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.

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.

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.

some show-and-tell

Today’s rehab report along with some photos of my knee in progress.

Day 58 (7/18)

After being gung-ho about going back to work, I realized that I wasn’t ready, yet. The first night without pain medicine was less than stellar. I had the CPM machine going at 80 degrees till about 2 AM and then felt some stiffness/bruising so I took my knee out of it and applied the pressure bandage and went to sleep without a cold pack system since I couldn’t feasibly hook it up and apply it myself. I awoke at around 4 AM with the knee feeling pretty stiff and, more worryingly, with a need to go the bathroom.

The horizontal to vertical pain now firmly entrenched in my head, I cautiously swung my legs down over the bed. Immediately, I felt the blood rush down my knee and the extreme pain had to be endured again. The pain is almost down in the calf area, not the knee, slightly to the sides where all the bruising is (I have pictures later for the curious few). It lasts for about 3-4 minutes–lesser if I decide to brave it and get on my crutches and try to put weight on the leg. I’m not sure what it is, but it is not comfortable. I used the restroom and collapsed back in bed. The gratification to going back to a horizontal position is instantaneous as well, so at least I have that respite.

Unfortunately, the lack of pain medicine (or perhaps the mental lack of pain medicine) kept me awake for most of the next few hours. Thankfully, at some point, my parents woke up and were able to apply the cold therapy machine on my knee. However, they’re going to be gone in a couple of days so I need this pain to go away soon or figure out how to get that machine going myself, in a comfortable manner. The ice was nice but it again leads to stiffness and discomfort and I had to shift my weight around to feel comfortable for periods of about 8-10 minutes.

Since I couldn’t sleep, I decided to research my pain on that veritable resource of information–the Internet–and found several accounts of people claiming that they had lots of pain when standing up during the 5th-6th day after surgery that eventually just went away. I’m hoping my pain will follow a similar course. I also made the decision to take off work/work from home the rest of the week since it seems that going to work for those 2-3 hours (as well as the extra time spent throughout the day in a non-horizontal position) may have intensified the pain.

I did have to drive my dad to the airport but after I got back I had the cold therapy machine to look forward to. Most of the rest of the day was spent with the cold therapy machine and short naps as it allowed. I was able to get a little bit of work done remotely, as well. I gave the doc’s office a call in the afternoon and he said he would put me on weaker pain meds and that I could rely on Ibuprofen and Advil to manage any pain as necessary, as well. I was also able to crank my CPM machine up to 85 degrees and finally spent some time doing my exercises (conveniently before the PT appointment). Doing the physiotherapy exercises actually feels good, possibly because I have something to distract my mind from the pain or possibly because I’m causing my blood to go to a different place. Although it’s all probably because I’m back to being somewhat horizontal.

The visit to the PT office today continued to establish the positivity as I was able to chat with another ACL surgery patient who was about a week ahead of me. He told me he had many of the same pain symptoms in the first week that have all but gone away now. My physiotherapist also reassured me that the pain when standing up from a laying down position should be on its way out fairly soon and is primarily because the various systems in the body are trying to reestablish the routes for the blood (or at least, that’s how I envision it). Anyhow, she said a lot of patients complain about those symptoms and that I should bring it up with my follow-up meeting with the doc on Monday if it is persisting.

As for the activities during the rehab session, I once again started by stretching (bending and straightening) the knee joint with a band and then did the little session with the electro-stimulating thing. My unknown units number this time was 72–just a 5-unit increase from last time. I blame it on the fact that I had gone into the session having done about 40 minutes of my own electro-therapy about an hour prior. After that I did straight leg raises and then a knee-bending exercise with a foam roller below my knee. The PT was pleased with the straightening on both these exercises.

I then got off the bench and did a set of calf raises. These were pretty painful since they basically hit the bruises down the side of my leg. Apparently this exercise will get rid of the “standing up pain” if I do it regularly so I’ve put it on the docket. Next, it was over to the leg-press machine where I did a couple of sets of leg presses (both legs and single leg) and a set of calf raises. After that was done, I did a knee extension exercise with an elastic band where I basically bent the knee, straightened the knee and then lifted my ankle. After a set of about 30 of those, it was time to walk.

The PT said I was ready to walk with one crutch just on my right-hand. After fumbling around with the balance aspect of it, I was able to do 4 sets of cone walks (walking over 5 6″ cones back and forth equaling one set) with one crutch (no brace)! This was exciting because it now gives me a free hand to hold stuff. I can’t express how awesome it is to finally be able to hold something other than crutches. She recommended me wearing a brace if I was out in public but that I could do it without a brace at home.

Finally, there were a few more exercises with the elastic bands (quad extensions–I’ll touch on them in a later entry) and an exercise where I lay on my expanding belly and tried to bend my leg up backwards. It was hard. I had to use my right leg to do the bend for my left leg. After it was all said and done, I was at the PT for over an hour but I felt refreshed and not pained!

My mom and I went to H-E-B to pick up groceries after that, where all the standing took a toll and hence we cancelled a following stop at Target. I came back home and iced my knee for about an hour before taking a shower. It’s probably psychological, but the pain is slowly decreasing when I’m standing up. Or, rather, I’ve found that if I just go straight into walking instead of standing and waiting for the pain to engulf me, it only takes 2-3 steps for the pain to dissipate. I’m hoping for a good night’s sleep tonight and if I have pain, I filled a prescription for hydrocodone to help me through. I’m hoping I don’t need it, though, especially after talking with the PT about the “standing up pain” being expected.

I’m probably going to work from home again tomorrow just to be safe and so that I can spend my mom’s last day here with me. If the standing up pain decreases, I’ll consider going into work on Friday for a half-day or so.

Now, for the photos (not for the faint of heart)!!

If you felt like this entry was two-toned, you’re not hallucinating–it was. The first half was written before physical therapy and the second half after it. Before PT, I was very negative and kind of tired of the pain. After physical therapy, I felt refreshed and reenergized. I’m glad my recovery is unlike other accounts I’ve read where the physical therapy causes all sorts of pain. I, for one, am glad for the concretely measurable improvements I’m making and, of course, for the only exercise I’m getting.

first day back to work

I continue chronicling my rehab from ACL surgery…

Day 57 (7/17)

Since I had postponed a few meetings from yesterday and we were nearing an iteration deadline, I decided to go into work today. When I woke up in the morning around 6 AM to take the first of my last three does of pain meds, though, there was a lot of pain getting out of bed and to the bathroom. The pain going from a horizontal position to a vertical position is still extreme–maybe a 7 or 8. I’ll have to talk to the doctor tomorrow about more pain meds or something over-the-counter because it’s pretty unbearable for the few minutes that my knee is adjusting to all the blood.

I worked remotely from about 7:30 AM to 9:30 AM before I left for work. I did some research on picking up a handicap placard and found out that I could do so at a county tax office and that one was about 2 miles away and had a drive-through service. It was about a 5 minute drive and 5 minute wait and $5 worth of fees and I had my red placard in hand that allows me to park closer to establishments and limp through their doors.

I reached work around 10 AM and once again was hit with the sending blood-down-the-knee thing. I limped over to my desk with the crutches and was able to prop my leg up on another chair and work at a completely different angle than I’m used to. I went to a couple of meetings and actually got some code written so I felt productive.

I was originally going to work till 2 PM but I didn’t want to deal with the adventure of acquiring food so I decided to leave around 1 PM and eat lunch at home and work remotely. This arrangement worked out pretty well from a comfort (and probably productivity) perspective. I was able to ice with my machine at home and even got my CPM machine cranked up to 80 degrees.

In the evening I felt a bit adventurous so I took my parents out to an Ethiopian restaurant we had gone to with friends–Aster’s. We all ended up getting their trademark Doro Watt dish and I think my parents liked it. Drove home and once again I was relieved to get back to the ice pack. I spent some time researching whether the pain I’m feeling now is normal or not. I will probably be emailing my PT tomorrow to get her opinion. I do have a PT session in the afternoon.

I’m planning to go in for more or less a whole day of work tomorrow, since I have an early morning meeting. I may skip out during lunch, once again, although this would involve more walking to and from the car. At least I can park fairly close.

My pain while my leg is elevated is around a 2 or 3 now. The pain while just standing up is around an 8, like I mentioned earlier. After standing up for a while, walking is about a 5-6. I do need to remember to wear my brace around, though.

 

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!