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.

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!

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!

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......