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.

Post Op - Day 1

Like I mentioned, we are getting some work done at home.  We are going to put in a shower stall in our powder room on the main level.  We started this work about a month ago, hoping to get it done by the time of my surgery.  The contractor promised it will be done by July 4.  You guessed it right – the work is not yet complete as of July 22.  In the powder room, we had a toilet and a sink, and as of July 22 morning, these are out of order (they were to be relocated).  So, I’ve been after the contractor to get the toilet fixed at the very least.  A family friend said he will make sure that will be done prior to our return from surgery.  We get home by about 10:20am and by the time the toilet was functional it was about 4pm!  No sink nor the shower stall – it will probably take a couple more days for these to be complete.  Such is life – you may plan as much as you want but there are no guarantees!

I was very groggy and barely made it home on crutches (using them for the first time).  I had a glass of water and then dozed off.  My wife insisted that I have something to eat and in that daze, I had some cereal and coffee.  With the anesthetic and drugs slowly wearing off, I was beginning to feel my leg but still very sleepy.  I think I slept till 3:30pm and then was fully awake and alert after that for the rest of the day.  I did go and talk to the contractor and had him put up the sink – it’s still not functional since the drain needs to be fixed and he didn’t have the right parts!  But the toilet is working!

Surprisingly enough, I did not have any pain whatsoever other than the discomfort due to knee brace, ice pack, bandage, etc.  May be I was prepared for a painful recovery.  Come to think of it, this is an arthroscopic surgery with four holes and since the bones and ligaments do not give pain, obviously the pain was quite limited and add to that the drugs (Vicodin is what I got) and I was pretty much pain free.  The only discomfort was this sensation of "pull" - is it due to inactivity?  May be it is the swelling that's causing this sensation.  I can't tell from the looks of it (due to all the bandaging, etc.) how bad the swelling is.  The "pulling" feeling is similar to when my knee was swollen prior to surgery. 

I went and sat in the Lazyboy with my feet up with a few wedge pillows – I remember someone saying that the toes should be above the nose level.  That reduced blood flow to the feet causing some discomfort as well – my wife said the foot was cold to touch.  She massaged it for a while and it felt much better.  In the meantime, the cold pak was on and really don’t have any icy feeling (like burning from ice paks).

The CPM machine guy said I should use the machine for about 6hrs after surgery and my surgeon said that I should only use it the second day for 1-2hrs in all.  So, no CPM today.  However, I was able to put full weight on my leg - not walk but stand!

I had some light dinner and then went to bed.  Going up the stairs was not as bad as I thought it would be, but was still a chore!  Lying down on the bed was more uncomfortable then on the Lazyboy chair.  So, that's a recommendation for anyone contemplating ACL surgery - get a lazyboy with some wedge pillows.  Anyway, couldn’t really sleep all night.  I was taking pain meds every 6 hrs and the next one was to be taken at 1am.  Since I wasn’t feeling sleepy, I thought I would blog some.  Anyways, it was not a good night as the discomfort was persistent throughout the night – not much pain but the bandage, etc. around the knee made it impossible to move the leg and that was definitely the cause for not getting much sleep – added to the fact that I slept until 3:30pm the previous day. 

All in all – I am happy with how the things turned out within the first 24hrs of surgery!  The biggest surprises are definitely being pain free and being able to stand!  In fact, the pain at the time of injury and the following weeks was much more severe than post op pain – at least the first day after surgery. 

Surgery

Got up real early (4:30am July 22) and completed my usual chores and my wife took me to the surgery center which is in a shopping mall – doesn’t necessarily give you a lot of confidence if you are going for a surgery in a building between a grocery chain and a Mexican fast food restaurant!  Some of my friends previously suggested that I should ask to be cut in an area hospital instead.  Too late for that now!

So, we go there by about 6:00am and we see one patient already checking in.  I was next and after usual paperwork (!) and payment, at about 6:30am, this nurse brings me inside and after changing into a hospital shirt, they give me crutches and show me how to use them – this activity takes about 2mins.  Let’s see – I need crutches for many weeks from this day and they spend two minutes showing me how to use them; I am given disclosures to sign, which if I really want to understand before signing and which probably have no consequence but legal will take hours to comprehend and sign.  They had previously called me to see if I already had a knee brace which I didn't and they provided one.   

I am given a stretcher kinda bed to lie back and fill in more paperwork.  I don’t understand how this is supposed to help – do you think people go through these disclosures an hour before surgery and then what if they say they don’t agree to those?  I almost wanted to do that!  Anyway, the forms include certain items like the surgeon will use his best judgment to do whatever necessary, etc.  Isn’t it why we go to the doctors in the first place?  Anyway, they ask me which knee was the problem one – which was again somewhat crazy – what if I say it is the other one?  The nurse made a circle with a sharpie on ‘the knee’ and the surgeon is supposed to initial it prior to anesthesia.  I am sure they were just reconfirming!  Prior to this, the nurse also shaves the surgical area while I wonder if the hair there will re-grow thicker.  Another young lady comes in and gets my blood pressure – 120/78 – pretty good for just before surgery I thought!  The nurse then wanted to poke me for IV and I tell him that my veins are hard to find – no matter what he tries twice and gets another nurse to do this right.  Then, the anesthesiologist (doctor) comes in and tells me how it goes.  I remember something that happened the previous day.  My colleague at work was joking that I should pay this doctor more or he may not bring me back.  After a little while, another anesthesiologist (assistant ?) comes in and says that he will be taking care of me.  At this point (and also periodically) I wonder what if they give me anesthesia and I may not be able to do anything but still feel the pain and know what’s going on around me?  I have read some stories on this subject on internet.  Oh, well!  It seemed like there was more than one surgery scheduled at the same time and the activity in that room was quite hectic – about 20 nurses, assistants, and doctors spilled in all over.  It seemed like a production environment with things moving really fast with precision.

About this time (say 7:00am), they bring my wife in and I could see she was concerned but was trying to put up a brave face!  We talk about kids activities for the day (it was last day of summer camp for them) and so as not to think of what was coming.  In the meantime, more papers were provided with details on what happens during anesthesia and also post-op instructions.  We try to make sense of it while the reality of the surgery is sinking in.  Around this time, the surgeon comes in and after a brief introduction to my wife, he initials the circle on the knee.  He briefly goes over the intended procedure and tells us that he will have pictures for me.  Due to my skepticism about the ACL tear, I say that hopefully ACL is fine to which he responds something like – he will be surprised if that’s the case.  He gives post-op directions as to when and how long the CPM should be used, pain medicines to use, when to come back, etc.  He also asked me if I got the ice pack and when we said no, he said he recommended one.  I asked him if they had one and he said I will be fitted with one and I should make the payment ($250) at the front desk.  The nurse brings the ice pak made by Breg (Breg Kodiak Intelli-flo knee pad).  Then, another young lady comes and reconfirms my name and DOB – lest someone else be sneaked in for surgery instead of me – right after check-in.  They also infuse antibiotics at this time and around 7:20am or so, I start to get some shivers and they said they are normal (or are they pre-surgery jitters – I do not know).  This is supposed to be an extremely hot day (turned out that the temp. records were broken during the day) and it was freezing (felt like it) inside.  So, the anesthesiologist (I hate typing this word) assistant comes in and gives Valium and tells me that within about 30secs I will feel better.

It is almost 7:30am now and I am trying to calm myself down.  That’s basically what I remember.  The next thing I know, the nurse is shaking me pretty vigorously trying to “wake me up”.  I guess the surgery was done!  My wife was next to me and the nurse (in her hurry to get me out of there) was asking me if I want to drink anything (I am groggy and could barely comprehend anything).  She also wanted to know how I got this injury.  I am blabbering something at this time.  In any case, she said everything went well (didn’t see my doctor or anyone else at this point) and I see that my t-shirt was on (I had to change into one of those hospital shirts when I went in).  She asked my wife to pull-in the van and got me out of there in a real hurry.  I am still groggy and they give me crutches and got me into the van.  Anesthesia (again) is a great thing – just amazing how it works.  I wonder how things were prior to this great breakthrough.  My wife tells me that I was talking to the nurses and they were joking and I was laughing and I said bye to my wife when they were wheeling me to the operating room, etc.  Not a clue of any of this. 

So my wife waits at the surgical center, and at 9:00am sharp, the doctor comes out and asks her to go inside.  He tells her that the surgery went well and that the ACL was in worse shape than anticipated (I guess he had another baseball practice when I was under) and that the meniscus was not as badly torn.  So, in a way it was good news and that two of the radiologists were correct and the MRI center radiologist (full tear) was also correct in the sense that if the ACL is torn to an extent that it is of no use then it is considered a full tear anyway.  But, two of the other radiologists were off.  Can’t blame them, they didn’t have the benefit of clinical diagnosis even though the other two who got it right didn’t either!

The timeline given to us prior to surgery was that we arrive at 6:00am, the surgery will start at about 7:30am and will take an hour-and-a-half followed by an hour in the recovery room.  Guess what, that’s exactly how it went – by the minute.  It was almost like they wanted to stick to that schedule as the nurse literally pushed me into the van at 10am!  Besides my sarcasm, I think the whole process went perfectly for me except that I wish I had another hour or so in the recovery room as I didn’t have my bearings in place for that long.  Got home and was somehow able to use crutches to get in and lie down in the sofa.  My wife bought me a La-Z-Boy chair that I intend to use a lot but not right now.  With little time to sleep the previous night and with all those drugs in the body, I just want to sleep.

Well, besides my comments (may seem like complaints), that are intended to be my observations during the surgery, I am extremely happy how it turned out thus far.  Still long ways to go, but it was a great start.

Done deal!

Ok folks - Surgery done as planned - it is about midnight following surgery right now.  Went very well - can one say 'very well' if one has to undergo surgery?  Will fill in the details tomorrow.  Until then, you can enjoy this video...

Seinfeld - I miss that show!  That's the show about common sense - which is becoming more and more "less common".  That doesn't sound right - let's try again "becoming less and less common".  Hmmm - I think it is "uncommon"!

Pre-op Physical Therapy-

This is the night before surgery about 11pm - the surgery is scheduled for 7:30am in the morning.  Had dinner around 8pm, went for a haircut at haircuttery just about the time they were closing which made them upset (I could understand), but I told them this is urgent and I couldn't go earlier - they were not impressed.  It showed in their attitude and the lady actually messed my head up a little bit.  I was saying thanks many times expecting an acknowledgement but nada!  I guess I really made them unhappy!  Will not go late again I guess.

Took shower and just drank two full glasses of water and am pretty much done drinking/eating until surgery.  Earlier in the evening, the rep from the company that's providing (on rent) the CPM machine came over.  The appointment was actually scheduled for yesterday - the guy called and asked if he could come today at 7pm instead.  So he came and gave a demo and told my nurse, I mean my better half, how to operate it and left.  Again, this seems to be a simple mechanical device controlled by a wired remote nevertheless - no engineering marvel, believe me - and they make it sound like it is such a big deal.  I think anytime anything pertaining to healthcare is involved, there is money to make.  I don't know at this time what the costs are but they rent this simple equipment and I bet it is quite expensive.  Writing about expensive, another thing about the healthcare costs - during my last posting I forgot to mention one thing.  I asked my doctor what I need to do to get my knee ready for the surgery.  He said that the better shape it is in prior to surgery, the better it would be after.  So, when I asked him what I need to do, he prescribed pre-op physical therapy.  So, I went back to the office and the first appointment I got was for the following Monday (7/18).

On 7/18, I go to the PT office and forget to take the prescription with me (my ACL is beginning to affect my memory).  Now, I'd think it should be fairly easy to verify, but she wanted me to call my doctor and have them send it and until then I can't be seen!  So, I call my wife who goes home and faxes the prescription (thankfully our office is just about a mile from home) - God bless her.  In the mean time, they give me a bunch of forms to fill out.  This is another common feature - anytime you go to a different doctor, you need to fill these forms out.  This is the electronic medical records era we are living in!

The physical therapist himself had both of his knees repaired - one for ACL and Meniscus - so, I wasn't alone.  He thought I will be in a bad shape but was surprised to see my flexibility and lack of movement in the knee.  So, he 'diagnosed' this a meniscal tear and probably partial ACL tear.  Anyway, so he takes me and makes me do these simple exercises which I breeze through and at one point he looked like he was out of ideas.  All this lasted about an hour.  I knew if I didn't do these exercises at the PT office, I would not do them at all - so took another appointment and went there yesterday (7/20) and it was even easier this time.  In fact, most of the work outs seemed pretty straightforward.  I wonder what their bill is going to look like.  As far as I am concerned, it shouldn't be any more than a trainer's cost at a gym.  Remember, anything you attach to healthcare - it will b expensive.  No wonder these costs are so expensive in this country!

Well, on home and work fronts, it's been as busy as usual - if not more as we are getting some work done at home.  That's for another day!  One funny thing though is that I have had some friends call and visit me this last few days and tell me not to worry and that everything will be fine.  I am not really worried and not even thinking about it for most part until they tell me not to worry, when I begin to think if I should worry - may be it didn't sink in due to my busy schedule.  Now, I am actually telling them not to worry!  This is it!  Will update in a couple of days on how it went...

Pre-op Doctor's Visit

My swelling has finally gone down.  All this while (over two months now), the swelling persisted and almost felt like it kept the knee in its place.  Now, when I turn on that knee, I have a real awkward/somewhat painful feeling.  Does this indicate a tear in the ACL?  Cannot explain, very uncomfortable though.  With swelling gone, the range of motion has almost returned 95%.  Can almost flex the knee fully and can walk almost normally - except for that turning motion.
 
Within the last week-

• I received a phone call from the doctor's office going over the procedures of getting to the surgery - which is scheduled now for July 22.  This was followed by an email that came with pre-op and post-op procedures.  Need to show up at the surgical center at 6am for 7:30 surgery.  Can wear pull-up type shorts which can be worn during surgery.  No food or drinks from mid-night on prior to the surgery.
• I received a phone call from the surgical center asking me usual medical questions like allergies, previous history, medications, etc.  Provided guidance on what to do pre-op like stopping Motrin and any other anti-inflammatory medicines for a week prior to surgery.
• I also recieved a letter from a "supplier of durable medical equipment" indicating that they have received an order from my surgeon to supply me with a CPM machine for post-op recovery.  It indicated that they will call me to arrange for a meeting to go over usage, etc. 

Now, I also went for the previously scheduled doctor's visit today (July 12) to get answers to my questions.  I asked the doctor what the procedures were - he said I will be under general anesthesia after meeting with the anesthesiologist (why are medical terms so difficult - why can't they use simple english).  Then the doctor will again do "baseball practice" with my leg to confirm the MRI results.  However, he will also "scope" my knee and indeed confirm for sure their diagnosis is correct by "seeing" it.  That basically answers my concern of getting cut unnecessarily.

Once the diagnosis is confirmed, he will either fix the meniscus tear (if it is torn where the blood supply is there) or remove (carve out?) the torn part.  I think he said four holes in all will be made.  Holes are drilled in top (femur) and bottom (tibia) bones to pass the "allograft" and put screws in there.  These are not metal screws and are left in place and the bone grows over a period of time filling the holes (I think) and gripping the graft. 

Depending on the extent of damage, the doctor indicated that I can pretty much get back on my feet the same day and start flexing and using my leg as much as possible (pain and swelling being the big inhibiting factors).  Since it is my right knee, I cannot drive for about four weeks or so and that's the only big issue at this point.  Otherwise, the post-op is supposed to go smoothly.  I asked the doctor what I should do to prepare myself.  He gave a prescription to go see a physiotherapist to get the knee ready - the better the shape it is in prior to surgery the better the recovery will be.  So, I intend to do this as much as possible.

It's been over a decade now since I have been fairly active.  Sitting on a couch is no fun!  I tried to do some stationary biking and a strolling through our neighborhood.  Was not a good feeling - knee was quite painful within the first ten minutes.  For the first time in this many years, I haven't really worked out seriously for over two months now.  To counter gaining weight, I have reduced my daily intake drastically - haven't had breakfast and proper lunch (I am used to having cereal for breakfast and a sandwich or something similar for lunch) in a few weeks.  Lunch is typically a banana or some other fruit.  The weight is thus steady - may have actually lost a pound or so!

So, there you have it.  I do hope it is as straightforward as the doctor made it sound like!  Looking forward to it (really!)...

Too Many Cooks

My brother-in-law was able to get another radiologist's opinion who confirmed a tear in the ACL.  At this point, Meniscus tear is mostly confirmed but the ACL tear was in question.  This and some of my symptoms over the last couple of days somewhat confirm ACL tear!  My postings probably reflect my confusion in this matter.  They sway nicely in tune with the opinions I receive.  Human mind is so fleeting and my behavior probably is quite human!  What I am getting at here is the fact that we all justify our actions based on what we want to hear.  I have done it many times and I know of others who have done it.  For instance, I am sure there are situations when we said or did something which we knew at that time was wrong – however, we try to justify these actions by coming up with all kinds of arguments in their favor.  It is just a way of ‘convincing’ ourselves that our actions were not our fault but under the circumstances we were right – all this while our inner voice is shouting at us telling us otherwise.  Enough of this philosophical ‘non’sense. 

BTW, my brother-in-law also showed the MRI to an orthopaedic surgeon who agreed with the course of action.  So, thus far I have the following MRI readings for my ACL – the MRI performing center diagnose it as full tear, two radiologists say no tear, two radiologists say partial tear.  If anyone reading this blog wants to make additional diagnoses, I have prepared a video of one of the MRI Series – feel free to look at it. 

I was actually impressed with how easy it was to actually create a movie using the MRI images.  Remember the MRI images are not in a format readable by typical image editors.  I was only able to use a ‘viewer’ that came with the CD to look at these images.  This is what I did to extract a movie out of it.  BTW, this can actually be very useful if you want to use continuous screen captures into an avi file, which is what I did.

This is what I did – searched for free software and came across CamStudio which I downloaded and installed on my computer – quite a small footprint and a seamless install.  Then, you open the software application and click on the record button (you can set the screen size) and until you stop whatever is happening on the screen is captured.  So, I opened the MRI Viewer and scrolled down slowly one image at a time which was captured into the avi file.  Then opened this file in Windows Movie Maker and split the files into reasonable size clips and combined them into a mov file.  I thought it was pretty cool.  Speaking of cool, my children – son who will be a teenager in a few weeks and daughter who is eleven and a half – think I am old and weird as they think only young kids can do ‘cool’ stuff (blogging and making clips, etc.) and I tell them they have one cool dad!

ObstACLes!

Let’s see!  One radiologist says no ACL tear, no meniscus tear and my MRI radiologist says ACL tear and medial meniscus tear!  These are technically two ends of the spectrum.  So, I thought I will consult another radiologist and see if I get another opinion.  My brother-in-law is a veterinary surgeon and when I mentioned these diagnoses to him, he said he knows someone and arranged for a meeting to show the MRI.  I uploaded my MRI files to our FTP site and had him download the MRI files to his laptop which he took to the radiologist and had a reading.  This time the reading was somewhere in the middle – possible ACL tear but inconclusive and same with the meniscus!  Oh, boy!  What to do now.  So, I go back to the first family friend who got a radiologist to read the MRI and told her about this diagnosis.  This person has already asked another radiologist to look at it (4^th reading) and he said he couldn’t see any tears!  This was getting to me at this point.  I wanted to get it right, tear or no tear didn’t matter at this point.  All this while, I still have little pain around the knee area – but cannot pinpoint where it came from.  Slight swelling still persistent. 

After several agonizing days regarding the surgery decision, I called up my ortho and asked for another appointment prior to scheduling for surgery.  I will be going on the 12^th (July) and will find out if I can get answers to my questions.  This time I want to ask him and see if he can perform diagnostic arthroscopy as well as fix the meniscus (if torn) at the same time before touching the ACL.  I am not sure if they can schedule an arthroscopic surgery and do an ACL surgery if ACL is torn.  Anyway, that’s the way I think I am going to go.  Another interesting event transpired yesterday (July 3).  My friend’s sister and her husband are doctors and were visiting my friend from Boston and they said they can read the MRI and see what’s going on.  Since my friend lives a few minutes from my home, I went there with the MRI CD and opened it up.  Even though they are not radiologists, they were also not too certain from the MRI if there was a tear.  One comment they made was that in my case clinical diagnosis is probably needed instead of an MRI.  In fact, one of them tried to check me out (remember the baseball practice with my leg by my ortho).  He was much gentler and did not find much of a movement indicating a full tear.  Since he is not an orthopaedic surgeon, he wasn’t 100% certain he could do a clinical diagnosis as a torn ACL.  Now, I am leaning more towards the possibility of my ACL being not torn afterall! 

Guess what, my brother in law called up and said he got another appointment with a different radiologist to see if they concur with any of these myriad of conclusions!  So, the saga continues.  In the meantime, I am hoping that the swelling will go down and may be the ortho will check me out one more time and do another clinical diagnoses prior to surgery (which seems to be certain – either diagnostic arthroscopy or arthroscopy to fix meniscus).  I guess I will wait till the 12^th before deciding for sure.

Kneed Surgery?

The following week (third week of June), on a thursday morning, got an MRI done and was given a CD which I thought would have a report.  So quickly went to my office and checked out the contents - only saw images but nothing else.  It is really intriguing that in this era of ultra fast computing and high tech diagnosis, the MRI images are still black and white!  Wouldn't it be nice to see them in color?  Not that any of the 290+ pictures made any sense.  I cut a few copies and contacted some of my doctor friends/advisors to see if they can get the MRI diagnosis.  In the mean time, I got an appointment to see the orthopaedic doctor the following tuesday. 


The first diagnosis I got from a doctor advisor (courtesy a Radiologist that works in the hospital) was that ACL is fine, meniscus is fine, but there is degenerative arthritis.  I wasn't sure if it was good news or bad news.  So, there I went to the internet and starting searching for degenerative arthritis and it sounded like it is osteoarthritis which results from damage to the knee or could be due to age (remember I am still not 'aged').


So, I go to the orthopaedic doctor whose assistant went over radiologist's report which gave the diagnosis as:  1. Full ACL tear; 2. Medial meniscal tear; 3. fluid in the knee; 4. arthritis.  In the mean time, the doctor comes in and goes over the film with me showing these things.  He had me lie down and this time was certain there was some laxity in my knee which he couldn't find during his baseball practice with my leg during the previous session.  He gave two options - 1. rehab and take anti-inflammatory drugs and live with it.  There may be times when these things flare up and I have to go through this process of  rehab/drugs, and  2. get in, perform ACL repair/reconstruction and rehab until better.  I wasn't prepared for this as this was in complete contrast with the initial reading I got.  So, I couldn't prepare the way I did for getting an MRI.  I needed time and said that I will have to check with my "better" half before making a decision.  The doctor said he will drain the fluid since the knee was quite swollen still (after almost two months of injury).  Got a huge syringe and drained out like a cup of blood.  Apparently, blood in the knee is also an indication of ACL tear!


The fun continues in my next post...

MRI time it is!

Per my doctor's referral, about two weeks ago (mid June 2011), made an appointment to see the orthopaedic surgeon.  This time, I was determined to get an MRI being fully aware that I am not a millionaire sports guy.  So, I spent some time trying to come up with things like "I am not a professional player but have been playing since I was little" - which is kind of lame.  But, you end up doing lame things when you get desperate.  Finally, I thought I will tell him how much I have been paying my health insurance company through all my openings!  You get the idea, I wanted an MRI really bad - just like our kids want everything they see no matter what!  It almost became an obsession and the real problem was not much of a concern at this point but getting an MRI was something I needed and I focused on.


This doctor was very typical of the breed and seemed to have seen these million times or he must be a real good actor!  He initially treated my leg as a baseball bat and swung it around (seemed like it) to make sure the ligaments are ok.  Then poked the knee joint around until I almost screamed in pain - which seemed to have delighted him (just kidding)!  Based on this initial "try out", he diagnosed it as a possible medial meniscal tear but said the ligaments are most likely fine but not certain if there are any tears.  However, he didn't care if I was a millionaire sports person or not but ordered the MRI anyway.  What a bummer that was - all the practice I did to convince the doctor to order an MRI was useless.  Finally getting the MRI ordered was somewhat of a disappointment!

To MRI or not to MRI

So, I've been playing Racquetball for a while now!  Then, early this year (Jan 2011), I twisted my knee pretty bad at home with my right leg pivoted on the floor and my entire body got twisted on it.  That was excruciatingly painful for about 10mins.  I couldn't touch my leg during those 10 mins.  After that, again I found out from my doctor that I wasn't making millions of dollars playing professonal sports and again no MRI- so rested for a few weeks and was back again at playing Racquetball ever so cautiously.  Life continued for a few months.


Come May 2011, there was a word that some charity "Cricket" tournament was to be held in Mid-June.  All the "young" folk around my age wanted to bring back our younger day memories and registered for this tournament.  Then, we decided to practice once a week until the tournament.  Little did we realize that the "feeling" of being young would be betrayed by the bodies that we carried.  Among some smaller bruises and injuries faced by my colleagues during the course of these practices and actual tournament, I for one (having participated at the high school/college and university levels when young) went about "full swing" the very first day of practice.  What a swing it was!  The first time I started to bowl, my knee "clicked" like when you pluck a string.  I started to be a little careful but when I flexed my knee after a little while to pick up a ball, it had become very stiff and I almost felt like my thigh muscles tore!  Within about 10 minutes, the knee started to swell (my knee never swelled up in the past).  In about one half an hour, I couldn't flex my knee at all. 


This time, I iced it and went to the doctor a few days later and asked about the MRI.  Reminded again about not making millions... but this time said let's revisit once the swelling goes down.  Took 400mg ibuprofen and iced it and by the weekend, felt a lot better - so went and played cricket again - ever so cautiously this time.  The knee swelled up again and I iced it and it became much better the following week - this continued until the tournament was over in which I participated with help from much younger kids.  At that time, I went back to the doctor who finally figured it didn't matter that I didn't make millions playing professional sports and referred me to an orthopaedic surgeon and calmly shifted the burden of ordering an MRI to him. 

Pop goes my knee

Sometime in 2009, I started playing Racquetball again and also found out about Badminton being played at a local community center.  The Badminton excited me as I did play that sport quite a bit during my high school and college days (at the college level).  My Racquetball buddies were also interested and we all decided to give it a shot.  And a shot it was!  During one of the badminton sessions, my right knee "popped" and was extremely painful for about 10 mins.  No swelling nor any other symptoms except some pain for a couple of weeks.  Went to my doctor and he said it may be a sprain and wanted me to rest for a few weeks.  When asked about MRI, he said if I were to make millions of dollars playing professional sports then he would order one, otherwise, he wanted me to rest it and "see" what happens.  I kept seeing it but nothing happened! 

On a serious note, I did rest my knee for about three weeks and went back to playing Racquetball very cautiously.  I was very conscious of this knee and was extremely careful not to push myself.  Due to scheduling issues between the Racquetball partners, we have been playing on and off since then.  Every once in a while, I would feel a little wierd in the knee - may be a click here or a click there but didn't have any issues - it did cause some stiffness couple of times, but that's the extent of it - no pain, no swelling, nada!

Background

Ok. this is my very first attempt at blogging! Hopefully, I will figure out how to do it right when I am recovering from my ACL surgery that will most likely happen.  I plan to keep updating this blog as things transpire and give my story of what is involved and what might happen.

Here is some background about myself!  I am a 45yr old male living in Virginia, USA.  Been in the area for about 18 years now and I call this my home.  Came to the USA (Illinois) in 1989 as a student and went on to obtain MS and then PhD.  Was quite active growing up playing Cricket and Badminton, and of course jogging/running, etc.  Got introduced to Racquetball as that was one sport that didn’t require more than one person to play with and was readily accessible for students.  Played quite a bit and really enjoyed the game as a recreational sport rather than a competitive one – though it got quite competitive as the years went by.

Job search brought me to the Washington, DC metro area and the summer job I took up in 1993 transpired into a prolonged stint that started with working for a government contractor that eventually lead to starting a government contracting firm with my partner/wife.  During this period, I got married (1995) and lost half of me (meaning now I am one-half and then there is “better” half).  Until that point, I was fairly active working out, playing Racquetball, etc.  All this stopped with marriage and started to gain perspective (in other words, weight).  This continued for a few years and the kids started popping out (a boy and a girl within 15 months).  Right around that time, a dear friend – who was quite active physically, died very young while on a treadmill!  As a result, the workout regimen started out again (also found out about high cholesterol, etc.) and have been keeping to a schedule of working out quite regularly atleast three times a week (from about 1999).

My work keeps me busy an average of 80hrs/week if not more.  Inspite of that, I like to keep fit and healthy for various reasons, one of which is to de-stress.  But, I do enjoy keeping fit and as enjoyable as it may be sitting around watching football (redskins) and hockey (capitals - I am an Acela ledge season ticket holder) games during their respective seasons, I prefer to be walking and playing whenever possible.  So, the events that transpired over the last couple of years have put a damper on my active lifestyle.  Even though my intention is to keep a chronicle of the latest developments with my ACL, I will try to add-in whatever that might be relevant or of significance (to me).