Health – Page 3 – My Truant Pen

ACL replacement – 5 days in

I really didn’t know what to expect coming out of this surgery. Although I asked the doctor and met people who had it, the responses I got were totally across the board. I heard “You won’t be able to do major athletic activities for 6 months.” “You will be in physical therapy for a year or so.” “The main recovery period for meniscus tears is 3 – 4 weeks. For ACL replacement it is 4 – 6 weeks. You are having both, so plan for more than 4 weeks minimum.” From this, I figured I would be more or less useless for a month, and probably limpy and gimpy for a month or two after. Was that 4 weeks of crutches? 6? I wondered if I would be able to do Mocksgiving ok. I gave up apple picking for the year. I figured the birthdays were going to be a real challenge to me.

And the pain. I heard of people hooked up to automatic-knee-moving-machines. I heard people talk about excruciating burning pain as they went to move their knees – about how they could not even move them without help. I took the pain of my initial injury and multiplied it in my head. I heard about the goooood drugs I would be getting, and the nerve block, and what a bad moment it would be when the nerve block wore off. (For the record, I am unconvinced that the nerve block actually blocked anything.) I was prepared for blinding agony.

I’m five days in and on the couch. But here’s how I’m feeling.

I’m thinking that major surgery is fun enough I should do it annually. I have gotten to play 900% more video games, read more, relax, sleep in, write letters, keep up on teh intarwebs and play fun games with my kids.

The pain? I definitely think the surgery is less painful than the initial injury. This might be because I do have appropriate pain medication (and I am taking it – there is nothing to be gained by not taking my prescriptions). It is also likely less painful because I’m keeping off it and actually resting, which I did NOT do with my injury. But the excruciating burning pain? Nah. The worst is when I wake up in the morning and all my meds have worn off. I feel the incision points. I feel a throbbing ache through my knee. My calf is screaming in dismay at the inactivity, extremely heavy brace etc. But is it the fiery agony of hell? Nah.

The incapacity? I have decided that I was in a best possible scenario for this injury. Consider:
– Due to on and off reinjuries since May, my good knee has bulked up and is used to compensating/standing by itself/doing all the lifting
– Thanks to physical therapy and activity on my part, my “bad” knee is strong. My “baby’s first physical therapy” involves 10 straight leg lifts. I can currently do more than 30 before I get bored and quit. I was doing them before, and they’re not much harder after.
– My “bad knee” is used to not having an ACL. It has compensatory muscles. So the instability of my new ACL is much less of a factor than it would be if I had just busted a working ACL.
– I’ve been practicing a one-leg lifestyle. The crutches are a pain, but I’m really good at doing things with one good and one gimpy leg. See also: since May.

So far, I have excellent flexibility. I’m up to 90 degrees. I have to take off my braces, because they stop my knee from moving before any swelling or tightness stops my knee from moving. I’m almost at where I was before surgery (which is not the same as perfectly good, since I’d reaggravated my knee). I can place my weight on my bad leg (carefully, while holding on to the crutches). It doesn’t hurt the knee to be jarred or bumped in to. When I am up to date on my meds, sitting in my couch with my cold pad I am not experiencing any pain.

So I’m thinking that 4 – 6 weeks of completely wiped-out-ness is unlikely. I’m hoping to have maybe another week of crutches and then start returning to life as normal!

A few notes, in case you come here through googling acl replacement and meniscus tears and wonder what’s ahead:

I have a four-stage dressing system:
1) Bandaids. Three of ’em. Covering three incisions with a total of 6 stitches.
2) ACE bandage. Buy an extra one with velcro before surgery because it will be gross and you will want a new one. Keep this on to prevent chafing and provide compression.
3) My cold pack is fan-freaking-tastic. I would SO recommend this system to anyone who regularly needs to ice an appendage. Here’s their website: http://www.dme-direct.com/deroyal-t600-atc-hot-cold-therapy-system/ . It has a reservoir for ice water and a temperature sensor. It circulates cold water through a thin pad that I wear under my bionic-brace. It is immediate and effective pain relief, as well as reducing swelling.
4) Over all of this (and over my pants) I have a Rom Knee brace. It’s articulated, adjustable and lockable. I keep it unlocked during the day and am supposed to lock it while I sleep. I’m not sure why that is. It’s pretty heavy duty hardware, and I’m finding it a bit annoying. If it is tight enough to not slip while I’m walking, I’m afraid it’s cutting off circulation to my foot. If it’s loose enough to not create welts, then it slips down while I walk. I have to wear it 24/7 and it is the element I’m most looking forward to ditching.
5) Crutches – just normal aluminum affairs. I should have been doing arm strength training in prep. The first few days my arms were as sore as my knee!

Medication:
Ibuprofen – I try to take 800 milligram doses, since I’ve heard that is the minimum dose to actually get an anti-inflammatory effect. This is probably the mainstay and most important pain medication I’m on. I reckon I’ll be on it for quite a while. A rule of thumb is an hour for every 100 mgs… so 800 mgs would be 8 hours, 400 mgs would be four, etc.

Percocet/Vicodin – I started on Percocet and could not tolerate the side effects of throwing up and falling asleep. We turned it in to the police when my husband picked up the Vicodin, which makes me a little light headed but otherwise seems to be having mild side effects.

Aspirin – for anticlotting/anticoagulation. It’s a very slight risk with this procedure, so it’s just sort of added in to the mix.

I took four days off work and will work from home (probably a touch part time) next week. I plan on going back into the office the following week – or about 12 days after the surgery was performed.

Questions, anyone?

Recovering

Surgery day was a blur. I have discovered this week that my reaction to opiates is to go to sleep. And maybe throw up. Surgery day I spent quite a bit of the time asleep, and ate very little.

Yesterday was a more painful day. I was tired of being asleep and not eating, so I opted not to take my big time pain meds. I called the doctor in the morning to get an alternate medication, and leaned on the unflinching rock of Ibuprofin to see me through. I didn’t get the new pain meds until nearly 5, however. Being up on important scientific findings, I supplemented the Ibuprofin with some “Zelda: Twilight Princess” for Wii. The fishing was a royal pain in the hienie and I resorted to a technique I try never to use (aka: asking my husband for help), but eventually I managed to conquer the first level.

My mother in law is here, and full of plans. So far we’ve deconstructed the kitchen table and chairs. For our combined birthday presents, she is paying to have them reupholstered. Also, she is spray painting the metal. This is ideal, since it’s really an awesome table and bench set from the 70s that is perfect for our kitchen, but whose stuffing is emerging. Then this weekend they’re planning on redoing the floor and fixtures in our bathroom – having demolished the floor last trip. I’m glad they’re keeping their plans modest this time.

Pictures from the knee scope - I think these are the meniscus tears

How am I recovering from the ACL reconstruction and meniscus tears? Let’s see. I’m in this astonishing articulated brace, which I have to wear 24/7 for at least another day. Tomorrow I can take the brace and dressing off to bathe. I have to sleep in it, which is a bit of a challenge. The pain fluctuates more than I expected. When properly managed, there is less pain I had with the initial injury. This might be partially because I didn’t have prescription pain medication when I busted it the first time. I have some decent range of motion – better than I was expecting – going from fully extended to maybe 35 degrees. The brace, not the knee, seems to be the limiting factor. I’ve been doing some preliminary PT, and can do leg lifts. I finally figured out how to go up and down my stairs on crutches. Although I can bear weight on the knee without much additional pain, it does not seem stable or reliable, so I have to have crutches for all movement. It turns out that all the techniques I’d been using with my sore knee all summer long are the same ones that I need with my recovering knee.

I have this amazing cold pack system going on. There’s a reservoir of ice water that I connect to two ports on my brace. The ice water is circulated under my metal brace around me knee. A sensor shows when the water has gotten too warm. I swear this is the most effective of the pain mitigations, although it requires me to be pretty stationary. Also, I was unprepared for needing bags and bags of ice, so my caretakers have had to make several runs to the corner store. Finally, I can’t really change the ice pack myself — carrying things is hard on crutches and this is awkward and heavy. So I really do need people around me. And as I can tell by a certain rambliness in even this writing … I’m not 100% sharp.

I’m feeling very lucky in my supportive community. My biggest challenge will be the stir-craziness, I think. I am ok in my limited context with the pain meds and ice packs, but I am probably not up for much adventuring. On the other hand, I’m constitutionally ill-suited to sitting still and not doing much. We’ll see which one of these imperatives has the most energy behind it!

Marvels of modern medicine

There is more to me now than there was this morning. Where I once had a missing ACL and two frayed menisci, I now have an ACL and two shaved down menisci.

I would like to take a moment to talk about the tendon they put in my leg this morning. This tendon was a donated by an organ donor – someone who marked their driver’s license, or talked with their family. I have every hope that the man or woman who is giving me the ability to walk, run, jump and move died at a very old age surrounded peacefully by their family.

When we think of organ donation, we think of the big life saving donations: the heart, lungs, kidney. You might think, “I’m not healthy enough for any of my organs to be of use.” But for other things that make a huge impact on quality of life – knee tendons, corneas etc. – it makes a tremendous difference. I am incredibly grateful for the foresight and generosity of spirit of the donor who has given me a leg to stand on.

That said, let me fascinate you with a discussion of my morning! (Note: if you are faint of stomach regarding medical procedures, please feel free to stop reading now!)

My surgery was originally scheduled for noon. Yesterday, I got a call asking me to come in at 9 instead. On one hand, this was very good news since it’s hard to wait and think with no food, drink or (GASP) coffee! On the other hand, I had to be there two hours early, and Grey cannot be dropped off prior to 8 am. Putting all that together, I drove myself to the hospital.

My procedure was done at the same hospital where my sons were born. I took the same road, just as the sun was rising to burn off the morning mist. It was a lovely day. There was remarkably little waiting around, it seems. I was questioned, prepped, pregnancy-tested (negative!), written on, informed and advised. It seems like a very long time ago. I was wheeled in to do a nerve block before my husband returned. After they had put in my IV and added the block, my husband and my pastor both arrived in the recovery room. We prayed together, joked, talked logistics and waited. It seemed like only a few minutes after that when they kicked the guys out to finalize my preparation for surgery.

One of the last things I remember was telling the nurse how fascinating I found one of the drugs they gave me. I was given a tremendous number of drugs for this procedure. But just before pushing me into the OR they gave me a drug which would allow me to interact and react perfectly normally with them but which would not permit me to remember what happened. Sure enough, that conversation is my last memory. I know that I was awake after that. I assisted and followed instructions. I probably asked questions. I remember none of it.

So Sci-fi!

Anyway, the procedure went well. I came up from anesthesia extremely concerned about whether I had been polite under its influence. That was my first question, not “How did it go” or anything. Apparently I was at least unremarkable under the influence.

I did not have a chance to talk to my surgeon (consciously) after the procedure. He did talk to my husband, though. Although the surgery was a success, not all the news is good news. More of the meniscus was damaged than he had expected, so he had to remove more cartilage than he expected. I have pictures. They look like white stripes. Also, my knee shows some very early signs of arthritis. He said we would discuss this more in my follow up, so I’ll wait to find out what the implications of these two things are. I’m guessing, however, that the Boston Marathon is right out for 2012.

Then I came home! I’ve got some cool gear – for example a neat ice-pack-like device that circulates ice water under my brace. Oh, and an epic brace. But I am already limping around on my crutches, and bearing some weight on my leg.

I’m a little concerned about my big time painkiller. I’m still (I believe) under the effects of the nerve block, so the whole weight of the pain hasn’t hit. However, my reaction to my pain pill is a) throwing up anything that might be in my stomach b) falling dead asleep. While there are ways to mitigate nausea, this is less feeling queasy and more “OMG Bring a bowl NOW!”. This is particularly a problem since the last time I ate anything was last night during the Pat’s game. HUNGRY!

I just did manage to keep something down, but I have a hunch it’s because my last round of vomitus included my pain pill. Not a sustainable model, folks. So I plan on calling tomorrow to see if I can find something less problematic.

Tomorrow I start needing to move and do exercises. I suspect that even that minor effort will wipe me out. But I find hope in that this is, if all goes well, my last knee recovery. I’ve been up and down all summer, but when I make this recovery, I’ll be at the best I can be.

So that’s the news with me. My thanks to everyone who sent prayer and good thoughts, and to all those who decide to share their bodies with others once they are done with them.

Back to life, back to reality

The vacation is over. The children have returned. The schedule is resumed. The fall planning has begun. The rules have been reapplied.

We’re back to our life. But with some changes. (NOTE: One being that I’ve been picking at this post on and off in 5 minute increments for about 4 days now…)

Last night, after Thane’s bed time, my husband, eldest and I laid on a blanket in the backyard, vainly fighting the full moon and suburban light pollution for a shooting glimpse of majestic fire. We laughed, joked, poked each other, and listened to the symphony of insects performing every summer evening. This was a moment that probably would have been an option in our pre-vacation world, but that we would have been to stressed, blind or busy to see. In the lassitude of people whose emotional needs have been met, though, we had a really joyous hour together.

In other urgently important news, Grey does not have a loose tooth. No he does not. He has TWO loose teeth. His bottom two center teeth are extremely wiggly. One has an imminent departure date. I was sniffling a little at dinner about him losing his teeth. He got very sad and tried to assure me that he’d done his very best to take good care of his teeth – brushing and flossing them! Factual analysis of his actual oral hygiene practices aside, I had to rush to reassure him that losing teeth was perfectly normal and expected – but that I like him the way he is and it’s hard to watch him growing up so fast. He gave me some big hugs, that made me feel better about it. (At least until I consider that I should be banking them against the inevitable teenage hug-drought, but that’s just borrowing trouble.)

And then there’s my knee thing. I believe I’ve agonized at length over here about my KNEE and how I’ll have to actually have surgery. I feel like a total wimp. I’ve always seen myself as a strong stoic person (hey! Stop laughing!) In fact if you’d asked me why I chose to give birth – TWICE – without drugs I’d say something about how it wasn’t actually that hard after you got over the screaming bit, and the toughest part was that your jokes just weren’t that funny between pushes. (Ah, hormones! How easy you make it seem in retrospect.) I begin to suspect, however, that I’m actually a wimp about medical procedures. You see, I have no problem with needles. I’ve given about five gallons of blood. No problem! And I’ve never caviled at the procedures I’ve needed. But, uh, I haven’t needed any. Or at least many. This will be my first time unconscious. Not asleep, but knocked out. I’ve never fainted, blanked out, passed out, gone unconscious or had general anesthesia before. This will also be the first time anyone has ever cut me open in any way. And it will definitely be the first time someone has inserted a cadaver tendon threaded through my knee, after trimming off ragged bits of meniscus.

And the more people I talk to, the more this surgery sounds like a big deal. I mean, weeks and weeks of badness. Probably two weeks of incapacitation, followed by a long period of limping. I don’t do well with incapacitation. I prefer to tough my way through the pain and do stuff anyway. In this case, doing so will be stupid and irresponsible. I have no coping skills for when I’m not allowed to tough it out.

It probably means I will have to (gulp) ask for help. So my husband will be with me the day of the surgery. My MIL (who is a saint) is flying down for that week. But that second week? I’m hoping I will be able to limp to the bathroom and get lunch for myself by that second week. But no way can I take care of my children, do the laundry or dishes or make dinner. And our household generates enough work to keep TWO people busy full time doing it. I’m terrible at asking people for help. I’ve had so many kind friends volunteer, and I don’t know how to graciously and gratefully accept.

I guess this whole surgery thing will teach me many things.

But first! We have a first day of kindergarten approaching. I’m hoping to sneak in a camping trip over Labor Day. I have two neat kids who are a ton of fun. My husband brought home about 20 boardgames from Gencon. We’ve had fun playing them together, and with friends. (And hey! We’ve been married for eleven years now!) And all my counters are completely covered in the bounty of my CSA. (Seriously, two watermelons and two cantaloupes!)

And of course, my usual sporadic once-a-week-a-third-of-what-I-want-to-tell-you postings will now resume. At least that should improve with surgery!

Knee analysis

This morning I went in to physical therapy, walking flawlessly down the hall. “So what’s up?” my PT asked. “Funny you should ask….” He looked downright put out when he heard the extent of the interior damage. “Let’s retest you and get a new baseline.”

So I laid down and bent my knee. I straightened it. He moved it left and right, up and down, all around. Finally, he put his hands on his hips, “Are you sure they had the right MRI, because there’s no instability at all in your knee.” So it’s not just me… I really am super stable sans ACL.

Still, I have a big decision to make. It’s not ok for me to spend the next several years of my life never bending my knee. Moments like that dinner will happen again, and you know… sometimes it’s not convenient not to be able to walk for several weeks. So I’ve more or less decided to get surgery. I was sure pretty much from the get-go that I’d get the meniscal tears mended. The recovery time (as in normally walking) is 2 – 4 weeks on that, probably more like 4 since I’m having two procedures done. I can do both ACL and meniscal procedures at the same time. The recovery time for an ACL reconstruction is 4 – 6 weeks. Both procedures will require months and months – up to a year for ACL – of physical therapy afterwards. With the ACL reconstruction, it will be 6 months before I’m up to my usual habits as an elite athlete. (Oh wait…)

On one hand, I seem to do pretty darn well without an ACL. On the other hand, the “incremental” cost of an ACL replacement is 2 or so weeks from just a meniscal tear. I also save “incremental” physical therapy costs by bundling the surgeries. Additional data points to consider:

– not having an ACL makes it more likely I will tear my meniscus… which means this whole scenario could happen again
– meniscal tears make arthritis more likely
– I am pretty active. I like hiking and would enjoy playing raquetball.
– my children are 2 and 5 … a two year old is hard to manage with a healing knee

So my tentative plan is this:
1) Plan for surgery in mid-September. (I’d like to enjoy my summer, thanks!)
2) Spend the next two months getting my knee super strong and healthy to make my recovery period as short as possible.
3) Can’t help but wonder if it would be better if I could lose some weight. Of course, if that was easy vanity would have already accomplished it.
4) From mid-September, with say 8 weeks of serious knee instability, I’m likely to be walking well by mid-November. This means that by the time the snow flies, I should be pretty stable.
5) Six months from September means that by next summer I should be fully healed, and should be able to, for example, go backpacking.
6) Surgeries are done on Tuesday. I’d probably take the remainder of the week off (sort of depends on how I’m doing with pain meds) and then work from home for another week or two.
7) I’ve done some investigation on my dr. and hospital, and they seem middle of the road: not the best in the state but perfectly fine. Is that good enough?

There’s absolutely never a good time for a young, working mother to be out of commission for a month. But I do need to be able to walk, and this appears like a permanent solution (assuming I never, ever, ever go skiing ever again).

So I’m curious what you guys think. Am I missing a data point? Am I correctly interpreting the abbreviated recovery? Do I need to replace the ACL at all given the stability? What would you do in my place?

ACL? ACL? We don’t need no stinkin’ ACL!

I waited a long time in the doctor’s office before he came in. The walls were plastered with various problem joints: knee, hand, ankle; and the ways they can all go horribly wrong. I averted my eyes from diagrams of pins and screws and plates and fractures.

Finally, after a good wait, the doctor came in. “The more we look, the more we find!” were his opening, cheerful comments. “They told you about the ACL tear, right? Here, you can see it on the MRI.” (I could do no such thing.) Then he directed my eyes to several other locations on the screen, “You can see the roughness and tears in the meniscus over here. And over on the other side – that white spot is a cyst formed because your knee is leaking fluid. There’s another tear in the meniscus on that side. And see this bruising? This must have been from your recent fall. It will take quite a while to heal. We call that a bone bruise.”

At the end of the session, I have five things wrong with my knee, three of which must be addressed:

1) Completely missing ACL. He says I must’ve torn it 12 years ago when I went skiing for the first time, and I haven’t had one since.
2) Meniscus tear 1 (lateral) – from my recent fall
3) Meniscus tear 2 (exterior) – from my recent fall
4) Cyst – from the meniscus tear
5) Bone bruise – from the recent fall

The cyst and bone bruise should heal themselves – or be healed by treating the meniscus. But that’s not one, but two surgeries laid out there. I would have to get ‘scoped for the meniscus. The ACL recovery would be rather more involved, probably including a cadaver tendon threaded through my knee and attached at both sides. Recovery would be in the months – to possibly a full year before I’m 100% A-OK! And lots and lots of physical therapy. (Although there’s a good prognosis that 100% A-OK would be the eventual outcome.) I honestly don’t know if I am going to do the ACL surgery, or if I’ll do it now. Maybe 7 and 10 would be better ages than 2 and 5 to be out of commission for a few weeks. And if I’ve gotten this far without an ACL… do I really need one? I’ve apparently hiked the Wonderland Trail without one. On the flip side, they make meniscus tears more likely, and meniscus tears make arthritis more likely. I think Dr. Google and I will have a long chat about this, but there’s no rush. The doctor said I could be a triathlete without an ACL – running, swimming, biking are all ok activities. Basketball, soccer and side-to-side activities are a real problem. I’d probably need a brace for even hiking.

The meniscus tears are more acute. They’re the probably cause of my swelling and pain. And possibly I have them because I had no ACL to protect me. So I have consented to the scoping surgery. I’ll schedule it for after my summer vacation.

The crazy thing is that with all this bad stuff going on in my knee… I’m actually walking ok. Not perfect, but ok. I was walking almost perfectly, WITH all five of these elements in play. I can walk distances without harm. I have most of my range of movement. I’m just…. kind of scared of it all. It all sounds like a big, painful deal that will have me flat on my back for weeks. I mean, when I got really sick this winter I couldn’t even take a few days off from my responsibilities – and I could make it upstairs. How would I do with weeks flat down and months of weakness? I don’t have TIME for weakness.

So that’s the news. I suppose the bright side is, well, I’m wasn’t overreacting to this injury!