-capsule set of 50mg Colace. Given that you're supposed to take 1-3 capsules daily, 60 count is definitely overkill. (Though I just jinxed it).
Saturday, September 12, 2009
Surgery selection
My surgery is on Monday September 14th.
I opted for the hamstring autograft. My orthopedic surgeon did not have a strong preference in the type of the graft, but did note that the hamstring graft (vs an allograft) tends to be stronger. Another doctor (I went to a 2nd surgeon for a 2nd opinion) mentioned that hamstrings tend to have a slightly higher success rate in young people. (I am almost 27).
Another factor was that the hamstring will retain 95% of its strength. This is difficult to distinguish, I'm sure, and I should be able to train the hamstring to have essentially equal strength (I doubt I will ever reach full strength capacity in either of my hamstrings anyway).
I will be going under general anesthesia, which I've done once earlier this year for wisdom tooth removal. I'm not sure whether they are going to give me Vicodin or Percocet for painkillers, but I need to remember to buy some over-the-counter laxatives just in case.
I opted for the hamstring autograft. My orthopedic surgeon did not have a strong preference in the type of the graft, but did note that the hamstring graft (vs an allograft) tends to be stronger. Another doctor (I went to a 2nd surgeon for a 2nd opinion) mentioned that hamstrings tend to have a slightly higher success rate in young people. (I am almost 27).
Another factor was that the hamstring will retain 95% of its strength. This is difficult to distinguish, I'm sure, and I should be able to train the hamstring to have essentially equal strength (I doubt I will ever reach full strength capacity in either of my hamstrings anyway).
I will be going under general anesthesia, which I've done once earlier this year for wisdom tooth removal. I'm not sure whether they are going to give me Vicodin or Percocet for painkillers, but I need to remember to buy some over-the-counter laxatives just in case.
Machinery Delivered
Today, I accepted the delivery of the Continuous Passive Motion machine, which is going to move my knee for me for some 6-8 hours of day (supposedly, haven't received the instructions yet). The rental of this machine is covered entirely by my insurance.
I also opted for a higher-end ice/compression machine, Game Ready. This was delivered as well this morning. It will cost me $250 for 3 week rental (4 weeks if needed), but the PT likes it, and so I'm willing to pay that, if not at least for the increased level of comfort.
I also opted for a higher-end ice/compression machine, Game Ready. This was delivered as well this morning. It will cost me $250 for 3 week rental (4 weeks if needed), but the PT likes it, and so I'm willing to pay that, if not at least for the increased level of comfort.
MRI Imagery
The MRI imagery revealed a full tear. Shown below is the sagittal view of the knee, PD and T2 imaging. Click on the image for a full size.
Otherwise, there is a bit of a meniscus tear, but nothing to worry about. Everything else looks clean.
After getting these images, I spent hours searching the web and comparing these to pictures of normal ACLs.
Other images in my MRI also show impact spots, where one bone moved and struck the other bone during the tear. The bone seems to have travelled unbelievably far, but that's what the doctors believe happened.
The MRI viewer is cool in that it also shows 3D views, made out of the image slices. I couldn't get too much useful info out of those, but I am also not an orthopedic surgeon.
Otherwise, there is a bit of a meniscus tear, but nothing to worry about. Everything else looks clean.
After getting these images, I spent hours searching the web and comparing these to pictures of normal ACLs.
Other images in my MRI also show impact spots, where one bone moved and struck the other bone during the tear. The bone seems to have travelled unbelievably far, but that's what the doctors believe happened.
The MRI viewer is cool in that it also shows 3D views, made out of the image slices. I couldn't get too much useful info out of those, but I am also not an orthopedic surgeon.
The diagnosis
Oh so anxious! What is going on? What did I tear? Torn meniscus? MCL? ACL?
I scheduled an appointment with my orthopedist in Brookline for Tuesday, 7:30am, 3 days after the injury. The ortho felt up the knee and said that I probably tore something, ordering an MRI. I ended up scheduling the MRI for Thursday morning (not as early as I wanted). I was hoping it'd be early enough to get the results by Friday afternoon. Unfortunately, the doctor was out Friday and I only got the word of the results Monday morning.
My mind messed with me in the MRI machine, making it difficult to lie still. At first, it is easy enough. 10-15 minutes into it, I was getting little muscle twitches and realizing that I just tightened some muscles. Still, a cool experience. The MRI machine made lots of weird noises, which, no doubt, would make a cool song.
Monday morning I got an e-mail note from the doctor stating that it's an ACL tear. I scheduled an appointment, earliest available was Thursday, to discuss the results. My anxiety has now come down and I could now begin to prepare mentally.
At the Thursday appointment, the doctor went over the MRI results and discussed the surgical option and its recovery timeframes.
Friday, September 11, 2009
An ACL is torn
I have a full tear of the anterior cruciate ligament in my right knee.
So what kind of glorious, intense activity led to the tear? Was I injured playing basketball? No. Soccer? No. Any kind of sport? No. Kicking puppies? No.
Alas, the moment of un-glory was the dancefloor at a friend's wedding on one Saturday night, August 15th. After tolerating a typically mediocre wedding dance selection and spending most of my time chatting with people, I decided seize the night and dance for at least a little bit. When else do I get to get down wearing a suit? Almost never.
The DJ, by this time, has switched to tolerable top-4o hiphop. I stepped out to "Get Low" by Flo-Rida ("and then she hit the floor"). Alright, not feeling it that much, but at least it's a strong beat with a little syncopation. One or two more songs of the same, and then the DJ dropped the "Rockafeller Skank" by Fatboy Slim ("Funk Soul Brother check it out now"). A-ha, that's my tune right there! Big beat breaks, groovy basslines, time to get down.
Turns out, this was my undoing. I was into it, doing some toprock moves, switching both my feet back and forth simultaneously. At some point, I remember landing on both my feet, my left foot behind me, my right foot ahead of me. As I landed, I felt a snap.
The snap was in my right knee; I felt the top part of my leg move, while the bottom part stayed in place. It was really strange. My first thought was: "that's not supposed to happen! Something just broke!"
I attempted to continue dancing, but the right leg felt strange and I couldn't push off it easily, it felt like it was giving way. There was no instant pain, only that "something ain't right" feeling. There was no instant swelling.
I told the groom "I think I just tore something!" He said: "Go big or go home!" Fair enough--I went big, then had to go home.
I drove home, with my knee feeling achy. I limped a little into my bed and woke up the next day with the knee swollen a bit. I was unable to flex my knee past 90 degrees without pain. I also couldn't extend it straight. Something was wrong.
To go to the local ER, I attempted to get into my Miata, but was unable to flex the knee enough to get the right leg inside the cabin. (Later, I figured out that I could've just moved the seat back). Thankfully, I was able to get in into my Protege5 (an econobox hatchback) and was able to drive myself to the ER.
Hobble was the name of the game. I was afraid to set my foot flat (as that would imply greater knee extension), so I kept the right foot on my toes. This definitely worked my right calf.
I remember hobbling around from registration to triage to the doctor. Every time, the nurse offered a wheel chair and I refused, saying "I'll just hobble around." The nurse replied with "we can fix your knee, but we can't fix your pride."
I was given a knee immobilizer and crutches. I spent the rest of Sunday icing the knee and staying off the right leg.
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