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!

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.

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.

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!

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.

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.