Finally Out and About

So this past Monday morning I finally was able to get out of bed and haul my friend the CPM back to the Orthopaedic Center of the Rockies (with help from my wonderful husband). And I was glad to be rid of it; I don't normally sleep on my back, so six nights in a row of being forced to sleep on my back with my leg elevated was really starting to take it's toll on my lower back and neck.

When I got over to OCR, Erica (my lovely physical therapist) put me on the stationary bike immediately.  Let's just say it was fairly unpleasant, because I hadn't been bending my knee that much in the PT I was doing before.  It did loosen up pretty quickly, however, and though it still hurt, it felt mostly manageable.

After that we went through the rest of my exercises, which are identical to the set I did after my meniscus surgery in June.  Those are:

• Heel Raises (30 reps, 3-4 times daily)
• Squats (30 reps, 3-4 times daily)
• Straight Leg Raises (Injured Leg, 30 reps w/5 seconds hold, 3-4 times daily)
• Straight Leg Extension (Just like I was doing right after surgery, 10 minutes w/5lbs weights, 3-4 times daily)
• One Leg Balance (Injured Let, 30 seconds at a time, 4 reps, 3-4 times daily)
• Stationary Bike (No Resistance, 10-15 minutes, 2-3 times daily)

These are all feeling really good so far; even better than they did this summer, somehow.

 After doing all my exercises, she checked my extension (pretty close to normal with a little guarding) and flexion (102º), then one of the nurses came over and pulled off all my dressings.

So my sutures are actually underneath the surface of my skin, which is really cool.  In the picture over there you can see the two ends where the blue string is sticking out.  The red line between them is the incision where they inserted the new tendon (and drilled the hole through my tibia and femur).  The nurse actually trimmed the top string off, and taped the bottom one down with a steristrip.  When they remove the sutures (next Monday), they just grab that one end and pull them all out.  The nicest part about that is that you don't get the railroad track scarring you can get with external sutures.

You can see the two arthroscopic incisions on my knee cap in this photo as well. 

The best part about getting the dressings off is now I can shower without wrapping myself in clingfilm! And I think they'll just let the steristrips they put over the incisions come off as they like, so as soon as they're gone, I'm all done with that stuff.  I think they'll still make me wait five weeks before I swim (boooo), but at least by then my small incisions should be mostly healed, as well as the two puncture wounds I have higher on my leg (I know one was for the saline they put in, and I think the other one is where they pulled the top of the tendon through and secured it with the titanium pin).

Monday I felt pretty terrific, but then I also forgot my work laptop at home, so as soon as I finished my meeting, I went home and worked from my couch with my cryocuff on for the afternoon.  Tuesday was a completely different story; sleeping on my side was great for my spine, but not so much for my knee.  Every time I moved I would overlap my legs and irritate that giant bruise on the inside of my knee.  I woke up feeling exhausted and sore, then managed to get the mother of all headaches in the afternoon.

Finally, by about 7:00PM I'd had enough and took a Vicodin.  Best decision EVER. I slept great Tuesday night and felt wonderful on Wednesday.  I got a headache again last night (the weather is very cold and nasty here in Colorado, so I think that's what's doing it), so I took a Vicodin again with similar results.  Same thing is happening TODAY (headache, ugh), so again with the Vicodin.  Hopefully tomorrow will be another good day!

Okay, signing off for now.  :)

Post Surgery: Day 5

And the last day of the PT sheet:

• keep your extension perfect (of course)
• your flexion should be at 100 degrees
• pain medication should be used only as needed

So far I haven't had a Vicodin since yesterday afternoon. I still don't have any pain when I'm just sitting, but walking hurts a lot more today. PT is about the same, pain wise, as it was on day two (3-4 on the pain scale).

I steadfastly refuse to take any Vicodin today, though. Not unless I happen to get up to a five or something. Because I'm a tough girl, and I can handle this! Or something.

By the way, for me a 1-2 is something like, okay, ouch that doesn't feel good, but I can live with it. Like when you whack you shin on the bedframe and it aches a little. 3-4 is more like this hurts enough that if I could stop doing what I'm doing (i.e. leg extensions), I would, because wow, uncomfortable. A couple times it's gotten to the point where I've been punching my other thigh toward the end of my ten minutes of weighted extensions because I really don't like how it feels.

Also, starting yesterday I've had kind of an odd popping behind my knee when I go from bent to straight leg. Not behind the knee cap, but the back of my leg, right below the surface of the skin. I don't know what that's about, and it doesn't hurt, but it doesn't feel pleasant either. I'll have to bring that up with my physical therapist tomorrow morning.

Oh! I keep forgetting to mention, but my GP called me before I went into surgery on Tuesday and told me by blood test came back normal, so I don't have a protein deficiency. Which means I don't appear to have a clotting disorder, yay! So as soon as I'm done with my three weeks of preventative Coumadin, I'm done with blood thinners for a while. Woo!


I'm so glad that I'm done with the hourly PT tonight.  It feels like I'm just a life support system for my knee at the moment.

Post Surgery: Day 4

PT Sheet Says:

• keep your extension perfect
• continue using the cpm, stay down to decrease your swelling
• your flexion should be past 90 degrees
• start decreasing your pain medication

I didn't read that last bullet point until after I'd already taken two Vicodin, so I started decreasing the painkillers on my second dose today to one pill every six hours instead of two. I hacen't really been having much pain, except when I'm pushing my flexion. It's strange to me how much less painful this has been compared to the meniscus surgery I had in June. I'm wondering if that one was so awful because of the trauma of the injury itself.

My swelling has gone down today, which makes me happy. I was a little stiff on my first set of PT today, and I was a little worried about being able to get my flexion past 90 degrees, but it's been getting better with each PT session.

I got up and showered again today. When I did, I noticed my knee was really red and hot to the touch. I'm keeping an eye on it, and had my husband change the ice and water in my Cryocuff, and it looks like it's getting better, so maybe it was just inflammation? I hope so. Infection would be no bueno.

For some reason my quadriceps has been really twitchy today, and really only when I'm sitting still in my CMP and Cryocuff. It doesn't hurt, but it's a really annoying feeling. I hope it knocks it off soon, because it's driving me bonkers.

Otherwise I'm just fully ready to be done with the bedrest. My back doesn't enjoy the position I have to sit/sleep in, and I really just want to be able to go to the kitchen and get food when I'm hungry rather than having to ask for food to be brought to me. I want to go sit on the couch or go get the mail. My knee doesn't hurt enough and my mobility is good enough that I feel like I could get along just fine. I know why I have to do this, and I'm going to do what I'm supposed to do, I'm just antsy and stir crazy today. Blah!

Post Surgery: Day 3

The PT sheet says:

• keep your extension perfect
• your flexion should be improving to 90 degrees
• keep your pain under control by continuing to use your pain medication

Over night this day I scared the hell out of myself. I woke up at 12:30AM out of a dream I was having where I'd stubbed my toe because my big toe on my left foot was actually hurting intensely. When I went on Coumadin in July I'd watched videos about things to watch for when on blood thinners, and one of the scary things was your toes turning purple. So I immediately pulled off my sock and checked my toe and everything looked fine. I also pulled off my stocking and checked the swelling and stuff in my knee, and made sure I didn't have any swelling in my calf.

Everything looked fine, so I convinced myself I was okay and went back to sleep. In the morning, my toe still hurt, so I pulled the stocking off my foot again, and less than half an hour later my foot felt fine. It turns out I just had pulled my stocking up too high, and then the Cryocuff pulled on it enough that it was putting pressure on my toes.

This was also the day I had my first bowel movement since my surgery. Which is a lovely topic, I know, but being on narcotics like this can wreck havoc on the digestive system. The day before, my friend Kristi brought me a bunch of fiber rich things to eat, and I'd started eating a lot of fruit and vegetables. All of that worked well for me, and I haven't had to employ any medication or anything.

All the swelling in my knee caused my flexion to be difficult, but I did manage to get to 90 degrees when sitting in a chair without pain. I do this thing in PT called a heel slide where I drag my heel toward my butt while sitting on my bed and getting as much bend as I can in my knee. That was a lot more difficult, but I could get to 90 degrees that way as well.

Post Surgery: Day 2

PT sheet for day two:

• keep your extension perfect (sensing a trend here?)
• it is okay to shower today, but keep the dressings dry and be careful not to fall getting in the shower
• keep your pain under control by continuing to use your pain medication

Day two I spent working from bed. I got up just after eight

and my friend Kristi came over to "baby-sit" me (basically feed me since I'm not supposed to go to the kitchen). It was a little hard to get into a work groove having to stop every hour to do PT. Again, I didn't really have a lot of pain, but I did notice this day that the medial side of my knee was very, very swollen and extremely bruised. I did some googling and all that seems to be normal for ACL surgery, so I wasn't too worried, but have been keeping an eye on it.

This evening I did end up taking a shower. I had my husband wrap me with plastic wrap and medical tape. I tried to sit on my stool to do it, but it was way harder to keep my leg out of the water that way, so I ended up just standing on my good leg and trying to prop the injured leg out of the spray. It was really nice to get to wash my hair, though, and get cleaned up. Bed rest can make you feel kinda grubby, since you have to sit in the same place for the most part for days on end. I'd say it's worth the trouble to keep the dressings dry to get up and bathe.

If anyone else decides to use the plastic wrap/tape method, waterproof tape would be a good idea. The tape soaked through really quickly and started to peel off, so it wouldn't have held up well at all if I'd had my leg more in the path of the water.

Another tip: for sleeping in the CPM, getting several loose blankets thrown over you is going to work a lot better than trying to use the blankets/sheets tucked into your bed. I also have someone else tuck me in so I can cover up my feet, since it's hard to do it myself from the position I'm in flat on my back with my leg up in the CPM.

Post Surgery: Day 1

Sleeping in hospital beds is always fun, because they're hot (on account of them being made out of plastic) and the pillows are so uncomfortable. That coupled with getting used to my leg moving constantly in the CPM (which is currently the God damn bane of my existence, OMG so sick of this thing today) and the five AM vitals check, I didn't sleep very well my first night after surgery.

I finally got up at about 8:15AM and got my morning Vicodin with toast and coffee. Erica came in about fifteen minutes later and changed my outer dressings and I snapped a picture, though the patches I was wearing over the actual incisions won't come off until my post-op appointment on Monday. At that point there hadn't been any leakage from my incisions (they fill your knee with saline during the surgery, so a lot of times that leaks out when you're healing – mine didn't after my last surgery, and hasn't after this one either), and really no swelling either.

By the way, they put a thrombosis stocking on my left leg after surgery, and I've been wearing them on both legs since, despite being on a preventative dose of Coumadin since the night of my surgery. These aren't nearly as tight as the ones I was wearing after I got out of the hospital, so I'm not sure what good they're doing, but I'm wearing them like I'm told. :)

Anyway, after Erica changed my dressings and showed me a couple more exercises, I had the rest of my breakfast (oatmeal with fruit), then got ready to go home.

I was home by about 10:15 and my husband helped me settle into bed (aka the place where I'd be exclusively spending the next five days of my life). I spent the rest of the day doing PT (I have to do it every hour on the hour from 8AM through at least 10PM) and sleeping off the narcotics.

The PT went well this first day. I had a lot more flexibility in my knee than I expected, and almost no pain.

I went to sleep early because I hadn't gotten much sleep the night before, but didn't sleep that well again. My back started aching from the position I was laying in, and I couldn't seem to get comfortable.

So ends my report on day one.

Oops, I meant to post what my PT paper says for each day as far as what my goals and such. So, for day one:

• keep your extension perfect
• today and tomorrow will be the most painful days (if this is true, then this whole ACL thing isn't going to be bad at ALL)
• your flexion may be less than yesterday (this was true)
• keep your pain under control by continuing to use your pain medication

The Main Event: Surgery Day

Okay, done! I'm in my room in the recovery center relaxing and feeling pretty good. So now a recap (typed via iPad).

When I got to the surgery center at 2:15 they took me and Jeff back to the little conference room and a guy from the medical equipment company showed me how to use my CryoCuff and the CPM (Continuous Passive Motion) machine. Then we headed back to the waiting room for about 20 minutes until they took me back to my curtain area.

Because of my historyof blood clots, they had me wear a thrombosis stocking on my right leg during surgery, so I put that on, as well as my gown, grippy socks, and sexy surgery cap. I got an IV and they started me on saline and took my vitals. About 15 minutes later I met with the anesthesiologist and he explained how the spinal would work, and we chatted about blood thinners and such.

About 15 minute after that, Dr. Trumper came by and signed my knee, we verified again that I was going to use a donor tendon, and he told me he was going to give me 5 mg of Coumadin tonight, then put me on a lower prophylactic dose for 2-3 weeks. After that the anesthesiologist came back over to administer my spinal.

I was freaked out, not going to lie. They had me sit with my legs over the side of the bed, leant over in a slump. A nurse gave me some roofies (Versed) and then stayed there to spot me in case I fell off the bed. The meds kicked in pretty quickly and I felt a little swimmy. Then the anesthesiologist gave me a lidocaine shot in my back to numb me before administering the epidural. The lidocaine hurt and burned, but it didn't last long. The needle for the epidural hurt too, but in a different way, like really uncomfortable pressure. I didn't like the way it felt at all. However, again, it was over quickly.

As soon as I was back on the bed correctly, they wheeled me into the OR. Like last time, it was freezing, and they immediately gave me warm blankets from the little blanket heater thing. The spinal started working, and my belly felt numb, then it spread down my legs, like they were getting warm and heavy. Pretty soon I couldn't feel anything below my navel. One of the nurses lifted up my leg to test the flexibility and I could see her doing it, could see my leg moving, but couldn't feel it at all. It was like it was detached from my body. Such a crazy feeling, and it totally gave me some insight as to what it might be like to have a spinal cord injury (so strange, Cheryl, I had NO idea how truly strange it must feel for you).

Not long after the out of body experience I just described, they pushed more roofies and I don't remember anything after that until they had me in the curtain area again. It's so weird because I know I was awake, and I remember some things from the last time I was on Versed, but this was completely different. The nice part about this is that I was far more coherent this time than I was when I had general anesthesia for my meniscus surgery (and I didn't have the freaky reaction that I did that time where I started shivering uncontrolably). The nurse asked if I could feel my belly button and I told her I was still pretty numb. Then she asked if it was normal for my pulse to be in the low 40s (it is), because I kept setting off alarms on my heart rate monitor.

--

Okay, everything up there was typed on Tuesday night. I tried to finish the whole surgery recap that day, but I had a lot of drugs in my system and was having a hard time focusing (and typing on my iPad). I'm going to try to finish the recap from memory now. :)

As soon as I was awake enough, the nurse gave me some crackers (woohoo, FOOD!) and my first dose of Vicodin, then took me to my room. They had me move from the transport bed to the room bed on my own, which was interesting because at that point I still couldn't feel much below my hips, and my ass was still numb. They got me into my CPM for the first time, covered me up in blankets, and gave me more crackers (yay!) and a nice, powerful anti inflammatory by IV.

Then my mom, sister, and husband came in to see me. My sister thought it was hilarious that I couldn't feel my feet and kept playing with my toes and trying to tickle me. My feeling came back pretty quickly, progressing from my belly down my legs. Strangely, the last three things to come back were my toes, my rear end, and my crotch. It was nice when my toes came back, because they felt cold and swollen when they were coming back from being numb.

About that time my dinner arrived. The OCR caters in their food, so I got cheese ravioli and salad from a yummy local Italian restaurant (Canino's). I think I ate it in less than five minutes, I was so hungry. And it tasted amazing. Best "hospital" food ever.

After dinner my physical therapist, Erica, came in and showed me how to do my exercises, and gave me a packet of paper where I could track my PT and meds over the next five days at home. I was planning to make a blog entry for each day, and I'm still going to do that, though I will be writing days 1-3 today, as well as day 4 (which IS today), rather than on the actual day (which was my original plan).

I think that about covers surgery day, so I'm going to go ahead and end this post and start the posts for the next three days, which should all be substantially shorter, hehe.

T-About 15 Hours

Well, tomorrow is surgery day. I'm tired as hell right now, but I'm staying up because I have to go NPO at midnight, and I'm not looking forward to not getting to eat for 14 hours. I found out that black coffee counts as a clear liquid, and I'm allowed to have those until 8AM, so I'm thinking I'm desperate enough to get up early and drink coffee.

At the moment I'm not really very nervous. I have a feeling that will change in the morning. I've never had spinal anesthetic before, and that worries me a little. I know I'll be awake (but hopefully drugged out of my brains), but I'm a little scared of what that will be like. When I was in the hospital I had a couple procedures on Versed and I mostly don't remember, but I do remember some, and I'm not sure I want to remember someone drilling holes in my leg bones.

And I just decided it was a good idea (spoiler: I was WRONG!) to watch YouTube videos of ACL reconstruction surgery. This is pretty close to what I'll be getting, if you're morbidly curious (and I do mean morbidly – it's pretty graphic). Yeah, um, I hope I get lots and lots of drugs before this thing. Because YIKES.

Okay, I'm going to go eat again before I can't anymore. I'll update here as soon as I can post-surgery (husband is bringing my iPad to my room, but I'm not sure how coherent I'll be) on how it went and how I'm feeling. The picture up there is what my knee looks like today so I can compare with what it looks like when I take the packing off.

Alright, wish me luck!

I'm what I like to call "ACL Deficient"

I got my bracelets yesterday! I ordered them last Wednesday and it was supposed to take 7 days just to make them, not counting shipping. Way to go wristbandsnow.com!

In other news, I'm wondering if my knees can sense the impending doom, because they were both really bothering me yesterday. The left one has been popping since I got out of the hospital, and yesterday it was doing it way more often than normal. I also almost lost my right knee in my willPower and grace class last night, just by locking my knees too much in my power stance. Today my left knee wasn't very happy about my butterfly kick at swim practice.

Last night I picked up my post-op drugs – looks like it's Vicodin again for the painkiller, which is fine by me. If they don't think it's a pain that's going to require something nasty, I can totally live with that. I'm sure this is going to hurt more than the last surgery did, but I can't imagine it's going to be worse than that first day in the ICU. The pain that day was so terrible that I was seriously wondering if it would hurt less to just amputate that leg at the hip.

This time I also get a prescription (aside: if it's spelled that way, why do we pronouce it "per-scription"?) strength anti-inflammatory. Woohoo NSAIDs! I'm unsure yet what my Warfarin dosage is going to be, when they'll want me to start it, and whether or not it's going to be therapeutic or not (i.e. needing to be monitored via protime).

Okay, so mostly this entry was me wanting to be excited about my bracelets. Enough with the fake substance. ;)

Epic Knee Fail: A Prologue

In about a week, I will undergo ACL replacement surgery in my left knee. This will be my second knee surgery this year, and I was thinking that I wished I'd blogged a bit about my arthroscopic surgery in June, so I thought I'd start blogging now, and then throughout my surgery and recovery.

First, though, a quick backstory. As a kid, I wasn't very athletic. I tried gymnastics and ballet when I was little, but I wasn't very coordinated, and it became sort of apparent that I was more suited for studying and being more academic.

When I was in college, however, I met a boy (you know how that goes) who played inline hockey, and thus I started playing my first sport at age nineteen. I played roller hockey for about five or so years, then decided to get a second degree (while working full-time), and had to remove any extracurricular actives that weren't sleeping. After a few years off, I met another boy (this one became my husband), and we decided to start playing hockey again (he'd played ice hockey in the past), so I started playing ice hockey about five years ago.

Ice hockey, obviously, takes slightly different skills than inline, and though I was a decent skater, I fell down a LOT. A couple different times I injured my knees (hyperextension, mostly), but never thought any of the injuries were very bad. My knees would hurt for a few weeks, then feel mostly better. Since then I've had some flexibility issues, and my knees would go out occasionally, but I figured that was just things healing slowly.

Two years ago, I injured my right knee trying to take third base in a softball game. That night I had my friend – a doctor who played on our team – examine my leg. She tested the flexibility of both knees and said they felt okay to her. I never saw a doctor because I figured I was fine.

Then this year – on June 7, a week after my 32nd birthday – I injured my left knee trying to avoid a collision at first base (moral of the story, softball is EVIL). This time I couldn't walk afterward, or the next day, so I had to actually go see an orthopedist, Dr. Trumper. He came in, jiggled both my knees and told me without any hesitation that I had blown the ACLs in both of my knees. I also had what's called a bucket handle tear in my right medial meniscus. This means that the meniscus tore right down the middle and then flipped into my knee joint, locking my knee at 90 degrees.

On June 14, I had routine arthroscopic surgery to trim out the torn portion of my meniscus. The surgery went fine, I was on bed rest for three days, then started physical therapy. Everything seemed to be going great, and on July 20, I went and saw Dr. Trumper for a followup appointment. That day I got permission to compete in my first triathlon since the surgery. That was also the day I started feeling pain in my left upper thigh, which I attributed to a pulled muscle (I'd been riding my bicycle, and thought maybe that's where I'd hurt myself).

The following Saturday morning I got up to do my tri and my leg hurt so badly I couldn't walk without a limp. I decided not to compete and went to swim practice instead. By that afternoon, the pain started radiating down behind my knee and along my calf. My husband, who had asked me that morning if I'd considered that maybe the pain wasn't a pulled muscle, took me to Urgent Care, and I was sent to the hospital for an ultrasound. They found that I had a blood clot that extended from my groin

all the way down my leg toward my ankle.

I was admitted to the hospital that night, and the next morning they inserted a catheter into my femoral vein, which they used to administer blood thinners directly to the most dangerous clot. The long story short is that it hurt unbelievably, I had to spend two days in the ICU (and five in the hospital total), and then spent the next two weeks on crutches because the clot in my lower leg and the giant hematoma behind my knee from the catheter made it impossible to bear weight on that leg. After that I had several weeks of additional physical therapy to get back to being able to walk normally.

I didn't really realize it at the time, but I was actually in very serious danger because of the clot in my femoral vein. If part of that clot had broken free, it could have gone to my lungs (pulmonary embolism) and killed me. At this point, they're still unsure why I clotted so badly, though there's still a possibility of a genetic disorder (pending a followup blood test to check my protein levels). It might have also just been "bad luck", a combination of the oral contraceptives I was taking and lower activity after surgery.

As of today, I'm probably about 95% recovered from the initial surgery and blood clot. After being on blood thinners for four months, I was able to come off the day after Thanksgiving (after having a clear ultrasound). A week from Tuesday, I'm finally getting my left ACL replaced.

And so I'm starting this blog. It's called "KneeStrong" to riff on a bit by Stephen Colbert (on which I'm harboring kind of a huge crush at the moment, not going to lie) that came up when he broke his wrist a few years ago – "WristStrong". I'm planning to use this space to talk about the surgery and recovery in detail, partially so I don't annoy the people who follow my regular blog, partially in case anyone who has to get their ACL replaced comes upon this and wants to know what it's like, and also to keep a record for me to reference when (if) I get my right ACL replaced.

Right now I'm equal parts excited and sad about the whole thing. I'm glad I'm getting my knee fixed, because it was causing me all sorts of problems with sports, and also I've been having a lot of popping since the meniscus surgery. On the other hand, this surgery is going to put me off my feet for a long time. Five weeks until I can get back to swimming (but thank God for that, because otherwise I might not be able to cope), but five MONTHS until I can go back to anything else (hockey, aerobics, etc.). I should get to bike, at least, though with it being winter it will probably be all stationary cycling. Better than nothing though!

Okay, that's enough for now. I should start updating this thing more regularly when I go in for surgery – December 13.

Bye for now!