How I spent my summer (4.5 months post-op)

Time has an interesting property of passing way to quickly.  My dear reader (for perhaps there's one or two remaining), I have fallen into the trap of procrastination to the point where writing a new post became an endeavor next to impossible.  Believe me when I say that in the past months I have often thought about writing a new post, but so many things have accumulated that it seemed I would have to write a small book to catch up.

Finally, I decided to bite the bullet and just do it.  My recovery is not yet close to being complete and so perhaps my challenges are still of some interest.  So first, let me catch you up on what has happened over the summer.

July: three months Post-Op and Strength Test

Back in July I had another follow up with the surgeon and a Biodex test to figure out how much strength I had accumulated in the leg.  It was an unpleasant experience - I had to kick my knee up as fast as possible with weights while sitting down with my waist and legs tied down.  The machine measures the strength of the kick as compared to the healthy leg.  This is a movement that I was not supposed to do in any of my exercises, so the test was painful and I knew I wasn't doing well.  The results confirmed it: I was significantly weaker in the right leg than in the left and needed to do a lot more work.  To say I was upset is to say nothing at all, but its all in the past now.  I have done what I could to step up my exercises, and can only hope that the next test, which is scheduled for October will go better.

After the test I visited my physiotherapist who told me that the strength would still take time to come back, and that the most important part was to regain the range of motion (which I already did).  She gave me more exercises which I am still doing at the gym a few times every week.

August: 4 months post-op 

In the past 2 months I have been making an effort to step up my exercise routine.  At the follow-up Dr. Zarnett told me I could start jogging with the brace.  I pushed myself through some considerable pain in the knee to build up the strength with one-legged squats, lunges, and leg presses.  I also stepped up my cardio (biking or eliptical for up to 25 min).

September 3 (today)

Nowadays the knee feels much more stable.  There is still pain, especially after weight exercises, but it is rarely sharp.  I sometimes ice at the end of the day, but I haven't needed painkillers to manage it.  I can do little jumps, and stretch and bend in almost every direction.

Here is a brief round up of the exercises I can do today:

• Jog with brace at 4.5 mph for 5 min
• Bike outside for 20 km on a flat path
• Biking or eliptical indoors for 25 min (level 12-14)
• Lunges in different directions
• One legged squats
• One-leg press at 70 lb

Last but not least, I won't make any promises this time around but it really is my intention to keep writing regular updates here.  Winter is coming, and we all know what that means.

2 months post-op check point

My procrastination has officially reached epic proportions.  I have abandoned weekly retrospectives without formally saying I would do so, and I didn't follow through on my promise to do a large-scale retro on how things have been going since surgery.  This lack of discipline is abominable, and is not likely to improve very much in the coming weeks.  But it has been two months since the surgery, and so the least I can do is write an update on how things are going now.

I had a follow up with doctor Zarnett last week as well, at which he told me that the knee looks good, but I need to be doing more to increase the muscle strength.  I have been exercising, but have found it challenging to increase the intensity, and so I have been feeling weaker and somewhat stuck.  I've been trying to get more motivated to go to the gym, which also hasn't been easy with the arrival of the gorgeous summer weather.

How's the knee feeling?

Compared to a month ago, I have more stamina, and can walk more and sit in the same position longer.  Having learned my lesson earlier, I avoid long distance walking or uneven terrain.  I can sit cross-legged for a bit as well, and even find that it feels good to stretch the knee by dropping it sideways.  There is less numbness, and almost no swelling.  The knee looks almost normal, although the right (operative) leg is still somewhat smaller than the left one.  There is still lots of tension on the outside of the knee and in the patella area.  I still find it hard to straighten the leg from a bent knee.  In the last week I have been feeling more pain which is probably partially due to the fact that I slacked off for a few days and then did two pretty intense workouts in a row. 
The incisions are looking very good - one of the small scoping ones has almost become invisible, and the long one is also fading.  There is still a small hard spot in the very bottom where a piece of stitch is likely causing trouble, but it doesn't seem to be trying to come out anymore.  Dr. Zarnett said it will eventually dissolve altogether.  The whole incision is fully closed and healed.

What am I able to do?

I exercise 3-4 times a week.  At each session I do some combination of half-squats and lunges, one-legged dead lifts, step downs and step ups, hamstring exercises, leg presses, use the cable machine to do hip abductions and adductions as well as to workout the glutes and the quads with about 10-15 lb weights.  I also do cardio on the eliptical and the stationary bike.  Believe it or not, this is the minimum amount of exercising I need to be doing.  I should be doing a lot more.
In terms of day to day activities, I can do almost anything that doesn't involve heavy lifting, squatting, or stepping up with the full weight on one leg.  I have been catching myself trying to skip, or quickening my step almost to running without much regard for the knee.  This feels good, but I still don't have an ok to actually go jogging or to skip.
I can't really squat or kneel yet either.

What's next?

Since the frequency of my physio has now been reduced to once every three weeks, I am facing the challenge I was weary of from the get go.  As evident from my perpetual procrastination in updating this blog, I am not the most disciplined person, and this shows in my recovery as well.  I worked very hard in the beginning and reached a certain level, but have now plateaued and need to get unstuck.
I am still formulating the plan to deal with this situation, and I will write an update on some ideas I will try in the next few days.
I also need to schedule a strength test with Dr. Zarnett's team in the next 4-6 weeks which give me a good deadline to work towards.   And the ultimate goal should not be forgotten: winter is less than 6 months away and I need to get in tip top shape for skiing by then. 

No pain, no gain? (6.5 weeks)

Summer finally came to Toronto, and I have been busier than a bumble bee with working, rehab, exercising, barbecuing, and otherwise enjoying life.  Can I be blamed for missing an update or two?   With some delay, here is then a comprehensive update on my progress.

Walking

Its been almost a month since I wrote about ambulating in Walking the talk shortly after I ditched the crutches and was working on loosing the limp.  It was challenging and sometimes painful, but the limp did go away after another week or so, and I was also able to walk greater distances without the leg numbing up.  When I say "greater distances" I don't mean miles and miles across the knolls and ridges - no, more like a couple of blocks from my house.

Before the surgery I installed Moves on my phone to track my daily walking.  Thanks to that nifty piece of technology I figured out that in general I walk every day:

• less than 1000 steps (0.5 km) just to go to my car and office
• around 2500 steps (2 km) if I add a short stroll in the neighborhood
• 4000-5000 steps (3.5-4 km) during a longer weekend walk in the park

The longer walks were getting manageable and all was well and good, until this happened last week:

At first I was like "Whoa!!! I can't believe I walked a whole 8 km, just 5 weeks after surgery while still spitting stiches." The next day, however, was more like "Wait... Ouch... It hurts! and not in a nice post-exercise way."  Turned out that despite the gym workouts, something about walking across uneven surfaces is inherently knee-intensive and these 9901 steps fatigued mine so much that I had to take two days off exercising to let it heal.

On top of that, as if to drive the point home, the knee developed a new attraction called Bursitis - inflammation of the bursa, a small fluid filled sac that prevents friction in the joint.  This new joy, that I likely got by bumping into something, pushes on the already over-strained tendons making walking more uncomfortable.  The physiotherapist says its not dangerous and will eventually go away on its own.  Oh, and yes, I am well on track to becoming an expert on knee anatomy.

This did not deter me from walking, but I do try to take it a bit easier for the time being.  Here's what my history of walking looks like since the beginning of May:

Exercising

The doc told me to be at the gym four times a week and gave me the green light to use almost any machine for glutes, hamstrings, calves.  Karla also showed me how I could do the same using cable machine or the exercise ball.  With some variation, my typical leg routine consists of about 80% of the following:

• Step downs (15x3)
• Step ups (15x3)
• Squats (half way) (20x2)
• Glute bridges 
• One-legged dead-lifts with 10 lb weight (10-15x3)
• Calf raises (10x3)
• Hip abductions, adductions, glute and hamstring swings with cable machine (10x3 each)
• Rolling the exercise ball with one leg (for hamstring) (15x3)
• A medley of stretches

I do this set 3 times a week.  I also have been doing 15-20 min of stationary biking once or twice a week for cardio.

Motion and Pain

I still experience some pain when I tire out the knee with walking or exercising, or when it gets tense after being in the same position for a while.  Being immobile for long periods of time is becoming easier, but sometimes will cause tension.  It makes driving unpleasant, especially, when I get stuck in traffic.  Stretching or biking helps loosen up the tendons and alleviate some discomfort.

I have been very carefully testing whether I can put pressure on the patella by kneeling on it lightly.  It is still sore and numb, so I can't kneel fully (i.e. won't be able to propose to anyone just now), but it is getting less unpleasant gradually.  
I can also drop the knee sideways more and hold it for a few seconds (sitting in a cross-legged position).  And I can sit with my legs crossed on a chair without any discomfort, though only with the operative leg on top.
Its still early to really judge this, but I think I feel more stability in the joint.  There is less discomfort in other parts of the leg, hopefully meaning that they don't need to compensate for the knee as much.
My range of motion is pretty much back to normal, with some pain remaining at the extremes that I will work through eventually.

Incision

... still spitting stitches, eh.  Outside of that, its healing nicely, and I think the scar will be really small.


This update has been brought to you by warm late May weather. Transmitting directly from the balcony, I wish everyone a great week and healthy knees.

Week 5 Retrospective

I'm becoming a serial procrastinator - its almost end of week 6 and I just got around to doing week 5 retro.  But I'm still doing it, so I get brownie points anyway.  I haven't been slacking, just having too much fun over the long weekend.  Well, on with it now.

At the last retro I said that I would include some upper body exercises in my workouts.  This did happen, once.  I did some machines and weights at the gym for the arms, back and chest.  I also said that I would keep the exercise records in one place, and I did.  They are all in Evernote.  And, finally, I was going to keep up with my exercises, and I also did that, having done the full routine four times last week.  So, I'm three for three on the action items!  Good for me.  I will be having a gluten-free cookie later to celebrate.

For week 5 retro I decided to come back to the simplest format of went well/could be better (read: I didn't have time to think of something more exciting).  So, here it is:

Went well

• Good news at the follow up with Dr. Zarnett
• Doing all exercises
• Doing an upper body workout
• Can walk a lot more
• Flexion and range of motion improving
• Don't get as tired anymore
• Housework is under control
• Part of stitch came out
• Going to bed/getting up early
• Stretching/breathing exercises in the morning

Could be better

• Still have inflamation on the incision
• Scar is itchy sometimes
• Can't wear skinny jeans
• Don't have enough time/energy to get big chores done
• Not doing enough cardio
• Procrastinating on retros

Action items

• Plan to get 1-2 big items done during the week
• Do eliptical/bike for cardio
• Do next retro on time

Because today is already Wednesday of week 6, I think there is a good chance that I will procrastinate on this week's retro as well.  To mitigate that I've decided to do a different retro at the end of the week: instead of going over the past 7 days I will be reviewing the whole time period since I had the surgery.  I will also do that in a different format to make things more interesting and dig deeper.  

Before then I'll write another post on my progress, the exercises I've been doing, and the latest improvements.

That's it for this retro, a great rest of the week to all, and ciao.

2nd Post-Op Follow up (4.5 weeks)

I had another follow up with Dr. Zarnett on Wednesday, and he told me that everything is going really well.  Rather counter-intuitively, this means that I should be at the gym at least four times a week, doing a ton of new exercises.  I'm planning to have killer glutes by the end of this process.

  

The inflammation in the scar is spitting a stitch knot that didn't dissolve.  The doctor said its pretty normal, and will clear up by itself eventually.  No special treatment needed.  For now that thing still looks medieval, not to mention that it is preventing me from taking scar-selfies that would show off how well the incision is healing.  It was very painful in the beginning of the week as the abscess was growing, then it opened up relieving the pressure a bit, and now its just annoying that it won't heal completely.  I think its trying to get me to sponsor Polysporin and bandaids manufacturers.  

Overall, it was an uneventful follow up that could otherwise be described as "no news is good news".  The next follow up is in a month. 

I suppose it gets a bit boring if all I talk about here is how well things are going, but I honestly don't have any bad news.  Except for traffic: it always drives me insane.

Week 4 Retrospective

Last week I said I would get better organized so I don't get so tired by end of day, and keep up the exercises.  I got a good head start in the beginning of the week by cleaning up and getting some food ready for the week with my mom's help.  During the week I did a little housework every day to keep my place clean and to make sure I have enough healthy food.  I went to the gym to work out, where I used the cable machine to do the leg exercises and biked for a bit of cardio.  And so I'm 2 for 2 on my action items from the third week! Yey, me.

For week 4 retro I decided to change it up a little.  Doing retros the same way every time gets boring quickly, and there is a danger of going through the motions without thinking about the substance.  So, instead of the previous "Went well - Could be better" format, this time around I thought about what made me glad, sad, or mad. Not like dishes throwing mad, more like "argh, wtf" mad.  I'm also going to add "thankful for" category.  I know, I know, I'm sounding life-coachy again, but it does make things more fun, I swear!

Glad :)

• Can walk longer distances
• Can bike longer
• Don't get as tired
• Exercises getting easier
• Leg muscle showing
• Stretching and breathing exercises in the morning
• Its getting warmer outside!
• Might be able to bike outdoors soon
• Moved up follow up with Dr. Zarnett

Sad :(

• Incision not fully healed
• Can't go swimming yet
• This blog has no comments
• More pain elsewhere
• Not doing any upper body exercises
• Exercise records aren't organized

Mad (grrr)

• Leg cramps
• Stitch coming out (yuk)
• Housework is tiresome and boring
• Traffic still sucks

Thanks

• My parents!
• My friends who call/write to ask how I'm doing
• Coworkers are very supportive

Action Items:

• Do some stretching every morning
• Start doing upper body workouts
• Keep exercises records in one place

Overall, my progress is still good - my flexion is getting close to the pre-op levels, I can feel increasing strength in the leg, going up and down stairs is becoming easier, etc.  The only hiccup is the part of the incision that seems to be "spitting" a stitch that my body seems to have refused to let dissolve.  Its pretty painful, not to mention unpleasant, and its not letting the incision to heal properly. I'm told this is a relatively regular occurrence, but I moved up my follow up with the surgeon to get it checked out.  

Week 3 Retrospective

I seem to have run into one of the classical retrospective problems: my action items aren't getting done despite being clear and fairly manageable.  I was thinking a lot about my long term goals this week, but the dog ate my homework I never actually defined them.  I think partially I'm ok with not having longer term goals set in stone for now, because I feel that I am on track or even ahead of schedule.  I also get lots of feedback about my progress at physio every week.  However, I'm guessing it will become more of a problem later on when I have fewer sessions, and will need to keep track on my own.  I will drop this action item for now and will revisit it later.
I did concentrate on stretching more, which was the second action item.  So I'm one for two on action items again this week.  With that said, here's week 3 retro:

Went well:

• Almost no limp
• Doing exercises every day
• Back to work
• Driving is ok
• More range of motion
• Muscles coming back
• Lots of feedback from physio
• Flexion is ahead of schedule

Could be better:

• Traffic sucks
• Small infection/irritation
• Getting tired quickly

Action Items:

• Get better organized so I don't get so tired by end of day
• Keep up the exercises

This week I was getting swamped with chores at home.  I kinda like home made food, and I don't like living in a pigsty, so at least a minimal amount of food shopping, cooking and cleaning has to be done to make that happen.  My mom helped me with cooking on Saturday, so food is covered for a little while.  Also, next week I will try to organize things a bit better (like getting my lunches ready the night before, packing my gym stuff ahead of time, sweeping and dusting a bit during the week).  

Nothing to say goodbye to this week, even the limp is still with me if I walk long enough.  But I'd like to welcome back my super-cool Donjoy brace which I now wear to do squats and some other exercises.  It accompanied me on a walk on some uneven terrain today, and it reminds me that I will soon be able to do light hiking, and I will one day ski again.  

Don't we look good together?

End of week 3 roundup (aka Day 22)

Its hard to believe that its been three weeks since surgery.  I feel a bit bipolar - it seems like a very long time ago, but at the same time also like yesterday.  Maybe all significant and drug-filled experiences in life feel this way.  I'm not sure.

This week has gone by very quickly - faster then the first two.  I suppose part of it is getting used to the rehab routine - because that's what it is: a routine that I will have to diligently stick to for a while.  I also went back to the office (I worked from home for part of the first, and all of the second week).  I didn't miss sitting in traffic, but its great to be back at work with all my awesome coworkers who are all very attentive and supportive.  The rest of my day is quickly eaten up by exercises and the minimum amount of regular home stuff, so the days are literally flying by.

Nevertheless, I did reach some important milestones this week:

• Went back to work on Monday
• Back behind the wheel since Tuesday
• Flexion is at 130 degrees, straightening is at 2 degrees (both ahead of schedule)
• Walking without limp for short distances

I had two physio sessions this week, 30 min each.  The latest exercises that I've been doing since the beginning of the week are:

• Toe raises on one foot, balancing on one leg (continued)
• Step downs on one leg
• Squats against the wall, with the exercise ball
• Hamstring curls with theraband, lying down
• Glute exercises lying down - with knee bent, with straight leg
• Abductions, adductions, back and forward swings with ankle weights
• Biking with a bit of resistance
• Walking forwards and backwards

I can't really do all of these in one day any more, so I spread them out.  I took it easy on a some occasions, doing only the very basic ones - its been pretty exhausting to get back to work, drive, and increase the exercise load all at the same time.

I feel frustrated to be getting so tired after a bit of walking and some housework, but there is progress in the department of Muscles and Tendons.  I no longer have to think about my quads before they decide to be kind enough to do their work (I'm guessing that would be "quad lag disappeared" in doctorspeak).  I decided to ignore the stiffness I feel in the morning and just walk through it - it works to some extent.  I feel more confident and stable when walking.  Exercises help significantly - there is very tangible improvement the next day.

There has been a little unpleasant snag this week.  A small part of the long patellar incision, which looked like it was healing very nicely, all of a sudden became irritated and slightly infected.  I noticed it a couple of days ago, and (excuse the gory details) squeezed some liquid out of it, cleaned and covered it up with a band aid.  There was no bad smell or heat which is apparently when you know things are really going sideways, and I'll cautiously say that it seems to be getting better now.  But it did give me an unpleasant pause since one of my biggest fears going into surgery was getting an infection.

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.

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:

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?...

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.

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.

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 - Тoday

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.

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!