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!

Post Op – Days 16-18 (Friday-Monday)

Weekend (day 16 and 17) has been uneventful.  Called the CPM machine guy to come and pick it up as I don’t see a need any longer.  I seem to be doing my ROM exercises properly and seem to be gaining strength in my quads and hamstring.  The swelling may have subsided some but not sure – I recall the PA saying that the bone bleeds and it will take time for the swelling to go away.  Hope it is sooner than later.  A lot of flexibility issues will be solved if the swelling goes away.  Also, I am waiting to hear back from my doctor to see if I could actually take the brace off and walk or sleep for that matter!

One aspect has become quite annoying over the last few days.  This pertains to sleeping.  Every night around 2pm or so, I wake up and it has been quite uncomfortable – can’t explain but it is a combination of sick feeling, pain in the knee, and discomfort from the brace.  They somehow seem to culminate at that hour and it takes me a little while to get back to sleep.  I just hope it goes away!

The other interesting aspect is that no matter how much flexibility (ROM) you may have, the knee seems to forget it when you wake up in the morning.  It becomes somewhat stiff (may be attributable to the knee brace) and you will need to do some repetitive flexing to get back your ROM. 

The biggest difference over this past weekend as opposed to the other days has been that my wife massaged the knee twice a day both Saturday and Sunday.  That really woke my knee up and not only does it feel good, it almost feels like I am getting my lost knee back!

I went to Home Depot and Lowes to buy some construction material.  At the end of it, the knee did hurt somewhat.  Based on my two-weeks of experience, this is what I found out.  The brace needs to be worn tight during walking and while putting all weight on the knee for the first few weeks (how many – I do not know).  I did unlock the brace a couple of times, but it would hurt in no time.  Basically what that’s telling me is that the knee is not ready for full weight with flexing motion.   However, when the brace is locked and in full-extension (straight), the whole leg acts as one weight bearing piece and the knee does not have any relative movement and hence it won’t cause any pain.  In any case, at other times (after the first week), I don’t see a need for the brace when sitting and laying around.  May be it is needed in the night for the first couple of weeks just so you don’t kick around in your sleep.

Today (Monday – day 18) can be classified as one of the worst days of my life – nothing to do with my knee!  One of our dearest employees/colleagues passed away at a relatively young age.  Though it happened on Friday, we were notified today.  I have been feeling sick in the stomach all day – just can’t seem to think of anything else.  A lot of other events that occurred had a very negative tone as well – not even counting the stock market which tanked as expected!  I don’t know why but it seems to happen all the time.  When things don’t go well – everything seems to go bad.  May be it is the mental state!  Whatever it is – it has been a very bad day thus far!  But, I am trying to keep my balance and take the bad with all the good!

I had my physical therapy as scheduled and did manage to bike for 10mins (stationary bike).  This is not even exciting anymore.  Did all the other simple exercises – but my mind is on my colleague.  Just can’t get over the fact that this young man just left this world!

The CPM guy came and took the machine away – that saves me about 4hrs of sitting around – even though I try to get some work done – it has become somewhat of a drag lately.  I think two weeks is a little too much.

Two weeks-

Well – it is two weeks now!  Can’t believe the time just passed by so fast!  That must mean I am progressing on schedule.  This week I have learned a few more things –

·    One, I hate the brace.  That’s the most discomforting thing in this whole experience. 

·    Two, nobody told me whether, at any time during the day, I could unlock the brace or not.  After two weeks, you don’t really want to have it on and locked at all times.  Someone can make money by devising a brace by not having one of the straps right on the main incision.  It has become a real pain wearing it.

·    Three, the CPM machine is a good relaxation – however, using the machine and getting to 110 degrees is not the same as flexing the knee on your own.  Believe me, it is much more difficult than laying your leg in that machine and letting it do the work. 

·    Four, the progression is not straight up – there are good days and bad days.  Got to be patient – which I have very little of.

·    Five, if you walk – you will have pain and swelling - duh! 

·    Six, I don’t have patience to sit around – even while working – and I want to walk, NOW!   

·    Seven, among other things, my wife keeps telling me that it’s only two weeks and I need to take it easy! 

·    Eight, you get used to the attention from your friends and family members during the first few days and expect it to last – two weeks later you are mostly on your own – no more attention; I actually try to grab their attention by suddenly lowering the lazyboy leg extension which squeaks and makes a thud. 

·    Nine, ice as much as you can – that’s the only soothing thing after two weeks.  BTW, have someone massage your foot while icing the knee – it really is the best feeling (since the blood flow is reduced in the foot when the leg is raised and you are icing the knee).  The list goes on…

Anyway, I call the doctor’s office to find out if I can walk with the brace unlocked.  The operator takes a message and tells me that the doctor and his crew are in surgery today and someone should get back to me the next day.  Today, the doctor’s office calls back and tells me that the doctor will be back Monday and the caller could not tell me anything.   So, I have to wait till Monday to see if I can walk ‘free’.

The week has otherwise been quite normal.  Same routine except that I started to unlock the brace and sit around a little more.  I also walked around somewhat and it does hurt after about 10mins.  Went to work for 3-4hrs/day and it is not that comfortable.  Also, massaged the area around incisions quite a bit and it still hurts around the main incision (where they drilled through).  In fact, the bone around it hurts when touched.  Here is a picture from Wednesday (8/3)-

Today (Friday 8/5), I removed the sterile strips on the wounds as they appear to crumple the skin.  Also, the wounds have healed and I figured I will ‘air’ them out a bit.  The scars are prominent and I need to somehow massage them away – but they hurt.  Here is the picture after removing these strips-

Today, I showered in the bathroom without the brace and without putting the weight on the leg.  Sat on a chair and using the hand shower took a pretty decent shower.  Last week, the physical therapist was surprised to learn that I have been showering since the first day!  The physical therapy session on Thursday went as planned.  The therapist thought I was progressing extremely well.  However, he wasn’t sure if I should do the biking yet – so, he was going to check with my doctor and find out for Monday’s session.  So, I just got stuck with some basic exercises like working on the hamstring, quads, and ROM.  However, the best part was that this guy really massaged the knee area for may be 10mins that felt so wonderful!   The weird thing is that every time I go to the therapist, it seems like everyone else is lying down/relaxing/getting massaged/etc., while I am the only one ‘working out’!  I am hoping that one day I get to relax – better yet if my insurance pays for it!

While I am writing this, for the first time in history, the US Debt has been downgraded from AAA to AA+.  Hmmm!  How the heck some stupid ratings firm gets to downgrade national debt rating.  This is one of the same firms that gave fantastic ratings to all those companies that don't exist anymore!  Can you say markets are dropping 20% next week?  Or is it already factored in.  Either way, based on the action in the markets this week, I think I did a smart thing by fixing my knee – I will need it for a very long time so I can delay my retirement.  No way I am saving enough money for retirement after taking into account all the money (401k) that is evaporating in the market.  Financial folks say if you start young you can save decent money – guess what I have less than what I put into my 401k after 18yrs of contributions!  I need my knee for a long time!  May be I will listen to my wife and just lay around the living room instead of trying to walk.

Post Op – Days 8-11 (Friday-Monday)

The progression has been better than normal over the last few days.   There have been a few firsts since surgery during this period.  On Friday, as I indicated in my previous post, I went to our office and worked for 2-3 hours and it was quite tiring.  It’s just amazing what a little inactivity and somewhat of a small surgery can do to you.  Got back home and continued to work on some urgent month end matters.  I continued to work through the weekend to catch up on these.

I am more comfortable with walking and that led to another first.  I went out to a restaurant (Macaroni Grill) for the first time on July 30 (Saturday) since surgery to celebrate our teenager (13) son’s birthday!  I was in the brace all this while except that I had unlocked it every once in a while to flex it.  I am starting to wonder if the brace has to be worn all the time – I am getting conflicting advice on this matter.  Will do some more research and find out if it is really necessary to wear it 24/7 after the first week or two.

Other than the birthday celebration, Saturday and Sunday have been uneventful.  Did the CPM and some walking around within the house ‘overseeing’ construction activities.  Showering has become easier now – nothing changed but I got used to the chore!  I think that’s the quality we all, as homosapiens, have unlike other species.  No, not showering ability, I am talking about the ability to adapt and do that quickly is what separates us from the other species.  BTW, I am able now to use our newly constructed bath room (see pic. below) – shower door is still awaited but with care I am able to use the hand shower.

Today (Monday) was the first scheduled physical therapy (PT) day.  The whole exercise lasted about an hour.   The therapist seemed to be impressed with my progress as I had a 90deg flexion or Range of Motion (ROM) without assistance and 105 deg with some effort (pushing in with hand).  My quad is beat – no strength what so ever.  He had to apply electric stimulus for about 10mins to stimulate this muscle.  Did some leg lifts, etc. and came home.  Nothing major other than I need to go back this Thursday for the next appt.  I got a sheet with the prescribed exercises.  Otherwise, I have been extremely busy on the work end.

Will post again towards the end of the week – hopefully I will start taking pics of my knee with my phone and post them – because I can never upload them from my camera!

Update:  See picture taken over the weekend.  The big bluish/purplish spot is the circle that the surgeon signed on prior to anasthesia and subsequent surgery.  It is ink and not a clot or bruise.  You can see the bruise/clot along the side of the calf.

Back to work?

Last night (with a properly fit brace) was the worst of all nights post-op for me.  Taking an hour’s nap in the evening didn’t help either.  I went to bed around 1am after responding to all emails, etc. and even though the brace was quite snug, it was as uncomfortable.   Somehow fell asleep and then woke up about 3am.  After that, it was a pain until about 7am and couldn’t really sleep – just dozed on and off.  Tried to turn and sleep on the side (the PA said it was ok to do so) and that didn’t help either.  Finally, fell asleep at 7am by which time my wife was up and about.  Got up at 9am and went about my usual routine including the CPM, etc.

At about 1pm, my wife took me to work (about a mile from our house) and it felt a whole lot better to be at a desk.  I unlocked the knee brace so I could bend it while I was sitting at the desk.  Unlocking allows the knee to bend in a straight line.  Was at work until 4pm.  Getting in and out of the front seat of a minivan was a pain.  That I noticed yesterday, so I started to use the middle seat and that’s not comfortable either.  Back to 'work from home', except now I am icing the knee which feels pretty good.

Technically speaking, this was my first day at work and I am lucky that our office is so close by and my wife could transport (this word makes me feel like I am some merchandise or something) me.  Otherwise, it would be next to impossible to get to work.  Just came to know that someone who works in our firm also needs to go through similar surgery and my estimate to him is a minimum of 4 weeks before even thinking of getting back to work – his work requires him to be at the work site.

In the meantime, I got a call from the surgical center and they said they have the pictures of the surgery for me.  So, my wife went there and picked them up.  Here they are – the first set are the before and after of meniscus; and the second that of ACL.  The third picture is of the new ACL with the screw (plug?) in place.  One screw each is placed in each bone.  Basically, when you go to a surgeon for the ACL replacement, expect to get screwed twice!

Now, I just have to let my bone grow and fill up the drilled areas and grip the graft.  The screw supposedly dissolves over this period of time as well.  It appears that it will be at least three months before the bone grows back and it could take up to an year for complete healing.  So, the surgeon goes in, messes things up, and leaves the mess for the body to clean up and repair itself!  This is somewhat like what we all do at home and then let the wife do the cleanup duty at the end!  May be that’s why my wife gets migraines all the time.  Unfortunately, this is one such day!  Feel sorry for her!  The most difficult part for me to deal with in life is when I am helpless to help myself or others - be it physically, mentally, or otherwise!

For the first time this evening, I took the brace out (contrary to PA’s advice) and sat in our LR sofa without a knee brace.  Wasn’t really able to bend the knee at 90 deg but was close.  It really felt good not to keep the knee straight all the time.  However, I couldn’t keep it in that bent position for too long.  It has been somewhat of a painful evening thus far – mostly because (I think) I stopped taking Ibuprofen since the previous night.  Will probably take one tonight prior to going to bed.

There goes one whole week.  I know it’s a long road ahead but I am extremely happy with the way things turned out overall.  Can’t wait for the day when I can take the brace out and actually sleep however I want.  First things first, looking forward to my first Physical Therapy appt Monday at 3:30pm followed by another at the same time on Thursday.  After that, I will be doing the same for the following five weeks.

Folks - have a great weekend and I will post again in a few days...

Post Op - Day 7 (Thursday)

This is the day!  Seven days went by (including the day of surgery) and I am to see the surgeon for the first post-op appointment.  Actually, I don’t have any questions other than asking about what’s next and when I can drive, etc.  The day progressed as usual in the morning through noon.  My wife took me to the doctor’s office for the appt at 1pm. 

I was taken inside and the nurse removed the bandage – in reality, the bandage inside had slid down all the way and the wounds were only covered with sterile strips with ace wrap over them.  She asked me some questions about what medications I was taking and how I was feeling, etc.  She said the Physician’s Assistant (PA) would then come and see me.  The PA (who had also been at my surgery) again went over the medications, etc. and examined the wounds.  The wounds were fully healed and the PA said everything looked great.  She then showed me the photos of the knee before and after and went over the procedure. 

Yes, there were four holes made, the ‘one’ in the shin bone (tibia) is the big incision and the drilling is performed through this one.  A very thin guide pin (or something like that) is then passed through this hole into the thigh bone (femur) and this is a very small hole.  Then, the carpentry ensued – I mean drilling into the bone.  The drill follows the guide through the shin bone and partially into the thigh bone.  Using the guide pin, the new graft is pulled through and once it’s all the way in, a screw (more a plug) is inserted in both bones from inside.  There was also a very small meniscal tear which was fixed through one of the other holes and they used another hole for ‘scope’.  Here are a couple of pictures.

Then, another assistant came in and took out the sutures.  He kept saying it may hurt, but it didn’t hurt at all.  May be I am numb to pain or may be my work made me numb to pain – I don’t know.  He also made me lift the leg straight up (horizontal to ground when I was lying down) – he essentially told me that I need to build my quads up as there is no strength there right now.  Everything else was fine and he put in new sterile strips and put this thin sock like thing over the knee.  Then, he put the brace on – and in reality this is when I realized it was not adjusted properly to begin with and was source of the most discomfort since surgery.  So, if anyone wants to get the surgery done, make sure they adjust the brace properly before they send you out.  He showed how it’s done and did proper adjustments – it feels so much better now.  Also, I was using the ice pack all night and the PA said it is not necessary any longer– that really reduces the burden (believe me it is heavy compared to the brace).

I wanted to know if I can start to flex my knee, rotate, stationary biking, etc.  No go – at least for the next five weeks or so.  However, I can start to walk without the crutches.  Strictly told to put on the brace at all times except when directed by the physical therapist or when using the CPM machine.  Even though I am at 90%, I was asked to use it for another week.  Was given a prescription for physical therapy for twice a week for six weeks and was asked to come back in five weeks.  Told not to drive until next appointment (five weeks) – bummer!

When we were about to leave, I asked for the pictures and was told to contact the surgical center and they would be able to make a copy for us.  I called them on the way out and left a message and no one called me back yet.  Will follow-up and post these pictures when available.  Went to Subway (my wife went inside while I waited in the van) and I enjoyed the sub with the family (kids were home) and was actually feeling quite tired and took a small nap at 5pm for an hour.  The rest of the evening and night have been uneventful.  Did some walking around the house without crutches.  No Ibuprofen since 8am or so and I still feel fine.  Took some just now around 10pm (200mg).  Did CPM for a total of four hours during the day and iced the knee a couple of times after I got back just for the good/cool feeling and to reduce swelling.  That’s about it.  Now, it is a waiting game until the body heals itself up – might be another month before I am a free bird!

Post Op - Days 5 (Tues) and 6 (Wed)

Both days, got up early again around 5am or so and dozed on and off until little later.  Finally, got up and took shower, etc. and came down.  Now my routine is pretty much set once I get up.  Get up and brush teeth, use bathroom, remove the ice pack and the brace, cover the knee bandage/ace wrap with plastic, take shower, reverse the whole process and get dressed and go downstairs.  Next, do CPM for about 2hrs at 90% (I start at about 45% and within 10mins go to 90%).  During this time, I eat breakfast and have a cup of coffee and I am ready to go and usually start off work by taking care of emails, phone calls, etc. - all this when the CPM is going on.  Both days, the contractor fixing the bathroom has had several questions regarding placement of various bars, etc. in the bathroom.  After this and some other interruptions, both days have been quite busy until about 6pm. 

However, nothing much to report on the knee front as everything is fine except that the ace wrapping is coming somewhat loose, it loosens more every time I use the CPM machine.  The swelling probably has come down a bit and may be that’s the reason for loose wrapping also.  The pain is almost non-existent.  It is still uncomfortable though.  I tried to walk a bit and was able to do so, the only problem is that the icepack is quite heavy and with brace in place, you will almost have to drag the leg.  Trying to be careful adds to the drama and walking doesn’t become natural anymore.  In spite of all that, I did walk without assistance from crutches and not feel any pain.  Can’t wait for tomorrow’s (Thursday) post-op appointment with the surgeon.  Even though I am not sure what is lined up, I just want this to be done – I am ready for the next step.

My post-op experience can be encapsulated into the following summary:

1.       Thank the donor, if you are getting a donor graft.

2.       Get a laZBoy chair that has a leg raise and get a few wedge pillows.  I had four and I usually used two to three with the lazyboy, one with CPM machine, and one in the night when sleeping.

3.       Make sure you have help around you, especially the first couple of days – especially when going to the bathroom.  Get a stepstool for your bathroom, if you don’t have one – this is to keep your leg straight if you are sitting on the toilet.  A vertical handle bar (18”-24”) is really handy when using the toilet – I had the luxury to get one installed!

4.       The doctor won’t tell you what to do with the brace and the icepack when you use the CPM machine.  Make sure you remove these things and put them back on when done.

5.       Make sure the CPM machine (the one I got is Dannyflex 450) is properly calibrated to your leg – mine caused issues when I raised it beyond 60% or so since my arms and legs are longer than the average.

6.       I felt that the ice machine ($250) was quite useful.  Without this machine, you will need to keep changing the ice packs and in addition they give a burning sensation after a short time.  The machine was quite nice and the ice in it lasted several hours.  It takes almost one full bag of ice every time – buy the ice that is all cubes and not the one that’s lumped together in one block.  The only negative is that there is condensation and no one tells you if it will wet the bandage.  The wetness was contained, in my case, by the Ace wrap or so it seemed.

7.       Find out from your doctor how you should re-wrap the Ace wrap(!) so you don’t mess up the bandage.

8.       Keeping your knee elevated above your heart level restricts bloodflow to your foot and it will hurt.  Use help to get this foot massaged when possible.  This is one possible reason why we have kids and if they are young enough you don’t give them a choice!

9.       They won’t tell you when to stop the medication – my experience suggests that you can take the narcotics for three-four days and then ease it off to Ibuprofen (OTC) starting the fifth day.  Always eat something (I usually ate a slice of toast if it was late in the night or early morning) prior to taking the narcs. 

10.   Have Milk of Magnesia (MOM) around and use it if you feel constipated.

11.   Avoid the anti-nausea medicine, that will kill your day – I was extremely groggy for 6-8hrs after taking that medicine.

12.   They suggest exercises every waking hour to strengthen your hamstrings, calves, thigh muscles, etc.  – I just wasn’t inclined to do those – especially the last few days, couldn’t get myself to do anything!  Not sure what that will do!

13.   This is a no-brainer – don’t sleep during the day if you can help.  This will ruin your night.

14.   Keep yourself busy with work or something else –the days will fly by.  You may want to watch movies or TV if you are that kind of person.

15.   Use this time to reflect upon what’s happening to you, your dear ones, and life in general.  If you live in a rat race, like most of us near large cities do, this time can actually be a good medicine to slow you down.

Post Op - Day 4

Last night, I tried to sleep with wedge pillows under my heel and it was very painful.  So, I just put a pillow under the lower leg and was somehow able to sleep.  I slept till about 4am and then couldn’t sleep again until 6am or so.  I kinda dozed off for a couple of hours and then got up and took shower and came downstairs. 

It is Monday morning and back to work day!  I had a conference call scheduled for 10am – so settled down in the CPM machine for a couple of hours and finished the call as well as checking emails, etc.  Continued to monitor work on and off during the course of the day.  The pain was not as bad as the previous day, so I stopped taking Vicodin and took Tylenol instead.  Later in the day, felt a little more pain during some walking inside the house and switched back to Vicodin (every six hours).  It is tough to sit around and not be working (walking).  Friends stopped by to say hello and chatted for a while.  The bathroom work is still going on - toilet working with sink partially functional (drain leak)!  The contractor promises that he will have the sink fully functional the next day.

Did CPM again in the night and was able to get to 90% for two hours.  Can actually walk with full weight on the legs – one step at a time.  Discomfort persists with some imbalance (may be mental) but pain is almost nonexistent after the first few minutes of standing.

I have been eating normally and have been having bowel movements regularly as well.  Even though I was able to attend to most of my daily work details, it is not the same ‘getting to’ work like every day.  I think I am ready to get up and get going.

Went to bed at midnight and dozed off…

Post Op - Day 3

Day 3 started with my waking up due to discomfort at about 4:30am.  The previous night, I had decided on sleeping in the Lazyboy in our living room rather than going upstairs to sleep on our bed.  Instead of waking my wife up for help (she was sleeping on the sofa in the living room), I decided on taking my Vicodin and sleeping.  I was told earlier that it should be taken with food or it may cause nausea.  Sure enough, I was feeling nauseated around 5am and this time I woke my wife up to get me out of the Lazyboy.  When I tried to stand, like I had done the past couple of days, it was extremely painful – more of a throbbing feeling in the leg (where they made incisions) – so, I sat down again for a bit.  It could be the blood that rushed through the leg after keeping it upright for several hours.  After a while, I tried to get up again, but the throbbing pain came back.  This time, I tried to walk it off.  After taking a few steps, I felt dizzy and my wife gave a bar chair for me to sit on.  After a little while, I took the anti-nausea medicine and went and fell asleep.  Around 10am or so, I was feeling very groggy and I thought I would go take a shower.  The throbbing pain came back as soon as I tried to stand.  So, I went and laid down on the couch and turned the CPM machine on and dozed on and off until noon or so.  I was able to flex about 70% this time in the machine.  I was still groggy and eventually got up around 1pm and took a shower.  I figured I needed to be careful getting up as whatever nerve blocks/drugs they gave during the surgery had surely worn off!  Showering is still a chore!

Rest of the day was uneventful.  I was careful getting up but did walk back and forth in our living room for over 10mins. with the help of crutches.  Did put full weight a few times with little or no pain or discomfort.  Basically, I had to be careful with getting up when it really hurt for a few minutes after which the pain slowly went away and I could essentially walk.  Later in the night, did the CPM again for a couple of hours at 70% and felt fine.  Did some exercises suggested in the post-op sheet – even though they suggest doing these hourly during waking hours, I probably did it two or three times total.  It’s painful and mostly seem to strengthen the hamstring/thigh muscle/etc. and I was in no mood for those. 

One big lesson today is not to take Vicodin on an empty stomach and then follow-up with Anti-nausea medicine – that combination really knocked me out and I felt pathetic almost half the day. Tonight, I decided to go upstairs and sleep in our bed.  I initially put a pillow under the heel, but it was very uncomfortable.  Took me an hour or so to sleep and even then it was quite uncomfortable.  However, as the night fell, I was able to settle into a decent sleeping pattern unlike the previous couple of nights.

Post Op - Day 2

I finally decided to get up about 7am or so since I couldn’t really sleep all night.  With my wife’s help, put the CPM machine to work on the bed itself (the surface needs to be flat for this one).  However, I didn’t know what to do with the brace.  After trying to see if we could loosen the hinge on the brace, we just called the surgical center.  A nurse called back and said we should remove the brace and everything else except the bandage before using the machine.  See – important details such as these get ignored in the process of filling ‘un’necessary paperwork.  Anyway, set the machine up to start at 10% flexion and went up to 30% within an hour or so.  No issues, it went as well as it could.  Felt I could easily increase it.

Finished the morning chores and wanted to take a shower.  This was probably the most difficult activity.  Covered the brace with a plastic bag and put a towel on top – just in case.  Our shower has a sliding door and is about 6ft long.  So, I kept my leg on a step stool just outside the stall and I sat on a lawn chair inside.  Got another bucket of hot water with a mug and turned the shower on.  As difficult as it was, I was at least able to get a decent shower.  Got dressed and came down the stairs which was not too bad and I was quite happy there was no pain.  Did the CPM for another hour or so and went up to 40% this time.  Had some friends over and chatted for a while and slept on and off on the lazyboy during the course of the day. 

Now the gross part.  Everyone was scaring me about bowel movements and since the surgery I hadn’t had one – so, I ate a few prunes (friends’ suggestion) and took four spoons (!) of milk of magnesia (MOM) – which is the dosage for adults.  I ate some cereal, had coffee, and ate more later in the day.  About 7pm or so, I began to have the ‘movements’ and it continued several times for the rest of the day.  I may have overdone it by taking too much MOM but it did make me feel much better. 

All this while, I was feeling fine and had been taking one Vicodin every six hours.  Towards the end of the day, I started to feel throbbing pain in the leg where they made the holes (I think).  Especially, when I got up, it would start to throb!  So, I was being more careful getting up.  I did the CPM for another hour around mid-night and went up to 60%.  I figured I would just sleep in the lazyboy instead of going upstairs.  So, I went to sleep in the living room  – quite an uneventful day, although it seemed to be a very long day.

After many years, I just sat around the whole day observing what was going on.  First thing I need to acknowledge is how much my wife took care of me and everything else.   The biggest problems in a relationship, I think, are due to taking each other for granted and not acknowledging each other enough.  I just hope I can convey my gratitude to my wife for all the things she has been doing since we met, especially during this period in my life.  The other aspect is how the children behave when an adult gets incapacitated.  Even though they are old enough to express themselves, it is almost as if they are unable to cope and instead, exhibit stressful behavior.  These are topics have been discussed for eternity and I don’t intend to add to this literature.  I just want to express my thankfulness to my family and my mother, and lest I forget my siblings (their families) and friends, they have been very helpful and were there for me during this ordeal.

How amazing is this human body!  We should be thankful that a human being has not designed nor created the human body.  Can you imagine how many problems there would be if this was a human creation? 

BTW, while I was going through the paperwork, there was a card from ‘LifeNet Health’ which made this ‘allograft’ available for me.  The card indicated that I may choose to send a letter which they will pass on to the family.  I want to thank the person and the family that donated the graft and through this writing here is my expression of my deepest and heartfelt thanks.