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.