Tuesday, April 29, 2014

Walking the Talk

I love how doctors have professional language that makes common things sound obscure and medically sophisticated.  The fact that English is not my first language only increases this effect.  In the post-op rehab procedure sheets that I was given by the surgeon's office, it said that I should be able to "ambulate without the splint or crutches" by the beginning of the 3rd week, which threw me for a loop.  The only word I was familiar with that had anything to do with ambulating was ambulance and I certainly didn't want to be in one with or without crutches.

Well, by and by it downed on my that ambulate means to walk, and I felt like I found a clue to a great mystery of the medical universe.  But by then I was already ambulating well enough on my own and so didn't need to have fancy words to describe padding across space.

Linguistics aside, I started walking without the splint right after Dr. Zarnett ok'd it at the follow up last Wednesday.  The nurse wanted to take the splint to throw it out, but I carried it from the appointment like a baby carries her safety blanket.  I never put it on again.  My knee felt weak, but I was overjoyed to be moving freely.  Of course at first I wasn't so much walking as limping, and not more than a few dozen meters at a time. Because all the muscles have weakened, and there was still lots of scarring and swelling from the surgery, my leg refused to behave normally resulting in a heavy limp with quite a lot of pain all over.  Muscles hurt that I never knew existed.  To keep this from happening it was very important that I start to walk normally as soon as possible.

It turns out that restoring normal gait is a lot of work. The physio and the exercises are helping bring the muscles back slowly, so things are improving, but it is taking more time than I expected.  Its been almost a week since the follow up and I'm still working on it.  After walking for a few minutes the knee becomes very stiff and achy and it is almost impossible to keep from limping.  I get tired quickly, and I'm usually exhausted by the end of the day.

A lot of the difficulty is mental - all the mechanical things needed for walking are functional.  Karla neatly illustrated this by making me walk backwards.  Because the mind doesn't think that walking backwards is a normal thing to do anyway, the gait pattern is almost unaffected.  Yet walking forwards the brain freaks out and tries to keep the weight off the hurt leg by any means possible.  It really is all in the mind, Grasshopper.  Although, I can attest to it that the pain is still in the knee.

Sunday, April 27, 2014

Week 2 Retrospective

At the beginning of each retro its good to review the actions from next week.  Lets see how I did on the two from last week.
  1. Define longer term milestones - I was too lazy to do the research that this required, so it rolls over to next week because I still think its important to have these goals.
  2. Start keeping track of exercises - I did start recording the sets and reps in a spreadsheet, so I'm gonna count this one as done.  
So, I'm 1 for 2 for the first week's commitments.  Now, lets see what went well and what wasn't as great during week 2 after the surgery.

Went well:

  • No more splint
  • Finished pills
  • Doc says all is going well
  • Can walk without crutches or splint (sort of)
  • I'm back home
  • Doing exercises every day
  • Keeping records of exercises
  • Working from home

Could be better:

  • Didn't define long term goals
  • Walking is painful
  • Different muscles are hurting all over
  • Not stretching enough
  • Hard to walk without a limp
  • Haven't gone to work yet

Action Items:

  • Define longer term milestones
  • Dedicate more time to stretching

Hm... Looks like last week a lot revolved around exercises and walking.  In fact walking has been  on my mind a lot, so I am going to do a whole post just about that next.

Besides starting to walk, last week was a time to say goodbye.  They were very useful to me for a while, but finally this threesome had to go, and lets hope I'll never need them again:

Wednesday, April 23, 2014

1st Post-Op Follow up (Day 12)

Milestone 2 (walking without the splint): check!

I had the first follow up appointment with my surgeon, Dr. Zarnett, today.  Well, the good news are that I can start walking without the Zimmer splint, the incisions are healing nicely and don't need to be covered up anymore, and last but not least - I can start driving as soon as I feel up for it.  And the bad news?  There are none!  The next check up is in four weeks.

While waiting in the hospital room, I sneaked a peak at the operative report that the nurse pulled up on the screen (it was right there on the wall in front of me, I almost didn't have to lean over).  Not that I would ever want to have it again, but arthroscopic surgery is so cool!  The report talked about what happened during mine.  Apparently, they put some morphine into the knee, which might explain my rather mellow disposition afterwards.  Other than talking about funky drugs, it also said that all the other parts of the joint were examined and they were good and stable.  

At physio two days ago my ROM (range of motion) was at 99 degrees.  With this joyful piece of news I also got a bunch of homework:

  • Balancing on the leg with eyes closed - trying to work up to 30 seconds
  • Heel raises on one foot
  • Leg lifts with theraband: inside, outside, backwards, forwards
  • Seated hamstring curl with band
  • Glute bridges (lying down with knees slightly bent raise bum squeezing glutes)
  • Bicycle pendulums (sitting on a bike, use the good leg to spin the pedals slowly flexing up the operative leg - work to get through the whole revolution)

All of these were hard to do at first, but got a lot easier by next time. Today I was at 25 seconds for balancing with eyes closed, and at 20 bike revolutions.  I've been doing a lot of stretching as well - it helps relieve the tension that accumulates with flexing and with walking.  Stretching out the hamstring also helps to activate the quad, which is getting used to doing its work.  However, the muscles in the leg are still very weak.  My right thigh (i.e. the operative leg) is noticeably smaller.  Its the first time in my life when I'm not happy about loosing weight, but I think the muscles will come back soon.   Exercising is causing the knee to swell up a bit more, and it gets numb and very tense in the patella area.  It helps to ice it and give it some rest.

I'm still seeing lots of progress every day, and its encouraging.  I started keeping track of the exercises, so I should have some metrics soon.  And I still have another milestone to reach by the end of the week: 110 degrees
P.S. They sure do give you good advice at the hospital.  Good thing I didn't have a cast, who knows what would end up in there?...

Sunday, April 20, 2014

Post-Op Day 9

Highlight of the day: I walked 1 km.
It kinda just happened - I went outside to get a little fresh air, and just kept moving.  I used the crutches a couple of times for a few minutes to give the leg a break.  The walk was tiring and enjoyable, and it wasn't painful.
Aside from the fun in the sun, I've been a little lazy all long weekend, and didn't do the full load of the latest exercises:

  • Weight transfers - standing on both feet without the splint put more weight on the operative leg (working towards 100%)
  • Heel raises
  • Hip swings (backwards, inside, outside)
  • Quad sets and leg lifts with ems

I keep working on the range of motion - I think I've moved further, but will have to wait until tomorrow to get the updated stats at physio.  I've also been doing more stretching since I realized that my previously hyper-extended knee no longer extends fully.

There is a lot less pain when I'm lying down or sitting - most of the time I'm more or less comfortable.  At night I no longer elevate the leg, and can sleep a whole 5-6 hours before the knee gets stiff and I have to wake up to ice it.  Today I napped on the side for a whole 45 minutes - oh, such heaven!

A few days ago the shinbone area developed a huge bruise.
I was surprised I didn't have it right after surgery, but apparently its normal for some bruising to develop when there is more movement.  I know it looks like someone battered me, but its not actually painful. The incisions are healing well.

Week 1 Retrospective

I've decided to do retrospectives at the end of each week.  I know this may make me sound a little life-coachy, but I think its the easiest and most useful way to reflect on how well (or how badly) things are going.  I'm borrowing this "ritual" from the practice of Agile software development, where we do retros every once in a while to figure out how well our processes are working and if something needs tweaking.  My rehab process is not very complex and involves just me most of the time, so the retros will be short and simple. I'll think about what went well, what could be better, and what I want to change going forward (actions).
Here's the retro for week one of my rehab:

Went well:

  • Having ice/compression machine
  • Staying with parents
  • Baggy pants, skirts, shorts
  • Blogging
  • Physio helps a lot
  • Doing exercises regularly
  • Reached first week's milestones (90 degrees, walking with splint only)

Could be better:

  • Exercises were painful for the first 2-3 days
  • Didn't know how to elevate leg properly
  • Didn't know when/how to change dressing
  • Didn't know when could take a shower
  • Not keeping track of exercises/repetitions
  • Don't have long-term milestones defined
  • Physio is expensive

Action Items:

  • Define longer term milestones
  • Start keeping track of exercises
That's it!

I like doing retros on stickies, and decided to try a virtual board this time.  This is what it looked like:

I used linoit.com for the board.

Thursday, April 17, 2014

Post-Op Day 6

First milestone: check!

Tomorrow will mark a week since surgery, but I am happy to report that I reached the first milestone one day ahead of schedule - I got to the 90 degree flex today.  Actually, it was more like 95 degrees, which puts me in the lead for the next week's milestone (110 degrees).

Coaxing the knee into the bend was no mean feat - it was paaaaainful.  I felt like the band over my knee (meet my dear, long suffering patela) was about to explode while being set on fire.  I exaggerate only a little.  The pain can be handled with ice well enough, so I stayed away from taking more Percocets (which puts my total Percocet count at 2).
Doing the exercises despite the pain is paying off - today I realized that I pretty much forget to take crutches and just walked in the splint.  There is little discomfort, except for a pulled muscle somewhere in the inner hip which burns a bit when I swing the leg through.
Karla made me stand up without crutches or the splint yesterday to do the weight-shifting exercise holding on to the wall.  This was discomforting and unpleasant at first - my knee felt displaced and tender - but the pain went away quickly and I could stand and even shift more than 50% of my weight onto the operative leg. 

Also at physio they lent me an EMS machine which I'm to use twice a day to activate the teardrop muscle and the quad.  As the muscles kick in, I lift the leg and hold it for a few seconds.  Its amazing how hard it is to get the teardrop muscle to do its work - that was my biggest problem after the injury as well - but it is starting to wake up a little.So, to sum up, to date my improvements include: bending the knee to 95 degrees, standing without crutches or splint, shifting more weight onto the leg, lifting the straight leg off the bed while activating the teardrop muscle and the quad.

Overall, I'm very happy with my progress.  The trick will be to keep it up as I gain more mobility and have to work harder to get further.  But for now, onto the next challenge: 110 degrees, and walking without the splint by the end of next week.

Tuesday, April 15, 2014

Post-Op Day 4 roundup

Well, its been four days since the surgery so its prime time for an update.  Here it is, day by day.

Surgery day

After I woke up from the anaesthetic, I was in a Zimmer splint with the ice man pack inside.  I couldn't move my leg at all, and had to be helped from the bed to walk on crutches.  I felt nauseous and very sleepy, but not in much pain, probably thanks to the freezing they put into the leg during surgery.  Back home I kept falling asleep as the anaesthetic wore off, and I was very thirsty.  I kept ice on the knee and had it elevated.  Surprisingly, I didn't have much of an appetite, despite fasting since early the night before.  I did eat in the evening, and slept ok that night, waking up only a few times to adjust the leg.

Post-op day 1

As the freezing wore off the pain increased.  The knee felt numb and raw and swollen all at the same time.  It was painful to put it in the splint and to get up, and every movement caused new pain.  Even lying down and icing was painful.  I was prescribed Naproxene to be taken twice daily and Percocets in case pain was unbearable.  I wanted to stay away from the latter, but ended up giving in and taking one that day. 
I tried to do the exercises (knee flexion, hamstring stretches) every few hours, but without much success.  The stretches were ok, but I felt lots of tension in the tendon when flexing the knee which was decidedly unpleasant.  I figured I would do my best, but wouldn't push it too much until I saw the physiotherapist on day 3.  
The second night was less comfortable than the first, but I was still able to sleep more or less through the night.

Post-op day 2

The second day was not very different from the first.  I mostly stayed in bed, elevating the leg and icing.  Getting into the splint and walking was rather painful because of the swelling, and so was doing the exercises. 
The most important goal for the first week after surgery is to get the knee flexing to 90 degrees.  On the second day this still seemed like a very far away if not unlikely accomplishment.
That night was the worst.  Somewhere in the middle of it I finally figured out the best way to lay out the cushions under my leg - three under the ankle and lower part of the calf, two under the knee (so that the actual knee is in the air), and a thin one under my butt so the hip doesn't get too tired, with the ice man pack on the actual knee.  Not the most comfortable way to sleep, but you will if you're as tired as I was by that point.

Post-op day 3

I tried coding for a bit, but soon realized that I had trouble concentrating.  It may have been the restless night, or the post-effects of the anaesthetic, or the painkillers, but in any case I vegged out and stayed in bed most of the day.  I had a bit more luck with the exercises, pushing through the pain and getting through suppine knee flexions a few times.  
The pain was not as bad as yesterday, though the whole leg still felt swollen and raw.  I took a Percocet because in the evening my dad drove me to physio, and I knew the car ride would be uncomfortable.  Even with the pill I felt every stop and start echoing somewhere in my knee.  
Karla (my physiotherapist) changed all the dressings, and I got to see my war wounds for the first time - the incisions are actually quite small and seem to be healing quickly.  She measured my knee flexion - I was at 55 degrees at the beginning of the session, and at 66 by the end.  She massaged my leg to release the tension and get rid of fluid accumulation, and the leg felt a lot better after the session.    
To the exercises I was already doing she added: 
- knee flexes sliding up and down a wall
- calf stretches
- toe points with therabond
- quad squeezes
- hamstring squeezes
- self-massaging the hip and the quad

Post-op day 4 - Đ¢oday

This is by far the best day since the surgery.
I slept better last night, though I still woke up every two hours to adjust the leg or to ice it for a bit.  I also felt better able to concentrate, although I decided to make it another sick day.  I walked a bit without crutches - slowly and carefully, with the split on, but without crutches!  And I got through all the exercises, pushing through the pain and feeling the flexion increase.  I spent the day reading and writing a bit, mostly sitting on a chair with the operated knee either flexed on the floor or up on another chair.   I also managed to lift the leg up about 15 cm lying down, which means that my muscles are starting to come back.  And that makes me super happy!
Another physio appointment tomorrow, and that 90 degrees no longer seems impossible.

Tuesday, April 8, 2014

In the beginning

This is the very first post on this blog, in which I tell you why I decided to start it at all. There are plenty of similar blogs, and they all have a purpose akin to mine - to document recovery from an ACL surgery. Just like them, I want this blog to be 1) a journal of my progress, 2) a way to encourage myself to stick to physio and to track milestones, and 3) perhaps a useful reference for someone facing a similar injury.

Now let me tell you how I injured my poor ACL.
In the beginning I had a knee. Well, actually I had two of them, and they were both healthy. My knees were tasked with doing many different things - walking, sitting, pressing gas and clutch, hiking, canoeing, skiing, biking, yoga, martial arts, etc. You get the idea - they are very hard working knees, though they mostly get to do fun stuff.
I've been skiing since I was a child, although mostly at a recreational level. Last year I finally had enough time and resources to really step up my game. I got my level 1 CSIA (Canadian Ski Instructors Association designation) in the beginning of the season. I taught at a private resort on weekends, and kept training all season. By the end of the winter I spent 30 days on the slopes, and was feeling awesome about my progress (which really was quite good).

Then, one day last March I was skiing at Lake Placid, when one of my skis caught on the heavy spring snow and I fell. It wasn't a bad fall, but my right knee got twisted behind the left and the skis stayed on. When I tried to get up, my knee gave in and so I was taken to the base in a sled. That was the end of the ski season for me.

In a couple of months the swelling subsided, but the pain and instability didn't go away, so I went to see a sports doctor. He sent me to an MRI, which showed that I had a partial or full ACL tear. The doctor recommended I do surgery if I wanted to ski again.
It being Canada the wait time for surgery was 8 months. This actually turned out to be a good thing because the wait gave me lots of time to do physio and figure out what I wanted to do. I won't go into all the factors that finally made me decide to go for the surgery, but the date is coming up in just a few days. I am equal parts excited and terrified, so it should be an interesting journey. Stay tuned for the updates!