This page is where I'll post periodic updates describing the aftermath of my ACL reconstruction; How the knee feels, what it's able to do, my mental state, what my surgeon, nurse, and therapist are and are not telling me, etc.
Monday, October 16, 2006 - Surgery Day
Checked in at the facility around 6am, like I was instructed. The took me to my hospital bed, had me change into a gown, and onto the bed. Every few minutes, a nurse would come by to insert an IV, take my clothes to a locker, or double/triple/quadruple check that I was the person described on the chart, and to write "yes" on the knee that I wanted fixed.
Apparently, my surgeon always shows up late and this is common knowlege to the nurses, yet I find out about it today. Super. To save him some time, he calls the hospital when he's a few minutes away so that they can zonk me out and have me all prepped by the time he gets there. As an added bonus (for him), he gets to avoid being in the same room with a conscious patient.
So they wheel me into the O.R... have me shimmy over to the surgery table, and then I lie back. The anesthesiologist reaches over to my IV and opens a valve, gives a little squeeze to one of the bags... and then the room starts to spin a little.
At this point, it's "Game On" for the operating staff. No sooner had I started getting woozy, when I feel somebody reaching down the top of my gown to plant those self-stick EKG pads so that they can monitor my heart during the operation. I counted a total of four of them and, although it probably took them about 5-10 seconds to put them all on, it seemed to me that they took no more than 2 seconds. That's the last thing I remember until....
.... 2 seconds later, I hear beeping. I open my eyes, and I'm in the recovery room. (Note to self: the anesthesiologist has officially earned his money... and he was worth every penny!).
The beeping is my heart-rate on the monitor over my head. I'm aware of discomfort in my knee... but I'm so doped up, I probably only notice it because I was expecting it. There's a nurse at the foot of my bed, making notes in my chart. "What time is it?", I ask. "Eleven o'clock", he repilies. I start looking around to get my bearings, and to see what I'm hooked up to, where my loved ones are, what hurts, what doesn't. About a minute later, I re-notice a nurse making notes in my chart. I'm not certain, but I think I've already talked to him. "Did I already ask you what time it is?". He replies "Yup... and it's still eleven o'clock". Note to self: you are *doped up*. Second note to self: if you ever have surgery again, bring a pen and paper so that you can write down everything you've already asked people so that you don't annoy them.
One of the things they've got me hooked up to is a nasal cannula, giving me oxygen. When my mom and Bonnie come in, they take it off of me. Soon after, I set off the oxygen-level alarm on the monitor. A nurse pops her head in and cheerily says "deep breath!". I take a few deep breaths and the alarm shuts up. I then go back to my normal breathing and set the alarm off again... nurse pops in... "deep breath", etc. This continues until they just come in and turn the monitor off because I must be getting annoyed by the beeping of the machine warning me that my blood-oxygen level is low.
A few minutes later, mom and Bonnie go out to the car to look for some paperwork or something. While they're gone, a nurse comes in and says "let's see if we can sit you up". I sit up and turn sideways on the bed with my feet hanging off. At this point, the nurse puts my pants on, socks, shoes, removes my gown, and gives me my shirt to put on. In the time it takes me to put my shirt on, she has left and returned with a wheelchair, and in I go... and then she wheels me right out the door to the parking lot.
Mom and Bonnie, who had been getting something out of the car, were quite surprised to turn around and see me there. The everyone helps me into the car and I'm off for home. I had heard new mothers complain about the "drive-through deliveries" these days, where the hospitals were sending them home very early. I hadn't fully appreciated their point until now. I mean... I completely felt like they couldn't be rid of me fast enough.
At home, I find a comfy place on the floor, with my leg up on the couch, and I go back to sleep, because I'm still pretty doped up. Two hours later, I wake up and I'm a completely different person. I feel 10-times more alert and awake. Nice and lucid for the long waiting game....
Tuesday, October 17, 2006 - 1 day post-op
Starting today, I'll give you updates on my overall pain level (10 being unbearable) and the "knee condition". The knee condition will be where the knee seems to be on a scale of 0 through 10, where 0 is not being able to put any weight on it, nor bend it, nor move it in any way without incurring pain. A 10 on the scale would be the knee as you were born with: no pain.. you can run, jump, cut, twist, squat, kick, etc.... without a care in the world.
10 years after my original accident and before re-injuring my meniscus, my knee condition was about a 7. I couldn't play stopping/cutting sports (raquetball, softball, basketball), but I could still play hockey without any problems... and I could jump, twist, squat, and kick.
After I re-injured the meniscus in February, the knee condition would go between 3 and 5. When the meniscus was out of place, I couldn't straighten the knee and couldn't flex it very much. When the meniscus was popped back into place, I could straighten it, but no flexion past about 130 degrees or so, or the meniscus would pop out of place again.
Today's Knee Condition: 0.5
Today's Pain Level: 3 (sometimes, briefly, 8 if I move wrong)
Mom and Bonnie have been taking turns looking after me and trying to figure out the proper operation of the stuff they sent me home with. All told, they've sent me home with four things with which I have zero experience with: a knee immobilizer, a cryo-cuff, a pain pump, and a surgically-repaired knee.
Having not been shown any exercises to do by my surgeon or any nurses, Bonnie calls the rehab place that shares the building with my surgeon. They schedule me for a visit tomorrow, so that we can see some of the stuff we should be doing.
With the aid of the ice-cuff, the pain pump, and a darvocet now and then, the knee just kinda aches mildly, if I don't move. Not quite enough to keep me from sleeping. However, sometimes, if I'm shifting around to get on crutches or for someone to put a pillow under my leg, it really smarts. Fortunately, it seems entirely linked with muscle use. When I go to lift my leg, if I use the wrong set of muscles, it feels like I'm tearing my stitches open. Furtunately, I discover that I can lean forward and lift my leg with my hand cradling my calf and then I'm in pretty good shape.
Wednesday, October 18, 2006 - 2 days post op
Today's Knee Condition: 0.5
Today's Pain Level: 2-3 (sometimes 8)
Today, I go to see Chuck, my rehab guy. We get there and Chuck has me get up on the table and says that we're going to take the brace off.
Now, up to this point, we haven't even adjusted any of the straps or anything. We've treated like it was a cast; intact and unchangeable... worried that any adjustment to it could mess up the repair or something.
So, Chuck un-does the main brace.... and then the inner DonJoy neoprene wrap. We get our first look at the cooling bladder that we hook the ice-chest up to. No big problems so far. Chuck pulls the cooling bladder and we see the ace bandage. Okay... things still look and feel okay.
So, Chuck unwraps the ace bandage, to reveal a white, cotton wrap. So, we're finally down to the layer where we're seeing signs of... well... let's just call it "leakage", because it's not all blood, and it's not all water... it's just... some combination of biological fluids. The point is that, from here on in, I know that it's just going to get more and more gruesome. I'm debating just keeping my eyes shut beyond this point so that I don't freak out. Don't get me wrong... I'm not squeamish... unless I'm looking at something gruesome that's attached to me.
Mercifully, this is as far as Chuck goes. He then slowly works me through a few range-of-motion exercises, has me do a few leg-lifts, and then wraps me back up. Not quite your high-impact workout... but at least I have an idea of what kind of exercises I should be doing.
Later that night, it's time to take the pain-pump out and, while we've got me all unwrapped, Bonnie insists on changing the dressings. So, off comes all of the stuff like before... and we get to the cotton wrapping. So, we start taking off the cotton wrap, and it's stuck to itself from all of the leakage (yummy), but we get it all unwrapped to expose some cottom pads over certain incisions. We eventually pull those away and we're down to just "the knee" with yellow gauze tape over the stiches and staples.
It doesn't look as bad as I had feared, and part of that is due to the fact that I've got betadine swabbed all over the knee (and, to top it all off, they shaved my knee!). So, with some soap and water, we're able to clean off the dried blood and the yellow betadine and it actually looks slightly like a knee. A very swollen knee... but a knee nonetheless.
So, Bonnie puts new gauze over everything, wraps me back up in a new ace bandage, put the wrap and brace back on, and I'm done. I then do a few range-of-motion exercises, but they're kinda tough to do with everything on because everything feels really tight.
Thursday, October 19, 2006 - 3 days post op
Today's Knee Condition: 1
Today's Pain Level: 2 (sometimes 7)
Welcome to the pit of despair. This is where I just couldn't hold it together anymore.
Bonnie had changed the dressings on the knee and we wrapped it all back up and she cajoled me into doing some rehab exercises. So, I'd lay back, eyes shut, while she'd gradually bend the knee until I told her to stop. Then, she'd straighten it, and we'd do it again. Each time, she seemed encouraged that I was bending it more each time. Feeling a little twinge of optimism, I opened my eyes to look at my progress. What had felt like 45-60 degrees to me was more like 10-15 degrees. Hardly a bend at all.
At that point, I just started sobbing. Any fight left in me was gone and there was only one voice left in my head, and it said: "You stupid ass fuck! What the hell were you thinking? You just couldn't be satisfied with what you had, huh? Lying here on the floor, it looks like your pre-op knee was pretty damn spectacular, doesn't it? At least you could bend it. At least you could walk!!!!!!".
Funny how you take for granted everything that you've always been able to do and you cherish the things that you've (either temporarily or permanently) lost. Having always been able to walk, I hadn't fully appreciated it's importance. Going into the surgery, I was looking forward to being able to run and play softball again. 4 days afterward, I had to tell myself that, if I just get through this thing merely able to walk, I'll never complain about my knee again and I won't jeopardize it again by pursuing silly things like being able to run and jump.
In other words, in response to the voice in my head, I was saying "I know... I screwed up. This was all a big mistake, and I promise to never do it again!".
Monday, October 30 - 14 days post-op
Today's Knee Condition: 3
Today's Pain Level: 1 (sometimes 4)
Today is my follow-up appt. with the surgeon. His assistant took the staples and stitches out, put some tape over the long incision, and then in comes the surgeon. He hands me some photos of the inside of my knee, describes the operation, assures me that I'm going to have a great knee and then asks if I have any questions.
So, I tell him about the post-operative disaster and hand him the document that I typed up describing all of the problems. He glances through it, says that he'll read it, and then takes ultimate responsibility for my treatment. As the surgeon, he says, he's ultimately responsible for delegating my care to other heath-care workers. That was unexpected. But I doubt he'll read the paper I wrote. Keep in mind that this is the first time I've seen this guy in 3 weeks... 1 week before the op. I didn't see him right before my surgery, and I didn't see him after. At this point, I'm fairly certain that he prefers his patients anesthetized.
Still, it's nice to get the staples and stitches out.
I returned to work today. It was a pain in the ass going even from the handicapped spots to my office. But I'm getting back to the old routines, which brings with it the notion of progress. One old routine that I absolutely savor that night is being able to take a real shower... where I can get completely in the shower stall and get completely wet. Talk about your simple pleasures.
After my shower, I decided that I no longer needed the ace bandage and the inner DonJoy wrap. In that case, I was able to actually put on normal clothes first, and then put the knee brace on over that. (Up to that point, all bandages/wraps/braces went on first, and then the clothes went on over that). Having normal clothes against my leg feels refreshing, and the whole contraption is much less bulky without the ace bandage and the DonJoy wrap.
Wednesday, November 1, 2006 - 16 days post-op
Today's Knee Condition: 3
Today's Pain Level: 1 (sometimes 4)
One of the things the surgeon had told me yesterday was that they wanted me to start rehab at 5 weeks post-op (actually, I think he said something like "We'll get you started on rehab at 5 weeks post-op..." even though my next appointment with the surgeon was at 6 weeks post-op... so I don't know where this "we" bit comes in). This was startling, since I had been taking rehab since day 3.
When I had mentioned this to the doctor, he responded that you don't get very much bang-for-your-buck early on, because they can only do a few exercises (at which point he demonstrated the very exercises that Chuck had me doing). Uh... great doc, but... if Chuck hadn't shown them to me, I would have been told about them by whom, exactly?
So, I called the rehab place to cancel my next appointment with Chuck. Doc says it's best to spend those limited-quantity insurance-covered rehab visits later on, when they can really work me out. Chuck says "okay", and we schedule an appointment for the last Friday before I cast off the crutches.
I actually feel a little better going without the rehab appointments for a while. On Monday, the doc said that my range-of-motion exercises should be easy. No brute-force flexion. During my rehab visits, however, when Chuck would work me through range-of-motion, when he'd flex it, my knee would start feeling just like it would right before my meniscus would pop out of place when I'd squat. Up until the post-op visit with the doc, I just kinda felt like "well, it's just sore from the repair"... but, after the doctor's admonition to avoid forceful flexion, I'm now paranoid about making sure that the meniscus can heal really well before I start walking on it in two weeks.
Keep in mind that it's the meniscus that drove me to get surgery. I had lived a fruitful life without my ACL for a decade. It was the re-tearing of my meniscus that I couldn't stand. So, the ACL repair was more of a "while you're in there, doc, can you fix this other thing?" kinda deal. With that in mind, if it turns out that something causes the ACL repair to fail (if the fixation screw slips, or something), then I'd be kinda like "Ah, well...", since I don't really remember what it feels like to have a good ACL in the knee anyway. However, if the meniscus repair doesn't hold up, then the operation was a total waste.
So, I'll have to mention this to Chuck at the next visit... in case he's been expecting me to cry "uncle" at a lower pain threshold than I have been.
At home, I start doing my "easy" range-of-motion stuff that the doctor talked about. Basically, I point my leg straight up in the air and, slowly, let gravity bend it. I can get to about 90 degrees before it starts feeling tight. Then, I straighten it. I can't straighten it all the way (probably to within 5 degrees of straight), and I can't tell if it's because if there's something mechanically different (where the structure of the knee has changed enough such that the muscles just can't get the leverage that they need to get it all the way straight) or if something with the muscles being too weak or with them refusing to pull any harder with the onset of pain.
One thing I'm noticing is that, although I'm not getting any meniscus pain like I was getting when I was doing rehab with Chuck, I'm experiencing pain around the kneecap. When you move your leg, your kneecap follows a little groove in the end of your upper-leg. The pain is in there, where the kneecap is riding in the groove. Granted, it doesn't feel like there's any stray piece of anything in there... but it just aches pretty acutely when I try to extend the leg after letting gravity flex it.
Thursday, November 9, 2006 - 24 days post-op
Today's Knee Condition: Unknown (probably a 4)
Today's Pain Level: 0 (Up to 2 or so during exercises)
3 more days of crutches. Ugh.... I am so ready to be done with these things.
I have a rehab appointment tomorrow. I think Chuck said that he was going to put me on some more weight-bearing stuff... probably in anticipation of my throwing my crutches into the sea on Monday.
My easy range of motion is gradually improving. I still can't extend it all the way without the help of gravity, but I'm up to about 110 degrees or so if I just let gravity try to flex the leg for me.
I'm still getting that strange kneecap pain when I do the flexion stuff, though.
Saturday, November 11, 2006 - 26 days post-op
Today's Knee Condition: Unknown (probably a 4)
Today's Pain Level: 0 (Up to 2 or so during exercises)
Welcome to "Weaning Weekend"! Starting last night, I'm starting to put my repaired leg down when I put the crutches down. By doing this, it simulates normal walking, but I can control how much weight I put on the knee by changing how much weight I leave on the crutches.
Yesterday, I actually experimented with bearing my full weight on the knee. It was a little strange, at first, because I had both feet and the crutches on the floor. I'd pick up my good foot and then start taking weight off of the crutches, to find that I had, without thinking, put down my good foot. So, I'd start picking up my good foot and notice that I had transferred weight to the crutches. I had to be very deliberate to try to keep my good foot lifted while I took weight off of the crutches. I got about 2/3 of my weight on the knee when it hit me: "Boy... 190 pounds is a lot".
Bearing weight on the knee is an interesting experience. Lots of "pins-n-needles" feelings in my foot when I put it down, just like when I drive. But it's even more involved than when I drive. While driving, I'm just extending the knee. While walking, I'm moving my whole leg foreward and back, and my foot is also having to flex as it pushes off at the end of a stride... so I'm noticing my calf muscle.
Later on the in the evening, I spent some time pacing back and forth in the kitchen with the crutches... all the while, trying to take more and more weight off of the crutches. After a few minutes, I was able to walk back and forth in the kitchen with the crutches suspended about an inch above the floor. I still didn't feel comfortable ditching the crutches, because it was a bit like learning how to walk again. But the big news is, I was able to actually walk without the crutches!
Sunday, November 12, 2006 - 27 days post-op
Today's Knee Condition: 3
Today's Pain Level: 1
Today, I spent most of the day walking mostly without the aid crutches. (Okay, actually, I spent most of the day watching football but, when I was moving around, I was doing it without the aid of crutches). Initially, when I would get up from sitting down for a while, I need the crutches because I still get the pins-n-needles feeling in my feet for the first 10 steps or so. After that, I can pick the crutches up and carry them while I amble along. It's tough trying to maintain a steady gait, though. 4 weeks on crutches have kinda pulled my spine out of whack, so I'm trying to get back to a uniform posture ASAP.
Update... it's Sunday evening, and the crutches are in the living room... and I'm not. I'm officially walking without crtuches. Hooray!
The pain level is about a 1. It doesn't hurt while I'm walking (although I can really sense the weight bearing on it), but after walking, I'll get these periodic sharp pains (about a 3-4 on a 10-scale) inside the knee that last for a half-second... every 3-4 minutes. This lasts about 15 minutes.
Also, now that I've officially tested the knee, I'm rating it as a 3 (whereas I suspected that it was a 4 before).
Oh... one more thing. I've been noticing that my left thigh is noticably smaller than my right, now. Since I'm going to start walking on it now, I figure that this is the "low-water mark" of the atrophy. So, I used a tape-measure to measure how big around my good leg is as compared to my bad one. The results? Good leg was 21 inches around. Bad leg was 19 inches. Good heavens!