Sunday, January 24, 2010

Disrobing the knee

So it's been 3 days since my surgery. I guess the whole procedure was pretty routine for my doctor, as nothing special was prescribed. As I suspected, I was overly nervous of the whole general anesthesia thing. My Anesthesiologist was really nice, very smart, and presented an amount of confidence that made me comfortable with what was going on. At last it was time for me to walk myself into the OR. The staff were nice enough to supply me with a blanket, so as not to moon everyone behind me through the opening in my gown, and they carried my IV's as well. As I walked into the OR, I saw the table there before me, long and cold looking, with the arm holders that could only remind me of images I've seen of tables presented to subjects about ready to be administered a lethal injection. It's all I could think of. I voluntarily climbed up and laid down on the table, doing my best to place trust in the staff that has treated me so well so far. I was pleasantly greeted to a warm posterior, to which I blurted out loud, "Hey, this ride has butt warmers!" That got a good laugh out of all in the room. The doctor and anesthesiologist hadn't arrived yet. Seconds later, my sleepy time doc walked in, and talked about all the good things he had in his medicine cabinet for me. That's the last thing I remember.

What seemed like a millisecond later, I was coming to in the PACU (Post Anesthesia Care Unit). I was given Saltines and Graham Crackers, and a can of ginger ale (my choice). Finally. I was still quite hungry, from not having eaten anything for 19 hours. Throat dry from drugs, I chewed on the plate of food, only able to swallow after soaking it in the ginger ale. Once I ate it all, I was given a percocet to help with what pain was still remaining. The anesthesiologist had given me a femoral nerve block that was taking care most of my problems. A little pain remained behind my knee and that's it. Over the next to hours a came to enough, read stuff, forgot it, and chatted with my wife and friend, who were there to take me home.

I've been on the CPM (continuous passive motion) machine almost continuously since I've been home and awake. It's amazing how it seems to keep the pain at bay. I'm to increase the Range of Motion by 10 degrees everyday, eventually working my way up to 110 degrees. Day 1, 45 degrees. So far so good. I've only taken drugs at night (except for the first day) to help me sleep. Standing up is probably the worst. I can feel the blood rush to the joint after being elevated, the the pressure can feel quite agonizing. It usually quickly subsides and lets me walk around though. I'm to only put 50% weight on my knee for the first 14 days, and I'm quite fine with that.

So after 3 days, I've decided to take of the dressings and inspect the wounds, make sure they are't getting infected or anything. Looks good to me.

It was quite an experience taking off the Ace bandage actually. I could feel blood beginning to flow where it hasn't flown all that well for the past few days, but it was different than standing up. Overall not to bad. 4 major holes. I was expecting 5, based on the pain I had been feeling, but there wasn't one from were the graft was harvested, and where I am feeling the most pain. I guess the doctor went through the incision made below my patella to harvest the tendons from my gracilis and semitendinosus.

Overall though, I think I'm doing well, and can feel improvements day to day. Either that or my tolerance to pain is improving. I'm going to continue the use of the CPM, and the RICE (Rest, Ice, Compression, Elevation) therapy until Thursday, when I have my first PT appointment. Supposedly I can get on my bike on day 21, and ride. Looking forward to that. Until next time...

Sunday, January 17, 2010

T minus 4 days

If all goes as planned (I don't get sick between now and Thursday), I'll finally be going in for my anterior cruciate ligament (ACL) reconstruction surgery on my left knee. For the sake of any type of amateur comparative study, below is a picture of my current state. Post surgery images to follow soon. (I apologize for the ugly picture. I've decided there's no way to elegantly present this part my anatomy. For that matter, there's probably no way to present any part of me elegantly.)

As you can see, my right leg, in particular my quadriceps has significantly more muscle tone. It's also a little bit straighter. Since the injury occurred, I've been able to get most of my range of motion back. With a little pressure on my knee, and my heel elevated, it will fully straighten out, once warmed up. For flexion, I can get my foot about a hands width away from my rear before I have tension in my knee. I'm not 100% certain what is causing this, but my guess is that it is probably a combination of loss of flexibility in the muscles around the joint, and possibly scar tissue in my MCL needing to be stretched out. Maybe the crud of what's left of my ACL is getting in the way too, not sure. Regular use of the limb and performing of assigned physical therapy exercises have made good strides in improving my range of motion though. I'll be continuing them up until my surgery.

I'm not sure how much swelling there still is in my knee currently. It does look more swollen, but I'm not sure how much of that is from atrophy. To describe the current condition of my knee, it seems to work well enough. When I sit for a long time it does start to feel "lethargic" or as if the joint is full of molasses. The only pain I have is at the bottom of my patella, where it joins with the patellar tendon, and only to touch. It feels as if it's bruised, but not too bad. I don't have a whole lot of confidence in my knee. I'm comfortable hiking in relatively rough terrain, and on steep slopes. Snowshoeing is fine too, but when it comes to anything that might involve any kind of jarring, or stop and pivot type motion, I am definitely not comfortable. It's probably more perception than reality, but I'd rather play it safe than risk additional injury. I can tell that strength has certainly left my leg, but I've been able to ride my bike trainer for as long as I want to. I usually stop out of boredom, not physical limitation. On a side note, I've started pedaling with one leg to work the individual muscles, and I can last just as long on my injured leg, as I can on my non-injured leg. Where's the power cranks when you need them?

I believe that they will be harvesting the new ligament material from the part of the tendon that connects my hamstring to my tibia. Supposedly use of this site makes for a less painful recovery, though it takes a little longer for the tissue to bond with the bone.

Post operation recovery involves cructches for a week or so. They say I can put 50% of my weight on the knee as soon as I can tolerate it. I have my first PT session one week after surgery. They are also putting me on a continuously passive motion (CPM) machine as well. From the reading I've done, the machine makes no long term difference in a full recovery, but it does tend to help keep pain down, and get your range of motion back faster. I'm supposed to use that for at least 8 hours a day.

So with all that being said, I'll report back next when I'm lucid enough to put some thoughts down after surgery.

Thanks to everyone who has offered me and my family support during this time. It means a lot!