ACL Surgery - Take 2! [Surgery Day Re-Cap]

It's been just over 6 weeks since my right knee ACL tear/MCL sprain playing outdoor soccer. In this time I was able to celebrate my 30th with some great friends and family, as well as attend a beautiful and super-fun wedding up north this past weekend (Congrats Schindlers!!).  Once the fun was over, it was time to get my game face on for surgery.

I tried to prep for surgery by doing the expected the day before- clean up, prepare the couch where I'll be sleeping the first few nights, do some grocery shopping to have snacks on hand... And luckily I also got to meet the brand-spankin'-new addition to the Schwartz family, Mr. Ashton Reid who was born on Friday the 13th! (I forget how small babies are in those first few days-- he is an absolute CUTIE!). It was a great distraction, and Congrats again to Jordan and Katy!

I had my reservations going into today's surgery.  This injury was a lot worse, with the sprain of the MCL and just general muscle tone already fading pre-op.  I also had pain when bending my right leg or putting weight on that leg while standing with it completely straight. I thought to myself that feeling "injured" pre-op (as opposed to feeling fabulous like I did prior to my other knee surgery) might mean that recovery would be more difficult. I can't say if this is true or not (seeing as how I'm not even a half day post-op as I type this) but Dr. Shapiro assured me that the two things were not necessarily linear, and that the pain I was feeling when standing was likely still from bone bruising.  This was good to learn, that apparently it can take 3-6 months for some bone bruising to completely heal, because I had started to convince myself that it was a mental thing. Going into post-op with a mental hurdle already in place would have made for a rough start, since learning to use your knee and surrounding muscles again is very much a mental challenge!

In the last few weeks I'd popped in to talk to Drew, the physical therapist I'll be seeing again. There were no Doctor's orders to do pre-op rehabilitation ("prehab" as I call it), so Drew gave me some at-home exercises with the goal being to fire my quad muscles. In the same visits he mentioned he's "got a plan" for me this time around, to hopefully avoid the oh-so-frustrating hiccup I had last time around 22 days post-op.

When this morning rolled around, the nerves really started to hit me. Which, in my defense, I think my way of being anxious or nervous is relatively laid-back... But still I felt my heart rate rise at times, or had a mental flicker reminding me that I'd soon have drilling done to my bones! :/  Luckily I was sent a ridiculous amount of texts and facebook messages of support from friends and family who knew I was going under the knife today, wishing me luck and a speedy recovery. Have I mentioned how absolutely lucky I am to be surrounded by such great people?! My nervousness must not have showed much, since the nurse anesthetist asked if my husband and I "were in the medical field" since we seemed so calm about the whole thing just minutes before surgery!

The schedule was very much like last time, just 2 hours earlier.  Today we had a 10:30a arrival, 12:30p scheduled surgery (which started closer to 1pm, I think), 3p-ish awakening from anesthesia, and by about 5p we'd already gotten home, got our daughter from a friend and were chillin' on the couch with the thermocompression unit (similar to THIS, but with a sleeve for the leg) wrapped around my knee!

Post-op at the hospital, Dr. Shapiro informed my hubby that they had to remove about 5% of my meniscus. This isn't much to speak of, but according to MRI they were not expecting meniscus damage.  Otherwise it sounds like surgery went as planned.

At home I focused on getting some water in my system, a little food, and using the thermocompression unit to keep me comfortable. For fun I decided to try to flex my quad of my surgical leg, expecting it wouldn't be possible since it normally "shuts off" due to the trauma of knee surgery. To my delight, it DID flex without having to focus too strongly on it, and it doesn't cause any additional pain to do so.  Granted I am not flexing with all my might, but firing at all is the goal, and I was excited to see I could do this (and, continue to do it) as a nice prep for upcoming physical therapy!

I also remember last time I had this surgery that standing up and taking my leg out of an elevated position was very VERY painful as the blood rushed to the knee. Today I've been up and around just a few times since I've been home from surgery, and either the pain meds are better this time around or I'm just having a more positive experience! I am hoping for the latter, and this is giving me a glimmer of hope that post-op will indeed be easier the second time around.

This does not mean that I expect to "get away" with taking it easier in physical therapy (PT). I still fully expect to have to feel the burn as I get back range of motion (ROM) and fire the muscles. I am grateful that I know what I'm in for (even if I'm not looking forward to it) and am ready to commit to the physical therapy to ensure a full recovery!

Let's just hope this positive attitude and committed demeanor don't get too shaken as the reality of it all comes upon me! Meanwhile I'm looking forward to my visitors/helpers and spending a little extra time with my 11-month old daughter, Ellie... Even if it does mean we'll be learning to walk at the same time!!

2 years Post Op

It's crazy to think it's only been 2 years since ACL surgery-- it seems like it was ages ago, and I credit that to getting back to 'normal life' and feeling good in respect to the knee and otherwise!

Any uncomfortable feelings that popped up around 1.5 years post-op have since subsided and I no longer have unexpected popping or discomfort.  The only times I can expect to be slightly annoyed are if I keep my leg in a bent position for an extended time (either sitting on my heel, or leg crossed underneath me - any time the knee is tightly bent) or sometimes with kneeling.  I have tried to get back into yoga and have wrapped up an egg-carton foam piece and brought it to my classes for kneeling poses.

Sports and activities up until the end of last year continued as I wanted ... I was playing year-round indoor soccer and outdoor in the summer, indoor volleyball (though I longed for sand in the summer but didn't have a team...), ultimate Frisbee pick-up games in the fall and the occasional yoga class.  The diversity of these activities didn't seem to matter as the knee held up fabulously!

In mid-December I learned of yet another change to my body that would impact my sports involvement... I got PREGNANT!  So, while I was bummed to have to bow out of my soccer teams and push aside the idea of getting another indoor volleyball team together - at least this time it was something that I wanted to happen! :) Luckily I still was able to sneak in 2 days of snowboarding in Boise over the Christmas holiday to get my taste of the snow for the winter since this meant missing an annual week-long trip out west.

Next week (April 14, 2011) marks my 2 year ACL surgery anniversary, and I'll be 21.5 weeks pregnant (more than halfway to the August due date!).  I've learned that in pregnancy I am becoming more susceptible to pulled / torn muscles and ligaments and over-stretching, etc as my body releases the Relaxin hormone to "loosen" my body for delivery. This, and the pregnancy in general, means my activity regimen has been reduced to running or walking on the treadmill as well as yoga classes that vary in difficulty.  By being aware of my limits and also knowing I want to avoid any other unnecessary medical procedures, I hope to keep myself healthy and uninjured!

Of course this means that this spring and summer I will be back on the sidelines but I plan to once again cheer on my hubby and friends who play on my adored sports teams so they'll have me back after the baby is born!!  Otherwise, all ACL-related feelings are very much 'back to normal' and I hope to keep it that way!

Less Blogs = All is Well! [9.5 Months Post-Op]

When you're not breaking through milestones every day, (or even every week) it is hard to find the time and make the effort to blog! Sometimes the 14th of any given month will come and go, and I do think "I should blog with a 'x month update'" but in all honesty, I don't have much new news to share!

I can say that I have gotten very comfortable, and between that, being busy with wedding planning and not having access to a gym, my only 'workouts' are a few soccer games here and there. Even my last post suggested I'd be hitting the slopes hard and give my knee a real run for it's money, but out of the 3 day weekend, we probably snowboarded for about 4 hours, and I spent lots of time on the bunny hill trying to teach my girlfriend Jess! [note to self: snowboard instructor may not be a career choice for me!].

However, as per tradition, we still have our one big ski trip of the year coming up. Last year, it was Salt Lake City and 1 day after I got home was when I tore my ACL playing flag football. So, this will be a triumphant return to the slopes as we head to Tahoe for 6 days, 4 of which we'll be snowboarding!! Hopefully I'll have something blog-worthy (in a positive way...) after our trip at the end of February!

Otherwise, the knee is holding up well, and with the exception of a little 'pop' sometimes when going from a flexed (straight) leg to slightly bent, there's no daily reminder of my reconstructed ACL!

Ciao, Dr. S! [20 Weeks Post-Op]

From the title, I'm sure you can guess... My good man, Dr. Jeffrey Shapiro gave me the final farewell yesterday in my follow-up visit! He admitted that I came out of the gate a little slower than most, but that I've made up ground since then and am right on track. I had often looked forward to my visits with Dr. S to get such confirmation, but at the same time I'm grateful that I had a (mostly) smooth road to recovery and that I'm nearly back to normal!! This must be what Drew felt like when I ended things with him, and PT... *sigh*

Despite halting doctor and PT appointments, I'm not done yet! PT (at home) will be ongoing, as I hope to stick with doing things on my own at least 3 times a week until I can work my way back into sports. For instance, today I strapped on my soccer/UF cleats for the first time and got a taste of the field. Unfortunately tomorrow's soccer practice was cancelled, but I will be doing a workout and eventually heading up to the driving range to dust off the 'ol golf clubs too! Knowing the doctor doesn't need to see me again gives me that 16-yr-old-with-a-set-of-car-keys feeling of freedom again!

But I must share... Yesterday's 'closure' with Dr. S did end on a bit of a personal sour note. My good friend Wendy was in one of his OTHER exam rooms, getting the news that she'd torn her ACL (just like me- playing flag football!). So, as much as I would have liked to avoid my injury, I am almost glad I have the experience (and blog!) under my belt to help reassure her that she'll come through it just fine!! [You can do it, Wendy!]

The gorgeous bouquet I received from Miss Wendy... just for helping! Aww, shucks!

Things I'm looking forward to: Golfing this weekend, Yoga class starting in 2 weeks, and hopefully dusting off the frisbee one of these weekends for some good 'ol fashioned pick-up games!

How I Broke Up With PT [4 Months Post-Op]

Tomorrow I will be 4 months post-op. If you're an avid reader (or, recap HERE) you'll know my Doctor gave me the impression I only had a 4 month recovery (or, perhaps he meant 4 months of PT?…). I was skeptical then, and now that I'm here, I still know I'm not at 100%, but I'm doing what I can to get there.

Over the weekend I got yet another medical bill, and while I am blessed to be insured, I'm also blessed with a mathematical mind. Is what I'm paying for in PT really worth it anymore? Before I used to tell myself that having someone guide me, albeit 1x per week, was worth any cost to know I'm on track. However, the last month or so was very hands-off for Drew, and even regarding equipment use- aside from the 1-leg press and a BOSU ball here and there, most everything I can do at home. So, I approached Drew yesterday as I came into PT, asking "Is it OK if this is my last visit?" Drew gave me a long look and asked, "Are you breaking up with me?!"

We did some L-to-R comparison of lunging, jumping, balancing on each leg individually, as well as measured circumference at my knee, lower and mid thigh. Here's how I see my progress as of today:
Strength ~ 90%: For instance, I can 1-leg press pre-surgical weight, but it's still a little shaky. Which brings us to...
Control ~55%: It is still difficult to absorb the impact when jumping and landing on my surgical leg. Controlling the motion of something like a 1-leg squat is very difficult and borderline painful to do as I work into deeper bending. I think toning the muscle around my knee as I get it back will help improve this.
Mass ~85%: I still have mass to regain in my L quad, but even the mass I do have is not as solid as my R leg. I know this will come in time, but as trainers have told me along the way, I have further to go than most people based on the large size of my non-surgical quad!
Endurance ~95%: I might be guessing high, but if my knee were miraculously healed tomorrow, I think my endurance would be pretty good. Although I might take that down to 90% or so when I think of playing the full duration of a soccer game with minimal subs, or the continuous sprints of ultimate frisbee.

Now that I'm PT-free I can consider my options (what unattached girl wouldn't?!). Buy some equipment for home exercise, like a BOSU ball? Or spring for a gym membership to have equipment at my disposal? Or go to some open swims at a local pool for some 'low impact' jumping to work on control? I know I can always call Drew for questions, pointers, or help… plus he provided me with a few pages of exercises to keep working on. Any way I work it, I'm pretty confident I can do this on my own now.

Sorry, PT… It's not you, it's me. ;)

We Talkin' 'Bout Practice! [15.5 Weeks Post-Op]

Monday (7/27) I met with my surgeon, and despite the fact that I didn't see him until over an hour after my original appointment time, it was a good, quick visit. My physical therapist didn't give me any ammunition to go in with, since I seem to be on track (I just have to get back that muscle mass and control!!). Also, I haven't had any odd pains or limitations to speak of, so I feel like we're doing things right so far.

One question I had was about distance running. I've kept to 1.5 miles or less up until this appointment, because I don't want to develop bad habits since my surgical leg still has muscle to get back. [Yes, I do still favor my leg a bit when running.] I figure if I keep the distance low, I can pick up the speed, and when I run more quickly, it seems to lessen any limping. Dr. Shapiro said up to 2 miles would be fine, so I will stay under that until I see him again in a month. I hadn't planned on running the Detroit Marathon in October anyhow... ;)

While it's nice to get back into running, that's not all I've been eager to do! Since I'm up for most any sport (except basketball, which I've never been too great at) I had to ask, what ELSE can I do? Dr. S threw a blanket statement out there, "You can run some drills and practice pretty much all of your sports now, just don't participate in any competitive games." I eyed him skeptically because really, isn't it the motions, not the contact I need to be worried about? But I also wasn't going to look a gift horse in the mouth either. So, to be sure he meant 'all' I thought of one of the sports that would be rough on the knees and said, "Even sand volleyball?" His response: "Well, no. That'll be next year. Too uneven." Luckily that's the answer I expected, so I went for a more hopeful one... "Soccer?" "Yes." Woo hoo! Look out local high school turf field!

In hindsight I should have asked about more activities, but by the time I would have gotten through the list of sports I want to start playing again, I might have kept him there another 10 minutes. ;) For now, it's all about doing what I am comfortable with, and stopping if there's pain.

Fine Tuning My Knee [3 Month 1 Week Post-Op]

"How's your knee?" ... It's a loaded question that I get all the time. I think most people are just being nice, but if you care to read, here are some extra specifics.

Being over 3 months out, I figure I'm more than halfway to recovery. At my last follow-up appointment with the surgeon, he said we're looking at a 4 month recovery, which normally I'd be super excited about. However, seeing as how I'm not a professional athlete (surprise!) I believe I'll be taking the full 6 months before I decide to commit to a sports team, perhaps subbing once in a while before that. We'll see-- I want to be steady and confident before I go out on a field and act timid and end up doing something dumb because of my fear.

Current Abilities:

• Walking without a limp (including speed-walking)
• Running (slight limp when I'm slower, but the faster I go, the less I limp). I have not tried a dead sprint yet, but really, what's the rush?
• Going up stairs- Very even and seems controlled. Even taking stairs 2 at a time doesn't seem to show much weakness.
• Going down stairs- I can still feel the unsteadiness in my surgical leg as I move my non-surgical leg to the next step down. While some days it seems easier than others, there isn't a time I've gone down stairs and 'forgot' about my knee.
• Jumping- When jumping on both legs (think: jumping rope) I can feel my right leg doing more work the longer I jump. When jumping on just my surgical leg, it's still not developed enough to accept the impact of the jump like my other leg does.
• Bending/Straightening- I can bend my knee so my heel touches my butt, though I'm still not confident when squatting all the way down and using my body weight to bend it. For straightening, there is some uncomfortable feeling when it gets close to hyperextending, but I think I need to keep working to make sure I don't lose range of motion there. My kneecap also seems to 'catch' or 'pop' every so often when I go from straight to bent, but it's not painful.

Current Focus/Exercises:

• Doing PT at home: I've been a lot better with this since my birthday, keeping a promise to myself to do my part in my recovery. I take 1-2 days off per week, but otherwise try to run every other day, and on the in-between days I'm doing more pointed exercises like lunges, step jumping, shuffling... etc.
• Physical Therapy with Drew: I am happy to announce I'm back up to my pre-surgical 1-leg press weight, as of a week ago! It feels good to be 'back to normal' in that sense, even though it doesn't translate to a 'back to normal' leg as a whole. PT will continue 1/week at least through the end of this month.
• Quad Strengthening: Lunge, lunge, lunge!!
• Calf/Knee/Jumping: Lots of jumping and quick shuffling to build up not just my muscle, but also the motor skills to be using the muscles AND moving at the same time. One exercise I do- Stand on L leg at a step with R leg resting up on step; In one jump, land with R leg beneath you, and at the same time lift L leg to touch up on step; Alternate which leg you land on (and which touches the step) after each jump, and do this as fast as you can for 30 seconds. I find this is a great gauge of how 'steady' my surgical knee is underneath me, as well as controlling that leg as I quickly touch the step through the repetitive motion.
• Jumping on one leg: Being able to balance just isn't enough. Trying to jump and accept the impact (as I mentioned before) is a whole new game. In PT on my own I try to jump forward in a straight line on just my surgical leg, and land softly. I still have a ways to go here.

Drew told me that the exercises I still feel 'unsteady' doing are the ones that are the last to come back, so I'm well on my way to recovery. Also, I have another follow-up appointment with Dr. Jeff Shapiro next Monday afternoon, and I expect more good news there!

My First 1-Mile Run [2 Months Post-Op]

Since my last PT visit, I hadn't made much time to get in quality exercise for my knee over the weekend. I blame being preoccupied, but a little of it was laziness. Over the weekend there was a lot of walking and standing, and the 'ol knee held up well. Occasionally an ache would find it's way around my knee, but nothing too painful. Either way, I was looking forward to today, since my last PT visit was finally a break from the monotonous routine I'd been doing.

Today's surprise was the 'timed 1-mile run'. As an ex-cross country runner and being an athlete in general, I know I used to be able to easily run 1 mile. Plus, I've done previous sessions of run-walk intervals in PT, covering more than 1 mile, but today's challenge was to do 1 mile running, and at a decent pace. So, once I'd done an 8 minute warm up on the elliptical and stretched a little, I headed for the treadmill. Drew was not over my shoulder during the run, so I didn't burn myself out on it, but I did make sure to turn up the pace from previous PT runs (from 6.0 to 6.5). I finished in ~9:30, and for my first mile back after knee surgery, I am OK with that! (Plus, I know I could have gone faster if I had to, but I still had a full slate of PT ahead of me!).

The run left me whipped, but as usual, I felt really good about it once I was done! I did a handful of other exercises (including shuffling side-to-side between cones; also pushing off side-to-side in a speed skater fashion on a slip board) which had me working on sideways movements and adding in a little squat motion as well. It's good to know I'm getting to a point where it's not all about the range of motion in a straight line!

While I did have to go down in weight on the one-leg press today by ~10#, I was fine with exhausting my leg muscles to the point where they were shaking throughout that exercise, and others. Lunging is still difficult to put the weight evenly through my surgical leg, but practice makes perfect, right?

Next Monday (just shy of 10 weeks post-op) I'll see the Doctor again and make sure I'm on track!

I haven't posted pics in a while, but then again not much is changing. Swelling seems minimal, the incision is healing up nicely, and the definition in my legs is coming back, little by little. The only thing I might ask about is the dark spot that still remains on the back of my knee where I had dark bruising after surgery. I am sure it's normal, but just out of curiosity.

Knees and Trees [7 Weeks Post-Op]

I am forced off work this week (it's all good!) and so that means daytime PT appointments and taking care of those little things that are often put off. Since I have been making improvements in PT and feeling stronger on my feet, it was decided that this week is when a big tree in our back yard would come down.

My dad, a seasoned tree-cutter-downer and general outdoors man, offered his services, but this is a big task for just one person. So, in addition to keeping him well fed and hydrated, I decided to monitor how my knee felt as I helped with the take down. I was aware that the backyard is a bit soft and, in some spots, uneven. Also, there is always the chance that a limb can come down more quickly or in a different direction than anticipated, so it meant being smart about where I was in relation to the action. Luckily Eric was able to be a big help when it came to needing extra elbow grease for the big cuts, and some of those times I was happy to stay on the sidelines instead of risk any injury.

2-day story short- and because you were surely holding your breath- there were no injuries, or even pain beyond normal use! There were even times I was able to plant both feet firmly and tug on guide wires, and I felt strong in my foundation. Or if I needed to step on a branch to hold it down as I broke it into smaller pieces, I could use either foot and wasn't nervous to do so.

This definitely isn't how I expected to be 'celebrating' my 7-week post-op anniversary. At the same time, if you would have asked me a few weeks ago if I would be helpful in an activity like this at 7 weeks, I might have thought you were crazy!

Meanwhile, PT is focusing on the same strength building exercises and transitioning me into running. Drew worked a lot on stretching my hamstring and really straightening out my leg at last PT, and I felt a lot better when I jumped on the treadmill immediately after. 10 minutes of speed walking followed by 3 minutes of running left me tired, sweaty, but most of all confident of my eventual return! Yay!

The backyard beast that had to come down:

Draped in chains that helped pull the tree down, limb by limb... it's not my limbs holding me back anymore! (OK, Cheesy, I know!)

"Rumping" [6 weeks, 4 days Post-Op]

When I left you, dear reader, I had told you of my first attempt at running. I have since undergone yet another PT session (which included about 10 minutes of 2-minute intervals of speed-walking and then 'running') ... but I wouldn't call it running. It's more of a cross between limping and running... which my good friend Jesse so cleverly coined "Rumping".

Today I gave the run/walk intervals another try. I was advised by Drew to go to a track (meaning level surfaces and a nice padded course) but since there was a soccer game going on in Berkley's track infield, I refused to run around the game and provide entertainment for the ~100 people there. So, I went outside of my trainer's wishes, and hit the streets (very carefully, might I add). First, it was taking my walk from a slow, to normal, to eventually quick pace. Then, once I felt comfy, I tried running again. It felt just as awkward as the first two times, but if nothing else, it felt good to be out, trying, and breaking a sweat!

I believe the reason I can't shake the limp while running is I am (1) still having a hard time mentally trusting my surgical leg, (2) my muscle mass in my surgical quad is substantially less than my non-surgical and (3) when I do run, I am not letting my surgical leg extend out all the way, therefore I'm running shorter strides on that leg versus my 'good' leg. This overcompensation caused a little pain in my 'good' leg's hip towards the end of the run, but nothing I feel when walking or going about my day-to-day.

Otherwise I feel I am reaching a point where I actually sometimes FORGET about my 'bum' knee! It is a wonderful thing. The more I find myself putting it out-of-mind, the more I realize I am getting back to that 'normal' lifestyle I so desire. In the coming week I'll still be seeing my trainer 3x, but after that we've decided I'm ready to go to 2x / week. This can only mean one thing... PROGRESS!! :)

Surgical vs 'Good' Leg [5 weeks, 1 Day Post-Op]

I was just thinking about how at the end of February I was hitting all the resorts in Salt Lake City with my snowboard, and here it is, almost 3 months later, and I've been through injury, surgery, and what they say is the hardest part of re-hab. I can't wait to hit the slopes again... among other activities I'm itching to get back to!

So in my continued efforts to get back to 100% (or better!) I returned to PT today assuming I'd have pretty much the same routine as normal: Ultrasound (locally @ incision), a few painless exercises and stretching, and eventually 'ice' by rubbing ice directly on my knee until it's numb! I was right on everything, but then I got a little more in the way of exercises.

At 26 Days Post-Op (just 10 days ago) I mentioned some 'upcoming milestones'...

One goal is to get back to a 'normal range of motion' , which is from zero to 130-135 degrees. Drew told me that I am within a few degrees of that as of today (Yay!) but that my 'good' leg is closer to 160, so I definitely have some more work to do!!

Another ongoing goal is to normalize my gait. Today I was told I have all the PARTS of walking normally, I just need to piece it all together in one fluid motion. I like to compare this to learning to golf -- it's not easy to do everything right at once! While I may be able to control my walk enough to appear not to have a limp, it is still a very conscious effort (hence my previous post, 'Could the limp be gone?!' not stating that it was gone!). Drew would watch me walk and of course compare- What was my 'good' leg doing that my surgical leg was not? [Answer: My surgical leg is slightly bent through the whole stride; I'm never completely straightening it out.]

My goal to walk smoothly comes back to another goal I was perspicacious enough to realize over a week ago- being able to trust my surgical leg as I balance on it and at the same time go between straight and slightly bent. I brought this up to Drew today and he had me 'practice' doing this very motion. There were some new twinges of pain as I did it, and my leg was shaking (oh, how sad the weakness is!), but it was good to be forced, because I hadn't challenged myself at home just yet. I had to stop a few times and do the same motion with my 'good' leg, just to remember how it's supposed to look and feel!

And so the battle of Surgical vs 'Good' Leg continues.... As for the other milestones I'd set:

• I'm happy to say I can go up stairs without favoring my surgical leg
• I can balance on my surgical leg when it's straight (as well as slightly bent) without pain or feeling like i'm going to tip over (it's going between the two that's tough!)
• I can go down stairs with one foot per stair (though I favor my surgical leg VERY much when doing so)
• I continue to massage around the incision to get the skin to move freely over the knee cap (and I've also been using Mederma to hopefully reduce visibility of the scar... eventually)

Pic as of today (you can ignore the waffle imprint- that's from using my ThermoComp icing machine...)

And, since I may not post again before the Memorial Holiday - I hope everyone has a safe and fun weekend, and I'll try not to do anything dumb to mess up all my hard work on my knee!!

Cheers!

If It Feels Good, Do It [4th Week Post-Op]

My week 4 anniversary has come and gone (yesterday) and between my woe is me attitude and having an occasion to get out of the house yesterday evening, I am just now posting. However, I'm glad I waited, as I think in some ways, I am feeling progression. Of sorts.

Bear with me, and let me preface by telling you a few parts of my day ...

I realized that as I walked around work I thought of statements I might blog, (similar to how I always think of captions for my photos, for those of you who know me!). Sadly, one statement that came to mind today was, "I am feeling a sense of disappointment [frustration? defeat?] with every step I take." What?! Did I just think that? True- it is hard to ignore my slow pace or pain every few steps, but DEFEAT? C'mon now. Lighten up, Louie.

Then, checking my (personal) email at work (shh!) I received today's dictionary.com 'Word of the Day': Abnegate which, has a second definition of "to relinquish; give up." You might think in my original state of rut, I would have thought, Gee, how fitting! But, I looked at that and asked myself, is that what I'm doing? Of course not. But where did I fall on the scale from frustration to giving up?

At some point my new boss came by and mentioned my knee. He said, "Aren't you some kind of super-jock?" Ha! I may not fall in that category, but there's few sports I won't try. I had to laugh at this rep I didn't realize I had at work...

I eventually left work and headed for PT, and as I hobbled to the front door, I saw a girl being dropped off with immobilizer on her leg and crutches under arm. "When was your surgery?" I asked. "Yesterday..." she said. Ahhh... I remember being there, and the pain just to stand. I felt for her as I held the door and helped her meet her trainer- my good friend, Drew.

A few exercises into my routine, another girl asked me how far along I was, as she was 3 weeks out. "Your scar looks great!!" she told me... Well, that was awfully kind of her!

OK, ok, ok... enough with the stories. I am not sure when, but at some point in the day, negativity started to crumble from my mentality, little by little. I now found myself in my (currently) dreaded position: being asked to 'walk the runway' for the trainer. Despite my hopes, I did not miraculously shake the limp. But this time I was not barked at on how to fix my gait either, which was refreshing. So it came to the next question... Now what?

I confronted Drew about the whisperings of tendonitis from last session. He would not (and I guess, could not) officially tell me I have it, as that is my doctor's call. However, when asked, he said, "You definitely [catch/pause] maybe have tendonitis." Enough said. He said around 10% of people get it (I'll have to research...) and that it's not that anything was done wrong, that it just sometimes happens. I could ask a million questions- did he push me too hard? Did I take my PT at home too seriously? Did I work through pain I thought was normal, but it was over-use? No matter- I now have direction that "if it hurts, don't do it." I'm going to bend that and say, if it feels good, do it! - which I thought a a nicer tone to it!

So for now, that's exactly what I'll do. At PT we continue to do ultrasound in the area of my patellar tendon (which I read, is a way to treat tendonitis) and ice is rubbed directly on my skin near the incision instead of a wrapped ice pack after PT. Other than that, the only way to 'treat' tendonitis is rest, only do the exercises which don't pain that area, and be patient. Isn't it ironic that being patient is the fastest road to recovery? :)

Week 4 Post-Op Pics

When flexing both legs it appears I'm getting some of my left quad back, but looks can be deceiving. While the 'definition' is starting to show a *little*, it's awfully soft in comparison!

The incision is healing nicely, and I am sure to massage it whenever I think to, which will help loosen the skin (as it's still quite stuck in place) and break up scar tissue beneath it.

Update & Remaining Milestones [26 Days Post-Op]

I am the first to admit my last post was pretty whiny. I apologize if it didn't leave a good taste in your mouth, but it is part of the recovery process, so no point in sugar-coating it!

But I can say that I am in a better place now. Yes, I am still limping, but I am feeling improvement (or, lack of pain I was feeling before) and am working more on balancing on my surgical leg while it is straightened to gain confidence in my leg as it teeters on the edge of locking/straightening or being just slightly bent. Once I feel good there, I think it will really improve my walking.

While I am physically improving, I am also grateful for the support of others who have either been through (or, will be going through!) this type of procedure, as well as those around me who continue to care about my well-being and encourage me to keep at it! I'm sure I'm not the first person to have moments of frustration and weakness in my recovery, so all I can say to those of you who might experience the same thing -- it will get better! I just hope I can remember my own advice as I continue on!

A few points of interest-

• I am no longer on a steady diet of pain medication, as of ~3 weeks post-op. I still pop something before heading to PT, but otherwise think keeping Motrin handy should be enough to curb most discomfort.
• I have no pain in standing for longer periods of time. (Immediately after surgery, this was what caused the MOST pain in normal day-to-day!)
• I will be returning to work tomorrow (mainly sitting at a desk all day) and while I was capable of returning a week ago, due to a temporary lay-off (don't worry, it's just a week here and there!) my start date was pushed back. I was grateful for the extra week of being able to stay home and focus on recovery.
• The most pain I have is in the region of my patellar tendon. Mostly it's caused by the simple motion of straightening the leg from bent, but without any support (As in, if sitting with legs dangling off a chair, trying to lift my foot so leg is straightened out in front of me). Similar to pain felt when trying to do 'straight leg raises' while lying on my back. [Note: I am not sure if this pain is because my graft was taken from this area, or if this occurs in all ACL reconstructions?? I assume the former...]

My upcoming milestones (in no particular order) include:

• Getting my bend to ~135° (considered 'normal' range of motion)
• Walking and climbing stairs w/o favoring my surgical leg
• Going down stairs w/o having to put both my feet on one step before descending the next stair
• As mentioned, focus on balancing on my surgical leg while it's straightened
• Eventually be able to balance on surgical leg w/leg straightened and remain balanced as I work into a slight bend
• Breaking up scar tissue in the area of the incision to allow the skin to move freely over my knee cap
• Continue to ice, elevate and massage around knee to reduce swelling and break up scar tissue

Perhaps returning to work will bring me some new challenges (I am thinking sitting in one spot for a bulk of time will end up with a lot of fidgeting so my leg doesn't stiffen up too badly). Either way I am looking forward to a change of pace and starting my return to a 'normal' lifestyle!

And, some photos of my progress. Enjoy!

I can now bend my knee to this angle somewhat (I say that lightly...) comfortably:

Swelling still there, but my knee is slowly showing shape again:
The scar is healing up nicely, though the skin does not move freely over the kneecap yet. I am massaging daily to break up scar tissue:
And how could I forget?! ... Happy Mother's Day!!

Learning to Walk Again [18 Days Post-Op]

In my second visit to PT (which was 3 days post-op) I was already being challenged to put weight on my surgical leg and try to 'walk' across the PT room. I remember thinking how ridiculous that was, because I was so unsure of my leg (and myself) and it must have looked like a baby deer teetering close to disaster with each step. Even Eric's mom, Sandy, said something to the tune of, "Does this remind you of learning to walk?" and of course, I have no recollection of that, but I'm sure I looked quite similar in technique!

So now I am closing in on 3 weeks post-op, and in yesterday's PT I again felt the pains of the forced bending (not sure what degree we got to but I hope it was 120!) and the frustrations of the most simple uses of my leg, which just aren't coming naturally. However, I have been improving every day (some days more than others!) and I'm now being told to work on 'walking'.

I have officially eliminated the use of crutches (even when going on somewhat uneven terrain) and have been walking in a controlled, slow and short-strided manner. I realize this is not how I want my gait to look when I'm done rehab-ing, but as they say... Baby Steps!

When asked to walk by my trainer yesterday, I made a conscious effort to stand upright (instead of look at my feet) and just walk evenly. Drew called me out on it immediately, telling me to speed up (I was going frightfully slow) and to stop trying to 'control' my stride. I followed directions (like the 'perfect princess' I said I'd be in PT) but there was an über-uncomfortable feeling below my kneecap, and at the times when walking requires balancing on the surgical leg at the sensitive position between completely straight and just bent, I felt like Bambi again.

"Let's put you on the treadmill," Drew said. Wha?! Didn't I just prove I'm not even ready to walk 'normally' yet? But sure enough, I climbed on and Drew took the belt speed up to what is probably a normal walking pace... but I looked like a pirate trying to speed-walk on my brand new peg-leg! Oh, and of course there was the return of the aforementioned pain below the kneecap (in the area of the patellar tendon).

This limping pirate look may have brought Drew back to reality, as I just couldn't seem to go with the 'flow' of the treadmill. So, for 5+ minutes I instead stood with my right leg off to the side of the treadmill belt, and at a much slower belt speed, would put down my left foot and 'walk' with my left leg. (I looked like I was skateboarding now) This allowed me to gradually put more weight on the leg as I got more comfortable, and my new task was to work on taking longer strides and stop avoiding straightening my leg all the way before 'pushing off' and lifting the leg up again.

Unfortunately, I do not have a treadmill or stationary bike at my disposal, so I am unable to work on such activities (and range-of-motion exercises) at home. This didn't stop me from going out today (Saturday) in the lovely noon-day sun and walking ~5 blocks. I tried to follow all of the tips and directions that Drew had given me, but in the end I know it still looked 'controlled' if not limping, because I had a friendly passer-by ask, "Are you OK?"

I compare this attempt at walking to learning to golf. There are so many things to remember when you learn to swing a club: head down, legs slightly bent, grip a certain way, twist your body a certain way, backswing so your arms do or don't bend too much... you get the idea. It's just a little overwhelming to try to remember it all and follow it all to a T. Same goes with this whole 'walking' bit. No matter that I've walked plenty in my lifetime, when it no longer comes 'naturally' it's truly an effort to make walking an effortless motion!

So, while I know I still have a ways to go before strangers aren't concerned for my well-being due to my unconventional walking style, I am making improvement, and that is all I can ask for now!

And because pictures are fun:

Day 16 post-op: I 'cleaned up' the incision area before re-taping. Looks good w/ the exception of the zig-zaggy part at the lower kneecap Day 18 post-op: OK, not a flattering pic at all, but for the sake of comparison, this is a pic with legs in the air, slightly bent and completely relaxed. Note the swelling still obvious to the sides of the knee and lower thigh/knee area. Also, major muscle mass difference in the thighs (lower portion of picture) which I hope to reclaim when this is all over!!

Pity Parties & Impressive Improvement [2 Weeks Post-Op]

As I start to type this, it's 12:30p - exactly two weeks ago I was checking into Beaumont Hospital with what felt like a perfectly good set of legs. Thanks to an MRI after hearing my knee *pop* in flag football, I knew that I really was in for a treat, as I headed for the pre-op to have my ACL reconstructed from my own patellar tendon.

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... ;)

Pics & Feeling of Note [2 Weeks Post Op]

In addition to how the knee looks, there is still tightness from swelling within the joint, which is primarily responsible for my limited range of motion. Majority of the swelling seems to have gathered above the knee and to the upper sides of the knee (both on the front of the leg). I try to massage these areas to help move the fluid upward towards my lymph node.

Also, nerves were cut when the incision was made, so directly to the outside of the incision I have a numb spot that I'm told will regain feeling in the next 6-12 months as the nerves grow back.

Finally, every time I go from bent to completely straight in my surgical leg, there is a small pop (think of two tendons rubbing together, not even a 'crack' feeling) in the area of the bruising on the back of my leg. I am told this is again due to swelling, and these two tendons are just being pushed onto each other. I will probably continue to ask about it until the feeling goes away. It isn't painful, but a little uncomfortable.

Pics - 2 weeks post-op

Swelling found mostly to the upper sides and top of the knee;

Quad muscle atrophy in the L leg w/ noticeable difference b/t legs even when relaxed

Bruising on the inside of the calf much less noticeable; Bruising on the back of the knee fading significantly

4 Minutes Well Spent [Informational Animation of the Surgery]

I was playing around on YouTube today and found this great animation of the surgery I had done. CLICK HERE to view the video. It's quite informative, and also shows why I have a small scab ~5 inches above my knee.

The only difference is that I did not use the 'continuous passive motion machine'. I'm on my own for regaining range of motion!

Cheers!

Screws and Glowing Reviews [8 Days Post-Op; First Follow-up Visit]

With a promise from Drew that he'd be kinder to me in PT today than Monday, I breathed a little easier as I limped into the building wearing only the immobilizer. We started out on a stationary bike, again using my right leg to control the rotation of the pedals, and slowly working my way to full revolutions (causing my leg to bend to an uncomfortable but somewhat tolerable angle).

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!

8 Days down... The better part of 6 months to go!

A Monumental Week [7 Days Post-Op]

Tomorrow is my 4th Physical Therapy and my first post-op appointment with Dr. Jeff Shapiro- I promise to get an entry up about that tomorrow... But, first things first: Here we are, 7 days post-op!!

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
• Running
• 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:

I don't seem to have any trouble straightening to Zero degrees, and there has been no change in the incision area, as I have not removed the tape nor gotten it wet. Bending the knee continues to be a challenge, and I can get it to about 100 degrees but not without pain.

Until tomorrow...

Bruising, Driving, Pain and Ditching the Crutches [6 Days Post Surgery]

I have heard of people getting bruising all the way down their shin and around their knee (seems normal since there was a saw, a drill and 2 screws in the mix of the procedure) but I hadn't seen too much of that on myself until recently.

Since pictures are worth 1000 words, here are some shots which show a little of the bruising, as well as my improvement in getting my knee to bend at home. [Remember, the Day 6 goal was 90 degrees per my Physical Therapist, Drew...] The swelling and tightness within the knee was what was keeping me from bending any further:

4 Days Post-Op:

5 Days Post Op:

6 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.... !

For further comparison to previous days, here are some shots from Day 6 Post-Op: