Monday, November 28, 2011

SUCCESS!!

I just got back from the fracture clinic for my 6 week post-op appointment and a follow-up xray, and YAY!!!! Everything is good, my range of motion is good, my xray looked good and I'm officially out of the zimmer splint and I'm allowed to start bearing weight slowly!

As you can see from the image on the right, the healing is coming along very well, and aside from a little scare on the weekend with the main incision, everything is looking great.  The swelling is still there but it goes down a little bit every day.  From my what PT says, it won't fully go down for about a year so I'm not too worried about that.

Sort of a neat thing I learned at the post-op was that I don't actually have regular surgical screws in my knee.  I have 4 flat staples in my tibia, 3 in my femur, and one screw in my femur.  The cool thing - they're absorbable plastic!  That's right; eventually my body will just absorb the material and I won't have anything in there anymore!  I just think that is one of the coolest things ever - how awesome is modern medicine :)

So that's my awesome news for the day - more updates as I begin to bear weight and work toward getting off these crutches!

***UPDATE***

Well I had my very first physio appointment after getting the good news that I am now working toward full ROM and weight-bearing.  I have a couple new stretches to help improve my ROM, which are pretty uncomfortable but I can handle it pretty well without lasting pain afterward which is pretty cool.  I have several new exercises that I have to do including the stationary bike, leg press and calf raises.

The leg press was the easiest since it mostly uses my quads and because I have such strong legs this one didn't give me much trouble.  The calf raises were trickier since you have to straighten your legs to do it and my leg can't quite go straight yet.  I'm unable to do a full rotation on the stationary bike, so for now I'm working the muscle as well as doing some good ROM stretches that will eventually allow me to do full rotations.

I also have to start 'miming' walking on my crutches.  This means that instead of just letting my leg 'dangle', I have to actually extend, press down with my heel, and follow through like I would as if I were walking on it normally.  Because of my inability to completely straighten my leg yet this is still hard to do, so for now I'm just working on the muscle and putting more and more weight on it as I can handle it.

I'm also very happy to report that I've gone from 85° flexion (bending your knee in) on my own to 90°, and from -11° extension (extending your knee out, starting at 90°) to about -30° since last Tuesday.  Essentially this means that the muscles and tendons allowing me to lift my own leg are getting stronger MUCH faster than me or my PT anticipated so I'm hoping that now that I'm weight-bearing, I will also be able to get off the crutches quickly and get back to my life!

Next up - gym membership!!

Tuesday, November 22, 2011

Great News!

Well despite the fact that I am absolutely exhausted and I caved and took one of two remaining Percocet that I had saved for days like today, I am psyched to share my progress!  Today at physio I finally reached 90 degree range of motion without assistance (95 degrees with assistance! But shhh don't tell the surgeon; he asked that I not go beyond 90).  In the image to the right you can see how it's measured (that's not me, but we do my physio and measurements and flexibility tests the same way).

As some of you remember from last Thursday, the PT also started me on attempts to start using my hamstring to begin working at lifting my leg with a roll behind my knee.  As you can see from the image to the left, it looks pretty simple.  Actually it's remarkable difficult as my patella (the meaty area just below your knee cap) is still very sore from the main incision, and attempting to flex that tendon and allowing my hamstring (the muscle along the back of your thigh) to tighten and flex is incredible hard still.  Well happily today, after 5 days of trying, I actually lifted my leg!!  Granted, I only lifted it about half an inch off the table, and my whole body was shaking from the effort, but I did it!  It was sort of funny having the other people there for their therapies cheering me on as they watched my progress.  When I finally managed to lift it and hold it up, I got a round of applause... it was one of the most rewarding experiences of my life I have to say.  Those people know damned well how hard that was for me... so it was very cool getting that kind of support from them :)

I've also been working very hard at being able to flatten my leg to the table.  As you can see in the image to the right, this again looks pretty easy.  Remember, though, that the new tendon I have (thanks Hamstring, you're a pal) is like a brand new rubber band.  It's very inflexible and very tight.  So what ends up happening is it pulls my leg up into an arch and I have to work to stretch it enough that my leg will lay flat.  I also still have a lot of swelling, so that causes quite a bit of discomfort yet.  Well this week I've managed to flatten it from having what my PT measures 'two whole fingers' to 'just one finger!' (underneath my knee as I flatten it).  This is great progress, and I'm sure with working at it I'll have it comfortably stretched where it belongs in a few more weeks.

So that's about it so far!  I have my 6 week post-op appointment with the surgeon this coming Monday where I find out if I'm allowed to set fire to stop wearing the iron maiden zimmer splint, and I find out if the meniscus healed okay and the graft is doing well (via an xray I'm SUPER excited to see! pics to come I'm sure), and if I can start slowing bearing weight on my knee again.  After that the PT suspects I'll be on the crutches for another 4-6 weeks but just for support while I regain the use of my leg and learn to walk normally again.

After all is said and done, it will be a total of about 6 months of rebuilding all the muscle around my knee and in my leg before it's safe to use again for anything more than just walking.  But once I'm off the crutches I'll be able to exercise from home or from a gym (looks like a gym membership is in my future - anyone want to take the opportunity of me HAVING to go to whip into shape with me? hee hee)

Anyhoo, I'm sure I'll update after my post-op on Monday if not sooner.  CHEERS!

Monday, November 21, 2011

MRI Images

This time last year I was strapped into an MRI getting some imaging done to see what was up with my knee.  Well now I know what was up with it... but here's a (somewhat graphic?) video of what the MRI looked like from one angle.

Some people found this disturbing so consider yourself warned lol

video

Sunday, November 20, 2011

5 weeks post-op

Tomorrow marks 5 weeks since the surgery.  Last week I went back to work full time, and also started the 'hard work' at physiotherapy.  Physio has begun getting harder on me only because my PT has decided I'm ready to start trying to use my hamstring to lift my leg.  It's amazing how difficult it is trying to regain the use of my muscles, and how painful it is.

Aside from the spasms and the muscle pain, I'm happy that the bruising is all gone.  I still have a fair bit of swelling, but the incisions are almost completely healed over and I'm working on the scarring with some Bio-Oil.

I'm finally able to use the stairs somewhat normally, and I've figured out a way to reduce the impact on my shoulders while I use the crutches, so that pain is slowly dissipating as well.  Now if only I could figure out a way to stop my palms from bruising from the crutches...   I have a feeling that'll stick around until I'm off of them completely though.

I have to give a shout-out to a good friend of mine, Joscelyn and the constant-reader Alex for obliging to go out for dinner with Eric and I on Friday night, so that I could get out of the house and start acting like a normal person again (haha).  It was very nice to get out of the house, even if people look at you weird when you're on crutches (don't worry, concerned citizen, it's not Ebola).

Thanks for stopping by!  I'll update more soon!

Tuesday, November 15, 2011

3 Weeks Post-Op

Well I just arrived home after my second day back at work and my 4th physio appointment, just three weeks after surgery.  I'm pretty exhausted but that's to be expected.  I haven't fallen down the stairs, spilled coffee on myself, peed my pants, or lost a crutch while battling a printer.  Okay that last one might not be entirely true...

But in all seriousness, it's great to be back into the swing of things and to have a change of scenery.  Even if the change is pretty tiring since I can't have my much-loved 3pm nap and I have to navigate the stairs at home every day now instead of twice a week.  On that front though I'm happy to report that I've built up enough muscle strength in my arms, shoulders and back that I'm able to use one crutch and the handrail to get up the stairs relatively easy.  I'm pretty psyched with being able to use the stairs somewhat normally again :)

Physio was actually GREAT today!  This 'Little Warrior' is officially at 85 degree range of motion (just for some perspective - I'm where I'm supposed to be at 6 weeks at just 3!!), my muscle strength is greatly improved, I'm almost able to lay my leg flat (this has become my new goal now that my range of motion is greatly improved), and I'm doing more reps of the weights on the pulleys with my leg.

Next week I'll be able to increase the weight and I'm going to reach for 90 degrees and a flatter leg!

My swelling is down a lot, the bruising is almost all gone, and all but the main incision are completely healed over and the scarring is looking very healthy.  I'll have to get someone to pick me up some Bio-Oil so I can start working on the ones that are healed over.

I'll check back in soon :)

Sunday, November 13, 2011

Pity Party

I've decided to allow myself an entire post to feel sorry for myself.  So if you have not a single ounce of empathy or just don't care, please don't stick around to judge me for my pity party - I couldn't put up the streamers and balloons because I've been too busy whining about my situation.

While I am recovering about as quickly as I expected, and things are definitely improving every day, there are several things that make this recovery very difficult to live with.  Come with me, I'll give you a tour of ACL post-op recovery fun!

My palms are turning purple from the bruises forming as a result of the crutches. I have pools of broken blood vessels on the back of my right leg, under my right ankle and behind my right knee from inactivity. The skin that is regrowing nerve endings around the surgical sites are constantly pins and needles without me touching it and when I do touch it it feels like a red-hot poker is burning me.

I am constantly reminded of just how incapable I am of even some of the most mundane activities right now; showering, going to the washroom, making coffee, standing, sleeping, sitting, dressing myself, putting shoes on, making food, getting a glass of water, feeding the animals... the list goes on and on.

And just as an added bonus, nobody wants to hear any of this.  People know I had surgery, but nobody wants to hear just how shitty this really is for me right now.  I'm certainly not blaming anyone for wanting to avoid such an uncomfortable topic, because really, what can anybody do?  Not much.  Nod sympathetically and tell me they wish me the best.  But really what they're thinking is Oh crap, she's going to tell me something nasty about her recovery and I'm going to have to pretend like I understand... maybe if I just sit here grimacing I won't have to tell her I have no idea what she's going through.

Ahh but that's okay, friends.  Soon I'll be up and mobile and being my usual spastic self and you won't have to worry about me talking about how my incisions are healing all gross or how I have to scoot up to my apartment on my bum on the stairs (that pulley system off the balcony is looking better and better).

Thursday, November 10, 2011

What is ACL Surgery?

***WARNING***  The medical images below may be disturbing for some viewers.  Proceed at your own discretion.



 


Several people have asked me what exactly I had done on my knee.  So instead of explaining the whole surgery to people, I thought I'd just explain the surgery here and link people to this post when they ask (with the aforementioned warning that it is a surgical procedure and that those who are squeamish should proceed with discretion).


First off, let's go over what makes up the knee, as far as ligaments go.  The knee is stabilized by a pair of cruciate ligaments. The ACL (anterior cruciate ligament) is critically important because it prevents the tibia (the larger bone in your calf) from being pushed too far forward relative to the femur (your thigh bone). It is often torn during twisting or bending of the knee (in my case, a nasty 4-wheeler incident about 6 years ago).

The PCL (posterior cruciate ligament) is the second of the two. Injury to this ligament is uncommon but can occur as a direct result of forced trauma to the ligament. This ligament prevents your calf from slipping behind your thigh (ICK). (wikipedia)

In ACL reconstructive surgery what the surgeon does is replace a torn ACL with a tissue graft replacement (in my case, a graft of my hamstring was used - see below).
















Without showing you gross surgery pictures, I'll show you a medical illustration of what ACL reconstructive surgery is (see below)




























(don't worry... I was asleep for this whole thing lol)











And here are those sites on my knee.  As you can see, Arthroscopic surgery is very non-invasive, leaves minimal scarring, and actually allows healing to move forward much quicker than the older, more invasive methods of knee surgery (which I'm continually thankful for).


In addition to the ACL reconstruction, I also had to undergo a Medial Meniscus Repair. 
The menisci of the knee joint are two pads of cartilaginous tissue which serve to disperse friction in the knee joint between the lower leg (tibia) and the thigh (femur). They are shaped concave on the top and flat on the bottom, articulating with the tibia.
The menisci act to disperse the weight of the body and reduce friction during movement. Since the condyles of the femur and tibia meet at one point (which changes during flexion and extension), the menisci spread the load of the body's weight.  (wikipedia)
As you can see in the image to the left, the Medial Meniscus is the piece on the inside edge of the knee.  It's likely I tore mine during the several years after the initial ACL tear, after each time my knee gave out (all you college friends can now appreciate why I swore so much when I landed on the other side of that fence... lol).

The repair isn't always possible if the tear is bad enough or if the tissue just isn't in the right position to repair it.  Fortunately mine was able to be repaired.  UNfortunately, because I had this repair done as well as the ACL reconstruction, my healing time is much longer, the swelling is worse, and it is why I can't bear weight on my knee quite yet and also why I have to remain in the splint and on the crutches for so long.

So that's the surgery I had on October 24th, for all those curious minds out there :)

17 days post-op

Well here I am, 17 days after surgery and things are looking pretty good.  Tuesday was my first physiotherapy appointment with actual muscle strengthening exercises and some serious stretching (interpret that as gross gross gross).

Today will be my second appointment and I'm hoping tomorrow I don't hurt as much as I did yesterday.

Thankfully, at my last appointment I found out that in the 6 days between my assessment appointment and my first real physio appointment I doubled my flexibility from about a 35 degree range of motion to a little over 70 degrees.  Unfortunately though not all the news was good news; as a result of the swelling in my knee that remains, my quad is almost completely unusable.  It's a weird feeling trying as hard as you can to flex a muscle that simply does not work right now.

The swelling does go down further every day though, so I'm hoping that I remain on track and by the time I get to my 6 week post-op appointment with the surgeon I'll be cleared to bear weight on my leg again.  Here's how far it has come already (see left).  As you can tell, the bruising is almost completely gone, the incisions are healing very nicely, the swelling in my calf, ankle and foot have reduced considerably (a little still remains though).  There is still quite a bit of swelling around my knee, and the physiotherapist says that swelling won't completely disappear for about a year post-op.

All in all, I'm pretty satisfied with how things are coming along, and I'm definitely looking forward to getting back to work on Monday.  I just hope I get used to the stairs and my bad shoulder cooperates eventually so it's not so tiring lol...

Speaking of which... I should really get someone to record just how I'm maneuvering up the three flights of stairs... to a soundtrack like Eye of the Tiger or something (hahaha).  It'd probably make for some pretty entertaining post-op YouTube content :)

Thanks for staying tuned... I'll update later today or tomorrow once I see how today's appointment goes.

Monday, November 7, 2011

Monday Knee Update

I'm happy to report that a large portion of the swelling in my knee has gone down, and the pain gets more manageable every day.  It is still quite achy and it's tricky finding a comfortable position to sit in while I'm in a chair since I can't quite reach a 90 degree bend in the joint yet.  My surgeon wants me at 90 degrees by November 28th, and I'm probably at about 75-80 or so if I were to guess (a vast improvement even over last week where I was at about 60-65).

One thing I'm not overly happy about is the condition of the large incision on my patella.  The suture tape finally came off and I was anything but happy to see how it's healing.  From what I can tell it looks like the incision was taped too tight and now it is healing in a pretty horrific 'puckered' fashion.  I'll embed a picture so you can see what I'm talking about, but be warned, it is pretty gross.

I don't know if this is common with suture tape, but I'm hoping the puckering goes away or at least reduces in the next few weeks, as it is pretty ghastly to say the least.

Other than that minor aesthetic setback, everything is going pretty great all things considered.  My strength is returning, my flexibility is on track, and today is the first full day without any percocet at all.  I have two left to save for the first couple physio appointments (this week Tuesday and Thursday) just in case I come home and feel like chewing my leg off from the pain (lol).

More updates as they happen!

Thursday, November 3, 2011

Physiotherapy Round 1

Well, once again my trepidations were unfounded and yet another aspect of this recovery wasn't nearly as bad as I thought it would be.  I had my physiotherapy assessment today, and in general it looks like things are going pretty well.  My physiotherapist did some measurements and did some flexibility and strength tests to see where I'm at a week and a half out of surgery and from what she saw apparently I'm a 'warrior' haha. 

I have pretty significant swelling, so definitely lots more icing (and possibly some heating as well to get the blood moving better to reduce the swelling), but I haven't lost any muscle mass in my leg so that's AWESOME.  She said that's pretty rare but for how much muscle I have in my legs she wasn't that surprised. 

My flexibility is decent but she wants that improved so I have some exercises to improve that, as well as improving the muscle use in my quad.  She explained that if you don't work on flexibility right away, by the time the 4 week mark hits and your scar tissue starts developing, it gets a LOT harder to get to the point that is optimal for range of motion (in my case I have to reach 90 degrees by week 6).

She also told me some updates that the surgeon and his nurses failed to tell me like I AM allowed to shower as long as it's safe, and I'm also allowed to get my suture tape wet because it'll come off when it's ready anyway.  I was super pumped that she showed me the proper way to adjust my zimmer splint too because the nurses completely failed to point that out after the surgery AND at the post-op (thanks for all the awesome patient care, hospital staff!).  She was kind enough to show me how to go up stairs with crutches too, so that was cool of her (despite making me hobble on my crutches pretty far to get to stairs to show me this lol).  Unfortunately, I was unable to actually do that with my bad shoulder on the same side as my injured knee so I still have to do the old 'butt scoot' up the stairs (haha).

I'm happy that I have some revised exercises (apparently the ones the hospital hands out are something close to 20 years old and the physiotherapists recommend NOT following those - how on par is that with the hospital service thus far lol).  My arms are getting a lot stronger so the crutches aren't nearly as bad as they were when I first came home.  Pretty happy with how well I'm recovering as well, all things considered.

So yes, here I am, less than two weeks out of surgery and feeling pretty good.  I still have another 4 weeks in the splint and on the crutches, but by doing the exercises and regaining my muscle and flexibility, soon I'll be walking on my own, going up and down stairs, driving, showering... oh man the things I took for granted before this surgery lol...

Wednesday, November 2, 2011

Post-op Guilt

I'm experiencing a range of emotions I was not only unprepared for, but I also certainly never expected while I've been at home recovering from surgery.  Of course if you are anything like me, and you are a relatively proud person, admitting you need help with something is hard enough on its own but actually asking someone for help can be a true test of your humility.

With that being said, I've started to develop a pang of guilt for being in the position I am currently in.  Let me elaborate.

I'm at home all day, every day, with nothing to do but sit in bed and 'recover'.  With a fair bit of discomfort I am able to sort of 'hop' around with the crutches to do things like go to the bathroom, go to the kitchen to get a new ice pack, etc.  Because I have to use both hands to use the crutches, carrying things around the apartment either doesn't work or I have to be pretty creative about it.  I'm also unable to put any weight at all on my recovering leg, so even if I put the crutches down, I am still only on one leg.  Now, this might not sound very bad to you, but I assure you that after a full week of doing this you find areas of your body are aching that you might have never expected.  My shoulders, the palms of my hands, and my wrists ache from using the crutches, my left hamstring and butt are VERY sore from being the sole leg I'm able to use, my right hip hurts from having to hold my right leg straight all the time, my back hurts from sitting in bed for hours and hours every day... the list goes on right now.

I'm restricted to eating what is left in the bedroom for me (currently I have a box of Quaker granola bars) and the water in the pitcher that is pretty much always room temperature.  If I get to the kitchen I can only stand for so long trying to get something to eat before I start to get dizzy from the pain of standing up, so I've been restricted to cold pizza on the two occasions I managed to get in there and get something to eat.

I can't shower yet because I am on one leg, and I can't have a bath yet because my incisions aren't completely healed yet, so I've only been allowed sponge baths.  You can imagine how inconvenient and tedious this process is.  I'm also only able to wash my hair in the sink, and with one sore leg and one leg I have to keep straight at all times, and having to use the small sink in the bathroom that my head barely fits in, this also gets to be very difficult.

So yeah... sitting at home recovering is nothing short of miserable.  I'm here alone all day every day with very little to entertain me, I'm pretty much always hungry and sore, and I'm hesitant to try to do too much at the risk of falling and not being able to get up, tweaking my knee in some weird way by accident and causing further injury, or just wearing myself out more than I already am by using my crutches too much.

And despite all this, I feel guilty.  I feel guilty that I can't clean my apartment despite the growing mess.  I feel guilty that I can't feed myself, I can't walk the dog, I can't do any laundry, I can't work, can't drive, can't go to the bank, can't do groceries...

Despite the many offers to help and the handful of people who have generously helped when and where they can, I still feel guilty that I can't just do these things myself.  I feel like I'm inconveniencing people when I ask for help, especially my husband.  Maybe some people don't find asking for help as difficult as I do, and if that's the case, then I envy those people.  But for me, asking for help is difficult because I hate to put people out; I hate to inconvenience people and I really hate to hear 'no' because often I take it personally and I know I shouldn't.

Even admitting these things out loud is difficult for me, because I have no idea how it will be taken, let alone if anyone will even care or at the very least even read this.  I suppose I'm just hoping that at least one person gets what I'm saying here, and then maybe I won't feel like such a freak for feeling guilty because I had surgery and I need other people to help me while I can't help myself.  And who knows... maybe one day I'll be able to get over asking for help and I won't feel like I'm admitting defeat by asking... and maybe people around me will finally realize just how hard it is for me to even ask.