Three Weeks!: Day 22

It’s been a while since I last posted, but life and work have come knocking, and progress has slowed a bit.  All to be expected.

Things continue to chug along nicely in the knee department.  I’ve had several physical therapy visits since the last post, including one today.  They’ve added in four-way hip extensions and shuttle presses (at a whopping 75 pounds, whoo!), and at the end of the visit, I was at full extension and 124 degrees of flexion.  The six-week goal is full extension and 130 degrees of flexion, so I’d say I’m well on my way.  I always look forward to PT, especially the massage/deep tissue manipulation, but that enthusiasm has taken on a masochistic edge lately because GOOD LORD does scar tissue manipulation hurt.  (Speaking of which, my steri-strips are gone!  Doesn’t look so bad:)

cars

Forced flexion in PT is also pretty rough.  My PT has me lie on my stomach and flex my knee as far as I can — then he pushes it a few more degrees.  Last week was the first time he really pushed it and by the end of that experience my whole body was shaking and I was seeing splotches of color.  Fun times.  But I gained a few degrees of flexion, so I suppose it was worth it?!

Another exciting moment came during hip extensions.  Today was the first time I’d done them since pre-hab.

hip_theraband

Before surgery, they generally felt fine, but during abduction (upper right image), I was always really aware of a shifting and instability caused by my useless ACL.  Today everything felt perfectly stable — real proof that I do have a working joint again, even if it’s still learning how to knee.

I also got promoted (downgraded?) to a single crutch today, and next week I’ll be out of the crutches and post-op brace and into a smaller Playmaker brace.  Looking forward to looking a little sleeker and less clunky than I do now.

All that said, the honeymoon phase of sheer excitement about making progress is starting to wear off, and I’m noticing various types of discomfort:

  • Sometimes I walk without the crutches at home, or if I’ve got a shopping cart at the grocery store or something, and I get pretty noticeable patella pain after too much weight-bearing for too long.
  • I’ve noticed a disconcerting shifting feeling after extension sometimes — this happens most often if I’m lying on my stomach with my legs out or if I’ve been bearing weight on my affected leg in extension.  When I go to bend the knee, I can feel something — maybe the patella, maybe the tibia — moving forward.  It doesn’t hurt, but it doesn’t feel like something that’s supposed to be happening.  I’ve asked my PT and a few veterans of ACL reconstruction about this; everyone says it’s a normal part of the healing/swelling process so I’m trying to ignore it and not worry about it too much.
  • On a social note: I really thought being on crutches would bring out kindness in people.  Generally that’s been true (see: previous post), but I’ve also been so surprised at the number of people who look me in the eyes before letting doors slam in my face or gunning their cars into my path in parking lots.  Rude.
  • I’ve really gotta learn not to bang my scars into the corners of tables.  Ow.

Life beyond the knee has also been exiting.  There’s been home-made fried chicken (thanks, Tom):

chicken

visits from little Einstein (thanks, Joy & Nick):

einstein

and the mild beginnings of back definition (thanks, self):

backdef

I think that’s all!

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Interlude: Thank You, Tom

This post is a belated but very, very heartfelt thank-you.  Many people have helped out over the past few weeks, lending ice machines and leg braces, bringing food and flowers and company.  But I owe a special word to someone who has gone above and beyond the call of friendship the past few weeks (and months and years, in other ways).

Tom was the first person I called sobbing and dooming and glooming about how my life and my athletic pursuits were forever ruined as I hobbled my sad way through the ski resort to the parking lot; that day, he offered (though I didn’t take him up on it) to drive ten hours round-trip to bring me home.  During prehab he listened to what I’m sure was a mind-numbingly constant stream of updates and complaints about the knee.  He helped me move — twice in three weeks — when I wasn’t in great shape to carry heavy things. But most of all, he offered me endless help and peace of mind in the days leading up to and after surgery.

I’m a grad student; I live alone, and it wasn’t feasible for family to fly out to take care of me during what I worried would be a pathetic few weeks of recovery and limited mobility.  Before surgery, Tom helped me brainstorm slow-cooker recipes to prepare an apocalyptic quantity of frozen food, and he brought over a spare display to make Netflixing more pleasant.  The day of surgery, he fetched me early in the morning and waited at the hospital for eight hours (several hours longer than expected).  He did errands, supplied me with chocolate, ensured the hungry ice machine was fed, cooked more food, took out my trash and carried my laundry, constantly checked in, and was very good company.  He chauffeured me around while I couldn’t drive and was a great comfort in the dark days of Percocet-induced misery.

He has listened to every minute, inane detail of this process without even a whisper of complaint or frustration.  He talked me down when I got anxious about the future of this injury, and I know he’s going to challenge me if I get complacent about recovery.

Thank you, Tom.  You deserve much more than a bottle of whiskey.  (And sorry for the creeper picture.)

helpertom

Liberation: Day 13

Exciting day today: I had my second post-op visit.  I got my stitches out, which was a nice relief because they were starting to get itchy, and I was starting to get very curious about what was under those steri-strips.  One fun surprise was that the tibia incision where the graft was inserted had been closed with a subcuticular running suture, which I had never heard of but is pretty cool:

fig8.jpg

You can’t see the individual stitches; instead it just looks like two threads poking out of the skin several inches apart.  Despite my understanding that suture removal isn’t painful at all, removing that one did sting a bit.  Oh well.  Unfortunately I didn’t think to take a photo before they put new steristrips on:

suture removal

At that appointment, I also got word that I can now sleep without the brace and shower without the whole plastic-bag rigamarole, and the physician’s assistant unlocked my brace a week early, so I’m now free to walk more normally.  I’m still supposed to be on crutches but can bear more weight.  As promised, I asked if the weight-bearing regulations actually did anything to promote healing, and he said crutches are really meant to protect patients from themselves (give an inch, take a mile), and they keep swelling down to promote quad activation.  He has assured me that weight-bearing won’t hurt the new ligament; he has also assured me that it can’t be stretched out through forced flexion.  Good to know.

That’s all for now.  Excited to relearn how to walk with a normal gait this week!

“I feel like a freakin’ superhuman”: Days 8-10

Progress is carrying on at a good pace.  I had official PT on Wednesday (day 8), and by the end of the session, my flexion was at 98 degrees and my extension was at 1 degree (with a 7 degree drop to-8 degrees with a leg raise).  That’s a gain of 25 degrees of flexion and 2 degrees of extension (with an improvement of 5 degrees when it comes to extension loss with the leg raise) from the first PT session (day 6).  I also managed my first full reverse rotation on the bike at the end of that session.

I did PT on my own in the gym on Thursday and Friday (days 9 and 10).  Leg lifts are getting much easier, so the quad is slowly but surely turning back on.  On Thursday I got my first forward rotation on the bike (hence the post title).  It was a small but exciting victory.

And here’s a photo illustrating the improvement in flexion from day 6 to today (day 10):

flexion

I also did another upper body lift while I was at the gym on Thursday.  It went much, much better than the one I talked about in the last post.  Despite the light weight (having a useless leg really shows you how much of a difference leg drive makes!), I enjoyed it and felt like myself, which was nice.  But I did look pretty ridiculous (note that the brace has received a facelift):

backtogym

Meanwhile, I’m feeling like I can bear pretty much full weight on the right leg again, and the crutches are starting to just feel like things I’m stuck carrying around.  I have another post-op appointment on Monday (day 13), so I’ll have to ask if partial weight-bearing is actually a positive good for the healing process of the graft or if it’s just meant as protection in a period of reduced quad control.  I’ve found a lot of post-op protocols online that have patients off crutches after a week or two, so it seems like professional opinions vary.  Hmm…

In less positive news, so much atrophying already!:

atrophy

 

“Every Walk Feels Like a Long Walk”: Days 6 & 7

The last few days have marked the official beginning of physical therapy, as well as my return to class and teaching and real life.  It feels good to be back out and participating in the world, though it’s a bit annoying that the arrival of warm weather has coincided with my dependence on crutches.  I feel gross and sweaty all the time.

PT was low-key.  The initial assessment (which involved a bit too much poking of sore spots for my taste) revealed that I’m at 3 degrees away from full extension.  Unfortunately, I lose 12 degrees of extension when I lift my leg because my quad isn’t firing very well.  Flexion was at a sad 73 degrees.  I think I probably managed a bit more flexion than that during my home PT today, though:

And straight-leg raises continue to be a painful struggle because of that useless quad (shout-out to My Brother, My Brother, and Me, one of my favorite podcasts, which is playing in the background):

Showering has been an exciting ordeal.  The whole process, including alcohol-swabbing the knee, takes upwards of 20 minutes.  It goes like this: first you gotta rub furiously at the leftover bandage adhesive and iodine with alcohol before giving up and hoping it will go away on its own.  Then you gotta wrap the knee up in some saran wrap, which really means you spend five minutes unraveling the saran wrap rope that inevitably forms.  Then you gotta wrap a lil mini trash bag around that.  Then you gotta slap some fanciful designer duct tape (because of course fanciful designer duct tape is all you have on hand) on the ends to make sure no water leaks in.  Then you gotta admire your creation, especially the thigh-muffin-top you got goin’ on:

showerleg

Then you gotta figure out how to get yourself on the little shower stool you bought so you don’t slip and re-tear everything.  Then when you get out, you gotta take all your packaging off while questioning the wisdom of putting duct tape on bare skin but failing to think of a feasible alternative.

An unexpected upside of the past few days has been using Stanford’s golf cart transit service.  The drivers are all Stanford undergrads, and it’s been nice having pleasant chats with strangers at least twice a day.  Also, the clumsy-brace-crutch look I’ve got going on has been a good conversation starter: lots of people have asked if I’ve had ACL reconstruction, and it seems they all have stories about their own ACL tears.  I had no idea it was such a common malady until it happened to me.

Here is a list of things that I did today that I probably should not have done today:

  • Drove (though my physician’s assistant did say that I could drive as soon as I was off narcotics, and I took my last Percocet three days ago…)
  • Went to the gym: My pretense was that I needed a stationary bike to do partial rotations as prescribed by my PT, but I also really wanted to do some upper-body lifts.  I sort of thought that being on crutches in the gym would make me look kinda badass, but instead I just felt weak and deeply unsatisfied by the whole experience.  Hopefully this will change, because it would really be awful to lose my lifting motivation over the course of this recovery.
  • Went to the grocery store: Needed some bananas, used the cart as a walker of-sorts.  Probably not a great idea because it was hard to keep enough weight off my right leg.

Today’s major difficulty was that every distance feels massive on crutches.  Even the trudge from a handicapped spot to the gym entrance is exhausting.  I guess tomorrow’s soreness and swelling levels will tell me loud and clear whether I pushed it too hard today.

Overall, though, I can tell the knee is already making progress.  I think I had more flexion today than yesterday, and partial weight-bearing is definitely easier and more comfortable today than it was a few days ago.  The quad still isn’t even contemplating doing its job, but I guess I can’t win ’em all.

“You were ready to take a penknife to your abdomen”: Days 4 & 5

Knee-wise, days four and five were fine.  Percocet-side-effect-wise, things were awful.  Like, really, really terrible.  Very few of the ACL blogs I read mentioned the full range of Percocet side effects, and unfortunately, this one ain’t gonna share all the gory details either.  Suffice it so say, what they say about Percocet’s gastrointestinal symptoms is horribly true.  I took all the…necessary precautions…and still woke up on the morning of day four in total abdominal misery. The Percs were also making me feel more light-headed than they had been, and the anti-nausea meds were causing headaches.  I was a crying mess for some of the morning and went cold turkey off the Percocet after my 6 am dose on day four because any knee-pain relief was absolutely not worth how awful those opiates were making me feel.  If you stumble upon this blog before having a similar surgery, really read up on the side effects of the pain meds you’re going to be taking, assume that they will be worse than you can imagine, and don’t take more than you absolutely have to.

After I got the Percocet problems sorted, I transitioned to a few doses of extra-strength Tylenol per day.  Without the opiates, my knee isn’t really in any pain, though it is a bit more sensitive when I move it or walk around.  Most notably, I get some nerve-y stinging when I strain to do things like get my leg in the car.

I also de-bulked my dressing again.  I now have a thin compression sleeve over the knee, some yoga pants over that, and the brace over that.  No more permanent ice cuff and ace bandage.  The bulkiness was making it hard to fit the brace on properly and it just seemed excessive.  I’ve tried a bit of straight-leg raising out of the brace and that is MUCH harder than in the brace.  I’m very anxious and excited to get to PT and really get exercise started.

Also notable, maybe, is that I spent a lot of time out of the house this weekend — though I was basically just transplanted to Tom’s couch for a Chinese New Year dinner on Saturday and the Super Bowl today.  It was a nice distraction to be around people, though it really emphasized how totally exhausting this recovery situation is.  Just getting up off the couch to move around involves putting the brace on, making sure the brace is locked, hoisting myself up, finding the crutches, and getting situated with the crutches, all before actually doing the thing that I stood up to do.  I’m sure this will get easier with time, but I can tell I’m entering the “frustrated” phase of recovery.

“It feels like the day after a hangover”: Day 3

Lots of the ACL blogs I read before having my own surgery suggest that the pain gets worse around day three.  Today has definitely been the toughest day so far, but it’s been manageable.  Perhaps I’m just finally getting over the giddiness of being at home and done with the surgery.

Last night was another relatively easy night of sleep.  Pain did wake me up once during the night, probably because my ice machine had ceased to be cold and my leg wasn’t elevated.  But after switching out the ice and taking a Percocet, things were fine.

This morning was my post-op appointment for dressing de-bulking, so I got the chance to see beyond the veil, if you will.  Because I had an allograft, my surgery was entirely arthroscopic, so I don’t have any large incisions.  It really doesn’t look too bad, aside from the iodine.

sutures

I was pleasantly surprised to see that the right knee doesn’t look too terribly swollen when juxtaposed with the left, even after sleeping with no elevation all night.  (That shininess on the right leg is just alcohol.)

legcomparison

Dressing de-bulking was nice, as I now have a smaller layer of gauze separating my leg from the ice cuff.  Charming as I find the little-girl-frilly-sock look in the above photo, de-bulking also meant that I got to ditch the compression socks, which were starting to be pretty irritating.

I’m also allowed to take the brace off when I’m lying around, though I have to wear it locked at 10 degrees when I’m sleeping or moving around on crutches.  This is nice because it allows me to experiment with range-of-motion, but it’s also exposing some soreness that the locked brace was hiding.  It definitely feels like I got a couple holes drilled in my bones.

During today’s appointment, I also learned that while my medial meniscus was totally intact, the surgical team did find some potentially-troubling cartilage damage.  In doctor-speak, it’s “chondral impact posterolateral femoral condyle.”  “[T]here was,” writes the surgeon in quite a run-on sentence, “a bit of a crutch to the lateral tibial plateau with quite a bit of fissuring and softening of the articular cartilage on the lateral tibial plateau from impact damage and in addition, there was about a 1 cm x 1 cm near full-thickness chondral impact of the lateral femoral condyle at the posterior weight bearing surface.”  Apparently this could be bad news for the health of my knee down the line, and the physician’s assistant suggested that I may need to limit my running and lifting.  This isn’t great news, but I’m not going to dwell on it until I talk to the surgeon himself in a few weeks.  (And frankly, I’m stubborn enough that in the long run, I’ll wind up doing some version of what I want to do anyway.)

I’ve kept up the ankle pumps and quad sets today, and I tried some (sort-of) straight-leg raises.  It seems like many people have a hard time with this movement post-op, so I was pleased to discover that I can muster enough quad activation to get my leg up.  It does hurt quite a bit, though.

Today’s biggest difficulty has been some mild queasiness and moderate light-headedness from the Percocet.  I don’t feel totally nauseated, exactly; it’s more like a residual hangover when your body still isn’t properly hydrated.  It’s been making it tough to stare at screens or books for extended periods of time, so my plans to while away my days with Reddit and reading have been foiled.

A few random things I’ve learned the last few days:

  • Ice machines are awesome, but they are very hungry.  If you have this surgery, I definitely recommend getting one, but plan on stocking up on far more ice than you expect you’ll need.  If people offer to come by with food, ask them to bring all the ice in their freezer or grab a bag on the way.
  • I am so much less hungry than I thought I would be.  I assumed I’d sit around and eat way too much, but the last few days in bed have been really insightful in terms of how many calories our bodies expend just getting from place to place and going about their daily business.  I haven’t been particularly hungry at all, and it’s tough to get through an entire meal without feeling very full.
  • People are just the best.  I’m mooching off a borrowed ice machine (thanks Will!) and post-op brace (thanks Joy!), and even had a local Redditor ask if I want his ice machine (thanks, /u/moldygiraffe!).  People have offered food, Girl Scout Cookies, Edible Arrangements, fruit baskets, rides, puppy visits, and human visits.  Most of all, my saint of a friend Tom has basically been at my beck and call, cooking, cleaning, driving, waiting for me at the hospital, and providing a steady stream of chocolate.  (Better thank-you-Tom post to come…)

Also, thank God this happened to me in California instead of the snowy monstrosity that is New England.