acl replacement – My Truant Pen

Preparing to exit disability

Four weeks ago tomorrow, I had ACL replacement surgery, as well as two meniscus tear trimmings. Since then, nearly every step I have taken has been taken with a ginormous brace on my knee. I spent the first week after the surgery on the couch with a near constant ice pack on my knee. I didn’t work at all that week. The second week I was on two crutches, plus big brace. I still spent hours with my knee iced. I worked from home for 6 – 7 hours a day, and was totally exhausted. The third week I returned to work, on crutches. I started putting a bit more weight on it, and feeling and looking better. This last week, I ditched my crutches. I’ve started taking the stairs with alternating feet, like a normal person (even if normal people don’t usually have a death-grip on the hand rail). I’ve sped up, and the pain is more or less gone.

I’ve been in physical therapy twice a week since the second week. I am pretty far ahead of “plan” for returning to normal knee function. My brace has created near permanent welts in my withered left leg – stripes of rashy skin at regular intervals. I’m sincerely hoping to get permission to ditch the darn thing at my physical therapy tomorrow. When that happens, I will more or less be as ok as I was before surgery (you know, when I just had three torn tendons). The brace actually makes me limp (I can’t quite have normal motion with it), so once it’s gone, people will be unlikely to be able to see that my ability is different than normal. And in another week or two, it will probably BE pretty normal, although I have a long road to full strength and agility.

This is a transition I am very lucky to make. There’s nothing like wearing an ankle to thigh metal brace to let people know you’re disabled. By my disability, such as it is, is a fleeting one. It’s not an identity, it’s a condition. But my time on crutches and limping has given me a greater sympathy and understanding for those who can’t leave their disabilities behind with a month of PT and icing.

This summer, I went on a hike with my family, including my Dad. I have always known that my father was considered medically disabled, but with the self-centeredness of youth, I never considered what it felt like for him. I never thought about what was scary, or hard, or tiring. My knee with the three torn tendons was probably about on par (or maybe a bit better) than the knee function my father has had since the 70s. I found that many of the mannerisms I think of as “Dad” (going down stairs one foot at a time, for example) are things that you have to do when your knees don’t work. But I never remember him complaining about it, or shying away from uneven ground, or popping Ibuprofen after a long walk.

I’ve also gotten the “what’s wrong with you attention”. Other than my fervent desire to have a better story than I do, I haven’t minded. Everyone notices I’m limping. Everyone says, “What’s wrong”. Depending on the time and my mood I joke about it “You should see the other guy!”, explain in a positive way, “I had surgery a few weeks ago, and now I’m thrilled that I’m down to just a brace and no crutches!” or go into the dire details, “So about 13 years ago I went skiing for the first time….” But it’s not my identity. It’s a phase, not my life. And it’s visible and well marked, so when I’m going slowly everyone waits. People hold the door for me, and don’t start inching forward when I’m crossing the street. No one treats my Dad with that courtesy – not even his thoughtless middle child.

I will be supremely grateful for a fully functional knee. You don’t know how much you miss kneeling until you have to give a two year old a bath without kneeling. I miss being active and bouncing my way up the stairs. I miss it being inconsequential to go up to the third floor. I’m tired of thinking about my leg, the footing. I’m tired of thinking when I need to get out of bed to check on a crying child, “I should really put on my brace first. The bedroom in the dark is exactly the kind of situation where I could take a horribly wrong step.” I’m tired of planning my wardrobe around what is loose enough or tight enough to work with my metal accessory. I’m so delighted that my recovery has been as fast as it has, and my movement and strength are returning. But most of all, I’m grateful I will be able to leave my disability behind. And I spend a moment thinking of all those who live with disability – visible and invisible – at all times.

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!