Physiotherapy and Reimagining

I had my first physiotherapy session this evening. Apparently I am doing great. My range of motion (ROM) is really very good. I extend down to around three degrees (almost flat) and can flex over a hundred and fifteen degrees. The physiotherapist mentioned that normally people get to be around five to seventy-five in the first week. She seemed like the kind who might exaggerate a bit to make me feel better.

She put me on a bike and the challenge was to complete full pedals forwards and backwards. At first I found going over the top in the forward direction quite hard. My knee got close to the top but no cigar. I then went backwards. Much better. Cycled a few times. In about five minutes I was able to complete several pedals forward and backward. Slowly.

Evidently people with good ROM do stupid things because they dont realize that their strength isnt there yet. So she made it very clear that the brace is a must whenever the footing is not sure. Which is likely all of the time outside the house. Consistent with the doctor's advice. We then worked on some strength building exercises. I felt really good after that. Deceptively simple yet the feeling was of a huge release and relief. She did warn me not to do these exercises more than once or twice a day.

Later that evening I went out. I had the brace on. Nobody really notices a borg-like fitting on your leg. I bought Vijay Iyer's Reimagining, came home and plopped it in the CD player.

Life seems to be returning to normal. Much work ahead, though.

Freedom. At least at home.

Today was my first real post-op visit. The eighth day. It looks like things are coming along really well. The wounds have healed very nicely and the swelling seems to have subsided as well.

My doctor also went over the pictures of the surgery with me. I hope you are not too squeamish but here they are. Before and After.





First the ACL. The picture on the top reveals that I have no ACL. It is a bit hard for me to make out or describe where or what the torn ACL is doing. I am pretty sure the doctor pointed something out.




I suppose you need to see the after picture right below it to really see the difference. How did I even get around without that thick strong-looking piece of tissue!



Well evidently, I did not get around too well. I have ended up with a tear in my lateral meniscus. While this could have happened when I ruptured my ACL, it is also possible that the buckling episodes I have had over the past couple of years have had something to do with it. Anyway, without further ado, I give you the before and after lateral meniscus. You can see the tear in the miniscus where the instrument is.




Meniscus damage is forever. All that can be done is to prevent it from tearing further. For this the area around the tear is trimmed. The V-shaped border in the picture below is prone to much less tear. Apparently, fixing up meniscuses (menisci?) is a common and simple (compared to reconstructing the ACL) arthroscopic procedure. People with torn menisci (meniscuses) experience their knees locking up. A little trim takes care of it.


The doctor then had a few pleasant surprises for me. First, he said I could take the brace off at home and only wear it when I leave home. I was over the moon with delight. I was hoping for a small break with my sleep and this was a huge relief. Second, he said I could drive if I wanted to. He first checked that I had an automatic transmission. So I guess it is a small blessing that my problem is with my left knee. He then said he'd see me in six weeks and wished me good luck with my physiotherapy.

That's it! That's as far as the surgery went.

Tuesday's just as good!

Another great day. Another great shower.

I think I can flex well over ninety degrees. Having the brace unlocked, and off when I am sitting and resting, has truly been a blessing. When I am awake that is. Sleep is still bad. I wonder if the brace being unlocked makes it worse for one to get some sleep. It certainly seemed that way last night. Still, I suppose I ought to feel good about feeling good when not sleeping.

I worked on my quads. Tightening them every now and then when sitting and doing nothing else.

I went for a long drive today. No I did not drive. I did not get out either. I sat in the car when others ran errands. What a nice feeling it is to get out. It was a beautiful crisp winter day. I told myself that I should savor the little things that I typically just take for granted. Notwithstanding that, I am quite sure I'll be back to my cynical crabby self in a week or so.

I think I could have gone to work today but luckily work's out for another week. Most of what I read or heard about pre-surgery suggested that folks are typically back on track in a week. So I suppose it is only natural that I should feel good today.

I am looking forward to my post-op visit tomorrow. I have my first physiotherapy appointment tomorrow as well. Yes, I am a bit excited. Like a student who has done well in their exams and is eagerly awaiting their grades.

Sleeping with the brace is still a nuisance though. (I guess I had to throw that in.)

Mondays should all be like this

Today was a great day.

After another lousy night with the brace, I removed it this morning and took a shower. I was told to clean the wound area. But to leave the steristrips on. It was the best shower I have taken in my life. I had completely forgotten how nice and cathartic a shower can feel.

I put the brace back on and unlocked it so I could flex my leg. I did pretty good. Nearly ninety degrees I reckon.


Unlocking the brace and taking it off when sitting still is really making my day. Sleep at night is a different matter of course.

I worked on my quads a little bit. Felt quite good. I am looking forward to my PT on wednesday.

Thanksgiving on Christmas

I have been really lucky to have family help me out through this time. I cannot imagine having gone through this ordeal without them.

So thanks you three! You too, little pig.

If you do not have anyone who can take care of you for a week, I suggest you put your surgery off until you find someone who can. (Of course, it is best not to have surgery at all if your ACL is not torn.)

Brace yourself

I slept well last night. No benadryl to help. Again, relatively speaking. The brace is a nuisance. The cryo-cuff water gets pretty warm when unheeded and that combined with the brace around the leg keeps one from sleeping uninterrupted.

I had a nice sponge bath this morning. Felt pretty good after that.

We had a few friends over last night. Had some pizza and even indulged in a glass of wine. (Quick rationalizations were made regarding being off pain medication.) I must have looked quite healthy. For my friends did not think it inappropriate to make fun of my leg and the surrounding brace.

I have been moving about a bit. With the brace locked at ten degrees. It looks ridiculous but I get around the house. I am afraid of getting a bit complacent and doing something stupid. The swelling in the knee is a good indicator. Unless you rest it, the swelling does not go down. So I try to rest as much as I can.

I suppose if I am only whining about the brace discomfort I must not be doing too bad.

Looking forward to Monday when I can shower and unlock the brace.

Back to normal?

Today has been my most normal day so far. I took no pain killers. I had a great appetite. Had breakfast and lunch. During the past couple of days meals have been a haze. It felt good to return to a routine.

I also started working on flexing my quads. And did some ankle pumps as well.

I slept fairly well last night. I took a couple of Benadryls before going to bed. I did get up a few times to recycle the cold water in the cryo cuff. Looking back over the couple of days, I think that has been very key to relief. I cannot overstate the importance of keeping the area around the knee cool all the time.

By the way, when I say I slept well, I mean relatively speaking. It is impossible to sleep well with the brace on. Especially with it locked at 10 degrees. If you tend to toss and turn in your sleep or change your position over sleep, then be prepared for some serious discomfort. Aside from the pain medication messing up my metabolism, I would have to rank this as the most uncomfortable part of my experience.

I was glad to take the brace off when lying in bed during the day. Perhaps that made it seem better than it actually was.

Great Success

After over fifty hours since the surgery. I have been able to go to the bathrom. I attribute this to backing off the pain medication. As Borat would say "Great Success!"

I also took a nice sponge bath. I protected the area around the wound with garbage bags and cleaned the rest of my body.

Felt terrific.

When it rains it pours

A lot has happened since last AM.

Last evening I was feeling quite uncomfortable and in a span of thirty minutes spiked a fever of 100.7. It is not really much, but the rate at which it went up was alarming and we wanted to watch out for signs of infection. We called the doctor. He said some fever is not unusual and not necessarily a sign of infection. He suggested that we continue to monitor it and let him know if it went over 101.5. Luckily it did not.

The pain however was excruciating. I felt as if my shin was a in a vice. It was not clear to me why my shin was sore and not my knee. Some folks suggested that it was my nervous system that was confused and that the pain was indeed from my knee. I was doing all the right things. Icing my knee; taking pain medication; still there was little relief. In any case, we already had an appointment with the doctor to change the dressing the next day and I could not wait to see him.

But everything changed overnight. I slept very poorly but kept feeling better. By the time I got up my fever had gone away completely and my pain had subsided as well.

We kept our appointment with the doctor to get the dressing changed. He removed the bandage and I got a first glimpse of my knee after surgery. As you can see below, on the left, there is some swelling but not too bad. The doctor removed the bandage and surprised me by saying that I do not need another bandage. As you can see on the right, the wound is healing quite well and there really is no sign of discharge.




The doctor asked me to lift my leg and he was quite impressed that I could. Or maybe that was just to make me feel better. He said I could take my brace off when I was resting or lying down and was sure to be careful. I could also wash myself provided I completely protected the knee area. I was allowed to have a shower and clean the wound area itself on monday (i.e. the fifth day after surgery). The doctor also highly recommended backing off the pain medication. I have had very little appetite and no bowel movements since my surgery. This is almost certainly a consequence of my pain medication. Another reason to back off it. I have also been having prune juice to help.

After the first night

I had a very restful sleep last night. And the pain-killer was definitely doing its job and I have not felt much pain at all. I am optimistic that I might get away with very little or no pain. We'll see.

The painkillers still cause a lot of itching and scratching. Much of this was alleviated with Aveeno hydrocortisone cream. I could tell it worked because the parts where I did not apply still itched quite a bit.

While I did have a restful night, I did not sleep through it. I kept getting up every now and then and felt like doing things. I was not in any discomfort. Just felt like getting up.

An interesting development at night was that there was a large spot of discharge on my bandage. We called the doctor and described it and the doctor suggested that based on our description that it did not sound like anything to get concerned about. He did ask us to bound the region with a marker, so we would know if it spread.

Then someone got the bright idea of taking pictures and e-mailing the doctor. And he confirmed that things were fine and it looked normal. He did ask me to come in tomorrow to get my bandage and dressing changed.

I have attached one picture. The blue stuff is the marker.

Things are still looking pretty good.

The day of the surgery

This morning I had my ACL fixed.

I showed up at the hospital at 6:30 AM. After the usual paper work, undignified clothing and trial-and-error IV attempts, they wheeled me in to the surgery room. Generally, everyone seemed to be in good spririts, and I remember being quite light-hearted about the whole thing. My surgery was scheduled to start at 8:30 AM.

I had decided to go with general anesthesia because I did not fancy looking at the doctors working on my knee for ninety minutes. That would have been the case, if I had opted for an epidural or some other form of local anesthesia.

As I was wondering when the surgery would get going, I noticed that I had a brace around my leg. It was all over! The general anesthesia was a first for me and it was remarkable! As far as I can tell it literally happened in the blink of an eye. After a short stint at the post-op room where the nurse went over some things about my medication I was wheeled to our car and we went home. I had practiced getting in the car with the brace on and it was easier now than when I practiced it. Overall it was as pleasant as a hospital experience can be.

I have not felt any pain at all. Probably because the pain medications and the anesthesia local to the knee are still very much under effect.

I have been following the instructions quite diligently. Elevate the leg. Ice the knee. And just rest. For icing the knee I am using a cryo-cuff. This is a very effective device. You have a bag that can take about a pound of water and you connect it to something like a bucket and recycle the water. The water flows from the cuff to the bucket (and vice-versa) due to gravity. Disconnect the bucket when you are done. I have people here lifting the bucket when I need to recycle the water. Here are a couple of pictures demonstrating this. Note that these pictures were not taken today. (Hence no brace).





I am also taking oxycodone tablets every two hours. I have been advised to take these before I feel the pain.

We have been watching movies. I cannot tell which ones are real and which ones I am imagining.
The pain killers do result in some histamine creation and I am scratching all over. It is not completely insufferable and I think I prefer it to pain. It was really bad right under my nose. The doctor suggested taking Benadryls.

Two years, two months later...

I am going to have my ACL surgery next week. After two years of occasional instability and constant procrastination, I have decided to get surgery. I will tolerate no more trauma on my knee than what's absolutely essential. So, I will be getting an allograft (i.e., cadaver graft). I realize that this has its cons, but I am fine with that. I do not plan to start for the Seattle Seahawks any time soon.

I tore my left ACL today

On a whim, I jumped over a table at work. I cleared the table with ease but I was not wearing shoes. Just birkenstocks. Darwin dictates that such stupidity must not go unpunished. I heard a loud pop. And then there was this blog...