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.
Friday, April 30, 2010
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.
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