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.

the commencement of rehabilitation

This post examines my experience of ACL surgery through the rehab process, which is currently ongoing.

Day 53 (7/13): Rehab starts

At some point during the night, my nerve block wore off and instead of being greeted by unparalleled pain, which I had expected, I was greeted by the warming ability of being able to wiggle my toes again. Of course, the oxycodone probable played a part in deflecting the pain, but let’s just pretend that I’m some sort of Herculean man unaware of little things such as nerves complaining.

I had my first rehab/physical therapy appointment at NASM at 10 AM, which was somewhat problematic because I was in no condition to drive. My friends were also at work and I didn’t want to bother them more than I already had so I convinced my father that he would be okay to drive the approximately 3 miles that the therapy location was. In retrospect, I’m glad that the surgeon’s office/physical therapy center is so close to where I live.

We headed over to the physical therapist who undressed my wound and commented that it looked pretty great for the day after surgery. Swelling was minimal and she was surprised that my only pain, thus far, had been soreness from the hamstring graft. She did caution me that sometimes the pain got a lot worse before it got better and that I could expect a considerable amount in the coming days.

She had me do some quadriceps flexing sets and some leg raises, both of which looked good. She also put some electrodes on me and got a baseline measure for how strong my quads were. They were 35 of some unknown unit. Apparently my right leg, if I had measured it, would have been about 350 of the same unknown unit. Long way to go. She also had me walk around with my brace and crutches, but bearing weight on the operated leg. Satisfied with the results, she re-dressed my operated leg and said I was doing very well and was ahead of schedule in terms of recovery. But she still cautioned me about the oncoming pain. I’m glad she did, because boy did the pain come.

My rehab/pain relieving habits at home basically comprised of the following:

  • 1-2 tabs of oxycodone every 4-6 hours
  • 1 capsule of cephalexin every 8 hours to prevent infection
  • 1-2 hour sessions of this neat cryo-cuff cold therapy system
  • 1 hour sessions of a continuous passive motion machine to regain range of motion
  • 40-minute sessions of an electric muscle stimulator
  • Lots of laying around in bed with my knee elevated above my heart to prevent swelling
  • Lots of delicious comfort food

In preparation for the oncoming pain, I decided to switch from single tablets of oxycodone to two at a time. I guess it may have helped. But the pain finally came. The last of the nerve block finally wore off and the pain around my knee came. It wasn’t really debilitating pain but it was constant and annoying. The ice pack made it worse because I had to put it on to keep swelling down, but it just contribute to the pain because it felt like my foot was going to fall off. In honesty, the worst of the pain happened when going from horizontal to vertical as the blood rushed down the knee.

Going to bed on Friday night was particularly difficult and I actually made the decision to switch from the ice pack system to the CPM machine a little past midnight. Luckily my Dad was awake and he was able to assist in the changeover. In contrast to the ice machine, the CPM machine was nicely padded (with what I am envisioning is llama fur) and had a comfortable hum and repetitive motion that made for easy sleep. It did bruise the back of my thighs, though, although I’m told this is expected.

Day 54 (7/14)

I managed to get a good 5-6 hours of sleep on the CPM machine until it was time to chomp some pain meds at around 7 AM in the morning. My hunt for a snack was cured by a cereal bar which I essentially inhaled and popped a couple of pain meds and tried to go back to sleep. I went back to the ice machine in the morning and it was a lot more comfortable, although I still had to tune it down to an almost minimal setting.

Oh, by the way, something no one talks about when it comes to repairing torn ACLs is… constipation. Yeah, it’s kind of nasty. The laxatives don’t really help. But prepare yourself for that if you have to go through it.

Anyways, what made Saturday doubly special was the fact that I was going to have grihapravesh done on my house, or the Hindu “house-warming puja”. Of course, I was in no position to sit on the ground for 2 hours so thankfully my father substituted in on my behalf. After dozing for most of the morning on pain meds and machines, I finally got out of bed at around 10 AM and brushed my teeth. I took a short shower, which basically comprised of me painfully applying a garbage bag around my knee to prevent water from getting in and infecting my wound, gingerly stepping into the shower and kind of trying to get my body wet without getting the garbage bag soaked. The acquisition of a loofah helped greatly in the area of hygiene.

Once I got out of bed, I hobbled around a little bit and managed to catch the end of the puja. After that, it was time for another dose of pain meds and more time on the CPM machine. I think I was up to around 65 degrees on the machine by then (I’ll try to get more accurate numbers of this in future posts).

In the afternoon/evening I decided to venture out and drive and was able to do a short drive to H-E-B and Target. I walked around H-E-B and that quickly caught up with me as the blood rushed to my knee. It was quite painful and I had to sit down at Target while my parents shopped. When I got back, the ice therapy was a welcome change. The rest of the day was not really exciting and basically involved eating, watching movies and doing more rehab.

Day 55 (7/15)

This was more of the same as the previous day, except that my dose of antibiotics was finally done. I did venture out to a furniture shop with the parental unit and purchased a dining table but that was about as much as I could handle before I had to rush back to my ice packs. I also decided to take another day off work to make sure I was back to a decent amount of strength, and also so that I could get another PT session in.

Day 56 (7/16)

This is today. I’ve got about a day’s worth of pain meds left and the knee pain is still there but it is subsiding considerably. The swelling is still there. One of the wounds from the incision is still bleeding a little bit, but there’s nothing bad, according to the physiotherapist. The measure for my quad-thing, which was 35 unknown units last time, has nearly doubled to 69 unknown units. The physiotherapist was excited to see that.

At the PT session, my maximum flex was measured at 95 degrees, which was awesome because the target for 2 weeks is 90 degrees. I’m not sure how straight I could get the knee. I also walked without the brace, but with the crutches today and it went swimmingly. I’ll be doing this at home and walking in public with the brace.

There’s still pain going from a horizontal to vertical but a lot of it is counteracted by the psychological reassurance from the physiotherapist. I’m hoping for more of the same! The plan is to go back to work tomorrow for at least half a day and come back early and work from home if I see too much swelling. I’m planning to set up the CPM machine at 75 degrees tonight while sleeping, to keep working on that range of motion!

 

 

a day in the life of acl surgery

This is continuing the ACL surgery post I made previously. The rehab posts will probably be more frequent since I’m spending a lot of time off my feet.

Day 52 (7/12): Surgery time!

I waited almost a full 2 months since my injury before I had surgery. The surgeon had recommended at least a 2-3 week resting period so that my knee would have had the swelling die down and not be inflamed (and also because he wasn’t available before then) but, as I mentioned previously, I went ahead and postponed it by a couple more weeks so I could enjoy a short vacation. The beach vacation I had with my friends was pretty stellar, by the way. A group of 10 of us drove down to South Padre and spent hours on the beach, in the ocean, in the pool and in a condo. We got to know each other very well–maybe better than we wanted to in some cases. Anyhow, back to my story.

The surgery was scheduled at the Cedar Park Surgery Center which is an ambulatory surgery center out in Cedar Park. What this basically means is that I get discharged the same day as surgery. I conveniently scheduled the surgery for a Thursday so that I could take one sick day (Friday) and still get about 3 days of rest before I had to entertain the thought of going back into work. As I mentioned previously, having my parents here was extremely awesome because I had someone to talk to, someone to take care of me 24×7 and also a delicious supply of home-cooked food (which I would have killed for without having to go through surgery, anyway).

I had to check in at 7:45 AM on Thursday, which meant a departure of time of about 7:15 AM since the surgery center was about 15 miles away. Because of general anesthesia, I was not permitted to consume anything past midnight (not even water). Surprisingly, I was able to get a good night’s sleep, which I had not expected because of nervousness and anxiety. I’m not complaining, though.

One of my friends had agreed to drive me to the surgery center and she arrived promptly at the scheduled time. The three of us piled into her car, crutches in tow, and we were on our way to the surgery center. The trip took less than the estimated 30 minutes, pushing me closer to being a part-time cripple quicker. Wee hoo.

The surgery center was small but swanky. I checked in with the nurse and signed a couple of things to the effect of “if you are dying, we have permission to save your life.” All pretty straightforward. There was a nice little TV screen there that had a spreadsheet broadcasting when each patient had checked in and when they had been admitted for pre-op. This gave me a somewhat concrete estimate of how long I had to wait. I ended up in the waiting room for about 20-25 minutes and was taken in for pre-op around 8:20 or so.

The pre-op nurse asked me to change out of my clothes into an exceedingly complicated hospital gown and then lie down on a bed with socks and a shower cap (or so it felt like). With socks. She then proceeded to shave my leg in a fashion that will embarrass me for weeks to come. Basically, the front of my left leg from my thighs down to about halfway through my shin. There is hair everywhere else. It looks spectacularly strange. She also gave me a tiny thimble of water with a couple of relaxants or pain killers or something. I didn’t complain or ask too many questions.

I was then interviewed by the anesthesiologist’s assistant who made sure I wasn’t carrying any infections in. Pre-op nurse tried to subtly put the IV drip into me but I was fairly distracted. At some point some more painkillers or relaxants were put into my IV and I began getting woozy. This is also when the anesthesiologist applied a nerve block on my quads to ease the pain I would feel post surgery.

I remember a few more things… me initialing my knee to make sure it was the correct one they were operating on, the rather large anesthesiologist talking to me, the surgeon coming in and writing “Yes!” on my knee to make sure he was going to operate on the right one, being wheeled into the OR, taking deep breaths of oxygen from a mask and then eventually being told that they were drugging me. And then I dreamed about a cricket match but was rudely interrupted. Post-surgery.

For those who are curious, my new ACL was constructed with a hamstring graft. When it comes to ACL surgeries, there are typically three choices: hamstring autograft, patella autograft and an allograft. The autograft implies that the tendon used to craft the new ligament is coming from the same source as the target ligament (i.e., me). Allograft is a tendon harvested from a cadaver. Before surgery, I did have to sign paperwork that said that an allograft would be used in the case that my hamstring tendon was deemed to be unusable. I would encourage talking with the surgeon about this because that was kind of a surprise.

The patella tendon has been the preferred source for ACL reconstructions for a while and that is only now changing with a bias towards the hamstring tendon. The hamstring autograft supposedly requires better expertise from the surgeon and also takes a little longer to heal, but the reconstructed ligament is supposed to be stronger and the long-term pain is supposed to be minimal. Apparently a patellar autograft leaves long-term pain in the patella that can prevent even kneeling on that knee again. It also comes down to the surgeon’s preference. My surgeon did all three procedures but the hamstring is apparently the one that he does the most often, so I figured I’d go with that option.

Back to my story… I woke up in a new room with the same people around me. My knee felt pretty numb. My parents were called in and I’m pretty sure I was not very fun to talk to. Several people came and went after that (people giving out the medical equipment I would need post-surgery, for example). I don’t think I saw the surgeon afterwards–I’m sure he had other procedures to do. I was offered some crackers and ginger ale, which I graciously accepted after much prodding. They were pretty good although I think the straw they gave me was defective because I kept spilling ginger ale on myself. I’m pretty sure it was the straw’s fault.

I called another friend to let him know I was ready to be discharged in about 30 minutes. We sat around and chatted till he arrived (with another friend) at which point I was allowed to put my clothes back on through that weird gown and was wheelchaired out to the car where I was remarkably able to get into the front-seat mostly unassisted. We dropped off a prescription on the way back home and then once I got home I pretty much passed out on my bed with the ice pack machine around my knee (more on the machines, later). I texted another friend and guilt-tripped her to pick up my meds for me from the pharmacy.

Since my leg was still pretty much numb, I didn’t feel much pain except for my hamstrings, which felt extremely sore. The staff at the surgery center had given me some leg exercises to do but they were basically exercises in futility since my quadriceps’ nerve block was still in action and I couldn’t even so much as wiggle my toes. That’s a weird feeling, by the way. Everyone should be able to wiggle their toes whenever they want to. It doesn’t seem like a difficult task.

I spent most of that day drifting in and out of sleep in my bed with my parents beside me. Once my meds arrived I had some oxycodone inside me, as well. Apparently the worst part was over.

of acl surgeries and more

I’ve decided to go ahead and include a few tidbits about my ACL surgery so that I can (a) come back and look at it when I have made a full recovery and (b) answers questions/doubts for people who are looking at ACL reconstruction surgery as a possible solution for a torn ACL issue. Feel free to add questions and I will do my best to answer them.

Day 0 (5/21): Injury

I injured myself playing basketball at work. Concrete courts are probably not the best location to be playing basketball regularly. I don’t clearly remember what happened except that I was going up for an offensive rebound and while I was jumping, I felt like I was pushed from behind (while leaving the ground). I bobbled the ball and jumped once again before crumpling to the floor. Both times I felt like someone had knocked knees from behind me. I’m not sure if they had or hadn’t, but that’s the sensation I got. I may have heard something pop, but I feel like that is just something I feel like happened because it is one of the common symptoms.

I wasn’t sure how bad the injury was since I’ve never had significant knee issues before, so I sprayed some Icy Hot on and waited around for about 10 minutes for the pain to subside. When it felt good (or, I guess, numb) I grabbed a ball and attempted a jump shot from three-point range. This time, it felt like one of my bones had knocked against my knee cap, or something. Yup. Definitely something serious. I knew I was done so I packed up my things as I debated whether to go to the ER or not. I was also depressed since I was going to be missing my team’s playoff game the next day.

After I went home and showered, my knee started developing more pain as it stiffened up and the Icy Hot wore off. I decided that going to the ER would be in my best interests and found that the North Austin Medical Center was the closest option so I drove over there. The wait was horrendously long but I was at least grateful that I wasn’t in as much pain as some of the other patients there, who were at various degrees of crying (from sobbing to wailing) presumably from physical pain. At this point my knee was getting pretty locked up and I had to hobble around.

It took probably about 2 hours at the ER before I was finally seen and the doctor ordered an x-ray to check for bone issues. The x-ray didn’t show any bone issues and going by the ligament tests they do (by pushing the knee in various directions to check for pain/range of motion) the ER doc diagnosed it as a strain in my lateral ligament and applied a brace to prevent motion. She indicated that I should be back in action in about 10 days and that I should see a specialist if the pain/swelling got worse.

Day 1 (5/22): First day after injury

I took the day off the next day since I was in a considerable amount of pain and because I didn’t trust the ER doctor, I scheduled an appointment with North Austin Sports Medicine, which had a pretty reputable knee surgeon. It helped that a couple of my friends from work had been going there for leg issues and were happy with the experience. I got an appointment for the next day itself. I spent most of this day on pain meds and hobbling around my apartment. I was still optimistic that the injury was not a serious one.

Day 2 (5/23): Diagnoses and drainage at NASM

I had my first appointment at NASM with an assistant doctor (or some weird title like that) about 36 hours after injury. She pulled the x-ray from NAMC and noticed the extreme amount of swelling and noted that this happened either with an ACL tear or a tibia fracture, which is kind of hard to diagnose from an x-ray unless you are specifically looking for it. She conducted the same range-of-motion tests that the ER had done and concluded that my ACL appeared intact. She also ordered an MRI for that day so that she could get a conclusive idea of what the issue actually was. She also went ahead and drained the fluid from my knee joint, which apparently contained a high percentage of blood, which confirmed her suspicion that it was either an ACL tear or tibia fracture.

I left the office with a prescription for crutches, an MRI appointment and two possible diagnoses. A tibia fracture would have resulted in a walking boot of some sort to prevent further pressure on that bone while the bone healed naturally, and possibly pain medications and regular draining to keep the pain away from the knee. An ACL tear would require… well, the rest of the content of this blog. 🙂

I returned to work for a couple of hours (after picking up a pair of $3 crutches from a medical prescription equipment store) and then left for my MRI. Apparently they had a machine specifically to look at the knee so I just got strapped in there with plenty of pillows and a bunch of magazines to read. Apparently I was relatively still since the MRI only took about 35-40 minutes. I went back to work with a 24-hour waiting window to find out what was actually wrong with my knee. Thrilling stuff.

Day 3 (5/24): The real diagnosis

In the middle of work on this Thursday, I called into NASM to figure out the severity of my injury. In classic mystery-style, the assistant for the surgeon was not available to take my call. He did eventually call me back and told me the results of the MRI: a complete acute/sub-acute tear of the ACL and damage to the medial meniscus to boot. Apparently the acute/sub-acute implied that they were not sure whether this tear had happened during this last incident or whether it had happened earlier. I forgot to mention earlier that I had been having pain in my left knee for a few months but a couple of visits to the health center at work had yielded no diagnoses. I now believe that I may have possibly had a partial tear well in advance but this incident may have pushed me over the top (or injured the meniscus which created the pain here, I guess).

The assistant asked me to come in and get fitted for an ACL brace and then schedule a meeting to meet with the surgeon and figure out the details of scheduling surgery and rehab and all that jazz. I begrudgingly did so. I was also told that I didn’t really have to use the crutches any more since the brace was weight-bearing.

The next few days were not all that exciting. I eventually met with the surgeon and he said that given my age and lifestyle and the fact that the meniscus was also torn, surgery was the best option so that I could get back to sports and so that I didn’t end up getting early arthritis in that knee. I scheduled the procedure for June 26th to begin with and then pushed it back 2 weeks so that I would have a chance to spend the July 4th vacation with a few friends before getting operated on and kicking off (pun intended) the arduous rehabilitation process. This was a good decision, in retrospect, because it also allowed my parents to fly over for my surgery which has been invaluable.

I’m going to end this post now and dedicate the next post to the actual surgery and the ongoing rehab process.