One Year!!!!

Today is one year from my ACI surgery, and that is a pretty big milestone. I also had an appointment with Dr. Trice today so I have updated guidance. Yay! It's not a total removal of restrictions, but it is progress.

He said I can go without my brace unless I am in a situation where I am walking a lot. That's what I was really hoping for, because it is nice to not have to wear it at work. However, he wants me to wait 3 more months before jogging and 6 more before doing any squats at the gym. He just doesn't think the benefit from squats justifies how hard it is on recovering knees. That's tricky though, because squats are exactly what personal trainers recommend to people who want to strengthen their quads. I guess my trainer will just have to find another way.

There were two other things in the conversation that surprised me. First, when I told Holly (Dr. Trice's surgical nurse) that I had been in contact with another patient who found me through this blog, she said that she also had another one or two who told her that he or she was reading my blog. I have readers! That's pretty shocking. Holly said she was glad because there is only so much detail she can provide on what the surgery and recovery feels like. It's still going to be different for each patient, but I have tried to accurately represent what this one patient felt.

Second, Dr. Trice told me that he specifically remembers me from before the surgery because he could see how much pain I was in. He said he just still remembers my face and how it had "Please just make this stop" written all over it. He's said before that I was worse off than a lot of his patients, but I didn't know how firmly my face had stuck in his mind. I mean, doctors see a lot of patients and I don't think of myself as particularly memorable.

So, here's an update on what I am experiencing.

1. I am not in pain, but the knee is weak and I still guard it and protect it. I am also still aware of it most of the time. Let me put it this way: a normal person would sometimes stumble or trip and it's not a big deal. I almost never stumble or trip because I am always paying a great deal of attention to my walking. 
2. Leg extensions (where I am sitting and straighten the leg in front of me) are very difficult. When I do them, the leg shakes and it takes a lot of effort to control it. 
3. Also, I still have trouble with stairs, particularly going down. 
4. In general, the knee pops a lot, but it's not catching or locking. It feels like cracking your knuckles or your back. It actually feels good. 
5. If I get up from sitting for a little while then I limp, but that goes away after walking for a minute or two and especially if I can get the knee to pop. If I am walking for a while, I have almost no limp. 
6. Some of the nerves are still dead on the outside of my knee so that area is still slightly numb (like if you sit on your hand for too long kind of tingly numb).

I think that's it for now. I don't have to see Dr. Trice again for 6 months and I will be getting another MRI at that time. I'll continue to update if anything changes, but recovery is slow at this point. Good luck everyone.

Less than 6 weeks from the One Year Mark

First let me say, that I love when people leave comments and let me know if this journal has been helpful to them. It absolutely makes my day! (I get an email when someone leaves a comment, so it does get noticed right away.) Good luck to those of you stopping by to prepare yourself! It was a life-changing experience, but it's been worth it for me.

One thing you learn pretty early when reading about ACI is that while it may take 2 years to feel "normal," the majority of the healing is done in the first year and restrictions are eased considerably after that. With this information in mind, I have my eye on the fact that my one year anniversary is less than 6 weeks away!

However, I am not quite where I want to be in terms of rebuilding muscle to properly support the knee. So, I have signed up with a personal trainer to see if he can guide me beyond my current plateau. I am very excited to start working with him this weekend. It has been a few months since I stopped seeing Sandy, my physical therapist. I really miss her, both personally and professionally. It was encouraging to have the regular, personalized guidance and to have someone cheering you on. I know a personal trainer can't bring the same level of experience and knowledge on this particular rehab, but his brand of guidance and cheering will be appreciated.

I have a few other notes: first, a reminder that not all aquatics classes are the same. I attempted to join an aquatics class held in 4 ft water which involved a lot of walking around the pool and some bouncing or hopping. I tried to keep the impact minimal, but I still had to leave before the class was over as I kept getting a "tweaking" feeling in my knee. I am glad I didn't stay - the knee was sore for days. Clearly only a class where movement around the pool is swimming-based and not impact-based will do.

Second note: I forgot to ask at the 9 month mark whether I could start to use the elliptical machine, so I followed up outside of my appointment schedule. Dr. Trice approved! Most ACI patients probably would have been allowed to use an elliptical much earlier, but I went over the reasoning for my particular guidance here so I won't repeat myself.

Also, a few weeks ago I relearned how to get up from sitting on the floor with no aid. It's such a small thing, but knowing I can get up makes me less afraid of falling. It's only February, so I expect there will be more ice and snow yet (though it is in the 60's today!?!)

So overall I am definitely progressing well, but I need to build more muscle and start losing some of this weight that I have put on over the last 2 years. I'll check in again in a few weeks after I have worked with the personal trainer for a bit.

Doctor Appointment (one week shy of 9 months)

Despite my little panic yesterday with regards to the snow, I really wanted to make it to my appointment with Dr. Trice to have him look at my MRI results. I dealt with the traffic and the slippery roads and it was worth the trip. I handed off my MRI CD when I arrived, and by the time Dr. Trice came into the examination room he had taken a look at them. He entered, saying "I hope your knee feels as good as your MRI looks!"

So, hooray! My MRI was showing about a 95% fill, with a little gap in the anterior region that might still fill itself out as the tissue matures. That's a pretty awesome result for such a large defect, so I am very happy. It makes me worry a little less about still needing to pop it regularly to get it operating smoothly. I still think the brace is causing that anyway.

We talked about what activities I could and couldn't do. I asked, mostly out of curiosity, when I might be allowed to jog if my recovery continues to be successful. His answer was the one-year mark, meaning this March. That's actually earlier than I was expecting! I have a number of people who would like to cheer me on at my first 5K.

I was instructed to up the weights on my SLRs. He wants me to get to 15 lbs. I need to buy new weights!

The best part was that he set my next appointment a full three months from now. That's how confident he is in my progress! My next appointment actually falls exactly on the one year anniversary since my ACI.

Rough Day

This morning there was a holiday party in my office. I went to the room, but it was fairly crowded. All I saw when looking at the crowd was a bunch of people who might knock me down. I panicked a little. When I got back to my office I was a little upset. I've been doing so well and I just wasn't expecting to encounter so much fear. It really shook my confidence.

And now it is snowing enough to lay down a slippery layer outside. If I fall, I don't know what would happen. I don't have normal balance, so I may not be able to recover. I can't get up from sitting on the ground without something to grab onto, to pull myself up. If I fell on the sidewalk, how long would I have to sit there until someone came along to help me?

I don't want to be so fearful. I'm having a rough day, but it's all inside my head.

MRI

Last night I went to get a 3.0 Tesla MRI, which is basically a very powerful MRI screening that can produce high quality imagery. Here's an article about the very one that I went to at the Hopkins Outpatient Center.

It takes a while and isn't the most pleasant experience. For 35 minutes you have to hold very still in a very cold room. It's really loud, even with the earplugs and thick headset, so you can't fall asleep. That being said, you aren't trapped in a tiny tube so I didn't get claustrophobic. The tube is big and your head and arms are outside of it.

I am very excited because this is my first MRI since the surgery and I have an appointment with Dr. Trice tomorrow where I will find out what it shows him. I feel like I am doing pretty well, but I would like the reality check.

8 1/2 Months out

I was looking for a specific post for someone and ended up reading some of my own blog. I'm glad I wrote it, since I think a few people may have found it helpful, but also because I would have forgotten a lot of this.

I saw my massage therapist (MT) again this weekend as my shoulder and upper back have continued to give me problems. It seems like the discomfort starts to build up over about a month before it becomes very bad. It makes sleep difficult because no position is really that comfortable. I'm going to start seeing him for 30 minutes every 2 weeks now to try to stay ahead of the building discomfort.

While I was there, I had him go over my knee to break up scar tissue. It's pretty unpleasant and difficult to do an adequate job on yourself. My MT suggested using a topical analgesic, such as Biofreeze, to dull the pain while using quick, short strokes to break up the scar tissue. It's a good suggestion and helps dull some of the aches too.

The knee gets stiff still and often I will feel pressure in it until I get a good pop out of it. (It's audible, so sometimes it catches people off-guard, which is highly entertaining.) I think that is due to the brace though since it pushes things out of a normal position. I've been walking up to 2 miles at a time, and the increase in distance may be one of the factors that have helped the knee feel smoother lately. Well, sometimes anyway. I am still quite aware of the knee but my limp has gotten noticeably better in the last few weeks. It's almost gone.

I added a new link on the right to the Chester ACI Rehabilitation Guide For Femoral and Tibial Articular Cartilage Repair, that someone shared on the knee geeks forum. It's a great find! It covers both the surgery and the rehab in one document. I was reminded again by reading that document that Dr. Trice is keeping me on a very slow path. Perhaps ACI is easier for some others? But then again, I don't seem to have any complications so it can be harder for others too. Anyway, it's a good reminder to mention to any readers that I was really bad off before, so don't get too scared. My experience might be on the more painful side.

8 Months Out

Yes, I know I posted the last post a little past the 7 month mark, but I was talking about an appointment that happened at about 7 months out. However, today actually does mark 8 months since my surgery.

Tomorrow is Thanksgiving and I am hosting. Since cooking is a hobby of mine, it will be nice to be able to stand in the kitchen again. Last year I did very little because it hurt too much. It is good to have something to be thankful for regarding the knee.

My knee is doing pretty well. I can still feel it most of the time. It aches and sometimes feels very hot, but never any sharp pain. Icing still feels good. I can go for walks now, so I accompany my husband as he walks the dogs. I used to be the one that walked them most of the time, but it's been almost 2 years since I've been able to do that. It's funny that I still remember my reaction to the first OS when he said I needed MFX and would spend 4 weeks on crutches afterward. I was shocked by that length of time. Now, that reaction seems kind of cute and innocent in retrospect. I suppose I have become a more patient person.

My shoulder has been bothering me. I think it is related to the remnants of my limp. It doesn't hurt exactly, but then again my standards for defining something as painful are not what they used to be. It just makes it hard to get comfortable. I have leftover pain relief goop from seeing the pain management doctor before my surgery, so I am using that. I don't want to take Tylenol too often since it can be rough on the liver. I'll see my massage therapist again soon too. A sports massage therapist is definitely the way to go when healing. It's such a more practical approach versus a traditional massage therapist.

There was one other interesting thing that happened in my last appointment with Dr. Trice. He seemed unusually happy to see me in the office, but I think I figured out why. When he came in for the consultation he introduced a nurse practitioner that was sitting in on his meetings with patients. Clearly she was not an orthopedic nurse because he was explaining to her what a MFX is, though I suppose she could have just been too polite to correct him! I am guessing that she was following various doctors within Johns Hopkins to understand their jobs better.

After I asked my questions of Dr. Trice and he answered them, he told me to tell this nurse how long I had been dealing with my knee. "Almost 2 years." I said. He told me to describe my condition before the ACI. I don't get asked that very often by someone who actually wants the full answer. I obliged, saying " I was in pain every day whether I was walking or not. With daily prescription pain medication, I could work in the office only about 2 days a week and work from home the rest of the time. The floors there just hurt and the times when I would uncontrollably scream from the pain were embarrassing. Without pain medication, I could barely get off the couch."

About here I realized Dr. Trice was showing me off. He told me to get up and walk across the room. I did so. He asked about my current pain level. I said it really didn't hurt, just aches, so perhaps a 1 (on the trusty 1-10 scale that you get asked about all the time). The nurse's eyes were huge and all she could say was "Wow." It's a lot to comprehend, which is why I usually tone down my descriptions of the experience in casual conversation. I believe Dr. Trice was happy to see me because I am a good example of the impact his work can have on someone's life, and that seems to be what he wanted to show her. It's kind of nice to be thought of as a success story, even if I'm not out of the woods yet.