Despite my little panic yesterday with regards to the snow, I really wanted to make it to my appointment with Dr. Trice to have him look at my MRI results. I dealt with the traffic and the slippery roads and it was worth the trip. I handed off my MRI CD when I arrived, and by the time Dr. Trice came into the examination room he had taken a look at them. He entered, saying "I hope your knee feels as good as your MRI looks!"
So, hooray! My MRI was showing about a 95% fill, with a little gap in the anterior region that might still fill itself out as the tissue matures. That's a pretty awesome result for such a large defect, so I am very happy. It makes me worry a little less about still needing to pop it regularly to get it operating smoothly. I still think the brace is causing that anyway.
We talked about what activities I could and couldn't do. I asked, mostly out of curiosity, when I might be allowed to jog if my recovery continues to be successful. His answer was the one-year mark, meaning this March. That's actually earlier than I was expecting! I have a number of people who would like to cheer me on at my first 5K.
I was instructed to up the weights on my SLRs. He wants me to get to 15 lbs. I need to buy new weights!
The best part was that he set my next appointment a full three months from now. That's how confident he is in my progress! My next appointment actually falls exactly on the one year anniversary since my ACI.
Friday, December 17, 2010
Thursday, December 16, 2010
Rough Day
This morning there was a holiday party in my office. I went to the room, but it was fairly crowded. All I saw when looking at the crowd was a bunch of people who might knock me down. I panicked a little. When I got back to my office I was a little upset. I've been doing so well and I just wasn't expecting to encounter so much fear. It really shook my confidence.
And now it is snowing enough to lay down a slippery layer outside. If I fall, I don't know what would happen. I don't have normal balance, so I may not be able to recover. I can't get up from sitting on the ground without something to grab onto, to pull myself up. If I fell on the sidewalk, how long would I have to sit there until someone came along to help me?
I don't want to be so fearful. I'm having a rough day, but it's all inside my head.
And now it is snowing enough to lay down a slippery layer outside. If I fall, I don't know what would happen. I don't have normal balance, so I may not be able to recover. I can't get up from sitting on the ground without something to grab onto, to pull myself up. If I fell on the sidewalk, how long would I have to sit there until someone came along to help me?
I don't want to be so fearful. I'm having a rough day, but it's all inside my head.
Wednesday, December 15, 2010
MRI
Last night I went to get a 3.0 Tesla MRI, which is basically a very powerful MRI screening that can produce high quality imagery. Here's an article about the very one that I went to at the Hopkins Outpatient Center.
It takes a while and isn't the most pleasant experience. For 35 minutes you have to hold very still in a very cold room. It's really loud, even with the earplugs and thick headset, so you can't fall asleep. That being said, you aren't trapped in a tiny tube so I didn't get claustrophobic. The tube is big and your head and arms are outside of it.
I am very excited because this is my first MRI since the surgery and I have an appointment with Dr. Trice tomorrow where I will find out what it shows him. I feel like I am doing pretty well, but I would like the reality check.
It takes a while and isn't the most pleasant experience. For 35 minutes you have to hold very still in a very cold room. It's really loud, even with the earplugs and thick headset, so you can't fall asleep. That being said, you aren't trapped in a tiny tube so I didn't get claustrophobic. The tube is big and your head and arms are outside of it.
I am very excited because this is my first MRI since the surgery and I have an appointment with Dr. Trice tomorrow where I will find out what it shows him. I feel like I am doing pretty well, but I would like the reality check.
Tuesday, December 7, 2010
8 1/2 Months out
I was looking for a specific post for someone and ended up reading some of my own blog. I'm glad I wrote it, since I think a few people may have found it helpful, but also because I would have forgotten a lot of this.
I saw my massage therapist (MT) again this weekend as my shoulder and upper back have continued to give me problems. It seems like the discomfort starts to build up over about a month before it becomes very bad. It makes sleep difficult because no position is really that comfortable. I'm going to start seeing him for 30 minutes every 2 weeks now to try to stay ahead of the building discomfort.
While I was there, I had him go over my knee to break up scar tissue. It's pretty unpleasant and difficult to do an adequate job on yourself. My MT suggested using a topical analgesic, such as Biofreeze, to dull the pain while using quick, short strokes to break up the scar tissue. It's a good suggestion and helps dull some of the aches too.
The knee gets stiff still and often I will feel pressure in it until I get a good pop out of it. (It's audible, so sometimes it catches people off-guard, which is highly entertaining.) I think that is due to the brace though since it pushes things out of a normal position. I've been walking up to 2 miles at a time, and the increase in distance may be one of the factors that have helped the knee feel smoother lately. Well, sometimes anyway. I am still quite aware of the knee but my limp has gotten noticeably better in the last few weeks. It's almost gone.
I added a new link on the right to the Chester ACI Rehabilitation Guide For Femoral and Tibial Articular Cartilage Repair, that someone shared on the knee geeks forum. It's a great find! It covers both the surgery and the rehab in one document. I was reminded again by reading that document that Dr. Trice is keeping me on a very slow path. Perhaps ACI is easier for some others? But then again, I don't seem to have any complications so it can be harder for others too. Anyway, it's a good reminder to mention to any readers that I was really bad off before, so don't get too scared. My experience might be on the more painful side.
I saw my massage therapist (MT) again this weekend as my shoulder and upper back have continued to give me problems. It seems like the discomfort starts to build up over about a month before it becomes very bad. It makes sleep difficult because no position is really that comfortable. I'm going to start seeing him for 30 minutes every 2 weeks now to try to stay ahead of the building discomfort.
While I was there, I had him go over my knee to break up scar tissue. It's pretty unpleasant and difficult to do an adequate job on yourself. My MT suggested using a topical analgesic, such as Biofreeze, to dull the pain while using quick, short strokes to break up the scar tissue. It's a good suggestion and helps dull some of the aches too.
The knee gets stiff still and often I will feel pressure in it until I get a good pop out of it. (It's audible, so sometimes it catches people off-guard, which is highly entertaining.) I think that is due to the brace though since it pushes things out of a normal position. I've been walking up to 2 miles at a time, and the increase in distance may be one of the factors that have helped the knee feel smoother lately. Well, sometimes anyway. I am still quite aware of the knee but my limp has gotten noticeably better in the last few weeks. It's almost gone.
I added a new link on the right to the Chester ACI Rehabilitation Guide For Femoral and Tibial Articular Cartilage Repair, that someone shared on the knee geeks forum. It's a great find! It covers both the surgery and the rehab in one document. I was reminded again by reading that document that Dr. Trice is keeping me on a very slow path. Perhaps ACI is easier for some others? But then again, I don't seem to have any complications so it can be harder for others too. Anyway, it's a good reminder to mention to any readers that I was really bad off before, so don't get too scared. My experience might be on the more painful side.
Wednesday, November 24, 2010
8 Months Out
Yes, I know I posted the last post a little past the 7 month mark, but I was talking about an appointment that happened at about 7 months out. However, today actually does mark 8 months since my surgery.
Tomorrow is Thanksgiving and I am hosting. Since cooking is a hobby of mine, it will be nice to be able to stand in the kitchen again. Last year I did very little because it hurt too much. It is good to have something to be thankful for regarding the knee.
My knee is doing pretty well. I can still feel it most of the time. It aches and sometimes feels very hot, but never any sharp pain. Icing still feels good. I can go for walks now, so I accompany my husband as he walks the dogs. I used to be the one that walked them most of the time, but it's been almost 2 years since I've been able to do that. It's funny that I still remember my reaction to the first OS when he said I needed MFX and would spend 4 weeks on crutches afterward. I was shocked by that length of time. Now, that reaction seems kind of cute and innocent in retrospect. I suppose I have become a more patient person.
My shoulder has been bothering me. I think it is related to the remnants of my limp. It doesn't hurt exactly, but then again my standards for defining something as painful are not what they used to be. It just makes it hard to get comfortable. I have leftover pain relief goop from seeing the pain management doctor before my surgery, so I am using that. I don't want to take Tylenol too often since it can be rough on the liver. I'll see my massage therapist again soon too. A sports massage therapist is definitely the way to go when healing. It's such a more practical approach versus a traditional massage therapist.
There was one other interesting thing that happened in my last appointment with Dr. Trice. He seemed unusually happy to see me in the office, but I think I figured out why. When he came in for the consultation he introduced a nurse practitioner that was sitting in on his meetings with patients. Clearly she was not an orthopedic nurse because he was explaining to her what a MFX is, though I suppose she could have just been too polite to correct him! I am guessing that she was following various doctors within Johns Hopkins to understand their jobs better.
After I asked my questions of Dr. Trice and he answered them, he told me to tell this nurse how long I had been dealing with my knee. "Almost 2 years." I said. He told me to describe my condition before the ACI. I don't get asked that very often by someone who actually wants the full answer. I obliged, saying " I was in pain every day whether I was walking or not. With daily prescription pain medication, I could work in the office only about 2 days a week and work from home the rest of the time. The floors there just hurt and the times when I would uncontrollably scream from the pain were embarrassing. Without pain medication, I could barely get off the couch."
About here I realized Dr. Trice was showing me off. He told me to get up and walk across the room. I did so. He asked about my current pain level. I said it really didn't hurt, just aches, so perhaps a 1 (on the trusty 1-10 scale that you get asked about all the time). The nurse's eyes were huge and all she could say was "Wow." It's a lot to comprehend, which is why I usually tone down my descriptions of the experience in casual conversation. I believe Dr. Trice was happy to see me because I am a good example of the impact his work can have on someone's life, and that seems to be what he wanted to show her. It's kind of nice to be thought of as a success story, even if I'm not out of the woods yet.
Tomorrow is Thanksgiving and I am hosting. Since cooking is a hobby of mine, it will be nice to be able to stand in the kitchen again. Last year I did very little because it hurt too much. It is good to have something to be thankful for regarding the knee.
My knee is doing pretty well. I can still feel it most of the time. It aches and sometimes feels very hot, but never any sharp pain. Icing still feels good. I can go for walks now, so I accompany my husband as he walks the dogs. I used to be the one that walked them most of the time, but it's been almost 2 years since I've been able to do that. It's funny that I still remember my reaction to the first OS when he said I needed MFX and would spend 4 weeks on crutches afterward. I was shocked by that length of time. Now, that reaction seems kind of cute and innocent in retrospect. I suppose I have become a more patient person.
My shoulder has been bothering me. I think it is related to the remnants of my limp. It doesn't hurt exactly, but then again my standards for defining something as painful are not what they used to be. It just makes it hard to get comfortable. I have leftover pain relief goop from seeing the pain management doctor before my surgery, so I am using that. I don't want to take Tylenol too often since it can be rough on the liver. I'll see my massage therapist again soon too. A sports massage therapist is definitely the way to go when healing. It's such a more practical approach versus a traditional massage therapist.
There was one other interesting thing that happened in my last appointment with Dr. Trice. He seemed unusually happy to see me in the office, but I think I figured out why. When he came in for the consultation he introduced a nurse practitioner that was sitting in on his meetings with patients. Clearly she was not an orthopedic nurse because he was explaining to her what a MFX is, though I suppose she could have just been too polite to correct him! I am guessing that she was following various doctors within Johns Hopkins to understand their jobs better.
After I asked my questions of Dr. Trice and he answered them, he told me to tell this nurse how long I had been dealing with my knee. "Almost 2 years." I said. He told me to describe my condition before the ACI. I don't get asked that very often by someone who actually wants the full answer. I obliged, saying " I was in pain every day whether I was walking or not. With daily prescription pain medication, I could work in the office only about 2 days a week and work from home the rest of the time. The floors there just hurt and the times when I would uncontrollably scream from the pain were embarrassing. Without pain medication, I could barely get off the couch."
About here I realized Dr. Trice was showing me off. He told me to get up and walk across the room. I did so. He asked about my current pain level. I said it really didn't hurt, just aches, so perhaps a 1 (on the trusty 1-10 scale that you get asked about all the time). The nurse's eyes were huge and all she could say was "Wow." It's a lot to comprehend, which is why I usually tone down my descriptions of the experience in casual conversation. I believe Dr. Trice was happy to see me because I am a good example of the impact his work can have on someone's life, and that seems to be what he wanted to show her. It's kind of nice to be thought of as a success story, even if I'm not out of the woods yet.
Wednesday, November 17, 2010
Doctor's Guidance at 7 Months Out
I posted this on the knee geeks forum because I found Dr. Trice's guidance to be interesting and thought others might too. I can't really say it any better than I did there, but it is an update so I'll add it to my story.
I am doing very well. The knee aches and pops a lot, but there is very little pain. The popping is probably due to the unloader brace shifting things around. There are some "crazy nerve spikes," as I call them, which feel like a quick shot of tissue based pain and are usually around the scar. Not bad at all!
My latest doctor appointment was very interesting and I thought I would share the experience. I have seen on here that at 7 months most ACI patients are permitted to run and such other activities, but my doctor has restricted these for me. Going into the latest appointment, he let me swim (aqua arthritis class only), use the recumbent bike, and walk up to one mile on even surfaces. That's it. No elliptical, no walking the dogs, nothing even close to running. Needless to say, I felt pretty restricted.
So I went into the appointment wanting to understand the reasons for my severe activity restrictions. He said that there were a few. The first two were that my defect was very large (I don't know exact measurements but I think it was about 2.5 x 3 cm on medial femoral condyle) and that I had been in more pain before the surgery than most of his patients (I'll admit I was pretty bad off).
However he said the strongest reason was the previous microfracture and that he had other patients with ACI after microfracture who were doing well at 7 months and then weren't at 9-10 months and he doesn't really know why. So, he wants to be cautious. I guess I thought I was mostly out of the woods as long as I didn't do anything stupid. Apparently he sees a lot more forest before me.
He did however loosen the restrictions a little bit saying I can walk up to 3 miles and I can sign up for a slightly more vigorous swimming class as long as I am very very careful. The elliptical and walking the dogs are still off limit.
This appointment was about 2 weeks ago and a little after 7 months out. Now I am creeping up on the 8 month mark and continuing to be cautious and optimistic. I just can't wait to get these woods behind me.
I am doing very well. The knee aches and pops a lot, but there is very little pain. The popping is probably due to the unloader brace shifting things around. There are some "crazy nerve spikes," as I call them, which feel like a quick shot of tissue based pain and are usually around the scar. Not bad at all!
My latest doctor appointment was very interesting and I thought I would share the experience. I have seen on here that at 7 months most ACI patients are permitted to run and such other activities, but my doctor has restricted these for me. Going into the latest appointment, he let me swim (aqua arthritis class only), use the recumbent bike, and walk up to one mile on even surfaces. That's it. No elliptical, no walking the dogs, nothing even close to running. Needless to say, I felt pretty restricted.
So I went into the appointment wanting to understand the reasons for my severe activity restrictions. He said that there were a few. The first two were that my defect was very large (I don't know exact measurements but I think it was about 2.5 x 3 cm on medial femoral condyle) and that I had been in more pain before the surgery than most of his patients (I'll admit I was pretty bad off).
However he said the strongest reason was the previous microfracture and that he had other patients with ACI after microfracture who were doing well at 7 months and then weren't at 9-10 months and he doesn't really know why. So, he wants to be cautious. I guess I thought I was mostly out of the woods as long as I didn't do anything stupid. Apparently he sees a lot more forest before me.
He did however loosen the restrictions a little bit saying I can walk up to 3 miles and I can sign up for a slightly more vigorous swimming class as long as I am very very careful. The elliptical and walking the dogs are still off limit.
This appointment was about 2 weeks ago and a little after 7 months out. Now I am creeping up on the 8 month mark and continuing to be cautious and optimistic. I just can't wait to get these woods behind me.
Tuesday, September 28, 2010
Six Months out
So I sincerely doubt any of my family or friends are reading this anymore, but I am trying to keep putting in updates periodically for others who might be going through the same surgery and stumble across this blog. I just passed the six month mark and had an appointment with Dr. Trice, so it's a good time to take inventory of my progress.
Overall, I am doing pretty darn well. I am in much better shape than before the surgery. My knee aches sometimes, but ice and Tylenol seem to calm it down. I just reduced PT to once a week and I am in an Aqua Arthritis class twice a week. I can do straight leg raises with 2 pound weights and side leg raises with 5-7 pound weights. I still have a limp, but it is less pronounced unless I am tired. I can get through a typical day at the office with no unusual fatigue (though Mondays are still Mondays, you know?) but I do get quite fatigued if I do something unusual such as driving a long distance to and from an all-day meeting. I am definitely optimistic about my recovery, but still aware that caution is required. I'm not out of the woods yet.
I have a few new instructions from Dr. Trice as well. He approved walking outside for exercise, starting with 1/4 mile at a time for one week, then 1/2 mile at a time for a week, and so on up to one mile. So in just a few weeks I will be allowed to walk with my husband and dogs for a whole mile at a time! He said to then stay at that level for about 3 months. I am planning on trying to do one thing each day, either walking outside, PT, swimming class, or the treadmill.
Dr. Trice also said he wanted me to continue wearing my unloader brace for another 6 months (whatever, it's not that uncomfortable) and that I can now do short arc exercises (GR1 - it's just a video showing the exercise). A short arc is basically straightening the leg from a horizontal and slightly bent position while it's unsupported. It was not something that I was allowed to do before as it is apparently pretty rough on the knee. I did them in PT and was shocked by how weak I was! It was a reminder that I still have a way to go.
I have come a long way, but there is still more work to be done. I'll keep updating periodically just to note progress at various milestones. Cheers!
Overall, I am doing pretty darn well. I am in much better shape than before the surgery. My knee aches sometimes, but ice and Tylenol seem to calm it down. I just reduced PT to once a week and I am in an Aqua Arthritis class twice a week. I can do straight leg raises with 2 pound weights and side leg raises with 5-7 pound weights. I still have a limp, but it is less pronounced unless I am tired. I can get through a typical day at the office with no unusual fatigue (though Mondays are still Mondays, you know?) but I do get quite fatigued if I do something unusual such as driving a long distance to and from an all-day meeting. I am definitely optimistic about my recovery, but still aware that caution is required. I'm not out of the woods yet.
I have a few new instructions from Dr. Trice as well. He approved walking outside for exercise, starting with 1/4 mile at a time for one week, then 1/2 mile at a time for a week, and so on up to one mile. So in just a few weeks I will be allowed to walk with my husband and dogs for a whole mile at a time! He said to then stay at that level for about 3 months. I am planning on trying to do one thing each day, either walking outside, PT, swimming class, or the treadmill.
Dr. Trice also said he wanted me to continue wearing my unloader brace for another 6 months (whatever, it's not that uncomfortable) and that I can now do short arc exercises (GR1 - it's just a video showing the exercise). A short arc is basically straightening the leg from a horizontal and slightly bent position while it's unsupported. It was not something that I was allowed to do before as it is apparently pretty rough on the knee. I did them in PT and was shocked by how weak I was! It was a reminder that I still have a way to go.
I have come a long way, but there is still more work to be done. I'll keep updating periodically just to note progress at various milestones. Cheers!
Tuesday, September 7, 2010
I can't believe I am still learning
I thought I had pretty much figured out all that I needed to know, but then this weekend happened. I have been having so much trouble with all my muscles aching and my back just all knotted up. It has been hard to get up in the morning. So, finally, I asked my PT for a recommendation for a massage therapist.
Lesson Learned: I should have gotten a massage a long time ago!
It is highly important to have the right type of massage therapist who knows how to actually heal the muscles, not just help you relax. Sports massage therapists seem to be the ticket. Anyway, a wonderful woman named Brandy took her magnificent elbows to the arch around my left shoulder blade. It was one huge knot from both the cane and how I have been compensating for my limp. I didn't even realize until she was done that I had been restricting the motion of my left arm. She freed it.
The next day I was sore, as expected. It has made a huge difference though and I wish I had done this months ago. I am finally starting to feel closer to normal.
Lesson Learned: I should have gotten a massage a long time ago!
It is highly important to have the right type of massage therapist who knows how to actually heal the muscles, not just help you relax. Sports massage therapists seem to be the ticket. Anyway, a wonderful woman named Brandy took her magnificent elbows to the arch around my left shoulder blade. It was one huge knot from both the cane and how I have been compensating for my limp. I didn't even realize until she was done that I had been restricting the motion of my left arm. She freed it.
The next day I was sore, as expected. It has made a huge difference though and I wish I had done this months ago. I am finally starting to feel closer to normal.
Tuesday, August 17, 2010
Slow and Steady
I went to see Dr. Trice yesterday and he was pleased with my progress and said I am right on track. The primary message I took away from the appointment was to stay cautious. As I feel better, I will want to do more, but I really need to still be protecting the implant as it hardens. So absolutely no weight-bearing exercises are allowed. He doesn't even want me to use the elliptical or walk any more than needed. I need to stay in tortoise mode and not be tempted to be more like the hare. So, I can pretty much just use the bike or swim.
Speaking of which, he thought the Aqua Arthritis class was a great idea so he signed the paperwork and now I am all signed up. It starts in September, but now that I have access to a pool I may just go and do some water-walking sometime.
Speaking of which, he thought the Aqua Arthritis class was a great idea so he signed the paperwork and now I am all signed up. It starts in September, but now that I have access to a pool I may just go and do some water-walking sometime.
Wednesday, August 11, 2010
20 Weeks
I am doing pretty well. I still have a bad limp and have to focus on how to walk, but I am not in much pain. My muscles ache a lot and my knee gets sore sometimes, but that is so little compared to before. People still wince when they see me and I get a lot of pity conversations from strangers. I try to convey that this is so much better, but I think that just scares them to even imagine what I've been through. I guess you don't really know what you can handle until you have had to face it, and my Big Scary Stuff is behind me now. It's just a part of my life.
My scar was healing up pretty rough (like a thick purple rope) so I looked into scar minimizing products. The two that seem most successful are Bio-oil and silicone strips. The Bio-oil sounded messy and since another patient at PT was praising the silicone strips, I am trying the strips. They are available on Amazon and the brand I am using is Scar Away. They seem to be working but they do take some getting used to. The silicone is only sticky when it is dry, which makes cleaning them easy. I clean them every day and wear each for about a week before discarding. The more you wear it, the more effective it seems to be. Don't be tempted to get the shorter ones and just use two to cover the long scar. I didn't see the long ones when I was first looking so I got the short ones. They are a waste of money. The longer ones stay on so much better!
I have my next appointment on Monday and I will be asking Dr. Trice about aquatics classes. The local YMCA has an Arthritis Aquatics class that I think will be perfect for continued strengthening. It requires my doctor to sign off on it, and I already picked up the form to bring with me. I hope they will let me participate. I'm not an arthritis sufferer, but I sure would benefit from the class. I think the other aquatics classes would be too vigorous right now, but I may give them a shot in a few months.
So yeah, I am doing alright but I still have a long way to go. My spirits have been higher lately though because the list of things I can do keeps growing and because there is so little pain. I am so happy to be recovering!
My scar was healing up pretty rough (like a thick purple rope) so I looked into scar minimizing products. The two that seem most successful are Bio-oil and silicone strips. The Bio-oil sounded messy and since another patient at PT was praising the silicone strips, I am trying the strips. They are available on Amazon and the brand I am using is Scar Away. They seem to be working but they do take some getting used to. The silicone is only sticky when it is dry, which makes cleaning them easy. I clean them every day and wear each for about a week before discarding. The more you wear it, the more effective it seems to be. Don't be tempted to get the shorter ones and just use two to cover the long scar. I didn't see the long ones when I was first looking so I got the short ones. They are a waste of money. The longer ones stay on so much better!
I have my next appointment on Monday and I will be asking Dr. Trice about aquatics classes. The local YMCA has an Arthritis Aquatics class that I think will be perfect for continued strengthening. It requires my doctor to sign off on it, and I already picked up the form to bring with me. I hope they will let me participate. I'm not an arthritis sufferer, but I sure would benefit from the class. I think the other aquatics classes would be too vigorous right now, but I may give them a shot in a few months.
So yeah, I am doing alright but I still have a long way to go. My spirits have been higher lately though because the list of things I can do keeps growing and because there is so little pain. I am so happy to be recovering!
Tuesday, July 13, 2010
Phase 3
Technically I am in phase 3 now, but there is no sudden change of activity or guidance. Everything is gradual. I did however ask if we could do a few new exercises in PT and Sandy showed me a few. They really were very simple stretching exercises mostly, but she warned I might be sore. When this morning rolled around, I sure was!
It can be frustrating how exhausted I get after doing such simple things. However, things are getting easier. I went to the grocery store again this past weekend and it was easier than the first time. The only way to get better is to keep pushing myself, but the recovery from each effort is still daunting.
It can be frustrating how exhausted I get after doing such simple things. However, things are getting easier. I went to the grocery store again this past weekend and it was easier than the first time. The only way to get better is to keep pushing myself, but the recovery from each effort is still daunting.
Friday, July 9, 2010
First Day Back in the Office and Other Things
In the past week I have challenged myself 3 times and boy am I beat! On Sunday I went to the grocery store with my husband and I walked through the entire trip! I used the cart to support myself and didn't make any extraneous trips. If we forgot something my husband went back for it, and he found it nice that my default slow speed meant I was usually still about where he left me when he got back! I normally have a tendency to wander off. (Ooh something shiny!) Anyway, by the end of the trip I was absolutely shaking from the effort and very weak, but it was still very satisfying. I iced as soon as I got home and rested. Overall it was a good experience.
Building on that success, I went into the office on Tuesday. I managed to make it 6 hours before thecrazy nerve tingles in my knee got out of hand. It's not pain exactly, just uncomfortable niggling tingles shooting through my knee. They get worse as I spend more time in one position, and eventually get constant and very distracting. There was some soreness as I walked out of the office too. I came home, applied ice, and rested until the tingles stopped. However, the next day I was so exhausted I felt almost ill so I guess I needed that next day to recover. It's the weak muscles that are such a huge limitation now. Ice makes the tingles go away quickly, but building muscles means wearing them out first. I just lost so much muscle in my entire body by being inactive for so long.
Then yesterday I really pushed myself. I drove 2 hours to a meeting and then 2 hours back afterward. Driving has been pretty easy, but can cause those nerve tingles since it is a lot of sitting. I arrived early for the meeting and found a spare office to remove my brace and ice right away. That helped a lot. I made it through the meeting and drove back, going straight to PT where I took it pretty easy. I was so tired I felt a little disoriented, but no harm was done. It did take me a long time to get out of bed today though.
Other things going on besides me wiping myself out repeatedly: The cane use appears to be aggravating a tendon in my shoulder causing a pinched feeling. I was trying to treat it with heat and massage, but Sandy, my PT, said to cut that out and use ice. I am never sure which to reach for since random pain is just random pain to me. She said it was probably an inflamed tendon so ice should calm it. She also gave me a sample of BioFreeze, which feels pretty cool (hee hee). I need to focus on getting away from the cane soon anyway, so this is further motivation.
Also, (insert drum roll!) I have a new lesson learned.
Lesson Learned # 12: Keep icing regularly even when the swelling stops. As I increased my activity, Sandy instructed me to ice regularly. The ice has had the unexpected effect of making the straight leg raises (SLR) easier! It is finally not so painful to get in a good "locked" position. The SLR are probably the single most valuable (and most difficult) rehab exercise. I wish I had known regular icing would help with them earlier, but I am glad I figured it out.
So overall, I am making progress and wiping myself out a lot. But hey, I am not going to get better by sitting on my bum. Well, at least not all the time. I am still exhausted from yesterday, so excuse me while I go sit on my bum for a little while. But this weekend I will be back to grocery shopping.
Building on that success, I went into the office on Tuesday. I managed to make it 6 hours before thecrazy nerve tingles in my knee got out of hand. It's not pain exactly, just uncomfortable niggling tingles shooting through my knee. They get worse as I spend more time in one position, and eventually get constant and very distracting. There was some soreness as I walked out of the office too. I came home, applied ice, and rested until the tingles stopped. However, the next day I was so exhausted I felt almost ill so I guess I needed that next day to recover. It's the weak muscles that are such a huge limitation now. Ice makes the tingles go away quickly, but building muscles means wearing them out first. I just lost so much muscle in my entire body by being inactive for so long.
Then yesterday I really pushed myself. I drove 2 hours to a meeting and then 2 hours back afterward. Driving has been pretty easy, but can cause those nerve tingles since it is a lot of sitting. I arrived early for the meeting and found a spare office to remove my brace and ice right away. That helped a lot. I made it through the meeting and drove back, going straight to PT where I took it pretty easy. I was so tired I felt a little disoriented, but no harm was done. It did take me a long time to get out of bed today though.
Other things going on besides me wiping myself out repeatedly: The cane use appears to be aggravating a tendon in my shoulder causing a pinched feeling. I was trying to treat it with heat and massage, but Sandy, my PT, said to cut that out and use ice. I am never sure which to reach for since random pain is just random pain to me. She said it was probably an inflamed tendon so ice should calm it. She also gave me a sample of BioFreeze, which feels pretty cool (hee hee). I need to focus on getting away from the cane soon anyway, so this is further motivation.
Also, (insert drum roll!) I have a new lesson learned.
Lesson Learned # 12: Keep icing regularly even when the swelling stops. As I increased my activity, Sandy instructed me to ice regularly. The ice has had the unexpected effect of making the straight leg raises (SLR) easier! It is finally not so painful to get in a good "locked" position. The SLR are probably the single most valuable (and most difficult) rehab exercise. I wish I had known regular icing would help with them earlier, but I am glad I figured it out.
So overall, I am making progress and wiping myself out a lot. But hey, I am not going to get better by sitting on my bum. Well, at least not all the time. I am still exhausted from yesterday, so excuse me while I go sit on my bum for a little while. But this weekend I will be back to grocery shopping.
Wednesday, June 30, 2010
Stairs
I was talking with my physical therapist and she said that after we enter Phase 3 she would teach me how to walk on stairs again! I have been just taking each step one at a time with my bad leg straight. I've been doing that for so long that I actually got excited at the idea of being able to walk normally up and down stairs! And then I get a little embarrassed that I got a little excited. But seriously, my house has three floors and tons of stairs. I can't wait to relearn them!
She did say not to try it on my own first. That is definitely something to begin with her guidance.
I still plan on walking around the grocery store this weekend. If it goes well, I will start going into the office. My job has been great since they have been letting me work from home. Before my surgery, days in the office were my most painful. The concrete floors there just killed my knee. I am a little nervous about going back, but the grocery store seems like a good test to see if I am ready.
She did say not to try it on my own first. That is definitely something to begin with her guidance.
I still plan on walking around the grocery store this weekend. If it goes well, I will start going into the office. My job has been great since they have been letting me work from home. Before my surgery, days in the office were my most painful. The concrete floors there just killed my knee. I am a little nervous about going back, but the grocery store seems like a good test to see if I am ready.
Monday, June 28, 2010
No More Whining (13 weeks and 5 days)
I have been hesitant to post lately because the progress is so slow it just feels like whining. In reality, I am not whining much and am actually pretty happy with the current state of my knee. No, it's not feeling awesome. But it feels much better than it used to! So I will try to keep posting, but focus on what has changed rather than the current state.
I had an appointment with Dr. Trice today and he was pleased with my progress at the three month mark, but said I am about two weeks behind so he wanted me to wait another two weeks before beginning Phase 3 of the recovery protocol. Phase 3 is a substantial return to activity so I am obviously excited, even if I know that it will be gradual. He also pointed out that at this time the implanted cells should be changing from a jelly-like consistency to a waxy consistency, so I still need to protect them. No squatting or twisting! I really wasn't planning on doing that anyway. :)
I am feeling like I haven't pushed myself as much lately. The little things are getting easier, like walking into a store but not around it. That used to wipe me out just a few weeks ago, but this past weekend I was less affected by it. So I was thinking that I might try grocery shopping (like actually walking around the store) with my husband this weekend. If I get tired there are places to sit and it is nice and level, as opposed to walking outside.
I have noticed a change in how each step feels. I realized that as I took each step, the knee would settle into a position as the weight went through it. There was a lot of movement and shifting going on and I walked so very slowly to allow that shifting and settling to occur. As my muscles around the joint have gotten stronger, there seems to be less settling when I put weight through it. As a result, I am actually walking a little faster. I just noticed this happening in the past week, but I sure like it!
I had an appointment with Dr. Trice today and he was pleased with my progress at the three month mark, but said I am about two weeks behind so he wanted me to wait another two weeks before beginning Phase 3 of the recovery protocol. Phase 3 is a substantial return to activity so I am obviously excited, even if I know that it will be gradual. He also pointed out that at this time the implanted cells should be changing from a jelly-like consistency to a waxy consistency, so I still need to protect them. No squatting or twisting! I really wasn't planning on doing that anyway. :)
I am feeling like I haven't pushed myself as much lately. The little things are getting easier, like walking into a store but not around it. That used to wipe me out just a few weeks ago, but this past weekend I was less affected by it. So I was thinking that I might try grocery shopping (like actually walking around the store) with my husband this weekend. If I get tired there are places to sit and it is nice and level, as opposed to walking outside.
I have noticed a change in how each step feels. I realized that as I took each step, the knee would settle into a position as the weight went through it. There was a lot of movement and shifting going on and I walked so very slowly to allow that shifting and settling to occur. As my muscles around the joint have gotten stronger, there seems to be less settling when I put weight through it. As a result, I am actually walking a little faster. I just noticed this happening in the past week, but I sure like it!
Monday, June 21, 2010
Nearly 13 Weeks
I just reread the last post here and realized how slowly things are changing. On June 3rd I was hoping to drive soon and I was occasionally going without the cane in the house. Now it is June 21 and I am driving short distances and regularly going without the cane in the house. Hmm. That doesn't seem that much of a change for 18 days.
So it goes. I am getting a little stronger. Every few days I just catch myself feeling maybe not so weak. On Saturday I actually ran a few errands. I can't shop for groceries, but I could walk into the grocery store, find one thing in the produce section, and go straight to the checkout. It was a huge challenge! So, does that deserve a woohoo? Meh. I wouldn't have done that on June 3rd, so I guess it is progress.
The straight leg raises are still very painful and are really the only part of PT where I haven't come a long way. Whenever I do them, I try to do 40-50 total. The first ten are one at a time, and I rest after each. I try to visualize the pain as water flowing over me and dissipating, flowing down to the floor and away from me. The second ten I do in sets of 5, and if I can, the rest I do in sets of ten. They get easier as I go, which is why I can keep increasing the number in each set.
Last week I was having a particularly hard time and could only manage sets of 5 all the way through to 50. I had been pondering why and I think I have figured it out. It was the same culprit as before: those stupid prone exercises! My leg had been straightening easily so I thought I could cut them out finally, but spending a little time prone seemed to help something shift in the knee so that it was less painful to lock it straight. Honestly, the remaining pain I am dealing with is very hard to describe, so forgive me for failing to convey it. It just hurts whenever I rely on the muscles around the knee to support it. That occurs when I lock it straight, lift the leg in any way, or if it has been in one position for too long and the muscles cramp from holding it there.
I am still in less pain than before the surgery and I try to keep that in mind. However, I am pretty sick of being a little weakling. Meep.
So it goes. I am getting a little stronger. Every few days I just catch myself feeling maybe not so weak. On Saturday I actually ran a few errands. I can't shop for groceries, but I could walk into the grocery store, find one thing in the produce section, and go straight to the checkout. It was a huge challenge! So, does that deserve a woohoo? Meh. I wouldn't have done that on June 3rd, so I guess it is progress.
The straight leg raises are still very painful and are really the only part of PT where I haven't come a long way. Whenever I do them, I try to do 40-50 total. The first ten are one at a time, and I rest after each. I try to visualize the pain as water flowing over me and dissipating, flowing down to the floor and away from me. The second ten I do in sets of 5, and if I can, the rest I do in sets of ten. They get easier as I go, which is why I can keep increasing the number in each set.
Last week I was having a particularly hard time and could only manage sets of 5 all the way through to 50. I had been pondering why and I think I have figured it out. It was the same culprit as before: those stupid prone exercises! My leg had been straightening easily so I thought I could cut them out finally, but spending a little time prone seemed to help something shift in the knee so that it was less painful to lock it straight. Honestly, the remaining pain I am dealing with is very hard to describe, so forgive me for failing to convey it. It just hurts whenever I rely on the muscles around the knee to support it. That occurs when I lock it straight, lift the leg in any way, or if it has been in one position for too long and the muscles cramp from holding it there.
I am still in less pain than before the surgery and I try to keep that in mind. However, I am pretty sick of being a little weakling. Meep.
Thursday, June 3, 2010
Slow and steady wins the race
I haven't posted for a bit, and I do think that at this point it makes more sense to post less frequently. Things are not changing on a day to day basis anymore as the recovery slows down.
Yesterday marked 10 weeks since I got a new chance at having a working knee again. It's been tough sometimes, but I am very lucky. Everything has been going to plan and there have been no complications so far. (And I just knocked on my wood desk.) My scar (GR 2) is healing beautifully and going through all kinds of fun colors. When I wake up, it is almost white. If I am cold, it turns dark purple. If I am hot, it is an angry sort of pink. And sometimes, one part of the scar is one color and another part is a different color. Whatever. I measured the scar too. It is a hair over five inches when my knee is perfectly straight, and 6 1/2 inches when bent. Not bad for scar bragging rights.
Last week I saw Dr. Trice again and he was happy with my extension (Yay!) so all that prone work paid off. At the time of the appointment I was down to using one crutch and he said to try to get off that remaining crutch within a week. Of course, I was very excited about that direction. About three days later I tried to switch out the remaining crutch for a cane. I was successful, but walking with the cane was quite difficult. I did notice that trying to walk with the cane made going back to walking with one crutch easier, so I am trying to continue the philosophy of going a little further than is comfortable and then pulling back. It makes the little steps more successful.
In fact, now I am trying to not use the cane when I am staying within one room in the house and there are surfaces I can reach for support. It is not good to do this too much, I think, because the limp is awful and I need the cane to practice walking correctly. But, I am hoping that walking a little without the cane will make it easier to walk with it. Go too far, and pull back. Another little step forward.
I working from home now and hoping that I might start driving again soon. It would be nice to be more independent and at least be able to get to my PT appointments by myself. My family has been wonderful in supporting me, but I really don't want to need so much support. It's been a year and a half since all this pain started and people have been compensating for my limitations for that long. I know that slow and steady will win out, but it's hard to feel like you might see the light at the end of the tunnel and not wish you could run for it!
Wow, I am full of clichés today, but at least I haven't broken out the sports metaphors. Well, now you all know I am still here, and I am still trying.
Heel, toe, heel, toe, heel, toe......
Yesterday marked 10 weeks since I got a new chance at having a working knee again. It's been tough sometimes, but I am very lucky. Everything has been going to plan and there have been no complications so far. (And I just knocked on my wood desk.) My scar (GR 2) is healing beautifully and going through all kinds of fun colors. When I wake up, it is almost white. If I am cold, it turns dark purple. If I am hot, it is an angry sort of pink. And sometimes, one part of the scar is one color and another part is a different color. Whatever. I measured the scar too. It is a hair over five inches when my knee is perfectly straight, and 6 1/2 inches when bent. Not bad for scar bragging rights.
Last week I saw Dr. Trice again and he was happy with my extension (Yay!) so all that prone work paid off. At the time of the appointment I was down to using one crutch and he said to try to get off that remaining crutch within a week. Of course, I was very excited about that direction. About three days later I tried to switch out the remaining crutch for a cane. I was successful, but walking with the cane was quite difficult. I did notice that trying to walk with the cane made going back to walking with one crutch easier, so I am trying to continue the philosophy of going a little further than is comfortable and then pulling back. It makes the little steps more successful.
In fact, now I am trying to not use the cane when I am staying within one room in the house and there are surfaces I can reach for support. It is not good to do this too much, I think, because the limp is awful and I need the cane to practice walking correctly. But, I am hoping that walking a little without the cane will make it easier to walk with it. Go too far, and pull back. Another little step forward.
I working from home now and hoping that I might start driving again soon. It would be nice to be more independent and at least be able to get to my PT appointments by myself. My family has been wonderful in supporting me, but I really don't want to need so much support. It's been a year and a half since all this pain started and people have been compensating for my limitations for that long. I know that slow and steady will win out, but it's hard to feel like you might see the light at the end of the tunnel and not wish you could run for it!
Wow, I am full of clichés today, but at least I haven't broken out the sports metaphors. Well, now you all know I am still here, and I am still trying.
Heel, toe, heel, toe, heel, toe......
Friday, May 14, 2010
Prone!
I have been seriously stepping up my prone exercises to straighten my leg. It has led to yet another lesson learned! (insert drumroll)
#11 Do a Complete Variety of Exercises. It was feeling hard to get all my exercises in everyday, so I ended up often skipping the same ones over and over. The prone exercise would usually make me feel unable to bend my knee very well for a good 30-60 minutes afterward (which made it harder to get other exercises in) so it was often the one I skipped. Once I started focusing on it though, it got so much easier and it got rid of that super painful "locking" in place that kept happening when my leg was straight. So, I guess all the exercises need to work together. If you can't fit them all in, make sure you aren't skipping the same one repeatedly.
Other than that, things are progressing pretty tentatively. After the microfracture last year, I was eager to get better and kept trying to do more and more. I don't know for sure if that led to the failure, but this time around I don't want to take any chances.
Dr. Trice and Sandy both said to use a scale to see how much 25-50 lbs really feels like. I did, and it is a lot of weight! I stood on the scale with about what I was initially comfortable to bear through that leg, and it only registered 23 lbs. I put more weight through it and it came up 38. I put as much weight as I possibly dared and it still came up only 47 lbs! So, as much weight as I dare right now falls inside Dr. Trice's guidance. That's good to know.
I am planning to start working from home next week (8 week mark). That was my initial plan and it still seems appropriate. My stamina is getting pretty solid and the swelling is really starting to come down, so I am looking forward to trying to work. However, I let work know that I wanted to work from home the first 4 weeks I am back. I think this will help prevent me from getting dangerously overconfident and push myself too far. It is a very real concern.
#11 Do a Complete Variety of Exercises. It was feeling hard to get all my exercises in everyday, so I ended up often skipping the same ones over and over. The prone exercise would usually make me feel unable to bend my knee very well for a good 30-60 minutes afterward (which made it harder to get other exercises in) so it was often the one I skipped. Once I started focusing on it though, it got so much easier and it got rid of that super painful "locking" in place that kept happening when my leg was straight. So, I guess all the exercises need to work together. If you can't fit them all in, make sure you aren't skipping the same one repeatedly.
Other than that, things are progressing pretty tentatively. After the microfracture last year, I was eager to get better and kept trying to do more and more. I don't know for sure if that led to the failure, but this time around I don't want to take any chances.
Dr. Trice and Sandy both said to use a scale to see how much 25-50 lbs really feels like. I did, and it is a lot of weight! I stood on the scale with about what I was initially comfortable to bear through that leg, and it only registered 23 lbs. I put more weight through it and it came up 38. I put as much weight as I possibly dared and it still came up only 47 lbs! So, as much weight as I dare right now falls inside Dr. Trice's guidance. That's good to know.
I am planning to start working from home next week (8 week mark). That was my initial plan and it still seems appropriate. My stamina is getting pretty solid and the swelling is really starting to come down, so I am looking forward to trying to work. However, I let work know that I wanted to work from home the first 4 weeks I am back. I think this will help prevent me from getting dangerously overconfident and push myself too far. It is a very real concern.
Tuesday, May 11, 2010
Weight
So my appointment with Dr. Trice was both good and bad. I'll start with the bad side.
Dr. Trice was not happy with my extension (straightening the leg) and was nearly about to make me wear yet another sort of leg brace/torture device. I really haven't been keeping up on the exercise that that helps this, which is called the prone position. You lay on your stomach with your leg straight out and the edge of whatever you are laying on only supports you from just above the knee and up. So, your knee and lower leg hang free and a weight is placed on your ankle to straighten the leg. Stay like that for 15 minutes. Sounds like fun, eh?
So, he asked me to do one of these prone stretches there in the office so that he could see how the knee extension looked afterward. Why it didn't occur to me, my mother-in-law who brought me, or Holly (Dr.Trice's surgical nurse) to note the time I started, I have no idea. One would think of the three of us that someone would have thought of that. So, my best guess is that I was in that position for 20 minutes or so. But, the knee sure did straighten after that! So, no new torture device was required. I am just supposed to step up the prone stretches to five times a day for 15 minutes each time.
The good news side is that Dr. Trice said I can put 25-50 pounds of weight through my leg and that when I reach the 8 week mark, I can work on getting to full weight-bearing. That is earlier than the generic protocol for the surgery! Woohoo!
So, in my PT session with Sandy yesterday, I did start putting weight through it. The heel of the bad leg goes down at the same time as the crutches, about 8-10 inches in front of the other foot. Heel and crutches, then weight, then good leg forward. It takes a surprising amount of concentration. I had random aches and pains from my muscles protesting, but my knee was silent. I kept putting weight on it when I walked all last night and this morning. The knee isn't hurting from the weight at all.
I am afraid to hope because after 16 months of pain and surgeries it seems like recovery is too much to hope for. Maybe maybe maybe oh just maybe this surgery might have worked!
Dr. Trice was not happy with my extension (straightening the leg) and was nearly about to make me wear yet another sort of leg brace/torture device. I really haven't been keeping up on the exercise that that helps this, which is called the prone position. You lay on your stomach with your leg straight out and the edge of whatever you are laying on only supports you from just above the knee and up. So, your knee and lower leg hang free and a weight is placed on your ankle to straighten the leg. Stay like that for 15 minutes. Sounds like fun, eh?
So, he asked me to do one of these prone stretches there in the office so that he could see how the knee extension looked afterward. Why it didn't occur to me, my mother-in-law who brought me, or Holly (Dr.Trice's surgical nurse) to note the time I started, I have no idea. One would think of the three of us that someone would have thought of that. So, my best guess is that I was in that position for 20 minutes or so. But, the knee sure did straighten after that! So, no new torture device was required. I am just supposed to step up the prone stretches to five times a day for 15 minutes each time.
The good news side is that Dr. Trice said I can put 25-50 pounds of weight through my leg and that when I reach the 8 week mark, I can work on getting to full weight-bearing. That is earlier than the generic protocol for the surgery! Woohoo!
So, in my PT session with Sandy yesterday, I did start putting weight through it. The heel of the bad leg goes down at the same time as the crutches, about 8-10 inches in front of the other foot. Heel and crutches, then weight, then good leg forward. It takes a surprising amount of concentration. I had random aches and pains from my muscles protesting, but my knee was silent. I kept putting weight on it when I walked all last night and this morning. The knee isn't hurting from the weight at all.
I am afraid to hope because after 16 months of pain and surgeries it seems like recovery is too much to hope for. Maybe maybe maybe oh just maybe this surgery might have worked!
Saturday, May 8, 2010
More Lessons Learned
Just adding a little more to the list....
#9 - Keep Taking Tylenol. The pain isn't so bad most of the time now, so it is easy to forget to take Tylenol before you do things that will make the pain worse. Taking Tylenol before PT and before bed are absolute requirements. The one time I did not take it before PT, I could not do a single straight leg raise. Why make it harder? It's hard enough.
#10 - Limit Exercises Before PT. Before one PT session, I was working on leg extension (getting it straight), but it just made the PT harder. Limit exercises within a few hours of meeting with your physical therapist to only quad sets and leg bending exercises. Those both help prepare you for the session, while other exercises can make actually make the session harder.
By the way, I have an appointment with Dr. Trice on Monday. We will likely be trying 25% weight-bearing, so I am very excited. I will let you know how it goes!
#9 - Keep Taking Tylenol. The pain isn't so bad most of the time now, so it is easy to forget to take Tylenol before you do things that will make the pain worse. Taking Tylenol before PT and before bed are absolute requirements. The one time I did not take it before PT, I could not do a single straight leg raise. Why make it harder? It's hard enough.
#10 - Limit Exercises Before PT. Before one PT session, I was working on leg extension (getting it straight), but it just made the PT harder. Limit exercises within a few hours of meeting with your physical therapist to only quad sets and leg bending exercises. Those both help prepare you for the session, while other exercises can make actually make the session harder.
By the way, I have an appointment with Dr. Trice on Monday. We will likely be trying 25% weight-bearing, so I am very excited. I will let you know how it goes!
Using the CPM
For some time now I have been wanting to make a post about proper positioning in the Continuous Passive Motion (CPM) machine. Well, I am finally getting around to it now that I am actually done using the machine!
The reason I wanted to make this post is that for the first 40 hours of CPM use in the hospital, my positioning was incorrect. This caused unneeded pain and also hampered my progress. Using the CPM is really very simple. However, they started me on it only 6 hours after surgery though, so I was obviously hurting, confused, and exhausted at the time. I think it would have helped if I had known, or if my husband had known, what good positioning should look like. So I have taken pictures.
There are a lot of different CPM machines on the market. I think this guidance will generally be sound advice, but it is only based on my own experience and I am certainly no medical professional.
This picture (GR 2 for visible scar) shows the knee properly positioned. Notice how the high point of the knee is directly above the joint in the CPM.
In order to get into this position, you often have to pull the machine towards you. Before you do that though, pay attention to the positioning of the foot support (GR 1). Notice that it is adjustable based on the length of your lower leg. Make sure it is out far enough that when you pull the machine towards you, it does not jam your foot. At one point in the hospital, this was accidentally adjusted to be too short. When the technician tried to get me back into it, she kept pushing the machine towards me, thinking it was caught on something. It was caught on me! Ouch!
This picture (GR 2 for visible scar) shows bad positioning. Notice how my knee is not directly over the joint. Also,you may be able to see that the angle of my leg is less than in the first photo, even though the machine is set to the same angle. This is how I screwed up in the hospital. If you push it away from you, then you are not achieving as much of a knee bend as the machine indicates. I thought I was up to 35 degrees, but really only had reached about 20.
If not reaching the flex goal isn't enough motivation, it turns out that the CPM will really really hurt if you are in a bad position. It feels much better when flexed (because it isn't going far enough), but when it straightens the leg, it feels like it is hyper-extending it beyond straight. I think this was partially responsible for my worst pain spike episode.
Here (GR 1) is one more photo of bad positioning, but you probably won't notice. Recovery dog is stealing the spotlight in the picture.
The reason I wanted to make this post is that for the first 40 hours of CPM use in the hospital, my positioning was incorrect. This caused unneeded pain and also hampered my progress. Using the CPM is really very simple. However, they started me on it only 6 hours after surgery though, so I was obviously hurting, confused, and exhausted at the time. I think it would have helped if I had known, or if my husband had known, what good positioning should look like. So I have taken pictures.
There are a lot of different CPM machines on the market. I think this guidance will generally be sound advice, but it is only based on my own experience and I am certainly no medical professional.
This picture (GR 2 for visible scar) shows the knee properly positioned. Notice how the high point of the knee is directly above the joint in the CPM.
In order to get into this position, you often have to pull the machine towards you. Before you do that though, pay attention to the positioning of the foot support (GR 1). Notice that it is adjustable based on the length of your lower leg. Make sure it is out far enough that when you pull the machine towards you, it does not jam your foot. At one point in the hospital, this was accidentally adjusted to be too short. When the technician tried to get me back into it, she kept pushing the machine towards me, thinking it was caught on something. It was caught on me! Ouch!
This picture (GR 2 for visible scar) shows bad positioning. Notice how my knee is not directly over the joint. Also,you may be able to see that the angle of my leg is less than in the first photo, even though the machine is set to the same angle. This is how I screwed up in the hospital. If you push it away from you, then you are not achieving as much of a knee bend as the machine indicates. I thought I was up to 35 degrees, but really only had reached about 20.
If not reaching the flex goal isn't enough motivation, it turns out that the CPM will really really hurt if you are in a bad position. It feels much better when flexed (because it isn't going far enough), but when it straightens the leg, it feels like it is hyper-extending it beyond straight. I think this was partially responsible for my worst pain spike episode.
Here (GR 1) is one more photo of bad positioning, but you probably won't notice. Recovery dog is stealing the spotlight in the picture.
Wednesday, May 5, 2010
6 Weeks
Six weeks have passed. Things have gotten easier in many ways. Some things are still hard. It hurts to move my leg around. If I sit with my knee straight then it tends to lock up and it is hard to get it bent. Whenever I bend my knee I need to warm it up to get any significant range of motion. Even with warming up, I can't seem to get much past 120 degrees. I still have swelling, and my foot still turns purple if I don't keep my leg at least up even with my body.
I think all this is normal, and it's not horrible. It's just a statement of where I am now. I am done with the CPM, which is a relief. Using that all the time was getting annoying.
For some reason I had gotten it in my head that I would start working towards full-weight bearing at 8 weeks, and that is what I told a lot of people. I looked at the phase II recovery protocol and that's not what it says. At 6 weeks, I can do 25% weight. At 8 weeks, I can do 50% weight. I can't even begin to wean off the crutches until 9-10 weeks. It will probably take another 2 weeks to wean off, I think. Oh well. What's another few weeks on crutches at this point?
I think all this is normal, and it's not horrible. It's just a statement of where I am now. I am done with the CPM, which is a relief. Using that all the time was getting annoying.
For some reason I had gotten it in my head that I would start working towards full-weight bearing at 8 weeks, and that is what I told a lot of people. I looked at the phase II recovery protocol and that's not what it says. At 6 weeks, I can do 25% weight. At 8 weeks, I can do 50% weight. I can't even begin to wean off the crutches until 9-10 weeks. It will probably take another 2 weeks to wean off, I think. Oh well. What's another few weeks on crutches at this point?
Sunday, May 2, 2010
Lessons Learned
I have been lucky enough to do a few things right that I didn't expect would matter so much and I have also just figured a few things out along the way. This is different from my checklist. These are my lessons learned (a.k.a. things I would have liked to know beforehand).
#1 - This Will Suck. The first few days were quite painful. In fact, the first 2 1/2 weeks were pretty awful. You have to be prepared for just how awful it will be, both in planning and mentally. However, it only stays that awful for 2-3 weeks. Then, if things go smoothly, suddenly it isn't so bad.
#2 - Know How to Use Crutches. Get confident on them. If you have stairs in your home, learn how to go up and down them with crutches. Figure out how to get and out of your bathtub or shower. I am talking more than a dry run. Use them until you are comfortable and confident. Practice with your leg in a normal position (slightly bent, held in front of your body), in a locked brace position (straight, able to move forward with the crutches on each step), and in a totally weak position (straight, unable to move your leg forward at all - this is more of a shuffle). I went through all three.
#3 - Quad Sets. Practice these until you can isolate the quad muscle and just do the exercise without moving your foot or pressing your knee down (two different methods used to show people how to activate the quad). If you haven't been to PT yet and don't know how to do a quad set, then here is a video showing how. Not only will your quad benefit from any strength you build up before the surgery, but it will be 1000 times harder to do the exercise after the surgery. It's only 100 times harder if you have practiced a lot (and I do mean a lot).
#4 - Stockpile Entertainment. I watched all 7 seasons of the West Wing in the first two weeks. Then I watched two seasons of Burn Notice, one season of Leverage, and one season of The Closer. Now is the time to borrow books, movies, and TV shows on DVD from your friends and family. Do not leave yourself to the mercy of daytime television!
#5 - Get Help. For the first week at home, if you can have someone there to help you all day then do it. For the next 2-3 weeks after that, try to have someone stop by once a day for an hour or two. You can't do laundry. You can't cook. You can't go to the store. Even if you get something delivered, you can't get the stupid box inside the house because you can't pick things up with crutches. That's just the sheer logistical side. Add in that every time you get up it's painful and you just need help. Accept it and plan for it.
#6 - Track Your Pills. When I came home from the hospital, I was taking 5 pills and one injection regularly at intervals ranging from 3-24 hours. It was extremely common for me to forget if I took something. I recorded everything I took so there was no question. This was helpful for setting my mind at ease and preventing dangerous mistakes (since usually the answer was yes, I did take it). There is no way I could have gone without a log.
#7 - Bend Your Leglifter. This may not be important for everyone, but I was very happy once I figured this out. The leglifter is a great little device, but every time I used it I felt almost as though I was putting weight through my knee. Eventually, I bent the head of the leglifter so I was pulling the foot up (GR2 for feet), instead of towards me (GR2 also for feet). In the early days of maximum suckage, this little realization helped a lot.
#8 - You Will Be Tired. This might manifest itself differently for others. I don't sleep well at night, and during the day I can easily get completely exhausted by simple acts, like bathing. I have taken quite a few serious naps. As I am slowly getting stronger, the need for naps has subsided but I do still tire very easily.
Since this is more of a reference post, I will add more as I think of them. I probably still have more to learn!
#1 - This Will Suck. The first few days were quite painful. In fact, the first 2 1/2 weeks were pretty awful. You have to be prepared for just how awful it will be, both in planning and mentally. However, it only stays that awful for 2-3 weeks. Then, if things go smoothly, suddenly it isn't so bad.
#2 - Know How to Use Crutches. Get confident on them. If you have stairs in your home, learn how to go up and down them with crutches. Figure out how to get and out of your bathtub or shower. I am talking more than a dry run. Use them until you are comfortable and confident. Practice with your leg in a normal position (slightly bent, held in front of your body), in a locked brace position (straight, able to move forward with the crutches on each step), and in a totally weak position (straight, unable to move your leg forward at all - this is more of a shuffle). I went through all three.
#3 - Quad Sets. Practice these until you can isolate the quad muscle and just do the exercise without moving your foot or pressing your knee down (two different methods used to show people how to activate the quad). If you haven't been to PT yet and don't know how to do a quad set, then here is a video showing how. Not only will your quad benefit from any strength you build up before the surgery, but it will be 1000 times harder to do the exercise after the surgery. It's only 100 times harder if you have practiced a lot (and I do mean a lot).
#4 - Stockpile Entertainment. I watched all 7 seasons of the West Wing in the first two weeks. Then I watched two seasons of Burn Notice, one season of Leverage, and one season of The Closer. Now is the time to borrow books, movies, and TV shows on DVD from your friends and family. Do not leave yourself to the mercy of daytime television!
#5 - Get Help. For the first week at home, if you can have someone there to help you all day then do it. For the next 2-3 weeks after that, try to have someone stop by once a day for an hour or two. You can't do laundry. You can't cook. You can't go to the store. Even if you get something delivered, you can't get the stupid box inside the house because you can't pick things up with crutches. That's just the sheer logistical side. Add in that every time you get up it's painful and you just need help. Accept it and plan for it.
#6 - Track Your Pills. When I came home from the hospital, I was taking 5 pills and one injection regularly at intervals ranging from 3-24 hours. It was extremely common for me to forget if I took something. I recorded everything I took so there was no question. This was helpful for setting my mind at ease and preventing dangerous mistakes (since usually the answer was yes, I did take it). There is no way I could have gone without a log.
#7 - Bend Your Leglifter. This may not be important for everyone, but I was very happy once I figured this out. The leglifter is a great little device, but every time I used it I felt almost as though I was putting weight through my knee. Eventually, I bent the head of the leglifter so I was pulling the foot up (GR2 for feet), instead of towards me (GR2 also for feet). In the early days of maximum suckage, this little realization helped a lot.
#8 - You Will Be Tired. This might manifest itself differently for others. I don't sleep well at night, and during the day I can easily get completely exhausted by simple acts, like bathing. I have taken quite a few serious naps. As I am slowly getting stronger, the need for naps has subsided but I do still tire very easily.
Since this is more of a reference post, I will add more as I think of them. I probably still have more to learn!
Friday, April 30, 2010
A Note on Pain
I am not on any painkillers right now. That may not seem like a big deal since I am over 5 weeks post-op and I probably should be healed enough from the surgery to not be on painkillers.
However, I was on painkillers every single day for about 5 months before the surgery because my pain was that intense. It ached all the time. Walking sent stabbing pain through my body. The inner side of my right knee (where the injury was located) was extremely sensitive to touch. These things are different after the surgery. There is no aching. It does not hurt when the side of my knee is touched, or even massaged. It is particularly hot there, but Sandy, my physical therapist said that just means it is REALLY healing there. It's a technical term. ;)
I am not pain-free. Moving around can hurt. My knee tightens up quickly and then needs to be gently brought back to the range of motion that I know I can reach. Also, my knee sort of locks when it is straight for a while and does not want to start the bend. Sometimes it pops, and that hurts too. But none of this compares to how much I hurt before the surgery.
So, I am hopeful. We will see what happens when I start walking on it in 19 days.
However, I was on painkillers every single day for about 5 months before the surgery because my pain was that intense. It ached all the time. Walking sent stabbing pain through my body. The inner side of my right knee (where the injury was located) was extremely sensitive to touch. These things are different after the surgery. There is no aching. It does not hurt when the side of my knee is touched, or even massaged. It is particularly hot there, but Sandy, my physical therapist said that just means it is REALLY healing there. It's a technical term. ;)
I am not pain-free. Moving around can hurt. My knee tightens up quickly and then needs to be gently brought back to the range of motion that I know I can reach. Also, my knee sort of locks when it is straight for a while and does not want to start the bend. Sometimes it pops, and that hurts too. But none of this compares to how much I hurt before the surgery.
So, I am hopeful. We will see what happens when I start walking on it in 19 days.
Thursday, April 29, 2010
Busy Busy Bee
I haven't posted in several days, though I did not intend for that much time to pass. It seems lately that two things are going on.
The first is that I never seem to have a moment to settle down. I am always doing something, whether it is PT exercises, CPM time, getting out of the house for a bit, or going to PT. Plus, each thing that I do takes absolutely forever! My day can easily be gobbled up by just CPM, a few exercises, recovering from those exercises, making lunch, and then more CPM time. Then it is evening already! I was worried about being bored and having so much time on my hands, but in fact I can' t seem to squeeze everything in.
The second thing is that the recovery has slowed down and started to level off. Yes, I am getting better, but yes, I still have an awful long way to go. However, a single day is no longer likely to be significantly different from the day before. I am slowly getting stronger, but I am also still likely to hit a wall and suddenly need a nap. My body is unpredictable and rather unreliable. Silly body.
The knee looks good. Unfortunately as soon as I started moving around more it started to swell more, so I have to actually pay attention to elevation and whether it is turning purple, as it often does. I also have to ice 3-4 times a day time to try to keep from having a fat knee. Oh well. The swelling is not exactly painful unless I am trying to do exercises at the moment or if I am wearing my snug custom brace, as sometimes the knee feels like it is trying to burst out of it's confines. It just disturbs me to see it poofy and turning colors if it is down for too long.
Yesterday was the 5 week mark, so I have 3 more weeks to go on crutches. Before the microfracture, I thought that meant that at the end of the timeframe I would be able to walk almost normally without crutches. Now I know that in 3 weeks I will be able to put full weight through my leg without damaging anything, but it will probably be a few more weeks after that before I can walk without the extra support of crutches. It is amazing how much muscle one loses after surgery and it is hard to regain that trust and balance. At least I may stop having the dreams where I am accidentally walking without my crutches and terrified that I busted my knee again. Those dreams are not fun!
The first is that I never seem to have a moment to settle down. I am always doing something, whether it is PT exercises, CPM time, getting out of the house for a bit, or going to PT. Plus, each thing that I do takes absolutely forever! My day can easily be gobbled up by just CPM, a few exercises, recovering from those exercises, making lunch, and then more CPM time. Then it is evening already! I was worried about being bored and having so much time on my hands, but in fact I can' t seem to squeeze everything in.
The second thing is that the recovery has slowed down and started to level off. Yes, I am getting better, but yes, I still have an awful long way to go. However, a single day is no longer likely to be significantly different from the day before. I am slowly getting stronger, but I am also still likely to hit a wall and suddenly need a nap. My body is unpredictable and rather unreliable. Silly body.
The knee looks good. Unfortunately as soon as I started moving around more it started to swell more, so I have to actually pay attention to elevation and whether it is turning purple, as it often does. I also have to ice 3-4 times a day time to try to keep from having a fat knee. Oh well. The swelling is not exactly painful unless I am trying to do exercises at the moment or if I am wearing my snug custom brace, as sometimes the knee feels like it is trying to burst out of it's confines. It just disturbs me to see it poofy and turning colors if it is down for too long.
Yesterday was the 5 week mark, so I have 3 more weeks to go on crutches. Before the microfracture, I thought that meant that at the end of the timeframe I would be able to walk almost normally without crutches. Now I know that in 3 weeks I will be able to put full weight through my leg without damaging anything, but it will probably be a few more weeks after that before I can walk without the extra support of crutches. It is amazing how much muscle one loses after surgery and it is hard to regain that trust and balance. At least I may stop having the dreams where I am accidentally walking without my crutches and terrified that I busted my knee again. Those dreams are not fun!
Monday, April 19, 2010
Stir-crazy!
As of Friday (Surgery + 23 days), I have been off the painkillers! Woohoo! I will still have to take some before physical therapy to get the most out of my sessions, but that's all. My first out-patient PT appointment is tomorrow. Up to now, someone has been coming to my home for PT.
This weekend, my focus was getting out of the house because I have been going absolutely stir-crazy in here! My husband and I went to a local wine bar on Saturday and shared some wine and munchies, since I can drink wine again. It was a little difficult to get comfortable, but I ended up using a case of wine (it was Educated Guess Cab Sauv) as a footrest. It was just right! My knee did stiffen up by the time we left though. I appreciated going during lunchtime since it is less crowded. My gimpy status is rather obvious and I don't like to be a spectacle.
I have been so enthusiastic about getting out of the bedroom, that I wanted to try using the CPM (leg-bending machine and warm place for recovery cat to sleep - cute picture, not gross) overnight instead of having to use it during the day and chaining myself to it in my bedroom. I attempted this last night, but it soon was proven to not be an option. Even though I reduced the speed at which it bent my leg and the angle to one I knew my knee could manage comfortably, my knee just could not take it anymore after 3 hours. It started to ache and throb. So, I guess I still need to use it during the day for multiple short sessions. Boo.
There is one other thing that I have been meaning to include here, but it doesn't really fit in with other topics. The side of my knee opposite to the injury side has an area a few inches across that is completely numb. If there is any sensation when touching it, it is more of a burning feeling. From talking to others and reading, this seems to be a common side effect of open knee surgery since nerves get severed when making the incision. It's pretty weird though.
This weekend, my focus was getting out of the house because I have been going absolutely stir-crazy in here! My husband and I went to a local wine bar on Saturday and shared some wine and munchies, since I can drink wine again. It was a little difficult to get comfortable, but I ended up using a case of wine (it was Educated Guess Cab Sauv) as a footrest. It was just right! My knee did stiffen up by the time we left though. I appreciated going during lunchtime since it is less crowded. My gimpy status is rather obvious and I don't like to be a spectacle.
I have been so enthusiastic about getting out of the bedroom, that I wanted to try using the CPM (leg-bending machine and warm place for recovery cat to sleep - cute picture, not gross) overnight instead of having to use it during the day and chaining myself to it in my bedroom. I attempted this last night, but it soon was proven to not be an option. Even though I reduced the speed at which it bent my leg and the angle to one I knew my knee could manage comfortably, my knee just could not take it anymore after 3 hours. It started to ache and throb. So, I guess I still need to use it during the day for multiple short sessions. Boo.
There is one other thing that I have been meaning to include here, but it doesn't really fit in with other topics. The side of my knee opposite to the injury side has an area a few inches across that is completely numb. If there is any sensation when touching it, it is more of a burning feeling. From talking to others and reading, this seems to be a common side effect of open knee surgery since nerves get severed when making the incision. It's pretty weird though.
Saturday, April 17, 2010
Checklist in Hindsight
Based on my experience, these things have been useful. I am going to keep updating it as I think of things.
- Alcohol Cleansing Pads or rubbing alcohol: to remove the iodine from my skin around the incision site. They gave me some from the hospital, but others might not get my goody bag.
- Toilet Seat Riser: Since getting up and down will be difficult with my knee locked.
- Toilet Support Bars: These are supported by legs that go down to the floor, so they are very stable. I highly recommend these.
- Shower Chair: When I can shower, I will need to sit. In the early days it allows sitting outside the tub or shower to allow washing (or allowing someone else to wash) your hair over the tub or shower.
- Leg lifter: Absolutely necessary for even getting up and lowering your leg carefully to the floor. I bought one, but also was given one at the hospital. By the way, this is used by taking the loop with the metal reinforcement and bending it into an open loop.
- Grabber: They gave me this at the hospital too, and I use it all the time.
- Body wipes: Showering is a lot of work, and there are other ways to get clean. A washcloth and soap is best, but wipes are quick and less messy. I found one kind in the grocery store near the adult diapers, as they are marketed for people with incontinence. These worked, but I found them to be sticky. I prefer using Oil of Olay facial wipes. They are larger than others, cloth-like, and have moisturizer. These were awesome in the hospital and the first week at home.
- Face wipes: I mentioned that I also used these for body wipes, but even if I hadn't done that then I still would have wanted face wipes.
- Dry shampoo: Useful, but not required. I didn't like it that much.
- Gold Bond Anti-itch powder: because spending too much time in bed may irritate the skin.
- Gold Bond Anti-itch lotion: because sometimes I was itchy but my skin was dry.
- The Perfect Shoes: I had a pair of these that I wore all the time after the MFX, but they got pretty worn out. They are nice because they are lightweight and supportive, but what makes them perfect is that they are very easy for someone else to take off and put on. Reaching your foot is very hard! And yes, I did order them in purple.
- The Perfect Shorts: Comfortable, stretchy, and loose-fitting. They have a long version too. These are pretty much all I wear right now.
- Non-medicated throat lozenges: because the breathing tube can be irritating. I didn't need them this time, but have for previous surgeries.
- A chair and ottoman: I set this up next to my bed at home since I was instructed to spend at least 2 hours out of bed each day. Use one that feels good on your back because staying in bed will make your back ache.
- Vitamin E lotion: I don't think it has been scientifically proven that vitamin E helps reduce the appearance of scars, but many people swear by it. Keeping the skin supple and healthy just doesn't seem like it could be a bad thing, so I will try it.
- Flushable wipes: Cleanliness is important.
- Lysol wipes: The toilet seat riser is not the most efficient device, and you want to be able to clean it quickly while standing on one foot.
- Colace and Senekot: Have these over counter digestive aids on hand. The narcotics really mess up your system. As I cut back on the meds (about 2 weeks after getting home), I replaced these with lots of fresh and dried fruit.
- Low dose (325 mg) aspirin: I was taking Lovenoxx (a blood thinner) for the first two weeks, but then was instructed to switch to aspirin. Need to prevent clots.
- Tylenol (500mg): I was instructed to take this with the Oxycodone. It is very important to take less than 4000 mg a day, so I recommend not getting the Extra Strength (625mg) version. Vicodin has Tylenol in it, so once you step down to that then stop taking Tylenol separately!
- Alcohol Cleansing Pads or rubbing alcohol: to remove the iodine from my skin around the incision site. They gave me some from the hospital, but others might not get my goody bag.
- Toilet Seat Riser: Since getting up and down will be difficult with my knee locked.
- Toilet Support Bars: These are supported by legs that go down to the floor, so they are very stable. I highly recommend these.
- Shower Chair: When I can shower, I will need to sit. In the early days it allows sitting outside the tub or shower to allow washing (or allowing someone else to wash) your hair over the tub or shower.
- Leg lifter: Absolutely necessary for even getting up and lowering your leg carefully to the floor. I bought one, but also was given one at the hospital. By the way, this is used by taking the loop with the metal reinforcement and bending it into an open loop.
- Grabber: They gave me this at the hospital too, and I use it all the time.
- Body wipes: Showering is a lot of work, and there are other ways to get clean. A washcloth and soap is best, but wipes are quick and less messy. I found one kind in the grocery store near the adult diapers, as they are marketed for people with incontinence. These worked, but I found them to be sticky. I prefer using Oil of Olay facial wipes. They are larger than others, cloth-like, and have moisturizer. These were awesome in the hospital and the first week at home.
- Face wipes: I mentioned that I also used these for body wipes, but even if I hadn't done that then I still would have wanted face wipes.
- Dry shampoo: Useful, but not required. I didn't like it that much.
- Gold Bond Anti-itch powder: because spending too much time in bed may irritate the skin.
- Gold Bond Anti-itch lotion: because sometimes I was itchy but my skin was dry.
- The Perfect Shoes: I had a pair of these that I wore all the time after the MFX, but they got pretty worn out. They are nice because they are lightweight and supportive, but what makes them perfect is that they are very easy for someone else to take off and put on. Reaching your foot is very hard! And yes, I did order them in purple.
- The Perfect Shorts: Comfortable, stretchy, and loose-fitting. They have a long version too. These are pretty much all I wear right now.
- Non-medicated throat lozenges: because the breathing tube can be irritating. I didn't need them this time, but have for previous surgeries.
- A chair and ottoman: I set this up next to my bed at home since I was instructed to spend at least 2 hours out of bed each day. Use one that feels good on your back because staying in bed will make your back ache.
- Vitamin E lotion: I don't think it has been scientifically proven that vitamin E helps reduce the appearance of scars, but many people swear by it. Keeping the skin supple and healthy just doesn't seem like it could be a bad thing, so I will try it.
- Flushable wipes: Cleanliness is important.
- Lysol wipes: The toilet seat riser is not the most efficient device, and you want to be able to clean it quickly while standing on one foot.
- Colace and Senekot: Have these over counter digestive aids on hand. The narcotics really mess up your system. As I cut back on the meds (about 2 weeks after getting home), I replaced these with lots of fresh and dried fruit.
- Low dose (325 mg) aspirin: I was taking Lovenoxx (a blood thinner) for the first two weeks, but then was instructed to switch to aspirin. Need to prevent clots.
- Tylenol (500mg): I was instructed to take this with the Oxycodone. It is very important to take less than 4000 mg a day, so I recommend not getting the Extra Strength (625mg) version. Vicodin has Tylenol in it, so once you step down to that then stop taking Tylenol separately!
Friday, April 16, 2010
Post-op Appointment #2
Yesterday I had my second post-op appointment with Dr. Trice. It was all good news.
I asked when I could switch to my DonJoy brace, since it is much more comfortable and it's custom fit is perfect for preventing any twisting or tweaking of the knee since it holds it so snugly. Not all ACI patients have such a fancy brace, but I have it because I needed it before the surgery. Dr. Trice said I could switch right away. Yay!
My second question was if I should take any joint supplements like glucosamine, but he said no.
My third question was just a general discussion of drugs, which I have been sharing here to provide others who might go through this surgery an idea of someone else's experience. I know it is different for everyone, but still it might help. I left off with reducing the Oxycontin to only a morning dose (successfully, by the way) and with taking one pill of Vicodin every 6 hours. I had been reducing the dosage of both drugs slowly and cautiously, operating on the principle of "staying ahead of the pain." Dr. Trice said it was time to change that principle to "as needed based on pain," except for before physical therapy.
Dr. Trice also told me that dependence on the Vicodin is not about how much you are taking, but whether you are taking it continuously or as needed. Even a low dose taken continuously can become a problem. Since I had gotten down to the minimum dose and since I was told to stop trying to stay ahead of the pain, I stopped taking it. My last dose was 9:00 AM yesterday, and so far so good as far as pain goes, but I sure did feel awful this morning. It must have been withdrawal, but strong coffee, an orange, and fresh air helped.
Since I have reduced the Oxycontin, I honestly feel that I could have cut back on it earlier. I would like to stop it completely, but stepping down is important to reduce withdrawal effects. Bleh. I'll stop it in a day or two.
I made a reservation for a nice French restaurant next weekend to celebrate being able to drink wine again. That should give me time to be completely clean. It also gives me something to look forward to! Last time I had to stop drinking wine I lost my palate for intense red wine, so I am expecting that to happen again. I will have to start with pinot noir and French blends to acquire it again. Oh darn.
@ Lynn - I can't wait to be back to traveling again!
@ Jess - At least this delay means you two might actually be unpacked by the time we visit. And no, I am a good girl so no selling of pills.
I asked when I could switch to my DonJoy brace, since it is much more comfortable and it's custom fit is perfect for preventing any twisting or tweaking of the knee since it holds it so snugly. Not all ACI patients have such a fancy brace, but I have it because I needed it before the surgery. Dr. Trice said I could switch right away. Yay!
My second question was if I should take any joint supplements like glucosamine, but he said no.
My third question was just a general discussion of drugs, which I have been sharing here to provide others who might go through this surgery an idea of someone else's experience. I know it is different for everyone, but still it might help. I left off with reducing the Oxycontin to only a morning dose (successfully, by the way) and with taking one pill of Vicodin every 6 hours. I had been reducing the dosage of both drugs slowly and cautiously, operating on the principle of "staying ahead of the pain." Dr. Trice said it was time to change that principle to "as needed based on pain," except for before physical therapy.
Dr. Trice also told me that dependence on the Vicodin is not about how much you are taking, but whether you are taking it continuously or as needed. Even a low dose taken continuously can become a problem. Since I had gotten down to the minimum dose and since I was told to stop trying to stay ahead of the pain, I stopped taking it. My last dose was 9:00 AM yesterday, and so far so good as far as pain goes, but I sure did feel awful this morning. It must have been withdrawal, but strong coffee, an orange, and fresh air helped.
Since I have reduced the Oxycontin, I honestly feel that I could have cut back on it earlier. I would like to stop it completely, but stepping down is important to reduce withdrawal effects. Bleh. I'll stop it in a day or two.
I made a reservation for a nice French restaurant next weekend to celebrate being able to drink wine again. That should give me time to be completely clean. It also gives me something to look forward to! Last time I had to stop drinking wine I lost my palate for intense red wine, so I am expecting that to happen again. I will have to start with pinot noir and French blends to acquire it again. Oh darn.
@ Lynn - I can't wait to be back to traveling again!
@ Jess - At least this delay means you two might actually be unpacked by the time we visit. And no, I am a good girl so no selling of pills.
Wednesday, April 14, 2010
Finally, some progress
This weekend my husband and I focused on my leaving the third floor of my home. Since the surgery, I had only left the third floor twice: once to go to the first post-op appointment with Dr. Trice and once to sit on the deck for an hour. Our bedroom is on the third floor and that has been the central location for my convalescence. It's very comfortable, but two weeks in one room is... well I am sure you can imagine. Going down the stairs on crutches is easy, but going back up is dangerously exhausting. I always have my husband spot me at least on the way up, and I would have fallen on Sunday if he hadn't.
Sometime on Monday, I seemed to turn an itty bitty corner. I began to notice that is was less painful to move my leg when getting up or sitting down. I became more willing to get up and crutch across the room to do or get something because the cost of that action was more reasonable.
My biggest triumph is that I discovered I could slightly bend and hold my own leg while on the crutches without the brace. It's hard to describe the position, but a healthy person playing with crutches would bend one leg to lift it slightly off the ground and then swing that leg forward whenever swinging the crutches forward. I can do that now, so it is comfortable and a significant improvement over leaving the leg locked and dragging it in a shuffle motion. When my in-home physical therapist came to see me Tuesday morning, I said "I can do something new!" and proceeded to crutch around to show him. :)
I have also further reduced my medication.
- Home +15 days (aka Surgery +18 days): Reduced Vicodin from one pill (7.5 mg Hydrocodone and 325 mg acetaminophen per pill) every 3 hours to one every 4 hours.
- +16 days: Reduced Vicodin to every 5 hours.
- +17 days: Reduced Vicodin to every 6 hours. Now at the lowest continuous dosage.
- +18 days (today): Plan to reduce Oxycontin from twice a day to once a day, which means no evening dose. Next step regarding Vicodin is to only take it before physical therapy, but I'm not going to try to stop continuous dosage until after reducing the Oxycontin.
Today marks three weeks since the surgery and I am very happy to finally feel just a little bit stronger. My next post-op appointment with Dr. Trice is tomorrow and I start outpatient physical therapy next Tuesday. Oh, we took off the steri-strips too so I have a new picture (GR 3).
Sometime on Monday, I seemed to turn an itty bitty corner. I began to notice that is was less painful to move my leg when getting up or sitting down. I became more willing to get up and crutch across the room to do or get something because the cost of that action was more reasonable.
My biggest triumph is that I discovered I could slightly bend and hold my own leg while on the crutches without the brace. It's hard to describe the position, but a healthy person playing with crutches would bend one leg to lift it slightly off the ground and then swing that leg forward whenever swinging the crutches forward. I can do that now, so it is comfortable and a significant improvement over leaving the leg locked and dragging it in a shuffle motion. When my in-home physical therapist came to see me Tuesday morning, I said "I can do something new!" and proceeded to crutch around to show him. :)
I have also further reduced my medication.
- Home +15 days (aka Surgery +18 days): Reduced Vicodin from one pill (7.5 mg Hydrocodone and 325 mg acetaminophen per pill) every 3 hours to one every 4 hours.
- +16 days: Reduced Vicodin to every 5 hours.
- +17 days: Reduced Vicodin to every 6 hours. Now at the lowest continuous dosage.
- +18 days (today): Plan to reduce Oxycontin from twice a day to once a day, which means no evening dose. Next step regarding Vicodin is to only take it before physical therapy, but I'm not going to try to stop continuous dosage until after reducing the Oxycontin.
Today marks three weeks since the surgery and I am very happy to finally feel just a little bit stronger. My next post-op appointment with Dr. Trice is tomorrow and I start outpatient physical therapy next Tuesday. Oh, we took off the steri-strips too so I have a new picture (GR 3).
Friday, April 9, 2010
Drugs
Thanks to everyone who left me notes. I needed them yesterday. :)
This surgery is really painful. I mean really really I used to be scared of the idea of childbirth and now couldn't be less worried about it painful. It takes a lot of drugs to get by, but I hate taking them. I hate the idea of dependence, I hate how the drugs confound my body, and I hate that I can't even have a glass of wine to look forward to in the evenings.
So, I keep trying to cut back on the drugs. Dr. Trice's office has helped by stepping me down with the drugs that they have prescribed, but a lot of it is up to me. Sometimes I have been successful and sometimes I have not, so I need to step it back up. I thought I would lay out how long it took me to take each step just as an example to others.
Home from hospital: 10 mg Oxycontin every 8 hours, 15 mg Oxycodone every 3 hours, 500 mg Tylenol every 4 hours
Home +3 days: Replaced Oxycodone and Tylenol with Vicodin (10 mg Hydrocodone and 325 mg acetaminophen per pill), taking 2 every 4 hours.
+6 days: I tried to take the Oxycontin every 12 hours, but had to go back to 8 hours.
+8 days: Successfully reduced Oxycontin to every 10 hours.
+9 days: I missed a pill of Oxycontin and things went all to heck. Decided I needed to fill the prescription for more.
+10 days: Changed the Vicodin to a weaker dose (7.5 mg Hydrocodone and 325 mg acetaminophen per pill), taking 2 every 4 hours.
+11 days: Got the prescription for more Oxycontin, but I believe it is a differently timed release since it can be taken only every 12 hours instead of 8-12 hours. It's still 10 mg.
+12 days: Changed Vicodin from 2 every 4 hours to 1 every 3 hours. This seems to be working so far.
Today is 13 days since I came home. My next two goals are to reduce the Vicodin to 1 every 4 hours and the Oxycontin to once a day.
So who wants to share a bottle of wine with me when I am free of this nonsense?
This surgery is really painful. I mean really really I used to be scared of the idea of childbirth and now couldn't be less worried about it painful. It takes a lot of drugs to get by, but I hate taking them. I hate the idea of dependence, I hate how the drugs confound my body, and I hate that I can't even have a glass of wine to look forward to in the evenings.
So, I keep trying to cut back on the drugs. Dr. Trice's office has helped by stepping me down with the drugs that they have prescribed, but a lot of it is up to me. Sometimes I have been successful and sometimes I have not, so I need to step it back up. I thought I would lay out how long it took me to take each step just as an example to others.
Home from hospital: 10 mg Oxycontin every 8 hours, 15 mg Oxycodone every 3 hours, 500 mg Tylenol every 4 hours
Home +3 days: Replaced Oxycodone and Tylenol with Vicodin (10 mg Hydrocodone and 325 mg acetaminophen per pill), taking 2 every 4 hours.
+6 days: I tried to take the Oxycontin every 12 hours, but had to go back to 8 hours.
+8 days: Successfully reduced Oxycontin to every 10 hours.
+9 days: I missed a pill of Oxycontin and things went all to heck. Decided I needed to fill the prescription for more.
+10 days: Changed the Vicodin to a weaker dose (7.5 mg Hydrocodone and 325 mg acetaminophen per pill), taking 2 every 4 hours.
+11 days: Got the prescription for more Oxycontin, but I believe it is a differently timed release since it can be taken only every 12 hours instead of 8-12 hours. It's still 10 mg.
+12 days: Changed Vicodin from 2 every 4 hours to 1 every 3 hours. This seems to be working so far.
Today is 13 days since I came home. My next two goals are to reduce the Vicodin to 1 every 4 hours and the Oxycontin to once a day.
So who wants to share a bottle of wine with me when I am free of this nonsense?
Thursday, April 8, 2010
Days Go By
Yesterday was two weeks since the surgery. I have to admit, I thought things would be easier by now. It's true that I am taking less pain medication, but it gets me to about the same place. Sometimes it gets me down. It's easy to feel sorry for myself, but that doesn't help either. All I can say is that I am trying.
Monday, April 5, 2010
Catching up to now
Writing about the hospital was pretty exhausting, so I took a few days off from the blog. I want to catch up to now so I can write when things happen instead of trying to remember what happened a week ago. Luckily, the events at home are far less extensive.
I came home on Saturday, about 70 hours after the end of surgery. Dr. Trice gave me a goal of getting to 90 degrees on the CPM by my first follow-up appointment on the next Thursday (April 1st). Physical therapy is my full-time job right now. I spend 6-8 hours on the CPM, but have to break that up into sessions of less than 2.5 hours max with significant breaks in between. Additionally, I have to manually wiggle my patella around (sounds dirty, right?), do quad sets (flexing and relaxing my thigh muscle), and sit in a chair and use my left leg to support my surgery leg through bending and straightening. Each of those exercises means I need to take off the ice and I can only go without ice for about 5-10 minutes. Bottom line, I am always doing some sort of PT or recovering from some sort of PT.
I reached my 90 degree goal and went to my first post-op on Thursday. A nurse removed the staples and I counted as she did. 41! That's a respectable number, right? She replaced them with little cloth strips (GR 3) that still hold the incision together. It's an exquisite incision and will leave a beauty of a scar. I will finally have something to show for all this knee trouble! The previous surgeries only left unsatisfying little dots.
The character of the pain has changed since the first few days home. At first, I ached all the time and pain management meant keeping the aching down. Now, I am actually pretty comfortable as long as I am not moving. That would be great and I could easily cut down the meds drastically if that was all that mattered. However, remember all that PT? I have to move in those exercises and change position between them. The muscles supporting my knee are weak, so it feels like it gets tweaked when I move it around. So, that is now the type of pain I am managing. I keep trying to cut back on pain meds, and then I winced and gasped every time I moved until my husband said, "Sometimes I love your stubborn streak, but this is not one of those times. So will you please take your pain meds now?" He's my reality check. :)
I came home on Saturday, about 70 hours after the end of surgery. Dr. Trice gave me a goal of getting to 90 degrees on the CPM by my first follow-up appointment on the next Thursday (April 1st). Physical therapy is my full-time job right now. I spend 6-8 hours on the CPM, but have to break that up into sessions of less than 2.5 hours max with significant breaks in between. Additionally, I have to manually wiggle my patella around (sounds dirty, right?), do quad sets (flexing and relaxing my thigh muscle), and sit in a chair and use my left leg to support my surgery leg through bending and straightening. Each of those exercises means I need to take off the ice and I can only go without ice for about 5-10 minutes. Bottom line, I am always doing some sort of PT or recovering from some sort of PT.
I reached my 90 degree goal and went to my first post-op on Thursday. A nurse removed the staples and I counted as she did. 41! That's a respectable number, right? She replaced them with little cloth strips (GR 3) that still hold the incision together. It's an exquisite incision and will leave a beauty of a scar. I will finally have something to show for all this knee trouble! The previous surgeries only left unsatisfying little dots.
The character of the pain has changed since the first few days home. At first, I ached all the time and pain management meant keeping the aching down. Now, I am actually pretty comfortable as long as I am not moving. That would be great and I could easily cut down the meds drastically if that was all that mattered. However, remember all that PT? I have to move in those exercises and change position between them. The muscles supporting my knee are weak, so it feels like it gets tweaked when I move it around. So, that is now the type of pain I am managing. I keep trying to cut back on pain meds, and then I winced and gasped every time I moved until my husband said, "Sometimes I love your stubborn streak, but this is not one of those times. So will you please take your pain meds now?" He's my reality check. :)
Friday, April 2, 2010
S + 2 Days
The next day began much like the previous, with having blood drawn at 4:00 AM. I was impressed that they let me get some real sleep up until then. It was so quiet, much more quiet than I expected in a hospital. They did take me off the morphine pump that morning too.
At about 9:00 AM, another physical therapist, Jenny, came to work with me. I was less light-headed so I was able to actually make some progress this day. I will tell you, I felt absolutely blessed that I was already comfortable and confident on crutches. I got up on those things, started zipping around, and my mood lightened considerably because here was something I could actually do! Jenny had me show her I was able to go up and down stairs (since I needed to handle stairs at home) and that I could get in and out of a chair. She went over the exercises I would need to do at home and with a physical therapist once I left. She stressed that it was my responsibility to understand the protocol and make sure the physical therapist stuck to it.
Then something important happened. Jenny helped get me into the CPM and saw that I had been doing it wrong. She got me straightened out on how to use it and we all realized that while I thought I was up to 35 degrees of bending, I really hadn't gotten past 20. I was supposed to be at 40! Kittens!
I got to work on the CPM and gained 5 degrees, but Dr. Trice came by not long after and was not happy to hear that I was only at 25. I got a little talking to about the horrible things that would happen if I didn't get back on track. Sufficiently terrified, I started to really push on the CPM.
I am sure for most people that would have been fine. However, I have a terrible habit of pushing myself too far. When I was in PT after the MFX last year, there was a running joke that no one wanted to tell the physical therapist, Sandy, when something was easy because she would increase the exercise. She always had to keep an eye on people to see if it looked too easy because they might not tell her. With me, she had to watch that I wasn't doing too much or going too far. I am just too stubborn to accept when my body won't do what I want it to do.
So by the time that CPM session had stopped, I was absolutely exhausted from the pain I had pushed myself through. I mentally disengaged and was barely responsive. A woman who I think introduced herself as an orthopedic assistant on Dr. Trice's team stopped by to check on me. I don't know what she saw that made her say this, but she said that she believed I had been underrating my pain level. I suppose the pain that first night could have skewed my rating system. So what I called a 7 or 8 and what they treated as a 7 or 8 was actually what should have been reported and treated as a 10. They gave me an IV push of morphine and changed my pain meds again.
The rest of the day went better for a while. At about 4:30 that evening I was just sitting in bed watching TV when my knee started to ache. It was the strangest thing. When it reached about a level 6 I called for the nurse to ask what immediate relief pain medication was available in case I needed it. In the 1-2 minutes it took for her to come into the room, the pain went up to an 8. In the 1-2 minutes it took for her to come back with an answer, it went off the charts. This was another attack in the ballpark of the one on the first night. It wasn't quite as bad, because I was able to hold my body still, but the white-out, the forgetting to breathe, and the hyperventilating were all still there. The speed was the terrifying thing though, as it went from uncomfortable to out of sight in a total of about 5 minutes. The nurse gave me a push of a dilution of morphine that was 8 times stronger than what I had gotten before. Once I settled down, (you guessed it) they changed my meds again.
Pain medication is far more trial and error than I realized. The hospital doesn't want to over-medicate their patients for all kinds of good reasons, so they have to start low and work up to find the right level. It is unfortunate that it took about 48 hours after the surgery before they found the right level for me, but that's just the way it goes. At least they figured it out before they sent me home, so I had the help I needed though both serious episodes.
Due to both the pain and some redness around the incision, I had to stay another night. They had found the right level of meds though, so my last night was comparatively peaceful.
At about 9:00 AM, another physical therapist, Jenny, came to work with me. I was less light-headed so I was able to actually make some progress this day. I will tell you, I felt absolutely blessed that I was already comfortable and confident on crutches. I got up on those things, started zipping around, and my mood lightened considerably because here was something I could actually do! Jenny had me show her I was able to go up and down stairs (since I needed to handle stairs at home) and that I could get in and out of a chair. She went over the exercises I would need to do at home and with a physical therapist once I left. She stressed that it was my responsibility to understand the protocol and make sure the physical therapist stuck to it.
Then something important happened. Jenny helped get me into the CPM and saw that I had been doing it wrong. She got me straightened out on how to use it and we all realized that while I thought I was up to 35 degrees of bending, I really hadn't gotten past 20. I was supposed to be at 40! Kittens!
I got to work on the CPM and gained 5 degrees, but Dr. Trice came by not long after and was not happy to hear that I was only at 25. I got a little talking to about the horrible things that would happen if I didn't get back on track. Sufficiently terrified, I started to really push on the CPM.
I am sure for most people that would have been fine. However, I have a terrible habit of pushing myself too far. When I was in PT after the MFX last year, there was a running joke that no one wanted to tell the physical therapist, Sandy, when something was easy because she would increase the exercise. She always had to keep an eye on people to see if it looked too easy because they might not tell her. With me, she had to watch that I wasn't doing too much or going too far. I am just too stubborn to accept when my body won't do what I want it to do.
So by the time that CPM session had stopped, I was absolutely exhausted from the pain I had pushed myself through. I mentally disengaged and was barely responsive. A woman who I think introduced herself as an orthopedic assistant on Dr. Trice's team stopped by to check on me. I don't know what she saw that made her say this, but she said that she believed I had been underrating my pain level. I suppose the pain that first night could have skewed my rating system. So what I called a 7 or 8 and what they treated as a 7 or 8 was actually what should have been reported and treated as a 10. They gave me an IV push of morphine and changed my pain meds again.
The rest of the day went better for a while. At about 4:30 that evening I was just sitting in bed watching TV when my knee started to ache. It was the strangest thing. When it reached about a level 6 I called for the nurse to ask what immediate relief pain medication was available in case I needed it. In the 1-2 minutes it took for her to come into the room, the pain went up to an 8. In the 1-2 minutes it took for her to come back with an answer, it went off the charts. This was another attack in the ballpark of the one on the first night. It wasn't quite as bad, because I was able to hold my body still, but the white-out, the forgetting to breathe, and the hyperventilating were all still there. The speed was the terrifying thing though, as it went from uncomfortable to out of sight in a total of about 5 minutes. The nurse gave me a push of a dilution of morphine that was 8 times stronger than what I had gotten before. Once I settled down, (you guessed it) they changed my meds again.
Pain medication is far more trial and error than I realized. The hospital doesn't want to over-medicate their patients for all kinds of good reasons, so they have to start low and work up to find the right level. It is unfortunate that it took about 48 hours after the surgery before they found the right level for me, but that's just the way it goes. At least they figured it out before they sent me home, so I had the help I needed though both serious episodes.
Due to both the pain and some redness around the incision, I had to stay another night. They had found the right level of meds though, so my last night was comparatively peaceful.
S + 1 Day Continued
So it was about 24 hours after the surgery, and it was obvious that my pain was not anywhere near where it should be to go home. My life was still parsed into 6 minute intervals.
I was talking to one of the nurses and she told me that of the 12 ACI patients she had seen since Dr. Trice started bringing them to that wing to recover, only one had gone home the next day. She also observed that ACI seemed to be, on average, one of the most painful of the different types of joint surgeries admitted in that wing. Knee replacements even seemed easier on the patient, though they are far more intrusive. This is consistent with what I had read, but still interesting to hear from someone who sees it every day.
The goal was to take me off the morphine pump in the morning, but my pain level was still too high as the night progressed. Once more, they increased my pain meds during the night so I would have a chance at being ready in the morning. Then I finally fell asleep.
I was talking to one of the nurses and she told me that of the 12 ACI patients she had seen since Dr. Trice started bringing them to that wing to recover, only one had gone home the next day. She also observed that ACI seemed to be, on average, one of the most painful of the different types of joint surgeries admitted in that wing. Knee replacements even seemed easier on the patient, though they are far more intrusive. This is consistent with what I had read, but still interesting to hear from someone who sees it every day.
The goal was to take me off the morphine pump in the morning, but my pain level was still too high as the night progressed. Once more, they increased my pain meds during the night so I would have a chance at being ready in the morning. Then I finally fell asleep.
Thursday, April 1, 2010
Pictures and Tools
At this point, I have a few more pictures to share. First is the incision itself (GR 4), which is a lot easier for me to look at than others since I know it doesn't hurt that much. I haven't measured it, but this picture (GR 4) kind of shows the scale.
I have three significant tools to assist in my recovery. The first is the CPM machine that I mentioned earlier and will discuss extensively later. It occurs to me that others might benefit from guidance on proper positioning so they get off to a better start than I did.
The second tool is my Iceman (GR 1). This flat pad is connected to two tubes that then connect to a small cooler (GR 1). The cooler is full of ice water. The water is run from the cooler through one tube, through the pad, and then back through the other tube to the cooler. A dial (GR 1) on the tubes allows me to adjust the flow to make the pad cooler or warmer. A thermometer (GR 1) on the tube indicates the temperature of the pad. This thing is awesome because a cooler full of ice lasts about eight hours and because too cold is as bad on a joint as too warm. It makes the joint stiff.
The last significant tool is my brace (GR 1). The goal for the first 8 weeks is to increase range of motion and protect the knee, both goals that the brace helps with. It has to be locked whenever I am moving and also when I am sleeping. It unlocks and provides enough freedom of movement to comfortably use the CPM up to about 70 degrees.
Additionally, now that I am home, I also have my recovery cat (GR 1 - it's a cat!).
I have three significant tools to assist in my recovery. The first is the CPM machine that I mentioned earlier and will discuss extensively later. It occurs to me that others might benefit from guidance on proper positioning so they get off to a better start than I did.
The second tool is my Iceman (GR 1). This flat pad is connected to two tubes that then connect to a small cooler (GR 1). The cooler is full of ice water. The water is run from the cooler through one tube, through the pad, and then back through the other tube to the cooler. A dial (GR 1) on the tubes allows me to adjust the flow to make the pad cooler or warmer. A thermometer (GR 1) on the tube indicates the temperature of the pad. This thing is awesome because a cooler full of ice lasts about eight hours and because too cold is as bad on a joint as too warm. It makes the joint stiff.
The last significant tool is my brace (GR 1). The goal for the first 8 weeks is to increase range of motion and protect the knee, both goals that the brace helps with. It has to be locked whenever I am moving and also when I am sleeping. It unlocks and provides enough freedom of movement to comfortably use the CPM up to about 70 degrees.
Additionally, now that I am home, I also have my recovery cat (GR 1 - it's a cat!).
The Next Day
I continued on the CPM machine on a schedule of 2 hours on and 4 hours off. At 4:00 AM someone drew blood. At 9:00 AM a physical therapist and an occupational therapist came in and showed me how to use a leg lifter and get into a chair. Unfortunately I was too light-headed to crutch around. This was a disappointment in two ways. First, I was hoping to only have to spend one night in the hospital. Second, they had already removed the catheter that morning and I wasn't able to get to the bathroom. (By the way, I had no idea I had a catheter in until morning. I couldn't feel it.)
After several IV bags of fluid, I had to go! I tried the bedpan but that was unpleasant. When I protested that I didn't want to use it, they informed me that there was another option. Woohoo! The bedpan can be placed in a portable frame that can be placed next next to the bed. Getting to it is no harder than getting to a chair. I mention this because others should know they can ask for the portable commode.
I had a few more pain spikes during the day, but nothing as bad as the first night. My pain averaged about an 8 all day and I was very aware of how long six minutes took to pass so my morphine pump would work again. Clearly I was not going home that day.
After several IV bags of fluid, I had to go! I tried the bedpan but that was unpleasant. When I protested that I didn't want to use it, they informed me that there was another option. Woohoo! The bedpan can be placed in a portable frame that can be placed next next to the bed. Getting to it is no harder than getting to a chair. I mention this because others should know they can ask for the portable commode.
I had a few more pain spikes during the day, but nothing as bad as the first night. My pain averaged about an 8 all day and I was very aware of how long six minutes took to pass so my morphine pump would work again. Clearly I was not going home that day.
Wednesday, March 31, 2010
First Night
Before blissfully allowing me alone to sleep, I was informed that I had to start using the CPM machine at 11:00 that night. Just before 11:00, my husband rejoined me in the private room to help me through that first night. He brought movies. :)
Getting into the CPM was okay, but it was somewhat painful. I kept pushing it away from me to try to get more comfortable but that only made the position worse. It especially hurt when fully straightened. As wonderful as the nurses were, I don't think they were confident in CPM positioning so they kept letting me make it worse. I finally found a fairly comfortable position, though it was very incorrect, and got through those first two hours.
This is where the night got interesting. The nurse and technician got me out of the CPM machine and allowed my leg to rest straight in the bed. I don't know if was the bad positioning of the CPM or if was just the effect of movement, but I was quickly overwhelmed by a level of pain which I had never experienced nor imagined. The best way I can describe it is that my brain whited out. I wasn't aware of anything but the pain and when I did remember to breathe, it came out as hyperventilating. The worst was that writhing made me move my leg which started fresh waves of pain. I didn't know that level of pain existed.
At any rate, they increased my pain medication and eventually I was able to regain myself and rest.
Getting into the CPM was okay, but it was somewhat painful. I kept pushing it away from me to try to get more comfortable but that only made the position worse. It especially hurt when fully straightened. As wonderful as the nurses were, I don't think they were confident in CPM positioning so they kept letting me make it worse. I finally found a fairly comfortable position, though it was very incorrect, and got through those first two hours.
This is where the night got interesting. The nurse and technician got me out of the CPM machine and allowed my leg to rest straight in the bed. I don't know if was the bad positioning of the CPM or if was just the effect of movement, but I was quickly overwhelmed by a level of pain which I had never experienced nor imagined. The best way I can describe it is that my brain whited out. I wasn't aware of anything but the pain and when I did remember to breathe, it came out as hyperventilating. The worst was that writhing made me move my leg which started fresh waves of pain. I didn't know that level of pain existed.
At any rate, they increased my pain medication and eventually I was able to regain myself and rest.
Another Perspective
Writing about the day of the surgery is strange. I read back over it and don't feel like I have actually said anything. I slept through most of the major events! In that spirit, I asked my husband to relay part of the day himself. Here is his account of a highlight: meeting with Dr. Trice after the waiting was over.
Family Waiting Room
Although Dr. Trice, Allison’s surgeon, had scheduled for eight hours, the surgery ‘only’ took about four and a half. At around 3:30, Dr. Trice came into the waiting room and found our two families (Allison’s mother and both my parents had come to visit) waiting for any news. Even through one of the many assistant nurses had called a few times during the procedure to keep me informed of her progress, I was looking forward to hearing from him. He looked understandably tired, and even though I expected it, my attention kept getting drawn to the small splatters of red that stood out against the green surgical scrubs.
After meeting the family, he explained how he found the condition of the cartilage and generally what the gist of the procedure was. He produced two pages of pictures, the first a series of four images (1 2 3 4 Warning: GR 5 for all of them) outlining the current damaged area. In these he pointed out that the surgical probe was able to easily puncture the cartilage; it looked like the consistency of curdled milk. The second page was a series of four images (1 2 3 4 Warning: GR 5) outlining the steps taken in the procedure. These pictures were the most striking, and he explained that he was able to clean out the impacted area, and implant the cultured cartilage under a thin membrane of organic material. From my obviously untrained eye, the remaining tissue looked a great deal healthier than the damaged cartilage.
Additionally, Dr. Trice shared with us a series of images from what I assumed was a successful procedure. In these, a picture stunningly similar to Allison’s damaged area was compared to the same knee after the patch had dissolved. The new cartilage was silky smooth, like an overly polished piece of pure white marble. He reminded me again that this procedure had a 70 percent chance of success, so nothing is guaranteed. Although, when compared to the option of having done nothing, I will take a 70 percent increased chance of getting a result like that. Dr. Trice wrapped up by saying Allison was coming out of the anesthetic well, and that it would be a few hours until they moved her into her room.
Monday, March 29, 2010
Details
So obviously it has been a few crazy days. I will try to relay as much as I can, but it will take several entries.
Surgery Day
My husband and I got up early and got to the hospital on time. I had to wait for about an hour as they had a full schedule and there was more than enough time allotted for my preparation. I cooled my heels in the family waiting room and got to see where my husband and mother would be waiting. It was a nice room with a monitor that provided updates on patients by their numbers. The room had a view of the Baltimore harbor and you could actually see the USS Comfort docked out there.
At 9:30 they called me back and I changed into a hospital gown. Soon a series of people started streaming in asking the standard questions about any complicating factors. Dr. Trice came by and signed the correct leg for surgery. He asked if I had any questions, but the way he looked at me I could tell he knew we had been through everything and there was just nothing left to discuss. This was it.
The operating room had been booked for eight hours. While we knew it would be a while, that was still a shockingly long time. My husband and mother would be given updates from inside the operating room every few hours and they could leave the waiting room (or hospital) and still get updates as long as they left cell phone numbers.
The surgery was scheduled for 11:00 and we headed back there just a few minutes after. When the operating room doors opened the first thing I saw was the smile of Holly, Dr. Trice’s surgical nurse who I had spoken with at every appointment leading up to this. She knew how glad I was to finally be there. I am not sure how often patients are that happy about surgery.
They moved me over from the pre-op bed to the operating table, which was very narrow. They swung in arm rests with foam egg crate padding and began strapping me down. They put a mask over my face and told me to breathe deep. I went out like a light.
After
Things went smoothly and they were able to finish in 4 ½ hours. I woke up in the recovery room in a more comfortable bed and in some pain. I actually came out of the anesthesia much smoother than I expected. I read a lot about others having nerve blocks, but I don’t think they did that with me. My painkiller was in my IV and I had a morphine pump that I could use once every six minutes.
The recovery room is basically where they take you to wake up. Family isn’t allowed in there and I don’t really remember much, so this part is hard to write about. About all I remember is that the recovery nurse did notice my pretty toes and got a kick out of them. :)
When I was clearly stable they took me to my room in the Wenz Orthopedic Wing and brought my husband and mother up to join me. The room was gorgeous! It was big, had hard wood floors, a few chairs, and a sofa that folded out into a bed. It looked like they hired the same designers that Westin uses. I saw all this in the morning though, because my eyes were closed. I was alert, but just had no interest in opening my eyes. After seeing me get settled in, my family left since all I wanted to do was sleep. I got right to that.
Surgery Day
My husband and I got up early and got to the hospital on time. I had to wait for about an hour as they had a full schedule and there was more than enough time allotted for my preparation. I cooled my heels in the family waiting room and got to see where my husband and mother would be waiting. It was a nice room with a monitor that provided updates on patients by their numbers. The room had a view of the Baltimore harbor and you could actually see the USS Comfort docked out there.
At 9:30 they called me back and I changed into a hospital gown. Soon a series of people started streaming in asking the standard questions about any complicating factors. Dr. Trice came by and signed the correct leg for surgery. He asked if I had any questions, but the way he looked at me I could tell he knew we had been through everything and there was just nothing left to discuss. This was it.
The operating room had been booked for eight hours. While we knew it would be a while, that was still a shockingly long time. My husband and mother would be given updates from inside the operating room every few hours and they could leave the waiting room (or hospital) and still get updates as long as they left cell phone numbers.
The surgery was scheduled for 11:00 and we headed back there just a few minutes after. When the operating room doors opened the first thing I saw was the smile of Holly, Dr. Trice’s surgical nurse who I had spoken with at every appointment leading up to this. She knew how glad I was to finally be there. I am not sure how often patients are that happy about surgery.
They moved me over from the pre-op bed to the operating table, which was very narrow. They swung in arm rests with foam egg crate padding and began strapping me down. They put a mask over my face and told me to breathe deep. I went out like a light.
After
Things went smoothly and they were able to finish in 4 ½ hours. I woke up in the recovery room in a more comfortable bed and in some pain. I actually came out of the anesthesia much smoother than I expected. I read a lot about others having nerve blocks, but I don’t think they did that with me. My painkiller was in my IV and I had a morphine pump that I could use once every six minutes.
The recovery room is basically where they take you to wake up. Family isn’t allowed in there and I don’t really remember much, so this part is hard to write about. About all I remember is that the recovery nurse did notice my pretty toes and got a kick out of them. :)
When I was clearly stable they took me to my room in the Wenz Orthopedic Wing and brought my husband and mother up to join me. The room was gorgeous! It was big, had hard wood floors, a few chairs, and a sofa that folded out into a bed. It looked like they hired the same designers that Westin uses. I saw all this in the morning though, because my eyes were closed. I was alert, but just had no interest in opening my eyes. After seeing me get settled in, my family left since all I wanted to do was sleep. I got right to that.
Saturday, March 27, 2010
Home again, home again, jiggity-jig!
I just came home this afternoon and wanted to let everyone know I am doing fine! I will post more details tomorrow once I get some rest. Thanks for all your support!
Wednesday, March 24, 2010
S-day
Today is the big day. I am supposed to be there at 8:00 am and my surgery begins at 11:00 am. Thank you so much for all the good wishes!
Tuesday, March 23, 2010
The Final Countdown
Now you have that song stuck in your head, right?
So today is my last day. I finished handing everything off at work yesterday and gave some treats to my wonderful team to thank them for putting up with me. I am certainly not the only one this injury affects. It was kind of sad leaving. I will miss everyone.
I did get my pre-surgery pedicure this weekend! My toes remind me of cupcakes with sprinkles. (I give the picture a GR of 2 only because some people have a thing about feet.)
Stepping off the Ryzolt has been unpleasant. It is a 12-hour pill so I am taking it once a day now instead of twice. Since I am not ahead of the pain, it never really calms down. Oh well. It will be worth it to not have to go through that withdrawal again.
The instructions I received from pre-op said they will call today to tell me what time my surgery will be tomorrow. I am waiting by the phone. They said that since they are a trauma hospital, they can only schedule things so far in advance. A friend of mine had her hip surgery rescheduled at the last minute recently and she was so frustrated. I totally understand! You get so worked up with anticipation. I don't think my surgery can be rescheduled though. Once the cells are ready and delivered, they have to be used immediately.
Adding a few more things to my list that I picked up over the weekend:
- Back pillow (the kind with arms)
- Bed tray
@ Jenn - My mother used to swear by Arnica gel! I haven't thought about that in years.
So today is my last day. I finished handing everything off at work yesterday and gave some treats to my wonderful team to thank them for putting up with me. I am certainly not the only one this injury affects. It was kind of sad leaving. I will miss everyone.
I did get my pre-surgery pedicure this weekend! My toes remind me of cupcakes with sprinkles. (I give the picture a GR of 2 only because some people have a thing about feet.)
Stepping off the Ryzolt has been unpleasant. It is a 12-hour pill so I am taking it once a day now instead of twice. Since I am not ahead of the pain, it never really calms down. Oh well. It will be worth it to not have to go through that withdrawal again.
The instructions I received from pre-op said they will call today to tell me what time my surgery will be tomorrow. I am waiting by the phone. They said that since they are a trauma hospital, they can only schedule things so far in advance. A friend of mine had her hip surgery rescheduled at the last minute recently and she was so frustrated. I totally understand! You get so worked up with anticipation. I don't think my surgery can be rescheduled though. Once the cells are ready and delivered, they have to be used immediately.
Adding a few more things to my list that I picked up over the weekend:
- Back pillow (the kind with arms)
- Bed tray
@ Jenn - My mother used to swear by Arnica gel! I haven't thought about that in years.
Friday, March 19, 2010
Checklist
I am assembling things that will be useful when I come home on Thursday.
- Rubbing Alcohol: to remove the iodine from my skin around the incision site.
- Toilet Seat Riser: Since getting up and down will be difficult with my knee locked. I looked at a few kinds and read that some people had trouble with the all-in-one models that included both a raised seat and handles for support. So, I just got the simple riser version and separately bought....
- Toilet Support Bars: These are supported by legs that go down to the floor, so they seem more stable.
- Leg lifter: I mentioned this one a while ago. It may be difficult to get in and out of the CPM machine on my own, and I am hoping this will help.
- Body wipes: I won't be able to shower for a few days but keeping clean helps tremendously with overall mood. I found these in the grocery store near the adult diapers, as they are marketed for people with incontinence. They will work for post-surgery care too!
- Dry shampoo: I haven't bought this one yet, but was informed I can get it at a drug store. It is like a mousse that you put in your hair to eliminate oil and make it feel a little fresher. It's not as good as washing, but better than nothing.
- Gold Bond Anti-itch powder: because spending too much time in bed irritates the skin.
- Gold Bond Anti-itch lotion: After my microfracture (MFX) surgery, my foot on the affected leg itched HORRIBLY and I could barely reach it. A little of this stuff felt like heaven! Note that I am not talking about the foot lotion that Gold Bond makes. That is a nice foot lotion, but it does not contain any anti-itch ingredients.
- Face Wipes: because standing at the sink to wash my face will not be comfortable for a long time.
- The Perfect Shoes: I had a pair of these that I wore all the time after the MFX, but they got pretty worn out. They are nice because they are lightweight and supportive, but what makes them perfect is that they are very easy for someone else to take off and put on. Reaching your foot is very hard! And yes, I did order them in purple.
- New curtains for the bedroom: because I will be in there a lot and want to spruce it up a bit. :)
- Non-medicated throat lozenges: because the breathing tube is irritating.
- An ottoman: I chose a round one that is 20" across. I like this one because it still isn't large, but it supports the length of my leg better than a small square ottoman. I have this under my desk in my home office that is on the same floor as my bedroom. When I can move around a little, I now have a comfortable and safe (no stairs) place to go. The ottoman is crucial. It took a while after the MFX before I could keep my leg in a non-elevated position for more than a few minutes. My foot kept turning purple! I would rather my shoes be purple, not my feet.
- Vitamin E lotion: I don't think it has been scientifically proven that vitamin E helps reduce the appearance of scars, but many people swear by it. Keeping the skin supple and healthy just doesn't seem like it could be a bad thing, so I will try it.
As you can see, I learned a lot from the MFX. The recovery for that is like a "lite" version of the recovery for ACI. It will be harder, but I am better prepared.
- Rubbing Alcohol: to remove the iodine from my skin around the incision site.
- Toilet Seat Riser: Since getting up and down will be difficult with my knee locked. I looked at a few kinds and read that some people had trouble with the all-in-one models that included both a raised seat and handles for support. So, I just got the simple riser version and separately bought....
- Toilet Support Bars: These are supported by legs that go down to the floor, so they seem more stable.
- Leg lifter: I mentioned this one a while ago. It may be difficult to get in and out of the CPM machine on my own, and I am hoping this will help.
- Body wipes: I won't be able to shower for a few days but keeping clean helps tremendously with overall mood. I found these in the grocery store near the adult diapers, as they are marketed for people with incontinence. They will work for post-surgery care too!
- Dry shampoo: I haven't bought this one yet, but was informed I can get it at a drug store. It is like a mousse that you put in your hair to eliminate oil and make it feel a little fresher. It's not as good as washing, but better than nothing.
- Gold Bond Anti-itch powder: because spending too much time in bed irritates the skin.
- Gold Bond Anti-itch lotion: After my microfracture (MFX) surgery, my foot on the affected leg itched HORRIBLY and I could barely reach it. A little of this stuff felt like heaven! Note that I am not talking about the foot lotion that Gold Bond makes. That is a nice foot lotion, but it does not contain any anti-itch ingredients.
- Face Wipes: because standing at the sink to wash my face will not be comfortable for a long time.
- The Perfect Shoes: I had a pair of these that I wore all the time after the MFX, but they got pretty worn out. They are nice because they are lightweight and supportive, but what makes them perfect is that they are very easy for someone else to take off and put on. Reaching your foot is very hard! And yes, I did order them in purple.
- New curtains for the bedroom: because I will be in there a lot and want to spruce it up a bit. :)
- Non-medicated throat lozenges: because the breathing tube is irritating.
- An ottoman: I chose a round one that is 20" across. I like this one because it still isn't large, but it supports the length of my leg better than a small square ottoman. I have this under my desk in my home office that is on the same floor as my bedroom. When I can move around a little, I now have a comfortable and safe (no stairs) place to go. The ottoman is crucial. It took a while after the MFX before I could keep my leg in a non-elevated position for more than a few minutes. My foot kept turning purple! I would rather my shoes be purple, not my feet.
- Vitamin E lotion: I don't think it has been scientifically proven that vitamin E helps reduce the appearance of scars, but many people swear by it. Keeping the skin supple and healthy just doesn't seem like it could be a bad thing, so I will try it.
As you can see, I learned a lot from the MFX. The recovery for that is like a "lite" version of the recovery for ACI. It will be harder, but I am better prepared.
Counting Down on One Hand
Five days to go...
I am about to start shopping to make some frozen meals. Here are two recipes that I plan on making. I also expect I will eat a lot of graham crackers, saltines, and those Archway old-fashioned molasses cookies.
Carrot Fennel Soup - This soup is mild and sweet, but very smooth. I expect that it will be nice as a light meal when I am still getting my appetite back and when my throat is still sore from the anesthesia.
Beef and Bok Choy Hot Pot - This is one of my favorite healthy comfort food recipes. My husband doesn't care for it, so I don't have much occasion to make it. Here's an occasion! It freezes pretty well too if using fettuccine (heartier noodle). Both carrot and bok choy are hefty vegetables that can take a little reheating and not get soggy. Still, I probably won't cook them at all before freezing.
I am about to start shopping to make some frozen meals. Here are two recipes that I plan on making. I also expect I will eat a lot of graham crackers, saltines, and those Archway old-fashioned molasses cookies.
Carrot Fennel Soup - This soup is mild and sweet, but very smooth. I expect that it will be nice as a light meal when I am still getting my appetite back and when my throat is still sore from the anesthesia.
Beef and Bok Choy Hot Pot - This is one of my favorite healthy comfort food recipes. My husband doesn't care for it, so I don't have much occasion to make it. Here's an occasion! It freezes pretty well too if using fettuccine (heartier noodle). Both carrot and bok choy are hefty vegetables that can take a little reheating and not get soggy. Still, I probably won't cook them at all before freezing.
Monday, March 15, 2010
Single Digits
Today is nine days until my surgery. I have been waiting so long and now it is only nine days away. Wow.
I thought I should mention that my pain medication is squared away and the pain is manageable again. Thanks to everyone that was pulling for me for those couple of bad days! It makes a difference. Honestly I am still so surprised when someone I know starts talking to me about something I wrote here. It makes me feel very special to know people are interested in checking in on me.
Before things get crazy, I do need to give some serious kudos to my wonderful husband. He has been an absolute angel and I don't know how I could have gotten this far without him. It is hard on him too, to see me hurting and to not be able to help, but he hasn't let me down even once. Sometimes I wonder if my knee problem is just to even out a cosmic balance sheet because I have been so unbelievably lucky to have him in my life. I just had to get that out there.
I think people expect me to be nervous about the upcoming surgery. Describing the recovery blows most people away. I think I finally found an analogy that makes sense to many people. Everyone knows that the traffic is bad around Los Angeles. During rush hour it can be mind-numbingly bad. The on ramps there have a stoplight to mediate the flow of traffic merging in during busy times. I feel like I have been stuck at one of those stoplights for a very long time! I know that once it turns green and I can get on the highway that it will still be insanely slow going. But right now, I am not moving at all. I want to get on that slow highway and start making my way to recovery. It will still be rough, but it's better than staying here stuck on the on ramp.
@Lottie - I know! Someday I will have normal knee function! I do try to stay focused on the end goal.
@Shae - Wow, that soup looks good! Do you freeze it at the point before you add the cream and then later add it when reheating?
@Jess - I feel your pain! Hope it is sorted out by now.
@Mike - Still trying to find a good date!
I thought I should mention that my pain medication is squared away and the pain is manageable again. Thanks to everyone that was pulling for me for those couple of bad days! It makes a difference. Honestly I am still so surprised when someone I know starts talking to me about something I wrote here. It makes me feel very special to know people are interested in checking in on me.
Before things get crazy, I do need to give some serious kudos to my wonderful husband. He has been an absolute angel and I don't know how I could have gotten this far without him. It is hard on him too, to see me hurting and to not be able to help, but he hasn't let me down even once. Sometimes I wonder if my knee problem is just to even out a cosmic balance sheet because I have been so unbelievably lucky to have him in my life. I just had to get that out there.
I think people expect me to be nervous about the upcoming surgery. Describing the recovery blows most people away. I think I finally found an analogy that makes sense to many people. Everyone knows that the traffic is bad around Los Angeles. During rush hour it can be mind-numbingly bad. The on ramps there have a stoplight to mediate the flow of traffic merging in during busy times. I feel like I have been stuck at one of those stoplights for a very long time! I know that once it turns green and I can get on the highway that it will still be insanely slow going. But right now, I am not moving at all. I want to get on that slow highway and start making my way to recovery. It will still be rough, but it's better than staying here stuck on the on ramp.
@Lottie - I know! Someday I will have normal knee function! I do try to stay focused on the end goal.
@Shae - Wow, that soup looks good! Do you freeze it at the point before you add the cream and then later add it when reheating?
@Jess - I feel your pain! Hope it is sorted out by now.
@Mike - Still trying to find a good date!
Monday, March 8, 2010
Well that was "fun"
I just had a really truly awful weekend, but I did learn a few things from it. Unfortunately it is kind of a long story.
The last time I went to my pain management doctor, I got a prescription for the painkiller I have been on for a few months now. It is kind of expensive and I still had about 2 weeks worth, so I sent the new prescription into the mail order delivery service that my pharmaceutical insurance coverage runs. Their delivery is fast and the co-pay is lower, so I figured that was a smart move. Boy was I wrong.
I got an email from them saying there was a delay in processing it. I still had about 5 days of meds left, so I called and asked what the issue was. The person I talked to didn't know, but said I could either get a filler prescription from my doctor in the meantime or I could transfer the prescription to a local pharmacy. I chose the filler prescription. So, I got another week's worth of painkiller called into a local pharmacy by my doctor and figured things would be fine.
Well, the next week was coming to an end, and I had no further communication from the mail order service. I only had a day's supply left, so I called and inquired how to transfer the prescription. The person I spoke with said that they just needed the pharmacy to call and confirmed that the prescription was available to be transferred. I called the pharmacy and they took the request and went to make the call. Everything sounded fine.
That was on a Friday. The pharmacy called and left a message later that day, but I was unable to get back to them until Saturday morning. Apparently when they called the mail order service they were informed that the prescription was not available to be transferred. I was told twice that it was! I called the mail order service (and tried not to lose my temper) and was informed that they didn't like the number of pills prescribed and that they were unable to contact my doctor, so they revoked the prescription (!!!!!) and sent it back to my doctor. It was gone. There was nothing I could do.
So, remember how this is Saturday? I called the emergency line for my doctor and was told they would not contact the doctor for prescription matters only. I needed to be in pain. I guess I can understand that, since this is a pain management doctor. Most of his patients are on opiates and probably beg for more all the time. However, I had been told specifically not to stop taking the Ryzolt suddenly because there can be nasty withdrawal effects.
All day Sunday I experienced those nasty withdrawal effects. Whee.
I do always try to find a silver lining, and I decided it would be verifying whether the pain was bad enough to warrant continuing the meds. I hate taking pills and always seek to stop as soon as possible. Unfortunately the answer is yes, I still need them.
So I learned that once your prescription leaves your hands to a mail order pharmacy you are taking an awful risk that you will ever actually see that filled. I also learned that you can never assume things are fine. You always have to press and find out exactly what the hold-up is. If I had pressed the first time I called, I would have been able to just get a new prescription instead of a week's worth. Finally, I learned that withdrawal sucks and I will definitely go through the trouble of stepping the Ryzolt down for the three days prior to the surgery, as was recommended.
Sigh. 16 days to go.
The last time I went to my pain management doctor, I got a prescription for the painkiller I have been on for a few months now. It is kind of expensive and I still had about 2 weeks worth, so I sent the new prescription into the mail order delivery service that my pharmaceutical insurance coverage runs. Their delivery is fast and the co-pay is lower, so I figured that was a smart move. Boy was I wrong.
I got an email from them saying there was a delay in processing it. I still had about 5 days of meds left, so I called and asked what the issue was. The person I talked to didn't know, but said I could either get a filler prescription from my doctor in the meantime or I could transfer the prescription to a local pharmacy. I chose the filler prescription. So, I got another week's worth of painkiller called into a local pharmacy by my doctor and figured things would be fine.
Well, the next week was coming to an end, and I had no further communication from the mail order service. I only had a day's supply left, so I called and inquired how to transfer the prescription. The person I spoke with said that they just needed the pharmacy to call and confirmed that the prescription was available to be transferred. I called the pharmacy and they took the request and went to make the call. Everything sounded fine.
That was on a Friday. The pharmacy called and left a message later that day, but I was unable to get back to them until Saturday morning. Apparently when they called the mail order service they were informed that the prescription was not available to be transferred. I was told twice that it was! I called the mail order service (and tried not to lose my temper) and was informed that they didn't like the number of pills prescribed and that they were unable to contact my doctor, so they revoked the prescription (!!!!!) and sent it back to my doctor. It was gone. There was nothing I could do.
So, remember how this is Saturday? I called the emergency line for my doctor and was told they would not contact the doctor for prescription matters only. I needed to be in pain. I guess I can understand that, since this is a pain management doctor. Most of his patients are on opiates and probably beg for more all the time. However, I had been told specifically not to stop taking the Ryzolt suddenly because there can be nasty withdrawal effects.
All day Sunday I experienced those nasty withdrawal effects. Whee.
I do always try to find a silver lining, and I decided it would be verifying whether the pain was bad enough to warrant continuing the meds. I hate taking pills and always seek to stop as soon as possible. Unfortunately the answer is yes, I still need them.
So I learned that once your prescription leaves your hands to a mail order pharmacy you are taking an awful risk that you will ever actually see that filled. I also learned that you can never assume things are fine. You always have to press and find out exactly what the hold-up is. If I had pressed the first time I called, I would have been able to just get a new prescription instead of a week's worth. Finally, I learned that withdrawal sucks and I will definitely go through the trouble of stepping the Ryzolt down for the three days prior to the surgery, as was recommended.
Sigh. 16 days to go.
Thursday, March 4, 2010
Counting the days
There isn't much going on right now. Every morning I wake up and think how many days are left. Right now, it is 20 to go. I am almost to the teens.
I do have a few things that will come up before the big day. I have my pre-surgery pedicure and I also plan on doing some cooking of freezable comfort food. Might as well share pictures and recipes!
I wish I had more to say, but all I would do is start whining about pain and that just isn't good for anyone. Hang in there with me everyone. Nearly there.
I do have a few things that will come up before the big day. I have my pre-surgery pedicure and I also plan on doing some cooking of freezable comfort food. Might as well share pictures and recipes!
I wish I had more to say, but all I would do is start whining about pain and that just isn't good for anyone. Hang in there with me everyone. Nearly there.
Friday, February 26, 2010
This little piggie..... helps in knee surgery?
There was one interesting question from my last appointment that I had to research before I could answer. I was asked if I wanted the doctor to use a Bio-gide patch. I had no idea what that was, but it turns out to be a pretty cool little bit of piggie.
A key part of the surgery is that the new cells are implanted under a little flap that holds them in place. That flap has in the past been typically taken from the surface of your bone in another part of your leg, just below the knee. That meant another incision was needed to harvest it, which meant more time under anesthesia and more required healing.
With this traditional method, by far the most common complication leading to more surgery was overgrowth. In other words the cells wouldn't stay in their little pocket, but would continue to grow and start getting in the way of knee function. Overgrowth would require that subsequent surgery to clean out the joint and allow it to move freely again.
Okay, now to get to the point. Bio-gide is a little flap of tissue that is harvested from a pig, instead of your leg. Right there one benefit is obvious as the use of Bio-gide means no second incision and a shorter surgery. However it gets even more interesting. For some reason using the Bio-gide instead of your own tissue patch significantly reduces the occurrence of overgrowth. In the study done on this, the comparable rates of required subsequent operation for the original method was 25.7% (77 of 300 patients) and the Bio-gide group was 5% (5 of 101 patients), with no significant difference in the overall ACI success rates. That is an 80% reduction in the occurrence of the most common cause of needing more surgery! Studies done in Europe are seeing similar results.
There is an important caveat that patients should understand. While the FDA has approved the use of Bio-gide in other surgical procedures (mostly dental), it has not been approved for knee surgery. As most people know, government agencies can move slowly. However, the benefit is so significant that surgeons don't want to wait at the expense of their patients.
So, thanks little piggie.
A key part of the surgery is that the new cells are implanted under a little flap that holds them in place. That flap has in the past been typically taken from the surface of your bone in another part of your leg, just below the knee. That meant another incision was needed to harvest it, which meant more time under anesthesia and more required healing.
With this traditional method, by far the most common complication leading to more surgery was overgrowth. In other words the cells wouldn't stay in their little pocket, but would continue to grow and start getting in the way of knee function. Overgrowth would require that subsequent surgery to clean out the joint and allow it to move freely again.
Okay, now to get to the point. Bio-gide is a little flap of tissue that is harvested from a pig, instead of your leg. Right there one benefit is obvious as the use of Bio-gide means no second incision and a shorter surgery. However it gets even more interesting. For some reason using the Bio-gide instead of your own tissue patch significantly reduces the occurrence of overgrowth. In the study done on this, the comparable rates of required subsequent operation for the original method was 25.7% (77 of 300 patients) and the Bio-gide group was 5% (5 of 101 patients), with no significant difference in the overall ACI success rates. That is an 80% reduction in the occurrence of the most common cause of needing more surgery! Studies done in Europe are seeing similar results.
There is an important caveat that patients should understand. While the FDA has approved the use of Bio-gide in other surgical procedures (mostly dental), it has not been approved for knee surgery. As most people know, government agencies can move slowly. However, the benefit is so significant that surgeons don't want to wait at the expense of their patients.
So, thanks little piggie.
Tuesday, February 16, 2010
Answers
Well, I had my last appointment with my OS before surgery. I got all my questions answered and two pieces of good news. First, I don't need an osteotomy! Second, my insurance approved the ACI after the peer-to-peer review! It's actually going to happen. I am getting more nervous, but unfortunately it is still over a month away. I just want it over with.
If you are curious, here are the answers to the questions I listed last time.
- 24/7 care really isn't needed, but it would be good to have my husband off work and around for the first week. He still asked off for two weeks since recovery is different for everyone and it would be better for him to return early than have to stay out longer than planned.
- Again, no osteotomy! The 51" long leg X-ray showed good alignment in my knee. This is very good news as an osteotomy would have increased the chance of complications, increased the pain, and put more limitations on my rehab protocol.
- As for what hardware I will need, the answer was yes, yes, and yes. I knew the CPM machine would be needed, but that was the first time we discussed the Bledsoe brace. It's huge! The ice machine will be nice since it means I will have continuous icing and not need to refreeze ice packs.
- Regarding the post-surgery meds, they have a pharmacy in the hospital so my husband can just take the scripts down there while I am still admitted. That's not so bad.
- I will have to stay in the hospital for a day or two, depending on so many things that I don't think he wanted to narrow them down.
- He used Google Scholar to print out the research for me. I have not had occasion to use that before, so I didn't think of it. I think I will be looking up some other research as well.
- I don't need to arrange for an in-home physical therapist. The hospital will take care of that. They apparently only brought it up to see if I already had someone I wanted to use.
- I can take the Ryzolt up to the day before. I plan to reduce how often I take it from twice a day to once a day for three days before so I don't stop suddenly.
- He said the drugs he was planning on giving me after surgery shouldn't interact with Rozerem or Lunesta so I should be able to take them if needed. My reasoning for thinking I might want them is because I am a light sleeper but I was really hoping to use the CPM machine at night. I am not sure if I can sleep through the motion and sound without help.
I still have some more things I need to do to get ready, but I can't help but feel like this appointment was a major milestone. The treatment is now defined and approved so there aren't any big questions remaining open.
If you are curious, here are the answers to the questions I listed last time.
- 24/7 care really isn't needed, but it would be good to have my husband off work and around for the first week. He still asked off for two weeks since recovery is different for everyone and it would be better for him to return early than have to stay out longer than planned.
- Again, no osteotomy! The 51" long leg X-ray showed good alignment in my knee. This is very good news as an osteotomy would have increased the chance of complications, increased the pain, and put more limitations on my rehab protocol.
- As for what hardware I will need, the answer was yes, yes, and yes. I knew the CPM machine would be needed, but that was the first time we discussed the Bledsoe brace. It's huge! The ice machine will be nice since it means I will have continuous icing and not need to refreeze ice packs.
- Regarding the post-surgery meds, they have a pharmacy in the hospital so my husband can just take the scripts down there while I am still admitted. That's not so bad.
- I will have to stay in the hospital for a day or two, depending on so many things that I don't think he wanted to narrow them down.
- He used Google Scholar to print out the research for me. I have not had occasion to use that before, so I didn't think of it. I think I will be looking up some other research as well.
- I don't need to arrange for an in-home physical therapist. The hospital will take care of that. They apparently only brought it up to see if I already had someone I wanted to use.
- I can take the Ryzolt up to the day before. I plan to reduce how often I take it from twice a day to once a day for three days before so I don't stop suddenly.
- He said the drugs he was planning on giving me after surgery shouldn't interact with Rozerem or Lunesta so I should be able to take them if needed. My reasoning for thinking I might want them is because I am a light sleeper but I was really hoping to use the CPM machine at night. I am not sure if I can sleep through the motion and sound without help.
I still have some more things I need to do to get ready, but I can't help but feel like this appointment was a major milestone. The treatment is now defined and approved so there aren't any big questions remaining open.
Wednesday, February 10, 2010
Questions
I wanted to write out and share the questions I am accumulating, both for the benefit of organizing my thoughts and as a reference for others.
- How long is 24/7 care recommended?
- What type of osteotomy are we talking about?
- What hardware will I need to use (i.e. CPM machine, Bledsoe brace, ice machine)?
- Can I pick up the post-surgery medications (pain killers and blood thinner) before the surgery so they will be waiting for me? I don't really want to have to stop at the pharmacy on the way home.
- How long do I have to stay in the hospital? I will have to climb two flights of stairs when I get home in order to get settled and that might need to be taken into consideration. Actually a better question might be to ask what conditions I need to meet in order to be released.
- Can they get me a copy of the relevant published research? The STAR study appears to be the biggest applicable effort that has been performed. Here is the information about it if anyone wants to find it, but it requires either payment or a subscription as it is a professional research paper. I figure my doctor probably has access and might be able to let me read it.
Kenneth Zaslav, MD, et al. A Prospective Study of Autologous Chondrocyte Implantation in Patients With Failed Prior Treatment for Articular Cartilage Defect of the Knee Results of the Study of the Treatment of Articular Repair (STAR) Clinical Trial. In The American Journal of Sports Medicine. 2009. Vol. 37. No. 1. Pp. 42-55.
- Do they have an in-home physical therapist they would recommend? My physical therapist does not have a recommendation for anyone local.
- When do I need to stop taking the Ryzolt? My pain management doctor mentioned that it is common to get nasty withdrawal effects if you stop it suddenly, so it is a good idea to step it down to once a day for three days before stopping entirely.
- I have some Rozerem and Lunesta left over from trying to sleep while the pain was out of control. Can I take that with the post-surgery drugs? After I step off certain drugs can I start taking them if needed?
- How long is 24/7 care recommended?
- What type of osteotomy are we talking about?
- What hardware will I need to use (i.e. CPM machine, Bledsoe brace, ice machine)?
- Can I pick up the post-surgery medications (pain killers and blood thinner) before the surgery so they will be waiting for me? I don't really want to have to stop at the pharmacy on the way home.
- How long do I have to stay in the hospital? I will have to climb two flights of stairs when I get home in order to get settled and that might need to be taken into consideration. Actually a better question might be to ask what conditions I need to meet in order to be released.
- Can they get me a copy of the relevant published research? The STAR study appears to be the biggest applicable effort that has been performed. Here is the information about it if anyone wants to find it, but it requires either payment or a subscription as it is a professional research paper. I figure my doctor probably has access and might be able to let me read it.
Kenneth Zaslav, MD, et al. A Prospective Study of Autologous Chondrocyte Implantation in Patients With Failed Prior Treatment for Articular Cartilage Defect of the Knee Results of the Study of the Treatment of Articular Repair (STAR) Clinical Trial. In The American Journal of Sports Medicine. 2009. Vol. 37. No. 1. Pp. 42-55.
- Do they have an in-home physical therapist they would recommend? My physical therapist does not have a recommendation for anyone local.
- When do I need to stop taking the Ryzolt? My pain management doctor mentioned that it is common to get nasty withdrawal effects if you stop it suddenly, so it is a good idea to step it down to once a day for three days before stopping entirely.
- I have some Rozerem and Lunesta left over from trying to sleep while the pain was out of control. Can I take that with the post-surgery drugs? After I step off certain drugs can I start taking them if needed?
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