Wednesday, December 17, 2008

Hack Shaft II: The Clone (Pictures!)

Welcome to the sequel.

Unlike many movie series, my second ACL reconstruction experience so far has exceeded expectations. Here's a few comparisons:

- Initial injury. No swelling vs. puffing up like a balloon. My ACL had somehow managed to fold over itself immediately after rupture, effectively choking off any hemorrhagic blood flow and preventing swelling. What a miracle and a blessing, it saved me from Pre-Op PT to restore Range Of Motion.
- Locating the femoral nerve. Got it the right away vs. needing a few minutes (and hitting some raw nerves in the knee joint.)
- Lower sedation levels. The spinal block injection didn't bother me any more than the prick from insertion of the I.V. catheter; last time they knocked me out for about 15 minutes. Since I was far less sedated, I was able to experience the whole surgical procedure without memory holes. Yes, I'm one of those sadists who watched his own surgery...Again!
- No nausea from pain meds. Since Vicodin made me constantly nauseous, I raised the issue this time. We ended up with good ol' Tylenol 3 (Tylenol + Codeine) and it worked like a charm. Vicodin and its analogs are powerful Codeine synthetics, and my pain threshold just didn't justify the side effects. I remembered tolerating Tylenol 3 in the past, so we combined that product with 800 mg doses of Ibuprofen and I was much more satisfied with the results. As of this morning I'm strictly on Ibuprofen since I had no significant pain when I woke up.

Some things weren't as positive. The spinal block began wearing off as they were closing up; last time it didn't begin wearing off until I was in Stage II recovery hanging out with Mrs. Shaft.

It didn't cause problems with any surgery-related pain since the femoral block was still active, but my posture on the table made things uncomfortable at that point.

My operative leg was strapped to an immobilizer board, and the end of it was digging into my left butt cheek. My right leg was dangling unsupported over the edge of the table at perhaps mid-thigh position.

The resulting dead (rapidly becoming live) weight pulled my lower back into an increasingly uncomfortable arch and began tweaking my lower back something fierce! I tolerated it to a point, and when it seemed like closure was still gonna take a bit I brought it to the attention of my nurse anesthetist. Since lumbar support wasn't available, and raising my torso to a higher angle just exaggerated the discomfort, I ended up with a shot of some narcotic (under protest.)

I felt it was overkill, and when the first dose didn't settle my lower back I got another. That settled things down, but made me a bit more woozy in recovery than I cared for. Leave it to an anesthetist to conclude the solution to any pain is more drugs.

My advice for anyone reading this and preparing for surgery: If you're awake, get lumbar support in place if possible!! My conclusion is they probably couldn't place anything there since it was the injection site for my spinal block, and perhaps they needed to watch it or something.

Once closing up was done, my cryo-cuff was installed as well as the immobilizer brace I'd brought in for re-use. This time, however, they installed a compression wrap along the length of my leg, rather than just gauze to hold dressings in place. Unfortunately this resulted in a lot of insulation between cryo-cuff and my knee, so it was pretty much ineffective until dressings were changed the following day and a few layers removed.

This morning was the 48-hour mark and so I removed the dressings to shower up. Things look pretty much as expected, but my leg as a whole seemed much more swollen than last time. I assume removing the compression wrap probably induced that, as well as a lack of proper cooling for the knee the day before.

The only thing out of the ordinary was a nickel-sized blister at the end of some of the steri-strips on my shin. I contacted a nurse at the clinic, and the conclusion is it was most likely the result of unusual rubbing at that spot. I trimmed back the steri-strips to better expose the blister, then padded the site with some larger gauze to protect it until it either drains or the fluid is re-absorbed. Fluid in it was clear, so I'm not too concerned unless it bursts and creates an opening for infection. Just something to watch over the next few days.

As for getting around, I'm on a cane at home already and crutches in public (for speed), so am able to bear weight well. Couldn't do a straight leg raise at PT yesterday, so I'm working on quad sets and assisted raises using my non-operative leg along with passive extension while icing and such. My numbers are +10° extension (should ultimately be around -10°) to about +75° flexion.

I got a looong way to go, baby!

For the gruesome of yousome, here's before and after pics of the ACL:

The tip of the probe is in front of the Posterior Cruciate Ligament, the ACL's partner. "Cruciate" refers to the crossing of the two ligaments working in concert to hold the shin in proper position relative to the thigh. The lower end of the ACL took some bone with it when it ruptured, and somehow folded over itself choking off blood flow that would have otherwise caused massive post-injury swelling.

Welcome the PCL (top-left to bottom-right) and it's new ACL partner (bottom-left to top-right.) May they perform their duet perfectly in concert until the day I die.

In closing this post, I want to take a moment to thank two anonymous people for their decision to be organ donors. Since my replacement ACL's are both allografts, (harvested from cadavers) I give my most heartfelt thanks to them both for checking that box on their state ID or driver's license forms. I hope you both enjoy the ride as I cruise into my 40's next month and continue my journey to black belt and beyond.


Blackbeltmama said...

You sound like you're doing great. I'm glad to hear it! Don't push it too soon though.

Anonymous said...

Thanks for the update. Glad this one went well, too, despite the spinal block wearing off.

You're getting to be a pro at this, so I know you'll do fine.

BobSpar said...

Oh, Hack, I have been way behind in my reading and only just now saw that you've been injured, and even gone through the operation again.

1) Hell, I'd say Jack Daniels and beer are almost REQUIRED after a second ACL injury;

2) Studying opponents isn't sinister, it's how you learn to improve;

3) You have a great attitude and a great work ethic, and you're a strong and resilient athlete. Hang in there.