Thursday, January 24, 2008

That old feeling...again!

It may seem a mundane thing, but a sweet little event happened this afternoon...my operative knee gave just a teensy "crack" as I got up from my office chair late this afternoon. Ahh, what a nice thing to hear again.

It echoes some progress I noted today, such as dimples in my knee when flexing the quads. Just a bit of persistent (but not painful) swelling remains below the knee cap.

At PT today, the big news is that I hit 126 degrees of flexion here on day number 22!

Next Friday when I go to see Miss Molly at PT, We'll begin "Closed-Chain" movements, if I recall the term correctly. That means one-legged knee bends, essentially, and taking stairs normally without guarding the operative knee. Later that same morning I have my 4-week follow-up with Dr. K.

In the meantime, I picked up an ankle weight, adjustable from 1/2 to 10 pounds in 1/2 pound increments. Was going with just 1 pound of weight for most leg lifts last week, and 3 pounds for prone and standing hamstring curls. This week I graduated to 2 and 4 pounds, respectively.

I'm gonna have to start exercising both legs at this point, or risk my operative knee and leg becoming stronger than the other!

Sunday, January 20, 2008

Day 18: A day almost like any other day.

Today was a nice change. Went to church, and comments varied widely from noticing I was walking so well and without a cane, to "Gee, your surgery is soon isn't it?" and "Didn't you just have surgery?"

It was nice to start being "normal" getting around. Yes, the daily life does have that background hum of soreness in the knee, but really things are smoothing out.

I figured out a way of using my arms and good leg to go two steps up or down at a time, so I don't have to take so much time navigating stairs until week 4 rolls around. Thats when I can officially start using my operative leg on steps, although I've already had it out for a test drive.

Gotta find some ankle weights for PT around 1 and 3 pounds, hoping that local sporting goods stores offer a wide enough variety. I'll be surfing the web to see who has what, or if online prices are good. Any suggestions from ACL/PCL tear rehabees reading this?

Other than continuing to improve on swelling and range of motion, the most annoying thing I deal with daily is cramping in the quads. Re-learning how to walk, as far as I can tell, is going to largely be a matter of getting my quads to back off a bit. Right know they seem to be in "guard" mode, and are hyper-reactive to any command my brain sends them to contract. As a result, by bedtime I have wicked cramps in my thigh!

Mrs. Shaft recently remembered where the heated massager was stored. That now provides me with most excellent relief from cramping at the end of the day.

Next weekend is going to be a busy one for video work. Friday night is the wife's choral concert, and Saturday is belt promotion testing at my Karate school. Then I have to dump and edit everything!

Thursday, January 17, 2008

Day 15: It's about time.

Sorry if I kept anyone hanging in suspense, it's just been a durned busy week.

Sunday: Ditched the crutches over the weekend, down to just a cane. Wasn't thinking, and stepped up with my operative knee. Hmm. Didn't hurt, but seems too early to even consider doing that by all accounts!

Monday: Back to work. Got caught up, so no stresses there now! Spent lots of time at my desk working that flexion range, and icing down the knee with a large gel pack.

Oh, and stepped down leading with my good knee. Again, it didn't hurt to bend the operative knee, but doesn't seem right I should be able to do that. Another hmm.

Monday night brought another episode of American Gladiators, and another contestant gets awarded a torn ACL. This time it's Adam "The Hebrew Hammer" Levin, taking a sideways tackle during Power Ball in a classic ACL-ripping moment. As typical, he shakes it off for a moment and collapses a few seconds later. They're going to have to seriously train these gladiators to watch what they're doing, it's getting a bit too aggressive out there!

Tuesday: Work decided to catch up with me this day! It's also the last day I used a cane walking. I'm taking things carefully, looking for the non-icy walking paths wherever I go, and will keep the cane at-hand in icy situations, but I'm bearing weight on the operative leg just fine now and walking well.

Wednesday: Took much of the afternoon off to go to PT and do a few things at home.

PT can only be described as amazing. To begin, we measured 120 degrees of flexion.

Oh. My. God.

Am I really progressing this well only two weeks post-op? I thought it a good sign to lose the immobilizer last Friday, but this--this feels HUGE!

We added ankle weights to the 4 directions of leg exercises (straight lifts, adduction, abduction, and hamstring curls), and did an easy 5 minutes backwards pedaling on the exercise bike without resistance.

I talked to my PT about leading with the operative leg going up steps, and leading with the good leg going down. I've read a few times that even months post-op, many people with ACL reconstruction unconsciously guard their knee by leading with the operative leg when stepping down. She put it kindly--bad news, but in a good way. Protocol says not to do those particular movements prior to at least week 4 post-op. Wow.

I'm not sure quite how to take that, except now I have to force myself to guard the operative knee until I'm "officially" allowed to use it in that manner.

Protocol also says 2 visits per week through next week, but my PT exclaimed that she had no further exercises to work with me until we hit week 4. She'd simply be watching me work while drinking tea. Things seem to be going well enough that we canceled tomorrow's session, and the first session next week. Barring anything unusual, I'll only check in with her late next week.

Oh. My. God.

The day later continued watching G-Shaft sparring with a dozen intermediate belt boys. Yes, she's the only girl in her class, and 2nd tallest. This serves her an advantage in 2 ways - she's got reach with punches (once she gets a bit more hip rotation to properly deliver the blow), and being a girl, many of the boys seem intimidated to attack! Just needs a little more work on throwing a punch with conviction, and she'll be a potent point-sparring student.

After all that excitement, I capped off the evening with a vocal recording session. My band has been working on a 6-song "EP" since Spring, and we finally have a lead vocalist to record. Overall, an amazing day--I'll link to the band's web site when we post some music for y'all to listen to.

Thursday: Finally we come to today. I caught up with the staggering blow work delivered me on Tuesday, and maybe I'll have a bit of time to slack off tomorrow afternoon at the office.

Tonight I volunteered at the Karate school's Winter Carnival, the biggest event for recruiting new students each year. I managed the balloon hop race, and that was a blast seeing all the kids enjoying themselves. The last half-hour of the evening was demonstrations by the students, and the ones who brought guests got the opportunity to break boards. G-Shaft was bummed none of her invites came through, but she still has 2 weeks to get a friend in for a trial class--and another chance to bust up wood.

So I sit here in shock and awe. I read about Black Belt Mama's struggles and feel bad she's still in an immobilizer brace, even though she's 4 weeks post-op at this point. I feel somewhat guilty for my progress, but need to remind myself constantly that people are all unique in how they respond to surgery.

So, Hack Shaft old boy, knock off the guilt trip.

Oh, and get on with the push-ups and crunches already!

Friday, January 11, 2008

Day 9: Antici..................................................

...pation!

I was just perusing the protocol for rehabilitation from knee surgery. Looking at weeks 13-24, about 4 to 6 months post-op, I'm shocked at the hopping exercises. I mean, my knee is giving me sympathy twinges thinking about square, diagonal, zig-zag, single-leg, and straight-line hopping! YIKES!

Still, I have to trust that my surgeon and PT know what they're doing. Based on costs, they'd darn well better!

For the martial artist reading this, think back to that very first class, when your uniform and white belt were both creased and stiff, still reeking of the plastic bag you just pulled them from.
Remember how far away your current belt seemed then!

The sick irony is that it will be longer for me to return than I've been taking classes. 7 months from injury until I expect to return, and I was just entering into month number 5 of classes. (I've studied the Arts previously, albeit quite some years ago!)

However, I realize that I can still fill time with Karate:
- Work on core.
- Do Form in a chair or in my head. Limp through it when I can, walking through the motions without actually kicking.
- Get familiar with that new Bo, so it becomes an extension of my arms when I return.
- Improve my upper body and core strength while getting the knee back in condition.
- Figure out exercises to use as a sub for some boring PT--like 4-count slow kicks vs. side leg raises to work abductors and hip flexors.
- Continue to record belt tests on DVD for the school--then review and learn from them, using the "best in class" as a visual aid for Bo and open hand Forms.

On a side note, I've taken notice of ACL injuries in the media all of a sudden. It's contagious, I swear! Previously I mentioned Jason Chambers' poorly executed tornado kick. Then comes the return of American Gladiators, where Jesse Foster tears her knee up during Power Ball. Looks like yet another one bites the dust!

Thursday, January 10, 2008

Day 8: Lots of excitement

Lots of exciting milestones today, far more than I expected this early in the game!

Was able to stand in the shower this morning comfortably, no more showering on a bench.

Saw Dr. K this afternoon. Stitches are out, immobilizer brace is gone, and he agreed I could drive after demonstrating good weight bearing and a solid straight leg lift.

Got a first measurement of post-op flexion at PT, 113 degrees. Woo-hoo! Jumped on an exercise bike for 5 minutes pedaling backwards with no resistance, and was introduced to more exercises for the hamstring and adductor muscles. Ouch!

Forward pedaling on the bike won't start until 4 weeks post-op.

After PT I went to watch my daughter's Karate class as they worked on beginning Bo forms and movements.

Auto-chill option showed up 2 days ago, that's some serious cold on the knee now. I love having the cryo-cuff cycling with gentle compression pulses, and staying wicked-cold the whole time.

Losing the brace also means I can start wearing regular pants. No more lounging around the house (and around town) in baggy sweats!

Things aren't all completely rosy, however. Once I've posted this blog, it's down the stairs to the basement--carefully--to take care of some overdue litter boxes. Man, I thought I could scam out of at least one cleaning cycle!

I also really gotta think a bit harder when going up steps. I stubbed my big toe when I had a momentary lapse of reason and tried to lead with my bad right leg. It didn't clear the step, leaving me a painful reminder to take it easy, stupid!

So...all in all, a phenomenal day. New freedoms, returning obligations, and the constant task of reminding myself to proceed carefully as I go forward.

The journey back from surgery is well underway, but there are still potholes to avoid on the road.

Tuesday, January 8, 2008

Day 6: On the cusp

Things went tremendously well at PT this afternoon. I've a challenge to work on straight leg raises now--initially it was only 9 in sets of 3, 4 times a day. Today I found out the goal is 300 in a day, which I don't intend to do right away!!!

Flexion is improving, and the auto-chill accessory showed up today. That'll be fun to try out this evening.

Took my first full-fledged shower on the loaned shower bench, and it was mahvelous, dahlink! I've been keeping clean and all, but ya just can't beat a good shower--except with a nice long, hot bath. The Steri-strips fell off, so I put a large band-aid in place to hold two clear nylon sutures that were poking out, looking rather important.

Oh, and looks like some extra blood is pooling around various places in my leg now, most notably on the instep of my foot. Not painful, not swollen, just a pretty shade of purple down there.

Been walking real well today, even with the brace. Hoping I'll get permission to drive Friday from Dr. K, as I'm doing well bearing weight on the new knee.

Tomorrow I'm 39, so today is the cusp-of-the-cusp, if you will, of turning 40. Aw, it's just another plateau in life's uphill climb anyway, may as well pause to enjoy the view!

Monday, January 7, 2008

Day 5 post-op: Progress and accessories

Ahh, my first day home alone. Nice and quiet, good opportunity to catch up on home office things like tidying up the room a bit!

G-Shaft and Mrs. Shaft are back at school and work respectively. I'll be waiting until at least next Monday before I head back to the office, want to see if I can return without the immobilizer brace.

Yesterday and today I've been able to move around the house without a walking stick. The brace is a necessary evil, yes, but it's close to the point of getting in my way walking! I also hope after my visit with Dr. K on Friday to remove stitches that I can at least lose the brace while sleeping.

Last night I returned to the 2nd floor bedroom as well. It was awesome sleeping on the adjustable firmness mattress again, away from the squeak of the hamster wheels.

My auto-chill feature should show up via UPS this afternoon. That'll make my ice sessions so much more convenient after PT. And speaking of PT, I go tomorrow afternoon--we'll see how things sit at that time. I also have a shower bench showing up that a friend is loaning me this evening, that'll be nice--along with the new hand-held shower that Mrs. Shaft installed Saturday!

A few of my favorite recovery accessories:


Useful for PT, for calf muscle stretching, for a neck roll.


This one keeps me entertained!


Several of these kept me company while sleeping on the couch downstairs.


These keep my crutches from taking flight in the land of ice and snow I live in.
First pic is the ice grip retracted, second is engaged.
Had to modify them slightly as well as notch the rubber foot of my crutch, but they work like a charm!

Wishing continued healing and progress to Black Belt Mama who had a bit of a setback last week..

Saturday, January 5, 2008

PT and Pics

My first PT session yesterday was quite an eye-opener.

My first attempt at a straight leg raise was futile-the quads simply did not want to acknowledge my command to lift! That gave me quite a chuckle.

My PT then spent a good 15 minutes with gentle massage on the quads to loosen and wake them up, then the usual heel slides and quad sets with towels rolled under the knee or the ankle.

I had full extension, which was not surprising since the immobilizer holds my leg almost all the way in extension. My PT picked up the leg and I was astonished to see very close to 90 degrees flexion with the PT bearing the weight of the leg. No official numbers, but that's a helluva start.

Once we got the quads wakened up, we did some straight leg raises, making sure to engage the quads first to wake them up. Just 10 of those was enough to get my hip flexor complaining!

Finally, we strapped the immobilizer back on, and he took a check of me walking. I had a pair of crutches, but was able to bear weight on the reconstructed knee quite well--another shocker.

Since then, I've set aside the crutches except when traveling out of the house. Protocol asks to bear weight on the leg right away, so I'm using the walking stick around the house. We'll see how I feel tonight, and maybe I'll carefully ascend (with lots of supervision, and backwards) to the second floor and sleep in my bed tonight. Though the couch is mighty comfortable, the hamsters running in their cage keep me up at night!

I continue to be narcotic-free, eating well, and am strictly on ibuprofen at this time. Overall I'm feeling much better than I expected, except for just a general sense of tiredness which I attribute to my body's response to surgery.

OK, picture time!

Does this make my leg look fat?


Cryo Cuff: your best friend post-PT!
Button at the top connects to the hose for chilled water.


3 days post-op, swelling's not too bad:


The "OK" is Dr. K making sure he works on the correct knee!
Sorry for the mess, I plan to wash up that leg later today.



Arthroscopic pics below:
skip this part if you get queasy about medical pics.






Nice, clean meniscus:



Good cartilage, too:


Torn ACL stump, no wonder it felt like a wrench in the works:


New ACL (kinda pretty and glimmery!):

Friday, January 4, 2008

Surgery: Let me introduce you to my good friend, Annie...

Folks, let me tell you. When having ACL reconstruction, you've got to meet Annie.

Her full name is Anne S. Tease-Ya, and she loves playing mind games! (Annie is a man actually, but humor me for the sake of word-play.)

I met Annie the morning of surgery, and she wore many labels that day:
- Femoral Nerve block
- Spinal block
- Monitored sedation

I was firmly against meeting her military aspect, the General, having seen the aftereffects in my daughter G-Shaft many times over the years.

The fun began with the Femoral Nerve block. Annie gave me a shot of something to bend all the straight lines on the ceiling. While I admired the interesting patterns forming overhead, Annie got busy with a probe making my right thigh jump in various ways. One location made my patella jump quite uncomfortably, so I warned Annie not to go there again with the probe! After a short time, she was satisfied with the location and shot me up with a long-term agent to shut down feeling in my thigh and knee for the next 12 hours.

Next was the Spinal Block. This one I remember nothing about after sitting up and leaning forward on a pillow in the operating room, so Annie must've slipped me a Mickey to make me forget those 10 minutes.

From that point on I was nicely mellowed out as I watched the team set up for surgery.

I felt just fine, no anxiety or anything while watching video of the procedure on a nice flat screen monitor. Once the scope portion was done, the nurse asked me if I wanted to watch the rest. I agreed, and she angled the monitor like a mirror for me to watch in fascination as the crew closed things up.

Rolling into recovery I felt just great, and was SO glad not to have general anesthesia when they shortly offered me coffee and a granola bar to snack on while Mrs. Shaft and I discussed lunch.
Once the tingling in my legs went away and I could differentiate between a rub and a scratch from the nurse's fingernail, I checked out and we headed for home.

For cryotherapy options, I went with the gold standard of a Cryo/Cuff Cooler. However, the system offered by my orthopaedic clinic was a manually cycled system, as opposed to the AutoChill system that many other people mention in their blogs about ACL reconstruction. The manual cycle isn't bad, just far less convenient than the autochill system (and only 50% of the price.) For a manual cycle, you connect the cuff around the leg to the cooler with a hose, open the air valve, and let gravity drain the warm water out of the cuff. Then you close the valve, swish the water to mix it with ice water in the cooler, open the valve, and hold the cooler above the level of the cuff. Gravity pushes chilled water into the cuff.

As you might imagine, this is a PITA to keep doing, and the chilled water in the cuff only stays effectively cold for perhaps 5 minutes, requiring another manual drain/chill/fill cycle.

So Mrs. Shaft and I did some digging and found a local sales rep to order the AutoChill add-on. It's a simple air compressor that connects to the top of the cooler, creating alternating vacuum and pressure to force chilled water in and out of the cuff automatically. It should arrive Monday.

So if you're reading this for research, my advice is to plan for the extra cost and get a cryo cuff with the auto chiller system, or plan to do a lot of 10 pound arm raises to cycle your chilled water manually.

Back to our story...once arriving home, I was blissfully pain-free and enjoyed my lunch and a couple of Vicodin, relaxing with the Mrs. and generally enjoying the afternoon.

In the evening, young G-Shaft went to her first sparring class--reluctantly--and I was very proud to hear she survived intact, winning two of three rounds against her fellow students. I heard one other student really wanted to wail on her and was reprimanded several times for swinging wildly. G-Shaft scored all her points with punches, which is pretty cool considering her slender build doesn't look like it packs much of a punch. However, the night before surgery I had her put on her gear and throw a few punches at my palms with sparring gloves on--that kid has a lot more power than I thought!!!

About 10pm, the femoral nerve block began wearing off, as evidenced by my leg broadcasting a moderate burning sensation to any nerves that were tuned in. Fortunately it was just in time for my next dose of Vicodin, so things settled down about an hour later.

That first night I tried just a half dose to keep my stomach settled, realizing that I'll need a full dose for a while longer and will just need to tolerate the slight nausea that accompanies it. Toughest challenge was finding a comfortable position that didn't push, pull, twist, or squeeze the leg in its immobilizer brace. I didn't really find a good position.


DAY TWO

The second day was filled with me tackling the near impossible task of finding a comfortable position to recline in, along with a post-up visit with the surgeon and a bit of running around at the local Target store for some odds-n-ends.

Dr. K was very happy with surgery results, and the good news is that I have no tears in the meniscus. Yay!!! I'd been using a walking stick regularly until surgery to avoid further injury to the soft tissues, looks like my vigilance paid off. I'll post a picture of the good and reconstructed knees once I download them from Mrs. Shaft's cell phone.

Target was fun as I toodled around in one of those electric shopping carts they make available to customers. That thing had the most obnoxious backup alarm, people must've thought I was a semi trailer backing up in the aisles!

A side note here to BobSpar--I bought a urinal at a local store, but haven't needed it yet since I'm currently recuperating on the couch within 20 feet of the bathroom. However, based on the sound of my voice this morning, I need to push fluids a bit more, so we'll see if anything "urgent" comes up! The urinal comes with a cap, and is probably a bit easier to use than a pickle jar. Also doesn't flavor the pickles...

DAY THREE

So we finally arrive to today, day number 3 post-op. The good sign I had this morning was that my leg had no pain in it while lying passively, so that's a major improvement. I go to my first PT session in about 2 hours, we'll see just what's what at that time and report back tomorrow.

(yawn)

I think I'll stop here, grab a quick bite to eat, and nap until PT.

Thanks to everyone for their advice, positive thoughts, and prayers. They're helping me tremendously!!!