Post Op – Days 68–91 (Sept 27 – Oct 20)

Hi there!  It’s been a while and I’ve been putting this off due to a fairly busy schedule.  The big thing during this period has been that the knee has improved (including scar tissue).  However, the heel (other leg) has been a big pain.  It has limited my mobility significantly to the extent that I cannot walk even a few hundred yards.  My PT has indicated that it could be “plantar fasciitis” and has been nice enough to massage it during my sessions.  I’ve not been able to ice it down as suggested.  However, now I am in a pretty bad phase with that heel.  Just yesterday went to my physician for my routine appointment and he suggested that I get on Ibuprofen 600mg three times a day to reduce inflammation. 

Back to the knee.  I haven’t been able to maintain my exercises at home.  The only things I do now are at the therapy sessions twice a week.  Knee feels so much better – except that the stiffness persists.  If I do heel slides for 15mins or so in the morning, it helps a lot with the mobility.  Otherwise, it remains quite stiff during the course of the day.  Other than that, the swelling is more or less gone; scar tissue has reduced quite a bit; waking up in the morning is a little painful for the first 5 mins (meniscus area); and, somewhat stiff once in a while.  The other thing is that it does hurt if I sit for too long in the same position (at meetings) or if I am in the car for too long (driving).  Still quite conscious of my stride and movement.  Taking the stairs has become much easier – easier to go up than to come down.  Doing lunges at the PT is painful.  Generally, I feel much better with the knee.  If my heel heals soon, I am looking forward to long walks. 

Surgeon’s appointment is scheduled for Nov. 3.  I am hoping he will let me do some jogging.  Mentally I am quite prepared for doing everything – but, I keep reminding myself that I need to be ‘smart’ – surgeon’s word!  Pictures next time –as I am quite busy right now!  Until later…

Post Op – Days 59–67 (Sept 18 – Sept26)

I hit the two month post-op mark on Sept 22!  As the days go by, the progress is becoming less and less apparent while the issues that didn’t exist before are becoming more and more obvious.  In addition, I am not able to devote my time to therapy like I did before, be it due to work load or due to other factors.

The issues that are cropping up are scar tissue and numbness around the incision area; pain in the foot (became prominent after calf raises) and pain in the heel of the other foot (non-surgical leg – became prominent with performing hamstring curls on the surgical leg).

I am working on the scar tissue and trying to massage away the numbness – but, it is not a good feeling right now.  I just hope the numbness goes away – it is a weird pain.  The pain in my feet has limited the walking even though I am trying to walk every other day as much as I can. 

The physical therapy sessions are continuing at twice a week schedule.  Adding an exercise here and an exercise there.  The best part of the routine is the massage – I am only doing this therapy for that one reason – even though the exercises do help.  The walking is becoming normal, although I am very conscious of my gait.  Stiffness still persists when I get up in the morning and after long periods of work (sitting).  I am able to do a lot more things than before – many times not thinking too much about the knee. 

My next goal is to get some jogging/running into my schedule but that has to wait till November first week when I see my doctor.  Will post again in the next couple of weeks with pictures.

Post Op – Days 47–58 (Sept 6 – Sept 17)

Another two weeks go by as I hit my 8 weeks mark post surgery.  The routine continues – work and more work.  Two of the most hectic weeks I have had work-wise in the last few months.  On the rehab front, things have been progressing well.  The physical therapist added some hamstring and calf exercises.  Just can’t believe what a couple of weeks of inactivity can do to your leg.  The quads and the calf have really gone down and the strength one loses is incredible.  In any case, the calf became extremely sore for a few days.  However, in a couple of days after I started these hamstring and calf exercises, my gait dramatically improved. 

Just after the six week mark, the scar tissue was becoming more prominent.  The PT mentioned that the body starts to ‘lay’ the scar tissue around this time.  This was interesting to know.  He ‘dug’ into the scar tissue and massaged the heck out of it.  It was incredible to see that the scar tissue – more a ‘blob’ – just disappeared after that visit.  I started to massage the tissue perpendicular to the cut every day now.  The scar tissue related pain comes and goes. 

I also learned that the time between the six and nine week marks is critical.  I forget how I got this information, but I learned that the allograft basically loses all its strength (about 50% that is) around this period as the body begins to grow its own tissue/cells in the graft.  It will be another month or so before the graft starts to come back to life.  That I thought was quite interesting.  The swelling has subsided tremendously –though there are good days and bad days – and I can almost walk normally now. 

In the mean time, my physical therapy at home has gone down to once a day now.  Just not enough time to do it twice anymore.  I have been biking about 20mins followed by walking about 1.5miles a day – four to five times a week.  Schedule permitting, I would like to walk every day, but has not happened yet.  My typical physical therapy includes 20 mins biking (stationary); 30 mins walking (around the neighborhood); heel slides for 20 mins; work on hamstring for 10 mins; quad tightening - 30 of them - about 5 mins; 30 straight leg lifts with 5lb cuffs - about 10 mins; squats (no weight) 2-3 sets of 10 each for about 10 mins; hamstring raises (standing straight and flexing the knee as much as possible with 5 lb cuffs) for about 5 mins; steps for about 5 mins; calf raises for about 5 mins; for a total of about 2hrs.

The surgery is a dream now!  I can’t even start to imagine how smooth the whole process has been.  If this is normal, then, people should just do it and not look at other non-surgical options.  I may be over-simplifying this, but, I can unequivocally say that the two months prior to surgery were more painful and more discomforting than the two months post-op (except that time when I had to wear the brace at all times).

Post Op - Days 42-46 (Sept 1- Sept 5)

The big day – my second post-op doctor’s appointment – came and went on Thursday.  There was much anticipation which kinda fizzled out very quickly.  First, my wife takes me to the doctor’s office just in time and while in the waiting room, this woman walks in with the brace that I detest the most.  I make a small conversation and she indicated that this was her six week appointment as well.  I wondered aloud how she was able to wear it for that long.  She showed me some pads that she used to keep it comfortable.  I could see that I was doing much better than her in terms of walking – may be not using the brace helped my thigh muscles to become stronger!  So, I think if one can walk without the brace, one should try (of course, without rushing it) – just my opinion!

Then, I go inside and was itching to see the surgeon and when he did come in, checked the leg by moving it more gently than his usual baseball practice.  Said everything looks great and asked me how my ROM is.  I went all the way – very very close to normal (like the other leg) and he was a little taken aback.  He said it puts stress on the ACL and I should not push it – which was a bummer!  Then, he said I could drive which I knew already– just that my wife wanted that reassurance.  He said I could walk a mile on flat surfaces, do stationary biking about 10mins or so – I was already at 25mins and his comment was to be smart about this.  He also mentioned that the swelling comes and goes.  Here was a pep talk – in my words: 

When a professional athlete tears ACL, he/she is done for the season/year – it takes that long for the ACL surgery and rehab.  The surgery creates major trauma in the knee area and it takes a long time to heal.  One has to be smart and not push it.  The body takes a long time to accept the ligament and starts growing its own cells and tissue in this ligament.  In about a year, the ligament is as good as its own and histology shows that the ACL is no different from other ligaments –meaning the tissue is histologically similar to other tissues in the body, even though the ACL in my case came from an Allograft.

So, I am told that I have to take it easy and let the body heal itself.  I was asked to come back after two months and I need to continue my physical therapy twice a week and see how it goes.  All in all it was fine but knowing that “it’s like wet cement in there”, I still wasn’t too excited following this visit.  Now, I just need to take things slow and focus on other aspects of life – like work and kids schools which starts tomorrow!

Yesterday (Sunday), I went for a walk around the neighborhood (1.5miles) and it felt really good.  In fact, when I woke up this morning, the knee felt much better than other days – not as stiff.  However, I did notice that the swelling was a little more than usual.  I think I am feeling better by the day and I have to be extremely careful not to hurt myself as I am not conscious of my knee as much anymore.  Add to that, I am extremely busy with work and other matters.  Will keep my fingers crossed and hope the next few months go by fast.

Post Op - Days 34-41 (Wednesday - Wednesday)

Ok – I am getting behind on my blog updates which means I am getting busier elsewhere – where else but work.  Too much going on and it has put a lot of pressure on my schedule – very little time to think about my knee.  Add to this, the earthquake followed by hurricane Irene (which wasn’t too bad where we live); the construction work going on in the house; kids' school starting in a week; and there you have it - seems to be enough going around.

I try to exercise twice a day now – once, if I go to physical therapy.  Once a day, I have started to bike about 25mins (started at around 15mins and now I am at 25 mins) along with a bunch of exercises totaling almost 1.5hrs and the other time, I don’t bike but go for about an hour.  So, spending 2.5hrs/day has made it difficult to catch up with many things.  Add to that, I had to go to client site several times during this period which basically meant I am out the whole day.

You get the idea – I am slowly transitioning into my regular schedule!  The knee becomes sore when I bike and when I spend the whole day on my legs and away from home.  The interesting thing though is that I almost feel normal – the wounds have healed quite well except that the scars still remain – see below (taken yesterday):

I would say I am at 70%-80% in terms of walking and remind myself to be careful as my therapist made a comment that I look ‘way ahead of schedule’, however, it is like ‘wet cement in there’ and I should be careful.  Also, the swelling and the soreness constantly remind me that I am not there yet.  But, I am getting there slowly but surely.  The best thing is that my six weeks doctor appointment is scheduled for tomorrow.  So, I will try to update my blog after the appointment.  Few more weeks and I should be up and running (hopefully)!

Post Op - Days 25-33 (Monday - Tuesday)

Another week goes by and the rehab continues – this past Friday, just completed the four week anniversary.  I just don’t know how the time went by but sure am happy that everything is going well.  I am continuing to go to my physical therapist twice a week and doing the exercises when possible at home.  I am walking around without the brace and am quite comfortable.  Swelling still comes and goes.  When trying to walk normally, the knee clicks – have to wait and see if that is a problem or if it goes away.  The knee still ‘forgets’ all the rehab and it takes me a while to get back the full ROM.  By pushing in with my hand after about 30mins of heel slides, I can touch my heel to my thigh.  Here are a couple of videos – one just as I start my exercise and the other one after 30 mins.

The scars are slowly healing and the pain (to touch) has significantly reduced.  I have started massaging the scars to get the scar tissue out.  I rub the scar perpendicular to the cut as much as I can during my exercises.  Still the scars are apparent as can be seen in the picture below (taken on Sunday).  Otherwise, I think I am coming along pretty well. 

My wife is not allowing me to drive as she overheard me telling one of my friends that the graft takes about eight weeks to heal and it can fail if I overdo anything.  Now, I have to wait for the doctor’s visit before I am allowed to drive!  Darn it – two more weeks!  Too bad for her, she drove me to the client site couple of times this past week.

Monday - I was catching up on a lot of work followed by a bunch of meetings on Tuesday, nothing earth shattering but a long day at work.  Speaking of earth shattering, we had an eventful day here in the Northeast USA - an earthquake measuring 5.9 on Richter Scale matching the largest quake ever measured in Virginia (recorded in 1897 in Giles County - Blacksburg area).  Didn't realize they were measuring back then or they must've extrapolated - I don't know.  Today, the epicenter was in Mineral, VA in Louisa County, Richmond.  This was the third major quake (over 5 and including the one in Pasadena in 1991 - when I was visiting LA) that I experienced in my life.  The previous two times, I was sleeping and the quakes woke me up.  This time, I was in a meeting (some might say I might be sleeping this time as well)!  But, when the quake hit, I was probably the only one trying to get under the meeting table - bad knee and all!  In any case, this quake seem to go on forever!  I will probably remember this for a long time.

Events such as these (including the death of my colleague) make me realize how precious this life is.  I am getting to see a lot of my family during my stay/work at home period.  It has been revealing how much of my kids growing up I’ve missed.  For example, yesterday, my daughter who is yet to turn 11 came down after the shower and said she almost drowned in the shower.  We were like –what?  She said her hair covered her entire face and the water falling on her face made her feel like she was drowning – it was a funny moment and brought lots of laughs around the house.

The school’s starting in two weeks and I feel bad that we didn’t go anywhere – not that we do that too often, but due to my surgery, we did not even leave home the entire summer.  A lot of my friends and colleagues did their short and long summer vacations and I wish we had gone somewhere.  Not that the work is making it any easier but would sure have been nice to get away!  Having said that, my wife took this day (Tuesday) off and took the kids to the Newseum in DC.  Guess what!  As they walked out, the earth shook - any coincidence?  Hmmm...  Then, they took the metro that goes underground within DC and partly into Virginia including running under the Potomac River.  Looking back, I feel lucky nothing bad happened as anything could've been possible with metro tunnels collapsing or water coming through the tunnels, etc.  I sure am glad there are no serious/life threatening injuries in the aftermath of this quake!

Post Op – Days 19-24 (Tuesday-Sunday)

Apart from mourning my colleague’s demise and attending his funeral on Saturday, Days 19 to 24 (Tuesday to Sunday) have been rehab and more rehab.  I got a phone call from the Physician’s Assistant (PA) on Wednesday and I got clarification on a) continuing to wear the brace and b) walking & driving.  She said different patients have different recovery times.  However, the quads and thigh muscles should be strong prior to my removing the brace and walking/driving. 

Brace:

The PA said that the brace could be unlocked while walking and taken out when sleeping – yaaahooooo!  I have been complaining all this while and getting rid of the brace has been heavenly.  This has been the biggest boon post-op.  The brace is out!  I slept the best on Friday night – no disturbance and just slept through.  I now keep two pillows on either side and whenever I turn to a side I use a pillow in between my legs for support.

Until Friday and only when I went out during the day, I wore the brace and then took it out completely.  Right now, when I go out, I am using one of those small braces that I used to wear playing racquetball.  Walking around the house but have some clicking going on in the back of the knee - not sure if it is due to not using the knee for about three weeks or if there is a problem.  Will find out at the next doctor’s visit.

Walking/Driving:

The PA also said that I can remove the brace and walk and potentially drive if I could do 20 leg lifts (I can do 40 and more) – another yaaahoooooo!  Essentially I got an ok from the PA to test this out.  But, there is only one problem – my wife!  I don’t mean my wife is a problem but I mean my wife will not allow me to drive until my next doctor’s visit.  Somehow, I convinced her that I will try driving when she is next to me to which she reluctantly agreed by bringing in a lot of emotions – but, like any other man I got tuned out as soon as the emotions reached me.  So, over the last few days, I was able to drive a little bit and did not find any problems or any discomfort.  BTW, I drive a stick-shift and wife has not given me permission to drive my car yet!  Looks like I have to wait for my doc’s visit for that!

Swelling:

Swelling has gone down substantially – see the picture below.  However, it is still there and it increases with exercise and walking.  I am told it will take a good couple of months before the swelling subsides completely.  The weirdish pain (which I don’t consider pain at all) from swelling is somewhat discomforting. 

Bruises/Scar Tissue:

I have started working on the bruises, clots, and the scar tissue.  In addition to having my wife massage my knee area twice a day, I also rub on the incisions quite a bit to get rid of the scar tissue.  It is somewhat painful but that was to be expected.  The massages have definitely helped me get rid of the clots and bruises.  Even though the visual signs have disappeared, the areas are still somewhat sore.

Moving forward:

One thing I found out from researching and reading papers online is that the graft takes 6-8weeks to heal into the bone.  As such, this timeframe is quite critical and the graft may fail if neglected.  Though it may appear that the knee has healed well within the first four or so weeks (in my case, I am feeling like I am good to go in about three weeks), however, the graft doesn’t heal into the bone yet.  Not being a doctor, I intend to continue my rehab while trying to limit my activities for about eight weeks.  This will have to be a conscious act as I feel I am good to go.  So, I have to do things against my instinct for my long term benefit.

In summary, during this period, I was able to – increase biking on the stationary bike from 10 to 15mins; increase ROM – after about 30mins flexing, I can almost bring my heel to touch my thigh; walk quite a bit in the house without the brace; sleep without the brace.  I have become more and more comfortable around the house and I need to stop myself from overdoing things as that seems to be the biggest problem.  May be I should let my wife work on my emotions (after almost 16yrs, good luck with that) so I don’t injure myself!