Week One and Two Post Right ACL Reconstruction

I'm a little behind again, so I'm going to break this post into two parts.

Week One Followup:

Just like the followup from the first surgery, the one week appointment was getting my list of PT (same as before – mini-squats, heel raises, 10 minute extensions, straight leg raise, one leg balance, and biking 10-15 minutes with no resistance, all 2-3 times a day), turning in my CPM (thank goodness – I'd be happy to never see one of those ever again), and having my dressings changed (I was very thankful for that too, since they were disgusting this go around).  Here, have a lovely picture of what the insides of my dressings looked like after they pulled them off.  Mmm, dried blood.  It was like an enormous scab.

The guy who changed them didn't clean my leg off, though.  Just slapped some steristrips down and gave me my little compression dressing.  So I had the privilege of being crusty until I got home from work.  Ew.

I tried to make it through the entire day in the office (last time I only worked a half day, then went home, but that was mostly because I'd forgotten my work computer at home, so I just went to a couple meetings, then worked the rest of the day from my couch).  I managed to tough it out until four, then I couldn't take it anymore and went home for some narcotics and time in my cryocuff.

I did get a shower once I'd gotten home and sat for a while, though, which was glorious.  The first shower after having the dressings changed is awesome because you don't have to hassle with the stupid Saran wrap anymore.  Plus it meant I could finally clean off the remaining dried blood and gunk.

Again, I had the totally awesome fishing wire stitches.  That stuff is so cool.  When Erica takes them out (as she did today), she just pulls the bottom string and they all come out at once in about half a second with zero pain.  So neat.

The bruising was about the same as what I had on the left side, and the past week it's been itchy and annoying as it's healing. It's mostly faded in the middle and is just still dark around the edges. Unfortunately, some of the darker bruising that's lingering is on the back of my knee/upper calf, which makes my leg ache when I stand for too long.

I did range of motion tests last Monday and came in at 136º on the left (which is about 6º short of "back to normal") and 117º on the right.

Week Two Followup:

I went in this morning for my second post-op appointment and got my PT bumped up again (same as the last time – leg press, hamstring curls, one and two leg squats, heel raises, skaters, standing hip abduction, gradually work up to 45 minutes biking or stair stepper). This means I can go back to the gym this week, woohoo! I'll be back down on weights again (was at 155 lbs double leg press and 75 lbs single leg, and 70 lbs double hamstring curl, 35 lbs single leg), but I get to EXERCISE. The hardest part is going to be working back up to 45 minutes on the bike, since I have to start at 5 minutes per session (OMG want 45 minutes NOW). If I go every day this week, I will be at 45 next Monday. I can't wait (I have a thing where plan it out so I get to the bike at 6:00PM so I can watch AC360º while I'm biking).

Range of motion today: 136º left (unchanged from the last visit, but I haven't been doing extensive PT on that side) and 125º right (not bad!).

They also shot x-rays again today, which I always enjoy (no really! I like looking at them!). I saw Dr. Trumper and he said that my knees were "freakishly symmetrical", and that usually they didn't come out quite so identical after double ACL reconstruction. I'm hoping my scars are equally symmetrical, because I'm OCD like that. Everything is aligned properly, and Dr. Trumper says I'm doing great.  :)

Additionally, he says I can get back in the pool in two weeks instead of three!!!!1 My incisions need to be completely healed (scars not scabs), but WOO FREAKING HOO! I'm still not sure I can swim at State (I'd have three weeks to train before the meet), but getting back in a week early is still fantastic, awesome news!

Anyway, here is the obligatory shot of the x-rays on the screens in the consulting room. My right knee is always labeled with an R tile, and left with an L (naturally).

Here's a better look at both knees together, front on.  Please excuse the crappiness of the photo demarkation, my software at work is pretty lame (yay freeware?). ANYWAY, these are my knees! This x-ray was taken with my knees bent at about 30º with my knee caps against the machine. The orientation is as if I'm facing the reader, so my right knee is on the left, and my left is on the right (yay confusion!).

Anyway, the blue circles are around the titanium pins that are holding the grafts in place through my femurs.  You can't see the plastic buttons that hold the other end through my tibias in the x-ray, but you can see the holes they drilled in there; those are circled in red.  The one on the right (my left leg) is harder to see because it's more healed.

That's about all I've got, I guess.  My next appointment is at five weeks (three weeks from now), and then ten (I never did ten on my left ACL because I had surgery again at week eight).  From here on out all my followups will be based on my right knee, with the caveat that my left is two months ahead in recovery.  Erica says I'll be getting strength tests in three weeks again. It will be interesting to see if my left leg has gained or lost any from my last five week test, since I've had two weeks of relative inactivity in the middle of my PT on the left side.

I Can Has ACLs!

I always start out writing these things with the intention of finishing the day after surgery.  But then the narcotics make me narcoleptic and I can't manage to get them done until recovery day four (which is the day I start reducing my pain killers). Today is day four, post surgery.

So, five days ago I had my right ACL reconstruction surgery.

Going in, I had no nerves at all.  I was actually feeling pretty laid back about the whole thing, since my last surgery was only two months ago and that went about as well as surgery can go.  And I was also excited that I got to go in at noon instead of after 2:00PM like my last two surgeries, because it meant I didn't have to fast for as long, hehe.

We got to the Orthopaedic Center at  10:30AM and ended up sitting in the waiting room for about 45 minutes before they took me back.  It was the same drill as the last time: change into my gown, booties, and cap, then go hang out in a pre-op curtain area.  That's where they gave me my thrombosis stocking for my left leg, and then went about trying to give me an IV.


I say trying because they had to poke me three times to get an IV started.  One of the two nurses had a decent vein in my left arm, but as soon as she injected the Lidocaine to numb it, the vein flattened out and she couldn't get the catheter in.  The other nurse tried to get it, then tried another spot higher up.  The second spot she got some blood to come out, but couldn't push saline in, so off to my right arm they went.  They did manage to get that one in pretty easily, and I was happy that I didn't have to have any more Lidocaine shots (the stuff burns).  I do have a fun bruise on my left forearm from the aborted attempts (made worse by the blood thinners I'm on now).

While they were stabbing my right arm, my anesthesiologist came in and we chatted about the spinal and I mentioned the back pain I had from the one in December. He said he thought that sounded weird and didn't think it was an issue (I think he thought I was being paranoid or something).  The spinal actually hurt less this time than last time, though, while it was going in.  The Lidocaine sucked, mostly because he gave it to me too soon after they pushed the Verced (and did I mention that Lidocaine is burny?).  I do think they gave me slightly more Verced, because I felt way more stoned once it finally kicked in.  I do remember that they stuck a drape to my back before they stuck me, and I tried to watch a bit more of what the anesthesiologist was doing with his little tray of goodies (there were a bunch of vials, but I only remember him opening one and pulling the liquid from that into the syringe).

Dr. Trumper finally came by about the time they were giving me the spinal and initialed my right knee (I was in fact sitting with my legs over the bed waiting to be stuck when he signed me), and so I was talking to him after I'd been drugged.  So I clarified that I would be getting "dead people parts" again, hehe.  Very classy.

Anyway, it didn't take long before my legs went numb and they wheeled me over to the OR.  I was introduced to the OR staff (I never remember the names of these people) and announced to the room that it was my right knee they'd be operating on.  I remember more about how they got me from my gurney to the table this time (they tipped me to the left, put a relatively short plastic thing under my bottom, then laid me flat and slid me across), and they needed me to move up on the table a bit and jokingly asked me to do it myself before grabbing the ends of my sheet and moving me themselves.  Then there was the fun dissociative moment of one of the nurses lifting up my right leg and propping it on her shoulder while she wrapped a tourniquet tightly around my thigh. I don't remember the tourniquet the first time. I was also glad that I couldn't feel my legs, because she really cranked it down, and I bet it would have felt unpleasant.

I woke up in recovery disoriented, thinking I was still in the OR. I had a ton of blankets on me, including one on my head like a hat.  And I was freezing. They actually put a heated bags of saline under each arm, and this weird heater that blew hot air directly into my blankets.  Even with all that I was still cold (but not shivering uncontrollably like the last time I had general anesthesia).  The oxygen canula they had in my nose was itchy and driving me crazy, and I kept adjusting it until the nurse finally took pity on me and took it out.  Again I set off alarms with my low heart rate (high 30s), and had to explain that it was normal for my resting heart rate to be so low.

Finally they took me to my room (I was in four this time, last time I was in room five).  The bad part is they took away my heat blower thing, but they did crank the heat up in my room to 80º (and it stayed that way the whole time I was there).  I also got my first dose of Vicodin, which I needed because I was in quite a bit of pain. My nurse, Jen, was amazing. Funny and sweet and she kept checking on me (mostly because I refuse to bother the nurses by hitting the call button).  She brought me lunch (turkey sandwich, but I took the turkey off and had a lettuce, tomato, and mayo sandwich :p) and coffee.  She brought me a second cup of coffee and I started to get really, really itchy.  Apparently that's normal when the spinal starts wearing off, but it was driving me bonkers, so she brought me some Benadryl.

About twenty minutes later I started feeling super groggy, and warm all over, and I thought it was the Benadryl kicking in.  But then I started to have a panic attack and went completely pale, so Jeff went and got Jen.  Apparently my blood pressure had dropped suddenly, which is another thing that happens sometimes when the spinal is wearing off.  She put the head of my bed down and gave me a ton of fluids via my IV (500 ml) and I perked back up in about half an hour.

I also learned that the very last thing to come back after the spinal (even after your bottom and your groin), is your bladder.  They had a pad underneath me in case I accidentally wet the bed (I didn't, jsyk, hehe).

The rest of the night was fairly uneventful.  I had another super yummy dinner (cheese filled shells, again from Canino's), and actually slept fairly well.  I did have a lapse in my pain killers because of the nurse shift change, so I ended up being in a lot of pain again when my first dose wore off before the night nurse came and gave me my second dose.  I started my PT and that went just fine.

Jen was back in the morning and she woke me up at seven for my Advair, so I just stayed up.  Erica (my physical therapist that I've been seeing since I had my left ACL done) came in again at 8:00 AM and changed my dressings.  This time my incisions actually leaked (they've always told me that can happen, but I didn't have any drainage after the first two surgeries), so there was kind of a bloody mess.  The best part about this is that I've had considerably less swelling this time around.

The first full day post surgery is so strange. I felt stoned out of my mind on Wednesday, but the real nodding happened three or four hours after I took my Vicodin. It probably had something to do with the lingering effects of the anesthesia. I was still itchy that day, too, my arms, neck, and torso mostly. Apparently coughing can help clear it out of your lungs and stuff.  It's all very odd. Otherwise I felt pretty good, didn't have much pain because I kept up on my pain killers and my anti-inflammatories.

I fell asleep early and woke up at 5:00AM feeling pretty sore.  I ate a couple graham crackers and then took two Vicodin.  About half an hour later I started having a full on panic attack and began to feel quite nauseated.  When I'd start to fall asleep, I'd jerk awake because I felt like I wasn't breathing, and like my throat was swelling up.  Jeff came in about eight and I was feeling more calm, but still really sick to my stomach.  I was afraid to take any more Vicodin, or any of my anti-inflammatories, because my stomach was empty and I was feeling so ill.  Jeff called the OCR and they prescribed me some anti-nausea meds that Jeff went and picked up for me.

I took one with the hope that I'd be able to eat, but I threw it up almost immediately.  Jeff brought me some clear soda and dry saltine crackers.  I ate about three crackers, then threw those up about twenty minutes later.  I was in quite a bit of pain since I couldn't take any pain killers, so I decided to just try and sleep for a while.  I dozed off and on until about two, then tried eating again.  This time I had macaroni and cheese, and it stayed down, so I was finally able to take my meds.  I've been feeling pretty normal since then, so I assume it was just the last of the anesthesia wearing off that was making me sick.

I had a shower on Thursday, which is the first time I changed my dressings after leaving the recovery center.  By then I'd had a little more seepage, but it wasn't too bad.  The shower was kind of a pain in the ass because I have to wrap my leg in cling film to keep the bandages dry, and I seem to be failing pretty hard at it this go around.  I got the bottom of my bandages wet, and thus the dried blood underneath got damp and gross.  I think my incisions stayed dry, though.  Since then I haven't had any more fresh blood or drainage.

My bruises started to really come out on Friday, looking much more like they had on the left side.  They look pretty awesome, red and purple and all around my knee front to back.  They don't really hurt, but I expect them to be uncomfortable and itchy by next week.

I'm really starting to get sick of sitting in the same position, again.  Today is the third full day, and my hips and ankles have been pretty sore and irritated since Thursday morning.  I've been taking some breaks from the CPM occasionally so I can sit in a position that is more comfortable for my other joints and my back.  I'm feeling good enough now that being bedridden is starting to make me crazy.  I'm trying really hard not to eat my body weight in food, but that's hard too, since I'm so bored.  It's doesn't help that I've been watching the Food Network and the Cooking Channel almost non-stop since yesterday.  So much chocolate, mmmm.  I've gained about three pounds since Monday, on top of the three pounds I gained after I was hospitalized and had my last surgery.  I guess it just means I'll have to be diligent when I can start working out again.

That's about it.  I'm still doing my PT (same regiment as the last time) and sitting on my butt the rest of the day.  It's boring and I'm remarkably sore, but it's almost over (just a day and a half to go).  When I'm done with all this I'll have functional knees, which means I can be more active (once I finish recovering), and I hopefully can avoid total knee replacements in the future.

Lastly, I made a video the night before surgery that documented the flexibility of my mostly "good" right knee, as well as the eight week progress of my recovering left knee.  Once I get that edited, I'll put that up on this blog.  It may not be very exciting, but I thought it was kind of interesting.  And my first video blog!  Woo!  Hehe.

Okay, I've got friends coming over (with Starbucks, bless them), so I should probably finish this post.  I'm sure I'll update again soon with my first post-op appointment and such.  Almost done with all this recovery stuff!  I can't wait!