Two weeks out...I can walk!!! (at least a little bit)

It's officially been two weeks since my knee surgery.  It has gotten a little better every day so far. 

I went to my Orthopedic Surgeon last week, and he told me everything was moving along nicely.  I was concerned about some inflammation I was having around one of my incisions, so he gave me a prescription for some antibiotics just in case.  It has gotten better, so probably nothing to worry about.  I had several questions for the surgeon when I saw him, and though he seemed a little put out, he answered them.  For those of you going through or preparing to go through an ACL reconstruction, here is what I asked and the answers.

1) Was there any indications of risidual damage to my cartilage or any signs of arthritis?
     Not much.  My cartilage looked pretty good, a little soft in spots.  There was a bit of fraying behind my kneecap, but nothing too bad.
2) When can I start physical therapy?
    Next week.  He gave me the prescription and I am just waiting on my insurance to catch up so I can start.
3) With the meniscus repair, how much (if any) should I be trying to bend my knee other than the CPM?
    As much as possible, but not more than 90 degrees for at least 4 weeks.
4) When should I expect to be full weight bearing?
    It depends.  The rule of thumb is when you have enough quad control to hold your leg straight with no lag.  The average is anywhere from 2-4 weeks. 
5) When should I be able to release the brace from 0 degrees? When can I get rid of the brace?
   Not until you start PT and get enough quad control.  I can get rid of the brace when I get my NEW brace, which he put the order in for and I should get in a couple of weeks or so.

It has been two weeks, and I do not have enough quad control to walk very far without crutches.  I can get around a little bit, like taking dishes from the dinner table to the kitchen, or going to the bathroom, but only if I have the brace on.  If I try to walk very far, my quad gets tired and I start to feel like it is giving way.  A few sessions of pt and I am confident I will be free of the crutches.

I am doing all the exercises my doc wants me to do.  I can get my knee all the way straight and even a little hyperextended.  I can bend it on my own to about 70-75 degrees, but I am up to 90 on the CPM.  The knee doesn't really hurt when I try to bend it, but the muscles on the outside of my quad tightens up so bad that I can't force it any further.  The only real knee pain I get is what feels like where he drilled through my tibia, but even that is very minor most of the time.

All in all, I feel pretty good about this knee thing.  I will feel even better when I can start pt and get off of these crutches.  Getting around campus is a pain in the butt!!!

Sitting and swelling, sitting and swelling...

...lather, rinse, repeat.

That is the extent of what I have been doing the past couple of days.  I have spent a lot of time in bed, icing a lot and using my CPM machine.  I did get out of the house for a little while for our weekly couple's game night.  It's good to know that pain medication has not affected my trivia knowledge.

I am up to 60 degrees of flexion in the CPM machine and I have gotten it to 0 degrees of extension which is straight.  Straight is the goal in the early going, I am told it saves a lot of problems later.  I am doing what rehab exercises I can, namely straigh leg raises and ankle pumps.  I have not tried bending it on my own, I'm not sure if I am suposed to with the meniscus repair.  The one time I tried I heard a weird squelching sound, so I stopped.  I see Dr. Gerbino on Wednesday, when I hope to get set up with physical therapy.  I will be doing physical therapy with my wife.  She is still recovering from her two knee surgeries last year.  It shold be humbling because she is working on high impact stuff while I will be doing very basic moves for a while.

I am still not weight bearing, staying in the brace loked at 0 degrees.  I have experimented with a little weight on my knee, it's just doesn't quite feel ready to me yet.  I'mhoping to be able to be able to bear some weight by the time I see the doctor on Wednesday.

Here is a picture of the increased swelling as compared to my good knee.

Day 2 - Finals Day

Most people when they have reconstructive surgery, they schedule it in such a way as to allow them to take at a minimum a week off from work to allow time to rest and recuperate.  I, however, am not that smart.  I schedule it two days before my two biggest grad school finals. 

I remember well from my wife's two knee surgeruies that the second day after surgery was the worst, so you knw I was looking foraard to today.  It wasn't too bad, but my knee is feeling it this evening!!

I took the dressings off last night to take a shower, which was an adventure.  But I made it through unscathed.  I was really surprised when I took off the dressing, I have three small holes and two small incisions in my knee...and no stitches!!  It was bleeding quite a bit, but not too bad overall.  There was almost no swelling last night before my shower, I could see almost my whole kneecap.  Tonight it was a lot more swollen.  I think part of that is being up and around a lot more today, and part is just due to a little more time passing.  My pain is still not terrible, mostly like a bad bruise.  When my knee is moved too quickly, like when my son's friend ran into my foot hanging off the recliner, it smarts!!!

Here are a couple of pictures of my knee unwrapped.

My knee a little more than 24 hours after surgery.  It's not very swollen, you can see kneecap.  You can see the incisions with NO STITCHES!!!

My knee tonight.  Much more swollen.

One more exam tomorrow morning and I can relax for most of the weekend!!!

Surgery done...now the road to recovery begins

Surgery was just less than 24 hours ago.  I got to Monterey Peninsula Surgery Center about 1pm for my scheduled 2:15pm surgery.  They took me back and started the IV, then asked me for the first of about 20 times, "What is your name? When is your birth date?  What are you having done today?"  I guess I successfully answered every time because they didn't send me away.  They even shaved my knee for me!!

At a little after 2, Dr. Gerbino came in to explain the procedure.  As my ACL was still intact on the MRI, he was still holding on to the option not to do the reconstruction if he didn't think it was necessary.  He tested the laxity of my knee again and said it was very loose, so he thought it would probably have to be reconstructed.  He put his initials on my right knee, presumably to ensure he didn't cut open the wrong one, and said he'd see me in a few minutes.  The anesthesiologist came in and started my "happy juice" and I was rolled into the OR.  It was much sunnier and open than the OR's on Grey's Anatomy...and very cold!!!  I climbed over onto the operating table and the anesthesiologist put a mask over my nose and mouth and told me to let him know when I started to feel woozy.  If I told him anything, I don't remember it.  The next thing I remember was waking up in the recovery room with the thought, "I'm going to throw up"...which, sadly, I did.

Dr. Gerbino came in to tell me that everything went well.  He did the ACL reconstruction and repaired my medial meniscus with three sutures.  The ACL was intact, but when he pulled on it with his tool it was way too loose.  Which explains why my knee felt like it was constantly about to give out.  I was told he said all this by my wife, because I don't really remember him coming in.

 My OLD ACL

This shows how much laxity was in my old ACL. It is not supposed to move at all.

 My new ACL...yummy!!!  It looks like bad sushi.

The stitches in my medial meniscus.

The pain wasn't that bad when I got out of surgery, but my leg felt like it weighted 1000 lbs.  Once I got a little bit awake, I was ready to leave.  It didn't feel like very long before I was getting dressed and into the wheelchair to leave.  The guy pushing the wheelchair kept trying to "help" get my leg adjusted on the leg rest, but he kept twisting my leg which hurt like h&%l!!!  I yelled at him like he was one of my sailors. :-)

After some adventures getting my pain meds prescription filled, I finally made it home, up the very imposing stairs without incident, and into bed, where I have pretty much been ever since. 

So far, it has been much better than I expected.  I slept ok in short stints and felt rested anyway.  My pain is not too bad, almost none when I am doing nothing, a little more when I do my exercises or get up and around, but nothing too terrible.  I have only taken three pain pills, which is not too bad.  I hate pain medication so I plan to take as little as possible, which my wife says is stupid (and she's probably right).  I spent two hours so far in the Continuous Passive Motion (CPM) machine, I am supposed to spend 8 hours a day in it.  I have to keep the brace locked unless I am doing exercises or in the CPM machine and I am allowed to bear as much weight as I can, which is none at the moment.  I will most likely be very cautious with that.  All in all, things are going pretty well.

 My leg in the brace.  The grey thing is the pad for my ice machine which runs contiuous cold water over my knee to keep swelling down.

My new best friend...the CPM machine.

"Beware the Ides Of March..."

Always quote Shakespeare if the situation arises...it makes you sound much smarter than you really are!!

Today is the day.  15 March 2011, the day my knee is fixed (theoretically).  I am all set for surgery at 2:15 PDT today.  I think I am about as prepared as I can be.  I have no idea what it is going to be like when I wake up, since my last surgery was when I was 4, but I am pretty sure I can survive it. 

My wife has had two knee surgeries in the past year, so I have seen it from that side.  The thing I am most nervous about is being limited in what I can do.  I don't really like having people wait on me.  I also am in the middle of finals at Naval Postgraduate School, so I have to be alert enough tomorrow to get the rest of my studying done for two finals on Thursday and one on Friday.  YIPEEE!!!

I will try to blog as soon as I can after the surgery to record how it went.

First...the back story

Hello all!!!

Welcome to my first ever blog, not that anyone will ever read it.  I have decided to try this to keep a record of my experience of going through knee surgery.

Here's the back story.  I first hurt my knee when I was 17 during a school ski trip.  The doctor at the time thought I had strained a ligament, gave me a brace and crutches and sent me on my way.  It has never really been right since.  Over the years it has always hurt and given way on me.  Several times badly enough to put me out for a couple of weeks.  I have seen 4 doctors about it with everybody agreeing that there was something "not quite right", but never agreeing on what was wrong or on any way to fix other than physical therapy, which never worked for very long.  I probably should have been more persistant about it sooner, but there was always a good reason not to.  When I finally had a good job with health insurance, I was in the Navy and assigned to a ship, or my kids were being born, or I was going to Iraq.  When I left my last ship, I was determined to get something done about my knee, I couldn't take it anymore.

Enter Dr. Gerbino.  I saw him at the Presidio of Monterey clinic where he does his Naval Reserve time seeing orthopedic patients.  He did an exam, actually looked at the MRI (a simple concept, but something none of the others had done), and told me that I probably partially tore my ACL back in high school on that ski trip and that it has gotten prgressively looser over time.  In his words, "you have probably added 15 extra years onto that knee."

So, I am finally going to have it fixed.  I will be having an Allograft ACL reconstruction with either a repair of my medial meniscus or a partial meniscectomy.  For you non-knee nerds, that means that the main ligament in my knee will be rebuilt with the tendon from a cadaver and the cartilage that sits between my femur and tibia on the inside that is torn will be either sewn back together or the damaged parts taken out.  I am expecting to be on crutches for about 2-4 weeks and in a brace for 4-6 weeks, all subject to what the doctor finds once he sticks the camera in my knee.

So, if there is still anyone reading this, I am off for surgery and the road to finally having two working knees.