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.
Friday, May 14, 2010
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!
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