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Tuesday, 20 October 2015

Day 20 - thou shalt get full ROM

Yesterday, exactly three weeks from my operation, I had my first proper physio check-up.  I was weirdly excited about this, anxious to know how I was doing and what exercises to progress to!

Over the last week I have stopped using my crutches. Walking is still 'stiff' and cautious and I don't feel particularly comfortable on slopes, but it seems incredible given how I felt just a couple of weeks ago. My physio therapist, however, was slightly less enthusiastic and, although he said my walking was looking pretty good considering, he prefers for people to stay on the crutches a little longer than my particular surgeon recommended. His reasoning is that it is better to get 'high quality' walking sorted with the crutches, rather than giving them up too early and learning 'bad quality walking'.  He suggested using one crutch when out and about. I'm not sure how good I will be at following this advice now that I have got used to not using the crutches, and I find using one crutch sort of disrupts my walking rhythm and makes me limp more, but we'll see!

The physiotherapist seemed pretty happy with how my knee was at the three week mark. He assessed my extension and flexion and explained that the knee-cap pain I was getting recently (which has gone now by the way!) was probably due to the knee 're-aligning' itself - during surgery it is effectively disassembled and then reassembled again, so it can take a while for things to settle down.

I was expecting to be given a whole host of new exercises, especially given that it is now three weeks since my op and all my online (obsessive?) researching seemed to suggest progression to new exercises weekly.  However, my PT has obviously had some more extensive training than a bit of internet browsing and has other ideas for me: get full range of movement (ROM) first, and then work on strength. And he means full ROM - the last couple of degrees of hyper extension that lift my heel off the floor, to match my other leg. Otherwise, he pointed out, if you work on strength before getting full ROM, then that strength has to be worked on all over again once you do get full ROM. Sounds logical to me! So I ahead of me I have a week of staring intensely at my foot, squeezing my quad and willing my heel lift off.  The only strength to work on for the time being are my hips - I've been instructed to do the 'side-lying clam' several times a day, basically until the muscles burn so much I can take no more! Well, saves counting, I guess.  This is for the hip abductor muscles, which play a role in stabilising my whole leg. I'm doing the exercises on both sides and am quite excited about the opportunity, through all this physio, to strengthen up both my legs while I'm at it!




Monday, 12 October 2015

Day 15 - Frankenstein's monster

Today is two weeks from my operation - the clips were taken out 5 days ago and I could finally inspect my scars! They are quite Frankenstein-esq at the moment because the metal staples leave dots either side of the scars, but I think they will fade to nothing. I've been using a bit of coconut oil on them to moisturise, as well as arnica oil around my knee in general - although I'm not going too crazy with that as the scars aren't fully closed (still scabby).  There's plenty of debate about whether coconut and arnica oils really have any clinical benefit but I find it comforting any way!

My knee is still a bit larger than the other one but generally not redder or warmer.  Yesterday I was walking around the house without crutches - not quite normal gait yet but feeling much more confident.  I think there is a lot to be said for listening to your body - I just found that suddenly I felt ready to leave the crutches to one side, it wasn't something that I had to force.  I'll still use them on stairs and outside for now, although two weeks is when my surgeon said to start weaning off them. I'm not sure how long the 'weaning' period is supposed to last but I guess my knee will tell me!

I'm still getting the knee cap-ish pain when going into and out of full extension, but it is less sharp than it was initially.  I haven't heard when my first physio appointment will be yet but will get a letter this week I hope! For now I'm just carrying on with the first-stage exercises, although getting more than 90 degrees flexion.

Tuesday, 6 October 2015

Days 7, 8 and 9

The last three days have seen me able to sit in the passenger seat of a car (no longer any excuse to lounge on the back seat!), go out and socialise a couple of times, manage to wash my hair again and, today, start shuffling around the house without my crutches! Well, not so much shuffle but very slow and deliberate baby steps, and with a limp because the 'swingy' bit of each step doesn't quite feel like what my knee wants to do yet! I find the kitchen is a good location because you are never far from a worksurface to hold on to if needed!  It is a very weird sensation and requires concentration to make sure the muscles remember what they are supposed to be doing.  Without the right co-ordination at the right time, the whole leg feels like it might buckle - really makes you appreciate how amazing muscles are most of the time!

Apart from the short bursts of activity or socialising in the evening, I am sat on my bum in the living room with my leg up (occasionally with ice), working on my lap top for most of the day.  Surprisingly I haven't got cabin fever yet and I haven't been itching to get some exercise, which I thought I might do by now.  I suppose a lot of that has to do with my (conscious and subconscious!) mental preparation - I'd thought about the decision to do this so much and done so much research that I fully understood what I was letting myself in for (or at least I think I do!) and knew that it was going to entail a period of downtime.  I was very fortunate that the date of my operation coincided with the end of (a busy) summer and shortening of the days (fewer opportunities for outdoor fun!), as well as a new phase in my PhD work which will basically require me to sit and transcribe interviews for a couple of months. For the wintery evenings ahead I was full of intentions to chip away at a backlog of reading I should do, until some friends lent us two box sets of 'Homeland'.  Something tells me that is going to be bad for productivity!

Sorry, back to the knee.  It is feel generally better each day, easier to manoeuvre, less swollen and stitches not pulling so much, but on Sunday (day 7) I think I over did the physio a bit and have suffered since: I got a bit obsessive with trying to get the same extension as my other leg, so spent a while doing the exercises which press your knee into full extension, clench quad and I tried very hard to get my heel to lift off, too. Did this a few times through the day and it seemed to be going well.  However, the next day I found quite severe pain on the inside and slightly below my knee cap doing the same exercise, and especially when trying to bring my knee out of extension and into a heel slide.  So I'm not sure whether I over stretched something, irritated or inflamed something, pinched something or something has just got tired from having to compensate for my quads and hamstrings not quite behaving as they should!  I have laid off those exercises since and carried on with everything else with no problems.  I will have my first post-op check-up tomorrow so will be able to ask.  Must try not to cry if I have to do the move and it hurts....

Saturday, 3 October 2015

Day 6 - stiff stitches

My stitches - or clips I think they are - are beginning to tighten and the plastic dressings over them pull my skin taught.  This gives an unpleasant 'tugging' sensation when I walk and makes the physio exercises a bit uncomfortable! I have to wait until Wednesday until the dressings come off ... I think I'll feel ready for it by then!

Other than that all is fine, I've been at home all day but am venturing out to socialise for the first time since the surgery tonight! (Ironically, to a Ceilidh - I'll just be watching!).

Day 5 - More beach time

Not too much new to report today, except that my knee gradually feels better each day - I'm more comfortable moving in bed, can put weight on it (although not walking without crutches! Just tiny shuffles) and generally feel reassured that it is actually 'solid'!

Another trip to the beach to lie in the sun was the highlight today. I could get used to this! It was nice to just watch the world go by - adults, kids, dogs, horses all enjoying the beach.  A kind lady offered my her beach chair while she took her dog for a walk.  Seeing as I had already manoeuvred myself down onto the sand and getting back up is a bit tricky I decline, but it was nice of her to offer!

The exercises I'm doing (4 times a day, lying on the floor) are

- Extensions (straight leg, contracting quad and trying to pull toes toward me and push knee down) x 10
- Towel under knee and press down with heel and quad/hamstring muscles x 10
- Put something under heel and let knee fall down, gently push and hold for five seconds and then release x 10
- Heel slides (sliding foot towards bum until leg is bent 90 degrees) x 10
- Heel slides sitting on a chair x 10

Obviously these are just my instructions - you should follow what you've been told by your surgeon/physio as I think it varies a lot depending on the type of surgery and whether you had any meniscus repairs.

Friday, 2 October 2015

Day 4 - Beach knee

Today I'm feeling pretty good (although I said that yesterday but later found myself snivelling like a toddler at bedtime, with a tired leg and delayed mild shock that I'd actually had an operation and my knee had been cut into and poked about).  However, today I am feeling pretty good - I took one ibuprofen this morning and haven't needed one since,  knee is looking slightly less lumpy through the tubi grip and I'm consistently getting 90 degrees flexation (I can almost sit at a table normally!).  It's not easy though! To hold my leg in that bent position while lying down makes my quad muscle really ache! The weirdest thing is trying to do whole leg raises.  It feels as though I have to do it through the power of my mind.  Just getting lift off feels impossible! I think it has to do with engaging the area where the hamstring was harvested (it's a bit bit weird to talk about your own leg being 'harvested' isn't it?!).  The initial lift-off moment makes the side of my knee twinge a little, and the leg just says 'let's not do this'.

Extension doesn't seem to be a problem, although my heel doesn't lift off quite as far as the other leg. I haven't really had to work at this at all - when I woke up from the op my leg was straight and I was told very clearly that extension is the most important thing initially, so I've been keeping it straight (usually with something underneath my calf or ankle) whenever I'm resting.  Getting it straight again after bending isn't a problem, but fully squeezing my quad to try and get the heel to lift and push the knee down further makes the base of my knee cap ache, around two of the incisions I think. 

The best thing today was going to the beach (oh, and washing my hair!) and walking a bit further than I have done before with the crutches (with bare feet on sand!). I found that walking a bit further lets me get into the rhythm, relax and use my leg a bit more normally.  I can put more weight through it now, having realised that I actively have to push down and back when I step with the operated leg - i.e engage muscles! - in order for it to feel 'normal'.  Which makes sense - no wonder it feels wobbly if I'm not actually engaging muscles.  It's quite a bizarre phenomenon having to re-activate muscles that were all fine and dandy before the operation.  It's not that they've had time to waste or get weaker, it's just that they say 'no thanks, not today'.

And the sunshine, that was good! Who'd have thought that on the 1st October we would be in shorts and t-shirt lying on the beach, me doing my physio exercises and Tadas reading a book.  It felt like a good idea to soak up the rays while we could - vitamin D is essential for absorbing calcium and I've got some bone tunnels to fill....

(Incidentally, I think I expected to feel some kind of sensation inside my knee  - either the fact that bone had been drilled, or the new ACL itself - but I don't feel anything like that (which I'm glad about!). The main sensation comes from the surface incision sites, occasional twinges at the back of my knee where the muscles/tendons are (presumably because of the tendon harvest), and tightness when I bend (from the swelling)).

Day 3 - Sausage leg

Phew today has been positively enjoyable, I've ditched the codine and just take ibuprofen and paracetamol now, and am feeling fine, no sickness.  My knee doesn't feel particularly painful while it is still any way, but for bends/moves/clenches the painkillers help!

I went back to ward this morning to have the bandage taken off and replaced with a tubigrip.  Saw my knee! Hello knee! it's got 4 (or 5?) incisions, each covered with a dressing.  All a bit lumpy and swollen in places but really not bad considering - no blood or oozing! The physio packaged my knee in a doubled-up tubi-grip using a technique that must have been borrowed from the sausage industry, and off I went on my cheery way ... slowly! I'm not fully weight-bearing yet on the crutches but I'm happy enough walking on them, it just takes me ten times longer to get anywhere.

The tubi-grip feels loads better, I can feel what is my knee and what isn't, I can bend it more, and I can but peas/cyro-cuff on and actually feel the cold!  I've done two rounds of the physio regime so far today (of a recommended four) and can almost bend my leg to 90 degrees, which I'm happy about!

All in all a good day - no sickness, started physio, feeling perky and beginning to feel how it is possible that my knee will feel better and better.  Well done knee!

Day 2 - Downer

Day 2 started well, I got half a really good night's sleep, then woke up for the loo and lay awake a while listening to my stomach gurgle.  By 7am I was raring to go, looking forward to breakfast, starting on physio and even doing a bit of work on my laptop.

However, after a hearty breakfast my stomach had other ideas and it seems I'm not too good with the strong pain killers.  I've been sick and have not taken any more pain killers, mainly because I didn't feel I could keep any food or water down long enough to do so!

So, knee is feeling pretty sore and fragile (have had two paracetamol all day), and I'm feeling pretty sorry for myself - well, I guess I had to expect to feel as though I'd had surgery at some point!

Feeling better this evening and will try some food and another ibuprofen. A surprise visit from some good friends perked me up too.  

I've been wiggling toes, clenching muscles and keeping extension with leg raised most of the day.  When I get up knee feels weird, almost as though it is being held together by the bandages and seems hard to believe that I should be off crutches in under two weeks - this is where I'm grateful to all those other blogs I've read who've said it is possible!

I'm also extremely grateful to NHS Wales - I've had two phone calls today from a nurse on the ward and from the physio to check how I'm doing, and they were there on the other end of the phone when I needed some advice about the painkiller sickness, too.  Thank you NHS!

Looking forward to tomorrow, I hope without sickness!

Day 1 - Surgery Day!

I had thought about nothing else but this surgery for about the last month, swerving between quite intense anxiety, to glimpses of excitement about the possibility of fully trusting my knee again, to agonising about whether it was the right thing to do or not (more on that in another post!)

The night before my surgery, on Monday 28th September, there happened to be a 'Super Blood Moon' lunar eclipse event which, being awake at 3am as I was any way, I watched from the attic window in our house.  It was very beautiful, and quite eerie.

Back to bed and then up at 6am (dreams of being late for the hospital and other knee dramas) to rush a bit and make sure I had everything and had done everything according to the many instructions the hospital had sent me. 

In the end I arrived at 7.30 to the ward but had to wait until 2.15pm before it was my turn. I can't say this was the most fun I've ever had, sat contemplating what was to come and questioning my decision to go through with it all. However, the hours went by surprising quickly, I was bustled in and out of consultation rooms several times (registrar..who worryingly didn't seem to know much about the  kind of reconstruction I was having but drew a big arrow on my leg nonetheless; Anaesthetist (a very nice man who said I had a 'solid' pulse. Phew!); and finally my surgeon who thankfully did know a lot more about the type of reconstruction I was having!

I was most scared about the anaesthetic.  Well, I had nothing to worry about! (as many people told me I didn't).  I was shown into a small room joining the operating room, where an assistant showed me to a bed, took my blood pressure and linked me up to heart monitor thingys.  I chattered away trying to calm my own nerves, asking him if he'd had anaesthetic before (he, too, reassured me that when I wake I'll wonder what all the fuss was about). Then my kindly anaesthetist showed up, gave me a smile and a pat on my arm, tool my pulse ('still solid!') and then he and the assistant put a needle into the back of my hand.  This didn't hurt at all but I squeezed the anaesthetist's hand quite hard nonetheless, as a comfort! Then, in very quick succession, he said he's putting in some pre-med (which, after a few seconds, did take the edge off my anxiety and gave a slightly fuzzy feeling), then in goes something to help with nausea, and then I think he said 'and this is your anaesthetic' but that is the last I remember! I didn't even have sensation of drowsiness of drifting off, or even a memory of 'blacking out'.  The next moment I was waking up with a nurse sitting beside me and someone asking me to wiggle my toes.  I think I must have wriggled them because the person seemed satisfied and wondered off. To begin with I thought I must be dreaming, too soon to wake up, but when it dawned on me it was actually over and I was awake I was feeling pretty good! Thank you Mr Anaesthetist.  Next stop was the recovery ward, where I started to become aware of the pain in my knee and was given something strong for it, which helped.  It was actually a wonderful feeling of slight drowsiness and relief, and a couple of hours must have passed by.  I had the best cup of sugary tea EVER and a cheese sandwich and think I snuffled back a few tears of happiness/gratitude. 

I spent a couple of hours on the recovery ward, knocking back tea, sandwiches, water and juice and probably annoying nurses with my slightly delirious and paranoid questions ('do I need to worry about those bubbles coming down the tube in the IV drip?'). The anaesthetist and surgeon both came to see me and said things had gone well. There is no damage to other parts of my knee so it was a straightforward ACL reconstruction and I will not need to wear a brace during re-hab. Tadas, my partner, who had also had an unpleasant day of waiting, could finally come and collect me at around 7pm.

The evening was, frankly, great! I was quite elated I think (A combination of drugs and relief), was comforted by kind words from friends and family, and enjoyed an evening of watching a few comedies, eating a proper meal and feeling smug that I could already get up and down the stairs pretty well with my crutches.

My instructions are to weight bear with crutches and start on basic physio immediately, concentrating mainly on getting extension.  My knee is quite tightly bandaged which makes it a bit a bit difficult to tell how much I can actually move it, but the support is quite comforting!