2 weeks post-op update

 So for the first time in a very long time (as in months) I was almost too busy to blog. Physiotherapy and research work is ramping up, plus the fact that I am not sleeping well makes me seek a nap during the day. My mind is fairly clear although I seriously support the fact that lack of stimulation from other humans, animals, or society in general greatly reduces your ability to think, process thoughts quickly, and react accordingly to sudden changes in life...The way I react these days (for example, when I found out that the hospital pay roll department where not taking enough tax off my earnings), is to cry. 
I Bawl my friggen eyes out and loudly proclaim, "that's it! I hate this stupid country, you have not given me a single break for the last 4 months, I'm running away to the North Pole" Meanwhile Kevin is giving me that pity look that I have become so used to these last few months, and gently reminded me why I can not do that.
 Regardless of my regular brain farts I seem to be plodding forward with regular achievements noted in the last week. I had my 2 weeks post-op follow up appointment with Dr. Zarkadas on Tuesday. My aim was to be able to confidently walk into his clinic room without the use of a crutch and 'wow' him. I think I did that, although bearing the fact that he was running an hour behind schedule, briefly saw me for 10 minutes and did the usual surgeon examination (quick touch, poke, tweak, and nod), I'm still unsure as to what he thought of me and my success!


Here's how the conversation went:
"how are you? you look good, you're walking, that's nice"
"yes, well I've been doing this and that and working out...(enter the usual Sarah blabber that usually goes off in a tangent) 
"oh, I guess we should examine the knee...whopps, sorry for almost kicking you in the knee"
"I see it's straight. Good job"
"oh yes, I've been working on that every day and it's been very difficult but I know how important it is...bla, bla, bla"
"(grunt) yes this moves very well. Good flexion (nod of approval)"
"hey, what did you do to my ankle? It's very bruised and not swollen...where you holding my ankle in the OR?"
"Oh..yea...sorry...you're kind of small (laugh), I think I was maybe leaning on it, or held it at some time...anyway, don't trip up!"
"can I drive?"
"if you feel safe then sure! If I was you I probably wouldn't listen to the doctor and drive anyway (laugh)"


Thanks doc for giving me a bruised ankle that is not directly linked to the actual surgical procedure! 
He briefly explained how he strips the tendons out of the hamstring, braids them on a sterile table and then drills right through my knee, pulls through a guide wire that is attached to the new graft, puts a metal plug at the top of the knee joint (in the femur), and screws in at the bottom of the joint (at the tibia), pulls firmly, and then does whatever surgeons do! 


The next step is to go into the sports medicine clinic next Tuesday to have my brace custom fitted. This is going to be rather interesting as they first place my knee in a cast, and from that skeleton they design the brace. It's going to cost approx $1400 (thank god for health insurance), and should take about a week to be built.

Prior to surgery I did ask him reasons for getting the brace vs. not, benefits of use for the first 3-4 months, would it be used post full recovery (as in a year later), and how adaptable it is for my 3 main sports, as they all require completely different body movements (trail running, skiing, and rock climbing). 

The literature out there states that it is recommended to have a brace for the first 3-4 months post ACL reconstruction as it generally takes 10 weeks for the graft to fully attach and become incorporated to the surrounding bone. However, there is a major psychological theme associated with the use of a brace, as in, I feel safe if I wear my brace. There are many people (Paolo, for example) who have gone through ACL rehab without the use of a brace and have been able to adequately support their knee by completing careful movements and have never had any repercussions. The research is very grey: although there is support for a brace within 3-4 months post surgery, it does come down to a combined physician, patient, and physiotherapy decision, bearing in mind if the patient would physically benefit from it, rather than psychologically. 
To be honest, from a physicians point of view they are going to say, "yes, get the brace" as many of them receive discounts from the company they chose to deal with, if they sell a certain amount.


My decision for getting the brace: so I can comfortably start back at the gym and increase my outdoor activities. Yes, for me I think there is a psychological pull as the thought of it makes me feel safe. And I am ok with the fact that I could do this without the brace, but I don't trust myself as I am very prone to tripping up on regular basis! It is a difficult choice as the research doesn't sway more to one side than the other, so in the end, it's up to the patient's decision, which should not be manipulated by a surgeon's preference. 

What the brace may look at: carbon fibre CTI OTS!

The next question burning through my mind was, "am I going to need this in a years time?" It it worth spending so much money for only a 4 month maximum use? 
Because I have a bit of thing for the terrain park, there is evidence to support the use of the brace when skiing, even after a year or 2 post surgery. In saying that, again the psychological aspect kicks in, as by that time I don't need a brace as the graft if fully healed, and just as strong as my original ACL. So am I keeping it on because it feels safe? 

I looked up many websites of professional skiing athletes who have gone through this process and noticed the majority of them still wore their brace when competing. Obviously, they are engaging their muscles and body in a very vigorous way, where as I won't be doing the same, but it was interesting to note that they still recommended wearing the support. One interesting thing to note is that it is well documented that by having arthroscopic surgery it can increase your chance of arthritis in the knee by 40%, so are these long term athletes suffering from arthritis pain, therefore using the brace for that? 


In the end I think for me it's going to be a matter of ' see how you feel and how much it hurts' basis. Simple but probably the most effective method for me! 


The next day I met up with Maggie (physio) for my weekly update, measurement, and plan of attack. Good news: I can flex to 110 degrees, which means I have graduated to the level of "hop on yer bike" 
So this weekend we will set up the indoor bike trainer and the first movement will be those half-moon pedal strokes, for about 5 minutes, no resistance. 
Enter photos:

2 weeks post op: very minimum swelling and reduction of bruising

Massive reduction in bruising!

And then we bend some more!

 As you can see the bruising has totally reduced, however there is still that nasty shadowing on the ankle. Honestly, if anything touches it, the pain is worse than my knee pain, it's ridiculous. The ankle pain along with a right hip protruding forward is making my nights a living hell. Sleep is again becoming rather difficult so it looks like I might have to go back on the hydromorphone overnight to assist in reducing the pain and therefore, allowing me to sleep. No matter what angle I am on I am never comfortable. 
The acute phase of pain seems to be almost over; now it's just the throbbing background pain that seems to be taking over. 


So, the overall rehab picture at 2 weeks post-op:


Movement/physiotherapy
0 degree extension (flat)
5 degree hyperflexion
110 degree knee flexion

• 20 minute all body pilates morning workout
• 20 minutes upper body pilates workout, around 3pm
• Continuing with calf/hamstring stretch with yoga strap on foot
• quad/hip flexor off end of bed
• quad sets (without stimulation)
• heel slides
• wall (or floor) ball rolling exercises 

Pain management:

• cryocuff or ice pack every 4 hours for 20 minutes (good evidence to support using the cryocuff for up to 4 weeks post-op)
• Tylenol extra strength for muscle and joint pain (650mg per tab), 1 tab every 4 hours
• Advil (Ibuprofen) 400mg per tab, 1 every 4 hours. Alternating hours with Tylenol which means I am taking some form of pain relief every 2 hours. 

Kevin has been making sure that everyday when he gets back from work he takes me outside for a little adventure. Whether this is going to the supermarket, going down to the river for a short walk, or to the wetlands to sit and look up at the Chief, it means that I am able to venture outside the block and get some fresh air in. He is amazing and I think this whole journey would be even more harder if I didn't have him...

To end, I would like to say that we have unofficially adopted 2 ducks! Looks like the big dip in the backyard is a make-shift pond post torrential rainfall and it seems we have some visitors! I have named them Basil and Gertrude.   

Basil!

Gertrude!

Where our future home is supposed to sit has now become a wetlands tour stop for ducks...



Next adventure: indoor bike trainer!!