Week 7 - Turned a corner

Sandlot (1993) - must see, classic

Lots of progress this week, on multiple levels.

My PT told me that I turned a corner! That I  was walking with an extra bounce in my step. I got lots of hugs and high fives and I can tell that she is really proud of how much work I am putting in. What's so good:

1) First of all, my extension and bending are really improving. My extension is -5 degrees! So only two degrees away from normal (what my left leg is). And my bending reached 138 degrees. Both of the measurements are new achievements for me and it feels so good to be progressing each week (finally). Apparently, I have to keep working on my stretching because 12 weeks is the deadline. Whatever I have at 12 weeks is what I am going to have FOREVER (I am saying that like on The Sandlot). FOR-EV-ER...

2) My VMO is finally responding to treatment and exercises. It is getting so strong and so I can see a dramatic movement of my knee cap when I do my quad sets. So I get to quit doing the electrical muscle stimulation!!! Yay!

3) And, since my muscles are starting to get stronger, I get to really start to increase my strength training. Last week we started doing hamstring exercises. This week we added squats and this cool new exercise called the Star exercise (video below).  For this you stand with your knee slightly bent and keep your hips square. Then you move you other leg around you, touching at 5 points. Front, 10 o'clock, 9 o'clock, 7 o'clock, 6 o'clock. And then back again. I think this helps with balance and stability and quad strength.

Elliptical

I did the elliptical machine for the first time since the surgery today!!! I was a bit nervous. But then the girl on the machine next to me asked "ACL?". Yup. She said that she was four months out from her surgery and had just been cleared to run. I said congrats and that I was 5 weeks out and had just been cleared to do the elliptical. She said "You can do it!". It was just the encouragement that I needed. Sometimes people are really nice.

I only did 10 minutes and was not just allowed to have any resistance. But it was fun and felt like quite the accomplishment!

Week 4

This was a really hard week of physical therapy. I literally spent about 10 hours in PT this week. Maybe more. It was really intense.

I regressed! Although I did all of the exercises to improve my extension and continued to work on my flexion (bending), my extension is worse than last week! NOT GOOD! Like a lot worse. I can't get my knee straight anymore.

My theory on this is that I tried too hard to get things to work and, as a result, I stopped focusing on my VMO and instead worked other stronger muscles to compensate. This resulted in a lot of pain in my shin. And, needless to say, didn't help. You can't force things!!! During my second follow-up appointment with my surgeon, he told me to relax. He said that a lot of resources say that patients need to get to full extension by 3 weeks or 4 weeks at the latest (which is now). But that really I have until 6-7 weeks. He said that I have a lot of tension in my body and that it doesn't help matters. He can tell that I am trying hard (which my PT substitute guy is unaware off) and he reassured me that my muscles will come around. He is nice.

So we added some new and exciting exercises to my current routine:

1. prone hangs with weight for 1 hour each day (ouch!)
2. a hyperextension brace to sleep in
3. electrical muscle stimulation (EMS) - to use electrical impulses to make my VMO contract; reminds of frog sciatic nerve experiments in cell biology lab in college

The amount of pain that I am in increased a bunch this week. I am exhausted and pretty stressed out.

Week 3

Working with the substitute PT guy and it was tough!

My bending is getting better. We measured it at 95 degrees, with me sitting at the end of a bench and holding it back with my left leg. This is great because it meant that I was able to get on the EXERCISE BIKE!!! I am not yet able to make a full revolution so I have to rotate the petals forward as far as I can and then backwards as far as I can. This will help me to back to a normal range of motion (ROM).

So although my bending is progressing, my extension is not. And this is bad. I am still at zero. And we tried a new test. When I hyperextend my left leg (the normal one) I am able to make my heel naturally just pop up off of the mat. It occurs really easily (try it at home!) but it requires me to be able to contract my quad muscles. We tried this test with my right leg and my heel didn't budge at all. So this is something that I am really going to work on. My VMO (vastus medialis oblique) is the quad muscle that I need to get to fire to make the hyperextension occur. This is the muscle that I have been working on by doing the quad sets. But it is not strong enough.

So I have a LOT of exercises to do this week:

1. heel props 10 minutes every waking hour (can heat back of knee with a heating pad)
2. quad set every waking hour
3. straight leg raises
4. side-lying his abductions
5. calf raises
6. patellar mobs
7. seating knee bending
8. practice walking in brace
9. heel props with ice
10. exercise bike for 15 minutes

Well, I am going to do these exercises because it feels really bad and frustrating to not be able to do something. I don't like feeling like I am not progressing as fast as I should. This makes me nervous.

Physical Therapy #2

This was a fun appointment. I started to feel like I am making progress.

We added exercises to those assigned in the first physical therapy appointment. These are a lot of exercises and I am starting to realize that physical therapy is a real time commitment. But it is really important so I can't slack on this.

Especially because my extension is still at 0 and we are starting to get a little bit worried about getting my knee to hyperextend like my normal knee...

1) calf raises with equal weight on both legs
2) single leg raises (SLRs) with both legs. Left leg in all directions. Right leg (injured leg) just to the front and to the side. I can't SLR to the back because I can't work my hamstring yet.
3) roll in chair to bend knee. hold for 10 sec and push back (this is a good exercise for me to do in lab).

The best part of this appointment was that we UNLOCKED MY BRACE!!! I learned how to walk with the brace and the crutches but this time I could bend me knee!! Very cool. We also worked on walking up and down stairs in the bendy brace. I have to take one stair at a time and use a hand rail and a crutch to support myself. Not natural at all yet but it is nice to start to feel a little more independent and strong.

Next week, I am going to be working with another physical therapist because my person is going on vacation. This makes me a little bit nervous but I am sure I will be in good hands.

at the top of some stairs in a bendy brace
work it girl!

First follow-up with the Surgeon

This was a quick appointment. We did an X-ray of the knee. It looked great. Then, the surgeon and the intern quickly checked my flexion and extension. I started to try to make my knee bend as much as possible and the doctor stopped me and said "we don't need anything heroic". I laughed. They just wanted to see that I could bend my knee. They didn't even measure the angle. My extension was zero, meaning that my leg was able to get completely straight, which is very important at this stage. The intern removed the stitches from the incisions for the arthroscopic part of the surgery. These are two small buttonhole-like cuts on both sides of my knee. It didn't hurt. So far, so good.

Physical Therapy #1

I was really nervous going in. I didn't know what to expect and still hadn't really re-established a relationship with my right knee. I was timid and reluctant to touch my knee.

But at the beginning of PT, I was told to touch my knee and that it needs LOVE. So I felt bad because I had been so timid and scared of my knee.

So my exercises for the week are:

1) heel props
2) patellar mobilizations and also rubbing the scar tissue
3) quad sets
4) single leg raises
5) knee bending (with assistance of my left leg)
6) desensitizing knee with different fabrics

Also, I was allowed to put some pressure on my leg. Walking with the brace (locked into the straight position) and with crutches.

Finally, I was told to rely on acetominophen for pain relief because the one of the stronger painkillers makes patients emotional and constipated.

Day 5 Undressing

So I have been deliberating for a bit on what to show my readers when it comes to the actual wounds from surgery. I don't want to cross that line of TMI or show anything too gross. But also, I want to be informative and "keep it real", as was stated in my mission statement. So after discussion with some close friends, I decided to show you some pictures. A word of caution if you get squeamish easily.

Okay. So the nurses said to switch my dressings on day 5. This would involve removing the white compression stocking. Then the brown ACE bandage that was wrapped tightly around me knee. Then the white gauze and some large white bandaid-like things. Finally, butterfly bandaids. We were told that the butterfly bandaids would come off when they were ready. So since most of them didn't come off on their own volition, we left them there.

Figure 1. Removal of dressings. A) The ACE bandage was found under the white compression sock. B) Under the ACE bandage was white gauze. C) After removing the white gauze and some large square patches, I saw this. These bandages were not yet removed as them seemed very firm and not ready to be moved. 

The knee was not as gross as what I was expecting. But it was definitely swollen and had some markings on it. I could see one set of stitches out of three (two for the arthroscopics and one for the graft). This was a relief because I was most nervous about the wound left from the hamstring graft. My leg overall looking weird because my thigh seemed to lack all muscle and was just kinda floppy. My knee was big and round and my foot was also swollen and club-like.

I was happy to redress the wounds.

Figure 2. Replacing dressings. A) First we put back new gauze and the ACE bandage. Then I put the compression stockings back on. The left leg stocking just keeps my leg warm. B) The non-slip socks were added, as well as the ice machine. C) Finally the brace! And I am as good as new. Almost. Soon. Hopefully.

Update on Bendy Machine Progress

My pain threshold significantly decreased when the nerve block ran out. I felt like I could feel so much more pain along the front of my knee that I had been blissfully unaware of before. As a result, the bendy machine hurts A LOT more. Not discomfort but actual pain. So I have been making progress a lot more slowly. But I am hoping not to regress again. I think if I continue to more forward I can still reach the goal of 110 degrees by my second follow-up appointment. 

Check it out this new chart. It is more simplified than the last. I simply want to convey that I am increasing the angle of flexion of my right knee overtime (slowly but surely). 

Sweet Inspiration

My incredibly sweet boyfriend had a present delivered to me today. It was a poster of RG3!!! For inspiration. We posted it over the TV so that now when I want to quit the bendy machine, I just look up and think "what would RG3 do?". Not only did the poster give me inspiration but it also made me laugh incredibly hard. 

Also, please notice the beautiful flowers on my mantel. The pink ones are from my awesome lab mates. And the yellow are from my very caring Mom and Dad. 

Thanks loved ones!

Bendy machine

Now it is time to describe the bendy machine. Its technical name is the CPM machine, which stands for "continuous passive motion". Misnomer!!! This machine is anything but passive! It is torture.

Here is a very boring video of me using the bending machine in the hospital. I was so pleased with my performance BUT it turns out it is easier to do the CPM in the hospital while under lots of local anesthesia.

So I have to track my progress. Below is my progress on the CPM machine since the surgery. It is not a perfect chart but you get the point. In pink are the time points from the hospital stay. In green are when I first got home and in blue are time points after my nerve block ran out. The size of the balls represent the length of time. The smaller balls are 1 hour and the larger are 2 hours.

Doctor's orders are to do the bendy machine 3 times a day for 2 hours each time, minimum. The goal is to get to 110 degrees by the second follow-up appointment.

Night of Day 1

Not good. 'Nuff said.

Post-op Goodies

So before the operation I got my brace and crutches. Basic tools.
But after the operation, I got more goodies that are so wild that they each warrant their own post.

1. the bendy machine
2. the ice machine
3. the nerve block

I think for many ACL reconstruction surgeries some of these gadgets may be optional but recommended. I highly recommend all of the them and if your surgeon doesn't provide them, change surgeons. Seriously. Change surgeons.

Day 1 Back home

smile is hiding grimace

Swollen leg with brace and ice machine

Day 0 Fuel for the Fit

Day 0 Drugs are Good

Before Drugs

Drugs

After drugs

Pre-op preparation

1. Stocked the kitchen with lots of water and gatorade. Soup and apple sauce.

2. Packed a small toiletry bag with toothbrush, toothpaste, etc for overnight stay in hospital.

3. Books and magazines. Including Mindy Kaling's book (present from David).

4. Crutches and brace.

Pre-op appointment

I was nervous about this appointment. But immediately felt better afterwards. I like my surgeon. Young but confident. High energy but not spastic. He gave his spiel and told me statistics about ACL surgeries in general and his practice, specifically.

Then he let me ask questions. He answered them all patiently, even the silly ones. Like, will I have to remove metal body piercings? Yes. Bummer. Oh well. He said some of my fears were "common but irrational". Okay. That makes sense. He was being honest with me.

Then my knee was examined again. Lachman test. Yup, still have a torn ACL...

Then I got fitted for my crutches and my brace. I got a cup of green antibacterial soup. And intern came in asked me if I drink or use drugs. (answers will remain undisclosed for the purposes of this blog).

I read some forms. Asked more questions. Signed some forms (the subjects I wish don't ever have to come into play).

Fingers crossed.

Sometimes Honey Badgers Care

I play defensive back for the Honey Badgers. And to say it nicely, "Honey badgers don't care".

So I stayed in the game and played as hard as I could after I stopped quickly to avoid a collision with my goalie and an the other team's striker. I had been running full speed when I went down.

My teammates huddled around me and when Jan tried to touch my knee, I scooted away anxiously. She said  I looked like a "dog with diarrhea". Which made me howl with laughter. Only Jan could make me laugh within minutes of destroying ligaments (yes plural) in my knee.

But I shook it off and finished the game. And the next one and the one after that.

I'm a honey badger, after all.

Or so I thought, until I heard that another player who was injured later in the same game had gone to the doctor and received some bad news. Torn ligaments. It was three weeks out from the injury and my knee was still swollen and still hurting. So I made an appointment with the sports med people.

Bad news and this time I care.