recovery: part 2

It’s been a couple of days since my surgery now–in fact it is almost exactly 48 hours since I was discharged from the fine Central Park Surgery Center facility. I actually started writing this entry the same evening I had surgery but after reaching two sentences I became disgruntled and took a nap instead.

The last couple of days have been interesting. The pain this time around is a lot less than the pain last time around, which was to be expected, I suppose, since the procedure was far less… serious.

Day 0 PS (9/13/2013)

I won’t go through the pre-op process and all that again since it was pretty much the same as last time. The anasthesia worked and did its job well and I woke up in the recovery room with a cracker and apple juice in my hand.

I have still not figured out the specifics of what they did in my knee but as I understand it, they basically cleaned up everything from my previous surgery. This included removing the “hardware” (washers and pins that were responsible for holding the previous reconstructed ligament to the bone until it grafted) from the previous surgery and getting rid of the remains of the old ligament. They also trimmed my medial meniscus because it was apparently too lacerated to be repaired. I’m not sure if they removed it completely or just trimmed the part that was torn and in my joint, though.

The surgery took about 2 hours and I spent an additional hour in the recovery room. I came back home and took a nice, long nap on the painkillers on Friday and survived on a diet of fruits and liquids (juices and such) since that would supposedly allow the anesthesia to get out of my system the fastest. I slept a bunch on Friday but since I was not in that much pain (they had supposedly injected morphene into my knee joint) I did remote in and got a little bit of work done.

Day 1 PS (9/14/2013)

On this Saturday I spent most of the day lying in bed watching football. Not a bad way to spend the day if you’re a professional couch potato. I’ve kept my leg elevated almost constantly since surgery. I probably spent less than 10 minutes off the bed on Saturday, and that was just to walk around the house a little bit and use the restroom.

I had a delicious lunch of lamb curry and rice cooked by my uncle which lifted my spirits considerably. Rice ended up squeezing through a victory in their game against Kansas so that put me in a good mood, as well. I ended up going to bed around 10:30 PM with a fresh batch of ice in my ice machine and slept without interruption till about 5AM. At this point I disconnected the ice machine since it felt a bit wet and went back to bed for another couple of hours.

Day 2 PS (9/15/2013)

When my uncle came in at 7.30 AM to replace the ice I said that the leg felt wet so I was going to open it up. I went into the bathroom and went to work on the bandaging and its many layers. The lowest layer of gauze was fairly bloody but it was also all dried. So the wetness that I was feeling just appeared to be nerves down around my knee being pinched or something.

I got rid of all the old dressing and then put some new surgical dressing that my uncle had bought from Walgreen’s and wrapped it all up. There’s maybe 1 or 2 fewer layers now because I can definitely feel the ice pack when I reconnect it. I’m not putting it on all the time, though, because I’m afraid that the moisture might seep through and get the wound wet.

Pain levels have decreased to just discomfort. I’m still not taking the risk of testing my knee too much but the last dose of hydrocodone I took was last night at around 7:30 PM and I have been able to sleep and such without too many problems. Hopefully this improvement continues.

NFL is about to begin in just about 29 minutes so the rest of the day is going to be focused around fantasy football!

going back under the kni– arthroscope

It’s almost been a full 2 months since I last posted something literary, and that post also happened to be a couple of days before I reinjured my knee. Since I’m going to be bedridden in a little more than 12 hours, I figured I’d get the creative juices flowing in anticipation of doing stuff to keep my mind occupied while recovering from my second knee surgery in as many years.

On July 22nd this year, exactly a year and 10 days after I had my first ACL reconstruction surgery and meniscus repair, I re-tore my ACL graft and meniscus while contemplating a game of volleyball. The entire injury was probably manifested over the last few months of my rehab where I had tweaked my knee a few times while running but was cleared to return to activities by the physical therapist.

Day 0 (7/22/2013)

On this fateful Monday, I was waiting in the rotation for a sand volleyball game when someone served the ball long. I retrieved the ball, turned around, took a skip step and threw the ball. Apparently my knee got stuck in the ground while the rest of the body pivoted and whatever was left of the graft shredded and took my meniscus with it.

The pain was not as extreme as I remember it being following my first ACL injury but still bad enough that I took a day off to ice it and got an appointment with North Austin Sports Medicine, the practice that handled my first surgery, as soon as I could. They sent me off to get an MRI and I spent the next three days or so icing my knee and staying off my feet. I then went to a bachelor party in New Orleans where I played phone tag with the surgeon’s assistant but couldn’t get through to find out what the diagnosis was. I did manage to reschedule my follow-up appointment to Monday from Wednesday through a series of voicemails. After doing extensive research on WebMD as well as the tests performed by both my primary care physician and the orthopedist surgeon, I was fairly confident that I had a medial meniscus tear. While this wasn’t ideal, the recovery schedule for this injury was about 3-6 months, a far cry from the 12 months I had just spent from my prior surgery.

Day 14 (8/5/2013)

I got to the orthopedist surgeon and after a 10-minute or so wait outside, I was ushered into a room and given my MRI results in paper form. I was then left to stew in what they said for the next 30 minutes or so, in the normal waiting game that NASM likes to play. This summary was pretty straightforward:

Impression:

  1. Complete tear of the anterior cruciate ligament graft.
  2. Displaced bucket-handle tear of the medial meniscus.
  3. Moderate knee joint effusion.
  4. Status post resection of the medial synovial plica.
  5. Mild bone marrow edema of the proximal tibia.

That first line was the killer blow. The world didn’t spin around and I didn’t throw up in the doctor’s office, but I did spend the next 30 minutes gathering my thoughts and preparing for the spiel.

The surgeon came in and seemed genuinely disappointed and surprised and went ahead and recommended surgery as soon as possible but definitely within the next 1-2 months before scar tissue began to develop that prevented my knee from straightening, or before the cartilage tear got any worse. Unlike last time, I asked for a copy of my MRI with an intention to get a second opinion and an even stronger intention of going with the second opinion’s expertise for the repair surgery. While I have few problems with Dr. Brotzman, unfortunately his practice is not very well-managed, at least as evidenced by how long a trip to see him usually takes.

Day 16 (8/7/2013)

I scheduled a second opinion for this date with Dr. Carey Windler of Austin Sports Medicine. A few people I know have been to this practice and had nothing but good words for them. I even know two people who’ve had ACL reconstruction surgery there and have been recovering well. I took a copy of my MRI and they were able to access my last x-ray.

The verdict was pretty much the same: surgery. However, Dr. Windler suggested a different process, which was to fix my medial meniscus tear first (as well as undo the stuff from the failed ACL surgery) first and get that healed up completely and then follow by getting the ACL reconstructed next year. While this would be more expensive and increase my rehab time by a few months, it also made a little bit of sense for me because I could see how life was without an ACL (but a good meniscus). If I choose to go without an ACL long-term, I’ll have to cut out most all sports and running, and start swimming and biking. It’s a decision I haven’t thought about extensively and won’t really until my rehab from the first surgery is winding down.

In the weeks following this meeting I contacted NASM to attempt to talk to Dr. Brotzman about Dr. Windler’s opinion but I was never able to get him on the phone. Since they didn’t seem to want my business, I decided to go with Dr. Windler for my procedure.

Day 52 (9/12/2013)

Over the last month or so my knee has felt better and gained strength but I still cannot extend it completely apart from, of course, being unable to run, cut, etc. At this point I’m probably back to the lowest physical form of my life (sadness). However, I did give up a little bit since it didn’t make sense for me to go hard with my workouts when I knew I would probably be spending about 3 weeks without any exercise anyway. I know, it’s rationalization at its finest, but I was okay with it.

My first surgery–to repair the meniscus and undo the work done in my previous surgery–is scheduled for tomorrow at 8.15am, which means that I will need to reach the surgery center at 6.45am, which means I will be having a very, very early day. My uncle has flown over from Las Vegas to help me out and that coupled with the fact that I’ve been through this once before has me feeling cautiously optimistic about the surgery and recovery. Hopefully it will all go as planned.

I’ll be using my bed-ridden state to blog ferociously and perhaps even work on some Windows Phone apps that I’ve been putting off, in between spurts of pain medicine and naps. We’ll see how it goes. Onwards to surgery!

16-week milestone

My left ACL is now 16 weeks and 1 day old. The coolest part about this is that I can start running again. The uncool parts include finding out how difficult running is going to be again and also waiting the 2 months until I’m cleared for sports. Especially now that NBA season has started and the Rockets are young and exciting. But I guess I cannot complain since I’m technically 67% of the way through, now.

I will admit that I have become quite lazy at rehab so I guess the 6-month mark may be pushed back a little bit. This coupled with the fact that my physical therapy appointments are now down to once every two weeks (more a function of not wanting to pay $140 a month for basically going and doing the same stuff over and over again) means that my recovery is a little slower than expected. But the dog adoption has ensured that I at least walk 20-25 minutes each day at a pretty brisk pace with effective resistance (Tucows still pulls on the leash quite a bit).

Next week is the San Antonio Half Marathon which I will obviously not be running. I’m contemplating going and supporting the one remaining friend who has not dropped out because of injury, but things like having to put the dog in boarding will probably make this an actual decision. Luckily, San Antonio is only about an hour and a half away and a really easy drive. And the weather should actually be good to walk around the river.

Anyways, that’s about it. Just a miniscule update on the ACL. I’ll be putting up a review of my Microsoft Surface (which I bought last Friday) over the weekend.

6 weeks out of surgery

Day 46 PS

Hello, my name is Jamtarnet and I am Jack’s Sohum’s new ACL. I am only 46 days old and also casually known as Jammy. I was named after Sohum’s hamster, the late Jamtarnet Jockeroewelxery. I guess that makes me JJII which kind of makes me feel like I’m dyslexic whenever I write my name but since I actually do not know how to write, this is not really going to become much of an issue.

I was actually going to write a post about the way I celebrated my first month of existence but unfortunately Sohum never let me get on the computer. He told me I should stop being so kneedy. I told him he shouldn’t have to resort to crappy puns to be funny and that he should let his fine sense of humor guide him. I think he thought I was being sarcastic because he proceeded to douse me with hydrogen peroxide.

Anyhow, I feel like my time in the world that will mostly be spent holding two bones together should exceed my predecessor’s. And I don’t mean just Jammy, because that would not be a very confidence-inspiring statement (Jammy couldn’t last through one summer). I have my eyes set on my competitor in the other knee–Portubus Pinternnacle–but only in an Olympics sort of competitive way. For those who don’t know what that means, it means that I will spend my time watching him every weekend for about 20 waking hours.

The recovery is on target. The doctor inspected me and told Sohum that I was looking spectacularly solid and that I wouldn’t need to be seen for another 2 months. I’m counting down the days to January, when I will be allowed to support Sohum as a friend in knee(d). Until then I will just have to watch basketball and hope that my contemporaries in Ricky Rubio’s and Derrick Rose’s respective knees make as strong a recovery as I will be making.

Until knee-xt time!

crutchlessness is the way to be

Day 25 PS

If you’ve noticed the frequency of my ACL-rehab posts going down, it’s because the frequency is inversely correlated with how good the rehab is going. The last week and a half have definitely been mostly positive and I feel like I’m getting back to a mostly normal lifestyle, minus the ability to really exercise with my lower body.

Last Friday, I was finally told that I can ditch the crutches. That was not entirely surprising and it was in fact something I had been expecting for a while. What I was also told is that I could unlock and even get rid of the brace if I was feeling up to it. I most certainly was because that brace may have been one of the most uncomfortable and annoying things I’ve ever had to wear. So this weekend was the first weekend without any sort of weight-bearing aid.

My walking gait has been a lot better though my knee extension has stagnated with about a degree or so remaining to be straightened out. Part of this is my fault since I have been lazy on doing the rehab at home. Knee flexion is returning slowly–I’m up to about 120 degrees as measured today at my physiotherapy appointment. I even managed to play some really poor badminton in my backyard this weekend–provided the shuttle was hit directly to me!

At PT, the rehab has got somewhat redundant. The only new exercises I’ve been introduced to over the last few sessions has been related to the balance board. This is basically a square piece of wood that has a kinda half-cylinder attached below it which it can pivot on (kinda like a see-saw). You can position your feet either perpendicular or parallel to the underlying cylinder to have two different forms of balance. The exercises I’ve done included tapping forward and back for a minute, just balancing for a minute and almost tapping forward and back for a minute. Last week I also did an exercise where I was on the balancing board and throwing a basketball at one of those spring-nets set up on the ground and catching the returned ball. That was kinda fun. It’s a great calf workout.

Right now, it seems like PT is kind of stagnating and the main reason I’m coming back is to make sure I actually rehab since I’m not doing it at home. However, I’ve now been given the greenlight to workout in the gym, including some lower-body exercises–such as the stationary bike (up to 20 minutes) and light-weight leg presses (single and both legs) as well as calf raises. Now, I just need to find a gym.

I’m approaching the 4-6 week period where the graft is supposed to be at its weakest. Or that may be the 6-8 week period. Who knows? Either way, at 6 weeks the graft should be at its weakest and I’ll need to take it easy. That is going to be around August 26th or so and thankfully I have nothing physically exerting planned for then.

Future updates to this story will probably be in the form of any new PT exercises or any other major developments (such as finding out that they injected me with some sort of liquid metal that will make me a Wolverine-Transformer hybrid).

bmi is a crappy measure of healthiness

Day 16 PS

Yesterday, I stepped on the scale for the first time since my surgery to check my weight. I was down to 150 lbs which, combined with my height of 5’6″, meant my BMI was down to 24.2. That happens to be on the very edge of a “normal” or “healthy” BMI. This is probably the first time I’ve been down in that healthy category in a loooong time. For the longest time, I’ve been right on the boundary between healthy and overweight. I blame my height. And my superior muscle mass.

But yeah, measuring my weight kinda quantified how much muscle mass I’ve lost. I’ve done absolutely no resistance training of note since the Tuesday before surgery, when I did a few bench press sets, and I’ve eaten a lot more calories than I’ve burnt. But I’ve still lost on the order of about 5-6 pounds. This would be confusing until I look down at my left thigh and see how depressing it looks. My right thigh is still kinda holding it’s own (it may even have gotten slightly stronger because it has been carrying more weight) but my left thigh is just a fraction of what it used to be. Luckily, that muscle matter is slooooowly coming back. But I’m impatient.

Watching the Olympics is probably one of the worst ideas when rehabbing an ACL injury because I’m (a) seeing people who are (mostly) at the pinnacle of their physical fitness and (b) not really being inspired by it (or, at least, not being able to transform that inspiration into actual results).

Okay, so all that was slightly negative.

The good news is that I have finally been able to get my left leg straight independently. 0 degrees, baby! Which means that by the end of next week, I should probably be  cleared to be crutch-free every where. The pain is down to about a 1 or 2 at the max and a 0 in most cases. I still haven’t been able to get full flexion but apparently getting that leg straight is a lot more important.

On Friday at the PT, I got on the stationary bike for the first time. It. Was. Extremely. Painful. Apparently 105 degrees is what I needed to be allowed on the bike. I had 110. It still caused shooting pains. All part of the rehab process, I suppose.

I’m looking forward to next week, though. I’ll finally be painkiller free, antibiotics free and hopefully crutches free (by the end of the week). I’ll also be able to cut down my PT appointments to once a week, which will be a welcome break for my wallet. Until then, I guess I’ll be reduced to watching the Indian athletes crash and burn at London and not feel as bad for myself.

managing

I’m going to go ahead and change the number to a post-surgery day so I have a better idea what is going on. Surgery happened on Day 52 so if you want to calculate days since injury, just add that number.

Day 13 PS (see what I did there?)

Before surgery, I greedily read up all the blogs I could find on the internet about people commenting about ACL surgery. Well, that’s a lie. I greedily read up around 5-6 blogs before tiring and thinking that I’d be some sort of unique scientific case to whom all the common symptoms/recovery processes wouldn’t apply. Of course, this wasn’t true. But it was nice to think about it.

Anyhow, I’m digressing.

The common theme that I think should have been prevalent in all the blogs but wasn’t, possibly because of the attitude the writers were trying to present, is that at some point or another, you’re going to feel sorry for yourself. It’s inevitable. And the reason I say this is because I think the vast majority of people who tear their ACL and actually elect to have surgery are active. My (unscientific) thinking behind this is that:

(a) It’s kind of hard to tear your ACL while being non-active. It’s not something that you just pull. Considerable force must be at play.
(b) Surgery is recommended only if there are additional tears that have long-term effects (such as meniscii) or with people who are young and don’t want to change their lifestyle.

An ACL surgery makes you go from some amount of activeness to no amount of activeness. It sucks.

Personally, in the weeks following my injury I laid low from a fitness perspective. When I got injured, I was in the best shape of my life (which is not a huge compliment to my fitness regime, by the way, because there was still lots to improve). I was playing basketball about 3 times a week and running about 3 times a week. My vertical had improved by at least a few inches in the past few months and I was about an inch or 2 from touching rim… which, for a guy who barely hits 5’6″, was pretty exciting. All that changed in the matter of seconds.

Following my injury, my leg didn’t really permit me to engage in any form of exercise. Thankfully, the initial swelling finally subsided and I had the chance to dedicate some much needed time to my upper body. I swapped out my fitness regiment to basically lifting 3 times a week and additionally alternating between shoulder sets and arms sets on those days. Once my legs became stronger, I added some stationary bike and leg presses. I was losing lower body muscle but I was still relatively fit since my metabolism was higher whatwith all the resistance training.

In the two weeks since surgery, my only exercise has been my rehab exercises. And. It. Sucks. As a person who was trying to get more active and actually enjoys it, ACL tears and surgery sucks. It doesn’t make you depressed but it makes you pretty damn annoyed. I went from exercising 5-6 days a week to working out my upper body 3 times a week to spending most of my day with my leg raised on a couch watching TV. The metamorphosis is unreal. My body hasn’t caught up with me yet, but I’ve lost most of the muscle mass I gained over the last few weeks in the form of fat. I’m afraid if this continue for a few more weeks, I’ll start actually putting on pounds on top of those pounds I already need to lose.

Anyhow, the rambly nature of this post is basically trying to say: if you are going to get ACL surgery, prepare yourself for at least some point in time where you feel really shitty about the situation you are in. For me, I have so far experienced this in the lack of an active lifestyle. But I know that when basketball season starts, I’ll be absolutely aching to get back on the court to play the sport I love. And it’s going to kill me to know that I can’t play until I’ve healed up well enough. It sucks.

Okay, back to regularly scheduled programming. Today marked the third straight day of going to work for a full day and it was also the first day since I got prescribed the new painkillers that I didn’t take any. My appointment with the PT also went well and I was cleared to walk without crutches at home. The walking is still a little rickety but I have good gait. New exercises at PT included balancing on one leg (both my good leg and my bad leg) and walking on the treadmill at a very slow speed for about 5 minutes (no crutches). It’s definitely nice to see concrete progress. My unknown-units measure went up from about 74 last time to 120 today. So that was a huge leap.

I’m guessing I’ll be allowed to walk without crutches, but with the brace, sometime next week. The criteria for having to walk without a brace is to do a perfect straight leg raise. Right now, I’d say my knee has about 3-4 degrees of flexion when it’s the straightest I can get it. I need to get that to 0. Apparently the only way to do this is to do a lot of straight leg raises.

Today, I also found out that the thing I thought was a nail in my leg is actually a pin that will eventually dissolve away. This is good to hear because it would be pretty annoying to have a nail in my bone for the rest of my life. I have provided photos below for people who are not Facebook friends with me.

Anyhow, that’s it for this long, rambling post. The gist of it is that I’m struggling to come to grips with my temporarily new lifestyle. But the progress has been positive and hopefully I can get back to the way things were sooner rather than later.

stitches be cray

Day 63

So I got my stitches out yesterday… woo hoo! Unfortunately, though, all was not well. Apparently some water had soaked in under the Tegraderm bandage and caused maceration around the wounds. Now, I had changed the dressing on Sunday and the wounds had been dry so I guess my shower on Sunday evening was to blame. Or probably the fact that I was running late for The Dark Knight Rises so I had to put the wrap on my knee before the are had dried.

Anyhow, my stitches, or, more accurately, sutures, were good to be removed so they were cut and removed. They also poured some hydrogen peroxide on it and asked me to keep doing that for the next couple of days to make sure the wound didn’t infected. They put some 3M steri-stips on the wounds which apparently keeps them closed, or something. I was also put on a 1 week antibiotics course. In good news, I was permitted to shower without a garbage bag (double woo hoo!). I’m hoping the wound stays uninfected.

I also went back for my first full day of work yesterday and it was not bad at all. In fact, the bending and straightening of the knees is promoting blood flow, I think, because the pain when standing up has decreased quite a bit. It’s still present, but it’s probably on the level of a 4-5, now. If I had to rank the pain, I have the most while standing still, the second-most while walking and the least while sitting down with my leg flat.

That’s it for now! I’ll have some more photos later this week when the wounds don’t look disgusting.

not much change

I’m not going to get into a day-by-day breakdown of the last couple of days but there’s basically not been a lot of change. I did my rehab sets on Friday and Saturday about 3 times total so I’m slipping a little in that regard. However, I am starting to get annoyed that the pain quotient is pretty much staying the same. It’s not bad enough to necessitate the pain meds regularly but it is bad enough that I need to pretty much be on ice and horizontal most of the day.

One thing that has been slightly different, I guess, is that the nerves on my legs are starting to return, which means I’m getting a little itchy. There is a patch around my shin area that just feels like dead skin but is slightly painful to the touch. Not sure what is going on there, either. I do think the swelling has gone down considerably, because the ice pack doesn’t fit as tightly around my leg, anymore. But it may just as well be that I’m not doing my rehab religiously enough and am losing the muscle matter.

The plan is to return to work tomorrow and then play it by the ear as to how long I stay. I will be taking an ice pack so that I can keep swelling down since I’ll be sitting a large portion.

still in a significant amount of pain

Day 59 (7/19)

Just a short update about yesterday. The pain seems to be lessening but not at a really quick rate. I’m hoping the sharp pains when standing will go away by this weekend. Luckily, I did not really need the hydrocodone since I spent most of the day with my legs up and iced (30 minutes on, 30 minutes off).

I can comfortably walk with one crutch now, so that’s another positive. I suspect if I keep doing my rehab exercises (which I did 2x yesterday instead of 3x) then by sometime next week I should be cleared to walk with just the brace. Monday is the day of my follow-up where I will hopefully get my stitches removed and get some doubts cleared about what sort of pain I should still be feeling.

On an unrelated note, my Mom cooked a wonderful dinner for the four of my friends who helped me out last week. We hung out and talked after dinner for about an hour and a half. This was one of my primary reasons to get a house–so that people can hang out and talk for no reason. Haha. There’s also looooots of leftovers in the fridge so I have delicious food to look forward to tomorrow.

When I woke up this morning my leg was far less stiff than before but I still couldn’t go back to sleep for more than short naps after the first time I woke up. It may even be a good idea to just get out of bed and take a walk to relieve the stiffness when I first wake up. I’ll try that out tomorrow.

I dropped my Mom off at the airport today. I’m sad to see her leave because she obviously knew how to take care of me, having done it for such a long period of my life. I’m very thankful for the love my family gives me.