In two weeks I've overcome some major milestones, from ditching the crutches and immobilizer, gaining some great range of motion, and slowly regaining muscle back in the quad of my surgical leg. Not to mention, getting out of the house to spectate some of my favorite sports teams!
This is not to say that it's been increasing improvement each day, or, without pain. As you may know, within 1 week of surgery, the goal was to get to a 90 degree bend. I was delighted to be able to reach that goal (even though in PT I went through the worst pain I've felt in my life...). Between that 90 degree PT visit and Sunday's home PT (6 days later) I figured I'd gain 5-10 degrees on any given day, and be flying towards full range of motion. Instead, I found myself getting to what looked to still be about 90 degrees and really beating myself up to get just a little more bend.
Welcome to my (then) pity party with RSVP of yours truly. Instead of being happy with at least remaining around 90, I was disappointed. I was coming up on the 2 week mark, and hardly had made progress in 6 days. Sure, I was walking a little more confidently, but I still had (and have) trust issues with my knee. What did I have to show for the previous week? I had even religiously done my PT work at home on Saturday and Sunday, and felt that it had hardly made a difference.
Reality check: At the time of my 1-person pity party, I was still under 2 weeks from major knee surgery. Recovery takes time. I had to remind myself (and be reminded) that I can't get down on myself when I still have 11/12ths of the road to recovery to go!!
This takes me to PT on Monday, 4/27. I worked with Michelle again and the first thing she asked me to do was try to flex my surgical quad. I did, and she lit up and said, "There you go! Much better [than Friday]!!" and with that, my mood started to turn more positive. I went on to do a few more exercises....
After a few warm-up tasks, it came time for the most dreaded part- forced bending. I mentioned to her that I tried to do it at home, but wasn't getting the improvement I'd hoped for. "We'll see..." she said. She tried to keep me occupied with other conversation, and I tried to relax. The less I fight her, perhaps there'd be more bend and less pain. A few slow bends, reaching a somewhat painful point, and coming back off, we maybe bent my leg 3 times or so. Finally, she got the tool to measure how much I was bending and we pushed it one last time...
"Last Friday you were freaking out around 90 degrees and look at you now! Just shy of 120 degrees! That's some impressive improvement!"
With that news, I was ecstatic. I allowed myself to enjoy the surprise of the new range of motion, and finished my work-out with determination. And while I'm not sure what I'm doing at home that might be helping increase the bend, this new achievement supported my plan to keep up with PT at home as if I had a trainer looking over me!
So here I am, 2 weeks post-op and pain and setbacks aside, I feel confident I'm on my way to that full recovery I keep hearing about... ;)
Bruising on the inside of the calf much less noticeable; Bruising on the back of the knee fading significantly
The only difference is that I did not use the 'continuous passive motion machine'. I'm on my own for regaining range of motion!
With the exception of a little forced straightening (which, I am pretty much there on my own, so it's not nearly as painful as bending), we stuck to some classic exercises to work on my range of motion. These exercises can be found in the 4/22 entry on my ACL Calendar.
Immediately following PT, I went upstairs in the same building to have my 1 week follow-up visit with Dr. Jeffrey Shapiro.
First, x-rays were taken. I am not sure this was entirely necessary, since there were no bone issues found in the pre-op MRI nor seen in surgery. However, this time I was all for it, because I wanted to see the two titanium screws that were holding my reconstructed ACL (aka, patellar tendon) in place! How do you like 'em?
After x-rays were taken, I had to wait a while so I listened to the hub-bub of the doctor's office that was going on outside of my exam room. I was so glad to be on the other side of the surgery now, and while there is still a lot to experience and learn, at least this wasn't all brand new to me anymore, and I wasn't nearly as scared!
When Dr. Shapiro finally came in, he gave me eye contact, a firm handshake, a smile and the inevitable question, "How are you doing?" I was comforted that I didn't feel like 'just another patient' and I give Dr. S credit for that, which perhaps I didn't give him the first time I met him.
The physical exam was short. First, he had me straighten the leg on the table in front of me (and said, "Good!" when he saw I could straighten it to zero degrees). Once straight, he placed his hands at the top and bottom of my kneecap which caused a jerk reaction: my body went completely stiff and I grabbed his closest arm (thanks a LOT PT!!). We actually both had a laugh at that, as I apologized, relaxed and he said he was just glad I didn't hit him! hehe...
With his hands at the top and bottom of my knee, he carefully manipulated the kneecap, squeezed a little here and there, and finally, tested for looseness. For you dedicated readers, you might remember how painful my initial visit with Dr. S was when he did this same test for 'looseness' and originally diagnosed my torn ACL. I am happy to report that he was not only a little more gentle this time, but thanks to a successful surgery, there was hardly any pain.
Finally, he had me bend it to 90 degrees (which, since I had recently iced after finishing PT was a little more difficult than I'd wanted), but I got there nonetheless. He was satisfied!
There was a quick Q&A, but basically he said that there were no other issues found within my knee during the surgery, and that if I keep on track with PT he expects nothing less than a full recovery. I didn't think he'd tell me any differently, but it was great to hear! From here I won't need to see Dr. Shapiro for another month.
And, I hope this isn't too long-winded (feel free to stop reading) but when the Dr's assistant [Krista!] came to re-tape the incision area, I learned something new. After surgery my incision had been stitched up from the inside using bioabsorbable stitches. Up until today there had been just one piece of vertical tape, which had a white string coming off of it. I thought this was just a piece of the tape, but this was the end of the stitching! So once untaped, Krista gave this string a gentle pull and cut it as close to the skin as possible. It was an odd sensation, but maybe moreso because I then knew that it ran inside of my knee and was holding the incision together!! In this pic you can kind of see the loose 'string' coming off the bottom of the one piece of tape that doesn't align w/ the rest:
I was then re-taped, and sent on my way. Before going, I asked if I could get a copy of the arthroscopic images taken during the surgery. They're in black and white, plus I have no clue what I'm looking at, but it's so great to have more fun images to share!
If you would have told me this week would go by so quickly, I wouldn't have believed you. But trials and tribulations aside, there have been some definite improvements that have me keeping a positive mind in my eventual recovery!
- I can bend beyond 90 degrees and straighten to zero degrees
- I can bear all of my body weight on my surgical leg (veeery carefully)
- I can walk (albeit slowly and quite hobble-ish) without aid of crutches or a brace
- I can get up and down stairs without assistance
- I can drive
- I can bathe (woo hoo!)
Of course, there are many milestones including:
- Going up and down stairs w/o having to take them one at a time
- Walking w/o a limp
- Regain balance (on both and) in my surgical leg
- Regaining entire range of motion
- Returning to sports (this is KEY for my sanity!!)
- Getting back to 'normal' !
I understand this will take 6-12 months, and I'm not planning on being a hero and getting out there too early. However, I hope I can continue with physical torture... I mean therapy (!) with vigor until I'm where I am capable of being, both physically and mentally! Of course I wouldn't be able to do it without a strong network of support, so again, thank you to everyone for all your help and kindness.
And because everyone likes photos (or, is it starting to gross you out?!)... some Day 7 post-op pics, for reference:
Increased yellowing and bruising, primarily on the inside of the knee and a little down the shin.
Bruising has also come about on the back of the knee:
4 Days Post-Op:
5 Days Post Op:
Now, granted, the pic above of 90 degrees was taken after PT, but to my credit, I did try at home that morning, and got to ~85 degrees and was delighted! As you can see here, on my way to PT I was able to get myself into the car and also crack a smile. Clearly I did not know what was waiting for me behind PT #3...
I arrived in my immobilizer and on crutches, and made my way so I could unwrap everything as I sat on one of the padded PT tables.
First, sitting upright with legs extended in front of me, I did 45 reps of using a belt around my surgical foot to pull the heel towards my butt, causing my leg to bend, then using my leg to push back out to straight. This is an easy way to 'warm up' the joint, as shown here during my at-home PT:Next, it was extend and bend time. I was lying on my back with legs extended as Drew massaged the lower thigh and knee-cap area. It was a cross between being painful and a relief. This manipulation lasted about 30 seconds, before he stood up (I was laying around his waist level) and he then leaned into my knee, forcing my leg to straighten as much as possible. In my opinion, I thought he was trying to bend my knee backwards, and this surprise pain caused me to flop around a bit. But it was nothing compared to PT#2's forced bend. I was then asked to flip over on my stomach, and got further massage on the back of my knee. In my few visits I knew this to be the prelude to a very painful forced bend, so already I was getting anxious. He did distract me though, by massaging the bruised area on the back of my knee (pictured below) which hurt a bit, but not terribly. Then, the moment I'd been dreading.
I am not sure where he places his hands, as I get into a foggy mentality at that point. But needless to say, he pushes my knee to bend beyond comfortable (or even uncomfortable) limits, into the screaming, gasping, never-felt-pain-like-this-before range. This is not meant to scare anyone, but I would not have wanted to watch this being done to myself or anyone else. Even though I was in an open PT area with other recovering people around me, I had no ability to limit the noises and cries coming out of my mouth. I actually cried/yelled, "STOP-STOP-STOP-STOP-STOP!!!" as he continued to bend my knee. Eventually, he did stop (this forced motion probably took all of 15-20 seconds, but felt like an eternity). My only saving grace was that instead of doing this 3 times, as he had done on Friday, he only did it once.
Drew told me he bent it to 95-100 degrees. I'm all for working towards a successful recovery, but be HONEST with me, man! If you're expecting more than 90, don't tell me 90! 5-10 degrees may not SEEM like a big difference, but trust me, I could feel every little degree (and the people around me could HEAR it!). There was an older man on the next table over who tried to make me feel better saying he's been through the same thing, but unless I heard his cries of pain, words didn't offer much consolation at that point. What I needed were Kleenex and more Vicodin....
PT carried on in challenging fashion, as I was forced to walk the ~80ft to a bike in the corner w/out brace or crutches, and it was all about being able to put full weight on the surgical leg, which I didn't think I could do w/out it giving out from under me. I had to trust Drew. I had to trust the guy who just put me in the most pain of this whole experience. Talk about a wild inner monologue.
I made it to the bike, where I used the force of my right leg to work on range of motion (ROM) for my surgical leg. Slowly I worked my leg forward and backward around the 'U' made by the lower portion of the pedal revolution, until I could finally make a full revolution with just a little pain.
After that it was more walking, some balancing, some marching in place and finally, icing my knee at the end. I was exhausted and in pain, but at least it was all over.
I went to leave, immobilizer on my leg and crutches under my armpits. As I said goodbye to Drew he looked at me with wild eyes and said, "What are you doing?!" and he motioned to an assistant, "Take those crutches away from her! No more crutches!" I became protective of my supportive crutches and responded, "OK, OK! I won't use them! But I'll carry them myself!" and hobbled my way to my car, where my crutches still sit.... So it's official, I've ditched the crutches!
There are no 'goals' for Wednesday PT, and Drew did say he promised not to beat up on me too badly every time, but perhaps every other time. I don't know what that means, but I did admit to him that if it is necessary for recovery, he can do whatever he wants (what was I THINKING?!). Maybe next time I'll bring a flask.... !
Even though this little 'trial run' seemed silly at first, it felt good to know I had the freedom of my car back!
And, finally, Sunday marked another great event- the start of the Outdoor Soccer Season of LOS HOOLIGANS F.C.- I can't wait to get back out and join you guys!!
Let me give you a quick insight into how things are going here at home. My go-to spot is the living room couch. I have not ventured upstairs to the master bedroom, so I've made this my spot 24/7. I have slept surprisingly well! Within reach I have my crutches, some snacks, puzzles, the laptop, my camera (of course!), water and meds. The coffee table has been moved so the room is open in the middle, and I use this open space to do my PT at home; as shown here:
[Laying on my belly, I am using my non-surgical leg to try to bend my surgical leg to regain range of motion]
Also nearby is the ThermoCompression Unit, which is a machine which cycles 43 degree distilled water/alcohol mixture through a cuff which velcros around my surgical leg. In addition to the cold mixture, it also pumps air into the cuff (alternating, slowly making the cuff more and more tight around my knee). This is similar to the Game Ready unit the same company provides, but I do not have to continuously add ice to it to keep it cool. Here is a pic of me while icing/compressing using the ThermoCompression Unit:
I might be slow, but this is just the beginning of my comeback! Yippee!! ;)
I skipped sign-in, in hopes of finding a seat where I could elevate my leg again. The worst pain has been when all that blood goes rushing to the knee area at first stand!! But it tends to subside, slightly, enough to be tolerable. But I didn't see Drew, my physical therapist, right away, so I laid out on a table until someone told me to move. Our first steps were to remove the immobilizer (which I'd only worn when in the car from the hospital, and now, on the way to PT) and then to undress the wound. There was an ace bandage from my mid-calf to mid-thigh, and under that, a layer of gauze. Around the knee was additional gauze and tape covering the incision sight. Once all of this was peeled away, it looked a lot like this:
As you can tell, I haven't taken the time to shower, as the doc's and my initials are still on my surgical leg!! But the wound was a lot 'prettier' than I expected, as I assumed there'd be more bruising, and perhaps oozing, in the area of the cut. I hear the bruising is on it's way, but otherwise I had minimal additional bleeding, and while this is good for clean-up, it may mean there's extra work for my body to do to relieve the swelling. No worries!
So, at this point I was fully exposed and thought Drew would give me a few pointers on how to be a little more mobile, give me a few things to do at home (simple, like wriggling my toes on the surgical leg), perhaps clean up my wound a little, and be on my way. In these assumptions, I was WRONG. Time to make me work!
First a baseline. I could get my leg completely straight, which is great. As far as bending, I could only get to about 35 degrees. Goal: 90 degrees by Monday (5 days after this visit). As a matter of fact, Drew said if I can't get it to 90 degrees by Monday.... HE will. Yikes.
From here it was a series of seemingly simple exercises for my leg, but it was my mind that took the real toll. I consider myself somewhat tough, but I was so scared that certain motions or movements would hurt, that limited me more than anything else. So whether it was trying to bend or straighten, or trying to use my quad muscles to move my leg, I had a VERY difficult time. And, being scared had me pretty emotional as well- I had to trust that Drew wasn't (a) asking me to do something I couldn't do and (b) if I required his support in moving or lifting my leg, I had to know he wouldn't move or twist too fast, or worse yet, drop my foot or leg unexpectedly. Of COURSE, he was 100% trustworthy, and knows what he's doing, but I felt so vulnerable, it was, again, just mentally tough for me.
This doesn't mean all the exercises were a piece of cake. We did about 5 or so, all just working on firing my quad muscles, or gaining range of motion, sometimes using gravity as an aid, when I couldn't get muscles to fire. (Some more detail available in the 4/15 PT entry of ACL calendar, found in the links to the righthand side...).
All of this reminded me... don't forget to BREATHE. I found myself not relaxing when I needed to, or holding my breath as I did something strenuous. I am lucky to have had an upbringing where I was often told to 'take a few deep breaths' and I will definitely be calling on those skills as I challenge myself in PT in the coming weeks.
Drew tells me I'll be running in 4 weeks. My orthopedic surgeon uncle said this is a very aggressive recovery, so I will follow directions, but don't plan to be a hero and try to get out there before I am good and ready. I am still assuming 6 months before I can get back to what I really love - those organized team sports!
But at home, while there are times of discomfort, I am getting so much support from Eric and my family (and his!) and it's been pretty seamless. I hope to continue in this fashion, and while there are sure to be times of difficulty, I will still manage to try and keep a light heart about it all. Thanks to my great friends and family, I have lots to keep me busy (and, fatten me up as I sit on the couch! hehe) and I am so grateful for that!
Next PT visit is tomorrow (Friday, 4/17) at 4pm. Until then, I'll work on exercises at home, and keep a positive outlook. How could I not, in this atmosphere? ....
But I can't say it enough... THANK YOU to EVERYONE for your amazing support!! xoxo
(nice stocking, eh? hehe) It was in between 1p and 230p that I met all kinds of people... Two nurses (Laura and Susan) had hooked up the IV and done some paperwork. Then came Tracy, the nurse that would be helping during surgery. I also met Randy, the anesthesiologist, and the nurse anesthetist, Shelly. And, of course, Dr. Shapiro. Throughout the introductions everyone was so kind and helpful, happy to answer any questions and I felt like they were really giving me their attention. I've had some poor experiences in the medical field before, and the way things went, I was confident my surgery would be fine. The procedure itself should take ~45 minutes, but they have the room blocked for 2 hours to include set-up, surgery, clean-up, and prepping for the next surgery.
After one last trip to the bathroom (dragging along my IV, my Mom teased that I reminded her of a cartoon, but was just missing having my butt exposed by the gown! hehe), I was then given some substance via IV, where Shelly told me it would just feel like I'd 'had a few drinks'. It did hit pretty quickly, but I was still aware enough to answer questions and talk to people. They then rolled me into the surgery room and I saw Randy, who would be giving me general anesthesia, as we had discussed earlier. [I was comforted by his MSU bandana!] I was told to take a few deep breaths.....
5:00p (?I think?)
All of a sudden I'd lost a few hours of my life! I was groggy and looking around; not in the surgical room anymore. I think this was a recovery room of sorts, but I was still on the bed and a few people were milling about, and another post-surgical patient was on the other side of the room The hospital staff asked me a few questions, but I don't remember what. I do recall trying to be funny in my responses, but I wish I could recall what I'd said! I drifted in and out once or twice, and recall them taking the sticky pads off my chest and ribs. Finally I became more permanently aware, and then they rolled me into a personal recovery room. After being sat in a recliner, I was given some graham crackers and apple juice, and finally, some vicodin! By now it was closer to 6:15p and between the local anesthesia that was injected in my knee at the end of the surgery, the fentanyl and vicodin, I was actually pretty comfortable. Once it was clear that I wasn't going to be sick from the drugs with no food in my stomach, I was taken to the car in a wheelchair, and the three of us headed back home to Thomas Ave.
So... There you have it! I was a little groggy, but for the most part felt aware. I was able to answer some text messages and carry on conversations. For some reason I thought I'd be so drugged up that everything I'd say would be nonsensical, but that was not the case. And, once the script for vicodin was filled, I was able to remain pretty comfortable as the other drugs wore off.
I ended up staying on the couch all night (no point in trying to make it up a flight of stairs to bed!) and was able to sleep well enough. I even had some great dreams about my knee healing, recovery, and being back out on the soccer field! All of this has to be a good sign, right?
So, now it is 1:00p, the day after the surgery, and while there is more pain now than there was at all yesterday, it's mostly manageable. Getting up to the bathroom is the hard part, but can be done. I have a PT visit at 4pm today, and believe all we'll do is undress my knee and take a look at where I am to start.
Again, THANK YOU everyone. I feel so loved and have gotten so much support, I truly am blessed!!
Yesterday was a day off work for Lear (my employer) so I had the day to myself at home. I thought about trying to really 'make it count' , but ended up cleaning and running a few errands (including a drive-by the hospital where they told me I'll need to go since I was already up in the area...) And it was one of those mental things, where previously I thought I'd be more worked up about it, but really, it was just another day.
I got a call in the early afternoon telling me my surgery time would be 2:30pm, so to arrive at Beaumont-Royal Oak Hospital at 12:30pm. I would have preferred an earlier time (just to get it over with, to be honest!) but that has left me with this nice time this morning to relax, take my time, and enjoy the morning to myself before Eric and my mom (who came into town last night) are still asleep. Funnily enough, the only real hassle of this later surgery time is that I was told not to eat or drink after midnight last night. I'm OK now, but I imagine come 2:30p my stomach will have it's own thoughts on the subject!!
So, last night we figured how to set the laptop up to the TV to take advantage of my new NetFlix account, and also watched all 2 hours of the $5 DVD I picked up at Best Buy - SNL's "The Best of Steve Martin" ... It was a fun distraction (and has me thinking of Halloween '09 already!!) ... and lead me right up to a nice cup of tea to round out the night around 11:30pm. [Did you think I wouldn't try to eat and drink right up until midnight? C'mon now!] :)
And after many sleepless nights in the last month and a half since my injury (some due to the injury, but many more due to the over-active brain of mine, which prior to this was never an issue at night...) I finally got a mostly solid good nights sleep, and feel refreshed going into today's events!
Out of everything though, I want to say THANK YOU to everyone for your overwhelming support. I know when it comes down to it, this is a routine surgery being done by an amazing doctor, and I'll be one of the 150 ACL reconstructions he'll do this year... But, of course it's more than that to me, and knowing I have so many of your well wishes, support, prayers, good vibes... call it what you want!... it just means so much!! After this blog I promise to get back into the real details of the surgery and keep my readers riveted!! ;) [Well, we'll see...]
Nowadays the knee is feeling very… normal! As I mentioned before, it’s hard to think that I feel just fine now, but will be putting myself through this surgery and a challenging rehab, just to feel this good again. Being able to plan to be barely mobile is a weird thing to do: it feels like planning for a car to break down. Most people just don’t get this luxury! I’ve been lucky to have the time to do research (and pre-hab) and rest my engineering mind. That, plus the pre-op prep around the house, will surely lead to me keeping my cool around surgery time, right?!
At the homestead the guest bedroom is all cleaned up for my mom, dad and Eric’s mom, respectively, as they’ll be helping me out during the week of surgery. I borrowed crutches (thanks Ed!) and Eric and I put in a removable shower head that will prove helpful in the beginning ‘difficult to stand’ days! Otherwise it’s the little things – like cleaning the floors and getting all the laundry up to speed - that will just be easier now instead of during recovery!
As I tie up those loose ends, I am still faced with the question- what will I do while I’m spending most of my time on the couch, resting and icing after surgery? There are the obvious- reading, puzzles and crosswords, TV/Movies (a trial membership to Netflix may be in order!)… Heck, I might even work on my Mario Kart for N64 so I can continue to take Dan to Koopa Troopa… But, then what? Blogging, surfing the internet and playing solitaire are sure to lose their luster after a few days. It’s here, my friends, that I would love to know what YOU would do!! Expected date to return to work is April 28, so I’ll have some time to kill!
Until then, the cruise control is on and I’ve got lots of fun things to occupy myself until next week… Seeing a show with Sarah, Detroit Tiger’s opening day on Friday, celebrating Eric’s birthday this weekend (Happy Bday, Babe!)… Oh, and did I mention watching MSU tonight in the NCAA CHAMPIONSHIP GAME?!!
(Photo Compliments of Margie's Phone during Saturday's big Final 4 win!!)