First day with no nap: I'm a big girl now!

 Super productive day...for Kevin while I supervised and stuck my hand in whenever I could. Actually, it was more like, "hey can you dig that dirt and move it there for me?" The amazing BBF of mine made me a cold frame! I had been harping on about how much we need one for months, and he had purposely built our bigger raised beds to become greenhouses for the winter. The weather has warmed up, the soil is lovely and moist, and as per the Farmer's Alamac calendar for Squamish, now is an ok moon-favourable date to start my planting your seeds outdoors. I've started about 6 different veggies and 5-6 perennials indoors and have got quite the little sweat shop factory style going on! 

My little buds have graduated to spending the night out in the cold frame, as I slowly conditioned them to the outdoors in order to not frighten them...or something like that. I have no idea, I'm just going with what seems right!!

The baby cold frame!

 So after a great sleep in that Kevin thoroughly deserved (that man works too hard), he made a great brunch of corn pancakes with bacon and maple syrup, and off we went to buy more seeds and tools required for the cold frame. Super simple and quick to make and cost under $20. Small milestone of the day: I can walk the entire length of Canadian Tire...excellent.
I potted more seeds and kept Kevin company by roaming around the place, and attempted tilling the raised beds by sitting on be ass...it can be done!

The babies and their new homes...so proud!

I also had a visit from my friend Dobbs today, which was super nice as he came all the way from Vancouver for some tea and muffins. I was surprised that by 5pm I wasn't too tired or sore: have started to add Diclofinac (NSAIDs) throughout the day in order to reduce the need for requiring breakthrough Hydromorphone. I now know when my knee is starting to get a bit "fed-up" which basically means that it needs to be moved or it will get stropy. I feel like I am the mother of a 4 year old: it can sit still and be polite for 15 minutes, but after that it starts to fidget, squirm, and give you that look, "can we go for ice cream now???" therefore, you have to distract it.

My distraction for an unruly knee? A good 10 minute stretch, thigh massage, and 15 minute CC (the knees' version of ice cream). I was treated out for dinner last night and after 20 minutes Kevin noticed how fidgety I was. Thankfully we where only at out local cafe and not some posh bistro...  

It's naked!

Peeled off the steri-strips in the shower this morning: I like picking scabs so I couldn't help it...what? 
Anyway, check out the minimum swelling. Thank you Cryocuff! Oh and hey, I found my knee cap.
You can also see that the right thigh is looking slightly smaller. 
Measurement; 15 inches...lost 2 inches. 10-days post op, no thanks to muscle atrophy

BENT!

 

Check out the bend!! Yippee!! I finally seem to have found a remedy that keeps me occupied, happy, productive, but not feeling like I'm rushing around or pushing myself too much. Each day I try to stretch a little further but don't reach too far; my little hands can only grab so much and I can't be too greedy. Even Kevin is noticing how much my energy is growing each day and am able to complete more tasks around the home. I've learnt not to be stoic and not to be stubborn. It cost me a few days ago and I do not want to be in that state again.

Though I do miss hanging out with my best friend. I miss going for our runs, climbing together, taking a nice stroll down by the river, or working in the garden together. We both enjoy to just lie side by side and just talk non-stop about anything for hours so I am glad we have kept that going. By the summer (lets say mid-August) I should be pretty close too 100% so I should be able to help Kevin finish building the bedroom, however that seems so long away. You can't help but feel left out when you are the one watching the other one drive away to play, even though you know you aren't. You don't want to hold them back from having fun because that's is not fair, nor do you have the right. But that's what you want to do. You want to scream, "you can't have fun because I'm not!" But again, that's not right. 
So instead you suck it up, you push him towards the door and say, "you deserve to go and have fun. You do everything and anything for me and I want you to go and enjoy yourself...but be home to cook me dinner ok 'cause I can't stand for that long..." Seal it with a kiss and just be thankful for him.
 

Bruiser

 I think bruising is cool. It looks like you're tough... I am usually covered in them. Mainly due to banging into a corner of something, tripping over anything, and they are generally clustered around my knees and shins from banging into climbing holds. The best? A whopper the size of Kevin's palm on my bum from falling and swinging into a hold sticking out like Kevin's nose...
Although I can not forget the band of bruising I received from crashing my mountain bike at age 18. This dark black and purple mess spread right across my pelvis and pubic area. Had to have 3 x-rays to make sure I hadn't fractured my pelvis. Thankfully I hadn't, which still amazes me that to this day, throughout all the most stupidest things I have done, I am yet to break a bone. 


Anyway, the bruising from the surgery is slowly coming out, and it's spreading! The darkest spot seems to be growing at the back of the knee joint, but from lower thigh region right down to my ankle, it's showing it's colours. Personally, I think it looks kind of cool, and I can point to it and say, "see? this is why I suck with controlling my pain!"

colour coordination noted here with sock and yoga mat

So it's starting to get darker around the shin/calf area..will keep an eye on this region. But I do love the ribbons of bruising: I'm becoming a purple tiger! 
You can also see that the ankle is showing some bruising too...

Bit of a glance at the back of the leg...it's spreading!

And another angle

 I am trying to get back into my project today for ICU Research. I just became the project coordinator, which is a promotion for me, but it's bloody scary to be honest as it's a whole new ball park to play in, with more responsibility...Am triple checking my emails before I send them off as I'm still not able to process thoughts 100%. But must persevere!

1st day of physiotherapy

First Milestone reached: jump for joy!

 Well I had my first physio appointment today and I was a bit nervous as I wasn't sure if I was ahead of the game or behind. I was booked to see Maggie at Reach Physio http://reachphysio.com/
Located in down town Squamish, by the senior centre (which is another story), and came highly recommend by Ed and Gwen. I will be followed by 2 physios, Maggie and Patrick as Maggie is returning from mat leave and the centre thought it would be good for me to see the 2 of them as they both trained together, and to fit around mine and Kevin's schedule (so he can drive me there on days off). 

Maggie took down my usual details: how I injured myself, when was the surgery, what I do for work and for recreation, what type of graft they used for surgery, what where the surgeon's post op recommendations, and what I have been doing since then. I demonstrated to her my program, what pain relief I use, how often I use the CC, my daily regiment, etc...
I pretty much blew her away! 

• swelling: very minimum, most likely due to using the CC every 2-3 hours for 20 minutes, including overnight

• Knee flexion: lying on my back I can slide my heel up towards my bum till it reaches 98 degrees. As per physiotherapists guidelines, they aim to progress their patients to 90 degrees flexion at the 2 week post-op mark. I got there and further in one week! 
• knee extension: 0 degrees, which as the diagram above shows, is perfectly straight..excellent!

This is the one thing that put fear in the back of my head: not being able to fully extend with the first 2 weeks post surgery. Many studies, and from speaking to others who were not able to gain full extension within the first 2 weeks found that their rehab was delayed, they struggled with hyperflexion in the long run (or could not achieve it at all), which in turn has caused hip and pelvis issues. 
By being able to fully extend on my own with no pain, this will greatly improve my range of motion quicker compared to if I still was struggling with straightening my leg. 

• hyperflexion: we want to be careful with this within the first 6 weeks post op as this puts a lot of strain on the graft. But with Maggie supporting the knee, she could gently assist me in hyperflexing my knee, which I can do with no pain up to 5 degrees. Below is a little video explaining it a bit more:

So needless to say, I was extremely happy with the progress I have made, but most importantly, with the program that Paolo set for me, which I have followed like as though it was my bible...thank you Paolo!!! I told you he was God.

Maggie and I hit it off instantly. She is very proactive but cautious at the same time and is helping me to set boundaries and within them to explore different ways of stretching and heeling. So, below are the guidelines and some recommendations I have been following. (the new ones I am to start working on are in pink!). These can be all applicable for the first 2 weeks of your rehab post-op:



Pain management:

• Cryocuff, every 3-4 hours x 15-20 minutes (including overnight use)
• Tylenol extra strength (acetaminophen extended release) 650mg per tab, every 4 hours
• PRN (as required) Hydromorphone 1mg or every 4 hours for breakthrough pain relief 

Please remember that this regiment is specific to me as Codeine was not kind to my body. However, your physician may prescribe completely different meds to you and I think it is best to talk with them to find a regime that works perfectly for you. 
 
Alternative treatment:

• PRN Bach Rescue Remedy, 16 drops in 1lt of water, sipped throughout the day
• 3 prunes and apricots daily for regular bowel motions
• "Poop smoothie" every morning at breakfast 
• have started taking Metamusil Fibre supplement 3 times a day only because I am still taking hydromorphone (opioid) and because I am slowly building up towards my regular diet, which is very high in fibre, roughages (raw vegetables), nuts, berries, multi grains, bran, and omega 3's (thankfully Kevin is just as much into healthy eating as I am). I recommend these remedies if you can not maintain a diet that is rich in the above ingredients as a balance of these and daily exercise will keep you incredibly regular, happy and glowing! 
• Pranayama: yoga breathing! Honestly, this really helps to calm that mind when you are moving through that stretch and it twinges and hurts. Simple and used for anything, but I found this as a useful tool to assist in blocking the sound of my inner voice shouting "mother f*****! this hurts!!"
• *long term* acupuncture to the knee but I will go over that once I start

Stretch and strength:

• calf/hamstring stretch with yoga strap on foot
• quad/hip flexor off end of bed
• quad sets with muscle stimulation (will explain further on this)
• heel slides
• bending/straightening the knee on your side
• wall (or floor) ball rolling" exercise ball placed under your knees, you on your back, legs out straight, and roll in towards your body, slowly and back

I take my time with the above exercises, no racing or trying to beat a time here. Approximately every 3-4 hours I'll spend 20 minutes on these, as well as sitting on the chair and using my good leg to assist with extension of the bad leg. 
If I am sitting in the chair in the shower, lying around in bed, or doing the dishes, I am generally flexing the ankle joint, or slowly moving the knee back and forth as I find that it can stiffen up quickly and that hurts.

I have been setting my alarm clock over night to take the pain meds and apply the the CC and I have found that this has not disrupted my sleep, or cause me to wake up groggy in the morning. I don't want to wake up due to agony. It's not fun, and it's not fair to yourself or to your partner. So, at 10pm I take one Tylenol and 1mg of Hydro, at 2am 1MG Hydro, and at 6am 1mg of Hydro and 1Tylenol. Both at 2 and 6 I apply the CC and after 15 minutes of it on I seem to fall asleep rather quickly. 
By doing this I find that when I wake up around 9am-ish and slowly stretch and get ready for the day I am not groggy, I feel clear in the head, and my pain is at a discomfort that does not hold my back from my usual active daily routines. 

Maggie gave me a TENS machine to use for the next 2 weeks. A TENS (trancutaneous electrical nerve stimulation) machine is a well known device used among many health care professionals, across many diverse practises. For me, this will be used whilst completing the quad set exercise. Because I have very little self nerve stimulation of the quad muscles and fibres, by applying the TENS machine will stimulate quad nerve fibres and increase the nerve action potentials. Basically this will assist in increasing muscle movement and indirectly reduce pain levels. Once I am able to fire the muscles on my own then we will not need the machine. Check out the video below! 

So looks like we are on the right track. After a day of feeling like hell, there is light. We all knew that, I knew it, but when you are stuck in the ditch it's hard to see what's over the hill. 
I know that there are going to be many more challenges and bad days ahead of me. And there are going to be many sections of goals to achieve, such as, re-assessing in 4 weeks, 6 weeks, etc... But it was such a relief to know that what I have chosen to make up my exercise schedule is working, and showing progress. I am not going to ramp up anything, I will keep with the same schedule for the next couple of weeks and slowly increase range of motion as I can tolerate. 

I will now go and celebrate by having a nap as Maggie gave the leg a good massage as whole right leg, from foot to groin is incredibly tight! 3 months of guarding that knee. The massage technique she used was to aid the lymphatic system in flushing out the excess toxins and lactic acid building up in my leg, as evident by swelling (which is also a normal part of your body's inflammatory process). 
Night!

Achievement!

Talk about spontaneous blogging! I just had my first shower all by my self! What a great feeling. I mean, it was rather lovely having Kevin run me a bath every night and help bathe me, as really, it was the only action I could give the poor man. I don't think any guy would say no to that! But to be able to sit there, wash myself, shave me legs and armpits, and just lie back enjoying the water beating down your back...bliss!!

 

Careful kitty

 Ok, I don't want the fire crackers coming out, but I actually had a decent sleep last night. No nightmares like I did the other night; did I forget to mention that? Had my favourite nightmare that likes to repeat itself every now and then...Kevin leaves me for an ex because they have become sicker than me and so he asks me to move out...and in the dream his head is always really small. Very odd. I dream a lot with not too many nightmares. I usually remember them and try to explain them back to Kevin, who always sits there with a huge grin and seems to enjoy this imaginative side of me.
The main thing I have noted since being with Kevin is that my dreams, whether good or bad, are full of vibrant colour. When I was with Sam, I don't recall colour, just a lot of blurred edges in black and white. The odd colour would stand out, like a bold red, but nothing else. With Kevin, the colour makes me remember the dreams, and they are bright! He is always there in a dream, either by my side and I can't see his face, or right in front of me and I see him clearly. 


In the last 2 months I have a dream that scared the living daylights out of me. The first was when Kevin and Mary where battling their way back from the Rockies in horrendous weather, trying frantically to get back home in one piece, in one day. I think they drove for more than 12 hours to get back to Vancouver. I was really upset that they would not be able to make it home in time, and more upset that I would have to wait another day for Kevin, which after 2 weeks without him was too much to handle. I managed to fall asleep and was really upset that I hadn't heard from him due to power failures and snowstorms in Alberta. 
The next part felt so real that I still feel like it wasn't a dream:
I was under the covers when I heard Kevin come home, but was too sleepy to poke my head out from under the duvet. I heard his footsteps come into the bedroom, felt him sit on the bed, lean down towards and felt the breath of his whisper as he said, "honeybee, it's ok, I'll be home soon. I promise"
I shot out of the covers and realised that it was a dream! I called out to Kevin but the house was pitch black and quiet. No one was there but me. I could still feel him in the room, smell him. That breath felt so real, so strong on my ear that I could not quite believe it was a dream. So of course, I thought he had died and this was his ghost coming to see me! Nevertheless, I sent frantic texts asking him if he was dead and his ghost visited me, and on and on I rambled until he called me ok, "honey, are YOU ok?" 


Anyway, I have no idea why I just rambled on about my dreams, but onwards I must proceed! I know mum takes dreams seriously but would be curious as to what others think of them...


So as the title states, I was a careful little kitty today. Felt like a brand new kitten when you first set it on the grass...

Walk slowly and you will not die!

It felt like that this morning. Woke up, checked myself into reality. Ok, feeling hungover but you've dealt with that before so remember back to those good old uni days and your remedy: carbs, tea, and poweraide.


I decided that for overnight I will take 2 Hydromorphones (2mg) every 4 hours so set my alarm for 2 and 6am. At 6am I also took 1 Tylenol extra-strength (650mg per tab), kissed Kevin goodbye and settled back to sleep, along with some CC action. 
Woke up at 10 and felt ok...cautiously got out of bed, sat on the edge and flexed my legs waiting too see what my body would do...it did nothing and I think it was waiting for me to make my move and then retaliate. Made a cup of mint tea and once that went down I downed a banana with yoghurt. So far, so good. Body is still holding back, like a spoiled brat waiting to find the perfect moment to throw a tantrum in the shopping mall...No, this will not happen today.
After sending some work emails to let them know my current status (mush brain, can not multi task), I decided to get into my knee specific stretches, but do them really, really slowly. It seemed like my body was ok with this progression and after hearing my stomach groan rather loudly, I decided to hit the next feux-hangover cure: carbs!

When we where younger with an upset tum, mum would fix us up a simple meal: boiled pasta, grated cheddar cheese, butter, salt and pepper. Incredibly simple but it has the right ingredients you are craving post feeling sick. Fat, crabs, protein and salt. Another cup of tea and some salty crackers and I thought that it was time to get outside and expect the garden..or lack of it. Now normally I would be out there picking up the stray branches, picking the sticks and making a fire wood stack, tilling the veggie patches. But that will all have to wait, which makes me a bit nervous as I should be tilling and getting the soil ready to plant outdoors...move on Sarah! 

I was really happy to see new buds popping up, seeing that the tulips I planted in October weren't washed away from the rains, or had drowned due to all the snow fall. The little seedlings that I had started indoors are being climatized to the outdoors, so every morning when Kevin goes to work he takes them outside so they spend a good solid 8 hours outside, then brings them back inside overnight. 

Precious little babies!

 I thought that throwing out old Illy Coffee containers was a waste so I drilled holes in the bottom, and am using them to grow herbs!
Grow Borage, grow!









We have the cutest little patch of these growing under the trees. I love crocus! 

 One of my many calendula baby plants that we started indoors...

Garlic!

Tulips finally deciding to show up

 That's right, I have no make up on, I am scruffy, my eyebrows are in dire need of some good grooming, and yet I am ok with being outside..I really should change that hoodie though. Been living in it for far too long.


So I felt really bad that I just was too sore to do the dishes the last couple of days. I let Kevin know how bad I feel. He has been doing everything: working all day in a difficult role, comes home around 5pmish, makes my dinner, cleans up, chats with me, runs my bath, helps wash me (I don't think he complains about that part part), makes sure I have my drinks and drugs by the bedside, that my ice has been topped up in the CC, and tucks me into bed. By this time it's 9.30pm and he's exhausted, barely having time for himself. I can't help but feel guilty as hell, I know I shouldn't and he said "this is what a relationship is about Sarah, you would do the same, and even more for me" 
I can not wait to cook him a meal. I love cooking for Kevin, and I always try to make it flash, with great presentation as he is my best critic. As old fashioned as it may sound, I love the fact that I can time dinner perfectly that when he enters the door, it is ready to be served! Don't get me wrong, I love it when he cooks for me but I am so happy doing it for him. So for now, the best I can do is the dishes. And while at the sink I started doing my knee lifts!

Lift your knee and scrub that pan!

 And then I wanted to see how my knee feels like with a squat:

Damn camera...

You can see the muscle definition around the left knee especially the calf coming out, but the right knee there is too much swelling and no definition. Plus, my balance is not centred and my left hip drops lower than the right...wonky!

The new toy...

Ok, it does look like some sort of medieval torture contraption and it might end up feeling like torture some day but this is going to contribute a great deal towards my rehab. This is an indoor bike trainer: I lock the back wheel into the machine and it provides a platform for me to cycle indoors without worrying about balancing. By using this I can adapt my own bike into a stationary bike that will fit easily into the bedroom. Because I won't be able to drive to the gym for a few weeks this will allow me to start some light cardio work at home and allow me to increase my range of mobility. 
I am off for my first physio assessment tomorrow morning and will ask them as to when it the right time to get back on the bike. Paolo informed me that when I do jump on the first exercise will only be practising "half moons" which is peddling only half the way. Once I have muscle control and strength to go all the way around, then I can start cycling with no resistance, for small amounts each day, then slowly increase depending on range and pain. 


Anyway, the sun is still shining so I will go for another stroll outside and take in some more fresh air.

Chicken soup...for the gut

be gentle with yourself.
                       remember that 'your experience counts'.
                                       there is nothing you need to prove in this experience - you are brilliant & beautiful & wise & strong & courageous - just as you are!
                                                       its OK to be, to feel whatever you need to ...

I hope that Mary doesn't mind that I have quoted her. Today was bad, it was mean, my body said "enough" and it said it verbally by throwing up the drugs I took to try and make it feel better. So I went "fine, you win" and I went straight back to bed, sleeping solidly for about 6 hours. 

I don't know where I got the attitude of, "you're fine, just toughen up, and get through it" I guess I could list 10 excuses, but in the end it is me who has made that final decision to suck it up and don't let the sadness overcome you. Yes, you head hurts like hell after a sob feast, you have ugly, large bags under your eyes, you have no spark, you speak in monotone, and you wear the big label on your forehead stating "poor me, give me sympathy" almost too proudly. 

I don't like that. But I guess it is ok to have a few days like that every now and then. It's when you have that brilliant day you look back and go, "well I overcame that, it really wasn't so bad" 

I had the notion that I do not have the right to feel bad, to feel sad, or struggle because it's "just a knee" I don't have cancer, I didn't have an amputation, or was the victim of a multi-trauma accident. But I can not compare myself to others around me. As the quote says above, this is my experience, and I will be judge of how bad or good it is. I will allow it to take control of my life, or not. 

Maybe I did push it. I think I do have high expectations for myself. I hear of another patient who underwent the same surgery as me a month ago...he is running, he has full range of motion and his heel can touch his bum...bastard! 

I thought of writing down goals o accomplish each week, and most are probably achievable, such as, walk with safety with one crutch. But I think I need to look at the more finer details. Control your pain, increase your appetite, bend that knee for 5 seconds longer. 

But right now, all I am hanging onto is finding those small achievements, praising myself on them, and using that strength to move on. Simple I guess, but I think it'll work.

Anyway, after a light bowl of chicken noodle soup and some ice cream that Kevin served up for me, I decided to get back on that yoga mat, stretch slowly and gently, and why not make a couple of short videos!!

 I didn't realise how wiped out I sound until I listened back to them!

I am looking forward to a nice sleep; my tummy is settled, just have a wicked headache, but am hoping that will be gone by tomorrow. Laziness is wicked, and I could very well change and go down that path. But that is not me, and I think I would beat myself up if I changed into that type of person. To have the odd lazy/rest day, say once a week is fine, but otherwise I have to keep slowly plodding through and soak up all the lovely advice everyone is giving me. I hear it and use it. Nothing beats the voice of friends and I totally value it. 

Bad day

Today feels like I've gone backwards 2 steps. I slept pathetically; am trying to stay on my back as much as possible but being a side/belly/wriggly sleeper for as long as I can remember, staying calm on my back the whole night is rather hard. I relax into Savasana as this usually brings on sleepiness and I feel that wave of tiredness ooze over me. However, last night the pain was overwhelming that I could not lie on my back for that long. The best thing that relaxes me and puts me into that dreamy state in when I'm nestled into the side of Kevin's arm, lying on his chest and listening the drum of his heart beat. It's strong, regular, and slow, and I don't know if that has stemmed from childhood when you would be lying on your mother's breast, listening to her heart beat. The drone of the heart, it's slow, rhythmic tone is so soothing. 

For someone who struggled for years with sleeping properly due to interloping, tangled thoughts reeking havoc through my head, I was very surprised and thankful to find that the sound of a heartbeat, and the slow movement of a chest rising and falling is utterly soothing. So last night all I wanted was to do was nuzzle in and drift off to sleep, and when I realised that I could not do it, I got quite upset. No matter what angle I lay on last night, I was sore. The CC was comforting but I can only wear it for a max of 30 minutes otherwise systemically I go cold. I have given up on taking T3's as the nausea is horrendous and I am just over nausea. So I took 2 Hydromorphone tabs and an Advil (plus Gravol as I thought I was going to throw up in bed), and tried to sleep.


This morning I feel hung-over. My head is pounding (and I know I am drinking more than enough water), I went to slowly stand up and my knee screamed out, "what the hell are you doing? No, don't walk on me!" I'm dizzy as hell and the morning smoothie barely was held in. What is wrong with me this morning? Did I push it too much yesterday? I am just aching to get down to my yoga mat and start my usual stretches but I am worried that as soon as I lay flat I will want to throw up again. I thought I'd balance the pain with taking 1 Hydromorphone and 1 Advil (NSAID) every 4 hours but now I think the Hydro is making me so dizzy. 


I feel bad as I wanted to gush over how great yesterday was as I met up with Ed and Gwen, who are 2 people who have been through so many good and bad times and come through stronger and closer. When I feel bad about myself I think about how much Ed has gone through and realise that I am being childish and arrogant as he has gone through many sketchy moments, had many brushes with death and come through stronger and positive. 
I wanted to mush over how just a small handful of friends can make your world seem to big and by having them by my side, I want to prove to them and to me that this is little blip is one of the best challenges life has thrown at me. I wanted to go over the top about how lucky I am to Kevin here by my side. The man is doing everything for me, with a smile on his face, and I can barely do anything back to thank him, but to say thank you. 


But I am just to darn dizzy, to muddled in the head to even think of the right words to put down that perfectly express what I think about these people. So I'm sorry that today's entry is not happy and positive as the others. But, I am hoping that today is not going to be one of many down days, as I do not have the energy or time to waste on sad, feeling crap days. I have far more important things to do with me time! 

So I am going to go nap and hopefully in a couple of hours when I wake I won't feel so shitty...

I have a confession...

 ...I'm having an affair! I reach to it twice at night and crave the numbing effect it gives my thigh...
Cryocuff, you are better than chocolate because you do not put me into a diabetic coma if I use too much of you. I had never heard of such thing until Mary introduced us in December, just after I injured myself. 
CC (as I lovingly call it) brings the combination of cold therapy and compression plus assists in controlling swelling, oedema, and pain. Many orthopaedics, sports specialists, allied health professionals, and general know-it-alls live, and swear by this, and I happily endorse it. The best way to relieve my pain is to numb it. Since the op I have been applying CC every 3 hours for about 20 minutes, with special consideration after physio.

Can anyone tell me why my knee cap has shifted to the left?

 Another confession: I really haven't pooped for 4 days...No I do not look or feel bloated, and am having no problems passing gas (in fact Kevin and I regularly battle each other out), but due to constant nausea, I am although drinking at least 2lt a day, my appetite is non-existent.
Kevin has developed a "poop-shake" for my breakfast:

POOP-SHAKE

• soy milk half a cup
• prune juice half a cup
• 1 banana
• 5 strawberries
• 1tbsp Manuka honey
• 1 scoop of natural, unsweetened yoghurt  

Blend all ingredients together, serve chilled...

It's super tasty and of course you can add extra fibre to it for more "bang" but for the average normal GI tract, this should do the trick. 

I am now taking supplements, we eat a high fibre, roughage diet anyway, plus I have added dried apricots to the mix. However, I think I just have reduced motility as all the symptoms are pointing towards that. Kevin agrees that I am showing a bit of a belly, but otherwise it's still flat... Thought I'd share that with you all as this is such a normal side effect associated with opioid use, and it only takes a couple to bung-up a girl. Reason number 57 why I want to stop taking them.

Still not straight...must work harder

This is what I call a wimpy bruise..and a lopsided stance!

 Good news to share: I am now walking with just 1 crutch, putting 100% weight transfer onto the right leg, and when I lie on my back and bend my right knee up until the foot is firmly planted on the floor! Shall take a photo of this little milestone. Am stoked as this morning I could not get the foot flat on the floor, but tonight as I slowly eased the leg up and bent at the knee, the foot came down. 


Kevin has also been mobilising the patella. He holds the knee cap with each hand on either side and slowly moves the cap from side to side. By doing this he assists with moving the stagnant fluid sitting under the patella around the joint, and if there are any adhesions this will help break them apart. It feels uncomfortable but it's got to be done. Nothing I do is not painful. The movements are slow and controlled but everything hurts and it is so tight that I feel I could rip it all. But if I don't move, it gets stiff, I hurt, I take more drugs, we OD on the Pooper shake, and life just falls apart! 

Sarah's physio schedule: post op day 4

• 20 mins light yoga stretch on mat (upper body and breathing exercises)
• 20 mins right knee specific strengthing exercises
• Breakfast
• 10 min balance/walking practise (aka, pacing the kitchen) and assisted demi-squat by the kitchen sink
• soil fluffing! (light gardening)
• 20 mins pilates: used the mat and resistance band (upper body and core)
• NAP
• half a block slow walk holding this really hot guy's hand...bonus!
• 10 right knee strengthening exercises  

Thigh measurement: 16 inches

Thigh muscle: non-existent...shite!

I seem to have misplaced my kneecap...

 So we took the dressing off to see what surprise lay underneath for me...and the surprise is that I have a missing knee cap! 
SURPRISE! You win the fat knee competition! Kevin and I both where itching to remove the bandages today mainly due to no more fresh blood ooze noted since day of op from the site, and that the ABD pad was a bit stinky. So after my lovely evening bath (totally recommend Burt's Bees bath oil for baby bees), we prepped ourselves an prepared a sterile field...that consisted of a clean green towel that almost resembles the sterile drapes we have at work. 


To be honest, I was expecting a higher "ick" factor with more obvious bruising. I have been extremely diligent with using the Crycuff every 3 hours since the op, so I am quite happy with the amount of swelling and bruising that is coming through. Yes, I have no knee cap, or anything that resembles it, and I have yet again developed a "canckle" but this is to be expected. 
The one thing that I am not happy about is that despite me completing the quad squeeze exercises as much as possible, there is barely any firing noted from the (R) quad set. I love seeing the (L) quad pump up and down, compared to Mr. Lazy Right Thigh who seems to have taken off in fear of his grumbling owner.

Peeling back the gauze...

Dried blood over the steri-strips.

Yup, no prominent leg definition found here!

Some light bruising coming up...I do wonder if it will spread...

You can already see that the (R) thigh is looking smaller...and still no knee cap

stinky bandage! Kevin made me a racy black one instead!

So tomorrow is my first full day alone as Kevin will be off climbing. I am a bit nervous but am thinking of things to do whilst I am home alone. It will be hard as it's not like I go go for a walk or a drive anywhere: I'm stuck here so I will try and keep busy. 

Will also try and stop taking the Tylenol 3's tomorrow and switch to an NSAIDs as it is much gentler on your stomach, and no nasty side effects to deal with, e.g. nausea, constipation, dizziness,  or feeling "fuzzy in the head"

Distraction therapy

Day 3:
I'm outside gardening! A week ago I started my little indoor green corner and it has been very exciting watching the little buds break through the dirt. We brought a couple of indoor growing lights and I have trained the little buds to get used to normal sun hours. Now that they are up, I will start taking/training the bigger ones outside to harden them to the air...kind of like training a kitten or puppy to the outdoors! 

The sun finally came out in Brackendale today so after a lovely chat on skype with mum and a pop-by visit by Mary, Kevin and I went to soak up as much sun as we could.

Distraction therapy:
When one is bored and prone to being stuck in their home, combine your imagination with love, and set up a "work station" for that person. This is what Kevin did for me. Within 5 minutes I had my own gardening table out in the sun, whilst the neighbours walked by waving and wondering, "who is that simple girl?" 


Goals accomplished today:
* reduced Hydromorphone dosage from 2 mg every 4 to 1mg when ever needed (so far, only once this past 24hr)
* reduced Tylenol 3 from 2tab every 4hr to 1tab every 4hr
* walked 200 metres! 


Range of motion accomplishments:
* leg raise: up to 12 inches from the ground, 12 sets
* knee bends: up to 40 degree angle 10 sets
*seated passive knee extension: to almost full knee extension 12 sets

Oh yea, look at me sprint by!

"It's more prettier outside!"

 Thanks for the well wishes all! It really helps boosts my spirits and brings back the smiles and giggles...I'm not me without a smile so thank you.

Post first outdoor walk evaluation...

In case you are wondering, nope I am not throwing a real tantrum! I wanted to keep walking down the road but the coach aid "no...." 

Instead I came back inside, realised just how bloody tired I was and had a nap! 

What am I grateful for today?
* being able to have the most glorious bath ever...highly recommend Burt's Bees bath oil for babies! (baby bees!)
* enjoying that fresh Squamish air and feeling the warmth of an approaching spring
* seeing my indoor seedlings bursting through: that's right, I made myself a little indoor greenhouse prior to surgery and have beets, borage, chives, oregano, basil, sweet peas, and calendula all growing inside that bring me pure joy each morning! 
 

POD2: Walkies

 

My personal Nurse took me outside today and I was able to walk around the house! Prior to this I spent the morning itching like crazy due to the regular Hydromorphone, so we have added some Benedryl to the mix, which I was not too happy about. In fact, I think my exact words where, "no more drugs!!" But I got that look from him and realised that even though I was terribly itchy due to regular meds, I was improving my movement and ability to stretch, flex, and straighten the knee. 

My whole nursing common sense has gone out the window: I feel like a child who looks pathetically uncomfortable, with big bags under her eyes. But despite this, I am moving, and when I do, I feel better. I am chirpier, I giggle, I laugh, and make fun of Kevin. Everything around me is loud and muffled, and I hate it, especially since I know it is due to the meds. But if I don't take something regularly, I become incredibly sore and freeze up.

Last night was not fun. 10/10 pain because I thought I was tough enough to deal with the pain mentally, and I did not want to wake Kevin up to help me to turn. So instead I just lay there, got more ridged, more sore, had the cryocuff on way too long, and froze my ass off. My pathetic sobs finally woke him...

So, new day today. Take the pain medications regularly, nap when required, but keep the movement steady. It's near the end of the day and here are my exercises that I am able to complete with some degree of confidence:

Quad Sets
While sitting on a flat surface with your legs straight, tighten your thigh muscle while pushing the back of your knee into the bed. I cannot do enough of these! This exercise should help to get my leg straight. 

Heel Slides
Lying on my back, I slowly bend the knee, sliding the foot along the surface of the floor. Once I have bent the knee as much as possible, I then slide my foot back down until the knee is straight. 

Seated passive knee motion
While sitting on the edge of the bed or chair, I let my knees bend and legs dangle over the edge. My normal foot goes behind the other ankle and gently assists in lifting the bung leg until my  knee is straight. Next, use your non-involved leg to slowly lower your involved leg. Your will feel some discomfort as your surgically repaired knee bends. Repeat this exercise 10 times.

I will add some photos tomorrow to these exercises as that helps to make sense of everything. Have just been trying out some upper body exercises too using my resistance band but it's a bit tricky when you're a bit wobbly on both feet due to the pain meds! 

I am barely transferring my weight onto the crutches tonight, which is super exciting! I don't went to get too cocky and push myself towards a fall but I think I am quite close to walking only using 1 crutch. For now I will just use the 2 and concentrate more on strengthening the quad and straightening that knee!!

Mothers are right: wear nice underwear when going to hospital...

Day of Op:
That was a very long day: due to arrive at the clinic at 1.30pm for a 2.30pm OR time. NPO (Nil per Orally) from midnight, and only clear fluids till 8am. So I had a few sips of coffee, some juice and water and that was it. My poor stomach was not at all impressed as I usually feed it well and on time. So of course, by 9am it was protesting so darn loudly that I was thankful no one else was in the office. Then come 12pm the Asian students down the hall open their lunch bags and out come the intensely mouth-watering smells of home cooked Dim Sums, Moo Shu pork, and stir fried black beans. Oh, how utterly cruel! 

At 1pm I had enough so packed my bag and walked really slowly to the clinic, which is literally across the road from the hospital. Now here is where the fun starts. I already had found out the day before that my physio Paolo was to have surgery at the same clinic and around the same time as me...talk about strange times. You know your physio is perfect when they go through the entire surgery process alongside you! Paolo was to have his meniscus trimmed and when he turned up half an hour after me we realised that are surgery times where both scheduled at 2.30! not only where we going to be in adjacent operating rooms, but we would probably wake up near each other!

Being on the "other side" is rather strange. Normally I am the one looking down to the patient, smiling, stroking their hair as I apply their leads, take their vitals, or put in their IV. Now it was my turn to be lying on my back looking up to my carers. Everyone knew I was an ICU nurse so my anaesthetist was telling me what drugs she was giving and dosage. I was making them all laugh by telling them how tall Kevin is and that I have already demanded a tall baby as the "midget-ness stops at me!" The poor anaesthetist had to tell me to stop making her laugh so she could put in my IV. 

"1 mg of Midaz Sarah"
"Hey so the lamp looks really pretty..."
"75 mg of Fentanyl Sarah...here, take a nice big breath from this mask"
"Hey, your ambu-bag is too big for my tiny face...." 
Enter sleep...Enter intubation...


I woke up to a "Sarah, it's all done. Are you cold? You look it, let's get you the bear-hugger"
I was intubated through the 2 hour surgery, which to be honest, scared me a bit when I was informed I was going to be. I assist in this every week with our ICU patients, and no, it was my turn to have the "breathing tube" Apparently I was an easy patient...Awesome! 

I hear my monitor beeping; I look over..."oh hey, I'm saturating at 79%!"
Excellent Sarah! The bear hugger is cosy, so I snuggle in more, hearing the nurse say, "remember to take big breaths Sarah"
"Yup, in a moment, I'm just getting cosy"


"Sunshine!" I look over and there is Paolo in the cubicle right besides me. How utterly strange yet awesome. I can barely get a sound out so I manage to rummage my hand up and out from the bear hugger and give him a wave. Looking over to the monitor again, everything is gold. Knee hurts like hell but only a moment ago I had some dude drilling into my knee in 2 places so what else is there to expect? 


Paolo and I eventually graduate to the lazy boys where a nasty wave of nausea hits me upon moving from the wheelchair to the lazyboy, associated with the room frantically spinning. 
"Sarah can we bring Kevin in?'
Frantic shaking of head and making a fish face made the nurse realise that if she did I might throw up on him. She gingerly smiled, brought me a cold face cloth and I did my yoga breathing and managed to hold it down. To take my mind of my stomach I was allowed to see my OR and anaesthetic record sheets.
Drugs: Midazolam, Fentanyl, Ketamine, Roc...nice choice! Rapid intubation sequence
Vitals: rock friggen solid! 


My better half comes in and I tell him that Paolo is next to me, so while they chat I again try to not throw up on Kevin's expensive Pea coat.
Surgeon dude visits: 
* The ACL was totally ripped, barely hanging on
* MCL - partial tear but did not warrant surgical repair
* Meniscus intact!!
* Knee joint in excellent form, strong and solid.


He took 2 ligaments from my hamstring, wrapped them around each other to make a ribbon and managed to use one end of the original ACL's start point as a guide for his drill hole (tibia). He then threaded it through, wrapped a part of the old ACL around the graft to incorporate them together, then drilled another hole in the femur. The graft was then pulled through and secured with a screw at each drill hole site.


In case you haven't realised, I am writing this on DAY 1 POST-OP and I am quite high, so please ignore the sentences that make no sense whatsoever. I have learnt that when I am high, I do not stop talking until I literally pass out. Poor Kevin, I think I kept him awake last night talking about jacket potatoes with baked beans, bacon, chives, and sour cream? Odd...


Anyway, I did say that this was going to partly educational, party talking out of my bum so lets move up towards the brain! From the car drive home to bed I did my foot and ankle stretches. This is the simple movement of flexing and relaxing the foot, moving forward and back, in order to assist the movement of oedema. I no doubt will get an effusion at the back of the knee joint so this will help reduce swelling and pooling, especially around the ankle joint.

Notice the ankle already becoming a "cankle"

I set my alarm clock for every 4 hours last night to take my pain medication as I did not want to wake up in agony. When I would wake I would also put the "Cryo-cuff" on for 30 minutes, and removing just before I dosed off. I woke up quite frequently as I am a light sleeper despite being loaded up with pain meds, and so I would do my ankle and foot stretches: 12 reps.

Squeezing the thigh and lifting the leg gently, then lower. Repeat as much as you can. 

I also included Isometric contraction of the quads...

Goals for the first 2 weeks:

• Eliminate swelling due to activity
• Progress from partial weight bearing to full weight bearing exercises
• Regain normal range of motion
• Increase quadriceps strength
• Increase hamstring strength
• Use of cryo-cuff every 3 hours for half and hour
• Ankle, knee, and hip flexion and extension every 1 hour for 15 minutes
• Short walkies to the kitchen and back every 1-2 hours.
• When lying in bed, the leg is to be straight!!
• No pillow under the knee whatsoever even though you are craving it

  

  Start with a straight leg on the side and slowly bend at the knee bringing the foot upwards

  
  

Kind of hard to see here but I am lying on my right side with my right leg as straight as possible.

• Flex the ankle back and forth 10 times 
• Bending at the knee bringing the foot back and forth slowly, 10 times 
• Flexing from the hip and knee, slide the foot up towards your bum and back slowly 10 times.

Do NOT be alarmed if you here a gurgling sound coming from the knee! Post procedure they usually clean out the wound and check for any leakages by squirting saline into the area then suction most out. So that funny gurgling is most likely extra saline in the knee.

Ok, so here we are lying flat on our back.

• Straighten the leg and hold, then relax 
• Tighten the quad on the effected side, breathe, and slowly lift up the leg using the quad.
• Relax down slowly.  
• Repeat 5 times... Gradually I'll increase the amounts I lift.

 Up you go Shep! 

It might seem like a big chore doing this every hour, but it is worth it in the long run.
Yes, it is only the first day but suck it up!!

Do not forget to have a smile and a giggle. Laughter is healing and even if it means you make fun of yourself and your fuggly little foot and clothing choice, just do it. Believe me, it does help!

Ok, so this one really should be done whilst sitting on a chair:
Gentle lower leg lifts. Try 5... simple? 

Pain relief:

• 4 hourly Tylenol with codeine
• PRN Hydromorphone 2-4mg

• Pain present? Hell yes! Feels like I have kicked and rucked-up hard in the hamstrings. Can also feel stabbing from the sites where he drilled into me...
• Bone pain is in it's own classification...bone pain due to being drilled at his something I have never experienced before
• my pain tolerance is high but this time round, I'm not going to suck it up too much. 4/10 I can deal with. 5/10, ok take your breakthrough. 7/10? Sarah, stop trying to be tough. 
• Remember: you are not going to become addicted, nor build up a tolerance to opioid in the first few weeks of taking them. Pain control is superior here. No being a superhero...you'll only set your rehab back and piss off your boyfriend.

  

  Checking out what's underneath!

As the title stated: wear nice underwear to hospital. Why? Of course no one is going to be checking out your cute little ass in your ruffled pink panties but yourself. So when you come home looking all groggy, with tape residue around your mouth from the OETT tube, and drool marks down the side of your face, make sure to look in the full length mirror and check yourself out in those nice ruffles. You will realise that despite feeling like hell and feeling sorry for yourself, your bum still looks good. This will prevent those tears from rolling down your face in utter disappointment of your mistakes. Instead a small wave of pride will wash over you, you will take a deep breath, smile, and go to sleep with it on your face.
Plus, it will remind your partner that despite her having horrible anaesthetic breath, looking like she wants puke all over me, her bum does look mighty perky and cute!