I saw the surgeon on Friday and he was pleased with the progress that I've been making. He took a look at my x-rays, tugged on my leg to check the strength of the new graft, checked my range of motion and how my quad strength is recovering. Based on what he saw, he said I could ditch my crutches as I could tolerate it and even ditch my leg brace as I felt comfortable with it.
Well, I didn't need much more permission than that. As soon as I got out to the car, I put my crutches in the back seat and I haven't felt like I needed to pick them up since! When I got home, I took off my brace just to see how long I felt I could go before I felt like I needed it. I haven't put that back on for two days either...
The doctor also told me to let my physical therapist know that he didn't have to worry about any weight-bearing restrictions any more and that he could "go ahead and torment me to the extent necessary." I was actually happy to hear this because (as anyone who has been reading my blog knows) I have been somewhat impatient with the pace of my progress so far. So now, I'm hoping that things will start to go a little more quickly.
Sunday, April 02, 2006
Monday, March 20, 2006
Stitches out...but still on crutches
On Thursday, I got my stitches and staples out. The incision sites look like they're healing pretty well, but I've still got quite a bit of bruising and discoloration left over from surgery. They had me do some leg lifts to check the quad strength and said things look pretty good. They also took another couple of x-rays to check the placement of the hardware inside my leg (they have a screw that anchors the graft in the tunnel they put in my tibia and a "button" that anchors the graft in the tunnel they put in my femur).
Overall they seemed pleased with the progress that I've been making with PT (my flexion was up to 128 degrees at Thursday morning's session and I was able to get on the stationary bike and ride for ten minutes without any pain) and they said that I should continue with the pace I've been following as long as things aren't hurting too much. Unfortunately, I will have to stay on the crutches for another two weeks to make sure that I give the fracture a chance to fully heal. I think that was the only big disappointment (for me) during the doctor visit, since I was tired of the crutches on the second or third day... On the other hand, they did say that I could start getting in the pool midweek next week and that I would be clear to drive once I felt comfortable slamming on the brakes.
Over the weekend, I noticed that I was waking up feeling pretty stiff and it seemed to me that I was losing some of my flexion, but when I went to PT this morning, I was at 125 degrees at the beginning of the session and up to 136 degrees by the end of the session. My good knee is about 146 or 147 degrees, so I'm pretty close to full range of motion now, though the swelling and discoloration are still present and the strength will take a lot longer to come back (especially since I'm not up to full weight bearing yet).
Overall they seemed pleased with the progress that I've been making with PT (my flexion was up to 128 degrees at Thursday morning's session and I was able to get on the stationary bike and ride for ten minutes without any pain) and they said that I should continue with the pace I've been following as long as things aren't hurting too much. Unfortunately, I will have to stay on the crutches for another two weeks to make sure that I give the fracture a chance to fully heal. I think that was the only big disappointment (for me) during the doctor visit, since I was tired of the crutches on the second or third day... On the other hand, they did say that I could start getting in the pool midweek next week and that I would be clear to drive once I felt comfortable slamming on the brakes.
Over the weekend, I noticed that I was waking up feeling pretty stiff and it seemed to me that I was losing some of my flexion, but when I went to PT this morning, I was at 125 degrees at the beginning of the session and up to 136 degrees by the end of the session. My good knee is about 146 or 147 degrees, so I'm pretty close to full range of motion now, though the swelling and discoloration are still present and the strength will take a lot longer to come back (especially since I'm not up to full weight bearing yet).
Tuesday, March 14, 2006
Days 1 and 2 of PT
Yesterday (Monday), I started Physical Therapy. The first thing they wanted to do was to check my range of motion so they can track that on a daily basis. I had been to one appointment about a week before surgery to set somewhat of a baseline. During that visit, I was able to get my knee extended to about 1 degree of hyperextension. On my good knee, I could get about 10 degrees of hyperextension. To check the hyperextension, they have you sit on a table with your legs in front of you and your ankle on a small towel roll and flex your quad muscle so that you get the back of your knee as close as you can to the table. They didn't use the towel for my injured knee, because they don't really want you to hyperextend your injured knee until it is stronger, but they do want you to be able to get it completely flat to the table (or 0 degrees). I was able to do 0 degrees yesterday and today, so that is good.
The next thing he checked was my range of motion, or how far I could bend my knee. On my good knee, I could get to about 143 degrees and on my injured knee, I was at about 120 degrees during my post-op visit. Yesterday, my flexion was only 107 degrees, but the therapist said that is very good for only being four days out of surgery. Today, I was at 115 degrees, so I'm making some progress. At 120 degrees, the doctor will often clear you to ride the stationary bike as soon as the staples and stitches are out, so hopefully I'll be doing that by the end of the week.
The rest of the time with the therapist both yesterday and today was spent doing various leg lifts, calf raises and mini-squats (holding the edge of a table and squatting down about six or eight inches, then standing back up). I'm supposed to be doing a lot of quad strengthening exercises whenever I can too.
Finally, the therapist worked with me on my walking - with crutches for now. I'm still wearing the brace when I'm walking around, mainly for stability, but I'm trying to simulate as close to a normal walking motion as possible. It takes a lot of pressure off my shoulders and upper arms to be able to use both legs again, so I'm pleased with that. The tradeoff is that now that I'm doing all this work with my bad leg, my swelling has increased pretty significantly. When I saw the therapist today and told him about this, he did not seem concerned, though he added that it all depends on whether the swelling is inhibiting your range of motion, so as long as I keep on moving, the swelling will eventually subside. It seems a little counter-intuitive, since my natural inclination is to stop moving a joint when it feels stiff, but apparently in this case, the constant movement is critical to getting the stiffness out of the joint. The good news is, my pain is way down from where it was over the weekend. I have cut way back on the narcotic pain killers and I'm using more Ibuprofen now, which should also help reduce the swelling.
All in all, it has been a good start to therapy, though I'm looking forward to Thursday when I see the surgeon again and hopefully get a better idea of when I can return to activities like driving and maybe getting in the pool to get some aerobic exercise (since I can't do running)...
The next thing he checked was my range of motion, or how far I could bend my knee. On my good knee, I could get to about 143 degrees and on my injured knee, I was at about 120 degrees during my post-op visit. Yesterday, my flexion was only 107 degrees, but the therapist said that is very good for only being four days out of surgery. Today, I was at 115 degrees, so I'm making some progress. At 120 degrees, the doctor will often clear you to ride the stationary bike as soon as the staples and stitches are out, so hopefully I'll be doing that by the end of the week.
The rest of the time with the therapist both yesterday and today was spent doing various leg lifts, calf raises and mini-squats (holding the edge of a table and squatting down about six or eight inches, then standing back up). I'm supposed to be doing a lot of quad strengthening exercises whenever I can too.
Finally, the therapist worked with me on my walking - with crutches for now. I'm still wearing the brace when I'm walking around, mainly for stability, but I'm trying to simulate as close to a normal walking motion as possible. It takes a lot of pressure off my shoulders and upper arms to be able to use both legs again, so I'm pleased with that. The tradeoff is that now that I'm doing all this work with my bad leg, my swelling has increased pretty significantly. When I saw the therapist today and told him about this, he did not seem concerned, though he added that it all depends on whether the swelling is inhibiting your range of motion, so as long as I keep on moving, the swelling will eventually subside. It seems a little counter-intuitive, since my natural inclination is to stop moving a joint when it feels stiff, but apparently in this case, the constant movement is critical to getting the stiffness out of the joint. The good news is, my pain is way down from where it was over the weekend. I have cut way back on the narcotic pain killers and I'm using more Ibuprofen now, which should also help reduce the swelling.
All in all, it has been a good start to therapy, though I'm looking forward to Thursday when I see the surgeon again and hopefully get a better idea of when I can return to activities like driving and maybe getting in the pool to get some aerobic exercise (since I can't do running)...
Sunday, March 12, 2006
The Iceman rocks!
I just have say that this "Iceman" thing is a lifesaver. My dad had one from his shoulder surgery last year and when we visited them a couple weeks ago, he offered to send it down here for me to use after my surgery. My doctor had prescribed one, but apparently insurance does not cover them, which is a shame because these things probably have the potential to shave weeks off of your recovery time by helping to get swelling under control. I think I've only had a few hours since my surgery where I have not had mine continually running and even in the few minutes when I have it disconnected, I notice an immediate improvement when I plug it back in.
Today was another improvement over the day before; I was probably at 4's and 5's for most of the day pain-wise and I was able to get all my exercises done with minimal pain. I was even able to start putting a little bit of weight on my knee while walking (putting most of my weight on my crutches, of course), but my doctor told me to start trying to return to normal motion as soon as possible, even if it was not normal weight-bearing.
We played a lot of board games as a family today, though Chase doesn't really have the patience to sit through an entire board game, so he usually floats in and out, forcing us to maintain his place in the game for when he decides to stop by and roll the dice once and a while. Last week, we introduced the kids to Monopoly, but it was a little too advanced for Chase, so we picked up Monopoly Junior to see if it was more his speed. The game was quite a bit simpler (and therefore less entertaining for adults), but Anne and I made the mistake of implementing a few of the "unofficial" rules from Monopoly in the Junior version, such as putting a nice big pile of cash in the middle of the board for when someone lands on "Free Parking" or doubling the salary received when someone lands directly on Go. In the Junior version, these only serve to make the game interminably long because no one EVER runs out of money once there is enough of it circulating throughout the game.
Isabelle is becoming a pretty good reader. She has been working towards earning a Barbie CD-ROM game that she's been begging for for about a year and a half. We finally decided last fall that if she wanted it that bad, we could use that to all of our advantage, so we made up a chart for her and told her that when she had filled it with books that she had read to us, she could have the game. Each time she finishes a book, she cuts out a little piece of paper in the shape of a book, writes the title on the "cover" and the date on the inside, and tapes it to the chart. I think there are probably close to fifty spaces on the chart, and she's down to the last seven or eight spots, so maybe in the next week or so, she'll finish it. Now if we can only figure out a way to replace Dragontales with Dumas...
Today was another improvement over the day before; I was probably at 4's and 5's for most of the day pain-wise and I was able to get all my exercises done with minimal pain. I was even able to start putting a little bit of weight on my knee while walking (putting most of my weight on my crutches, of course), but my doctor told me to start trying to return to normal motion as soon as possible, even if it was not normal weight-bearing.
We played a lot of board games as a family today, though Chase doesn't really have the patience to sit through an entire board game, so he usually floats in and out, forcing us to maintain his place in the game for when he decides to stop by and roll the dice once and a while. Last week, we introduced the kids to Monopoly, but it was a little too advanced for Chase, so we picked up Monopoly Junior to see if it was more his speed. The game was quite a bit simpler (and therefore less entertaining for adults), but Anne and I made the mistake of implementing a few of the "unofficial" rules from Monopoly in the Junior version, such as putting a nice big pile of cash in the middle of the board for when someone lands on "Free Parking" or doubling the salary received when someone lands directly on Go. In the Junior version, these only serve to make the game interminably long because no one EVER runs out of money once there is enough of it circulating throughout the game.
Isabelle is becoming a pretty good reader. She has been working towards earning a Barbie CD-ROM game that she's been begging for for about a year and a half. We finally decided last fall that if she wanted it that bad, we could use that to all of our advantage, so we made up a chart for her and told her that when she had filled it with books that she had read to us, she could have the game. Each time she finishes a book, she cuts out a little piece of paper in the shape of a book, writes the title on the "cover" and the date on the inside, and tapes it to the chart. I think there are probably close to fifty spaces on the chart, and she's down to the last seven or eight spots, so maybe in the next week or so, she'll finish it. Now if we can only figure out a way to replace Dragontales with Dumas...
Saturday, March 11, 2006
Making progress...
I want to say that I'm making progress, but I think I'm impatient for more. Today has been a much better day pain-wise than yesterday. I think I probably hit 8's and 9's (on a scale of from 1 to 10) a few of times yesterday, whereas today's worst has probably been a 6. I also slept pretty well last night, especially considering how I wasn't able to get much rest during the day yesterday because of the pain.
Today also marked my big "unveiling" ceremony where I got to take the big gauze dressing off and replace it with band-aids. Oh - and I got to take a shower - which I'm sure the rest of the family appreciated...no matter how much people say they love you, it has got to be preferable for people to bathe more often than every 48 hours! I was actually surprised at how minimal the evidence is of my surgery in terms of a) stitches, b) staples, and c) swelling. I have about a 2 1/2 inch incision in my lower leg that is stapled closed and then two small incisions (technically, I think they're punctures) slightly above them with a couple of stitches in each of them.
Before I put band-aids on, I asked the kids if they wanted to come see, which of course they did. Chase (aka Spiderman) pointed to the stitches and said "why do you have those webs on your knee, Daddy?" and then insisted that I put Spiderman band-aids on them...
Anyway, like I said, so far today is better than yesterday, but just in case I'm still out of it tomorrow, I called someone at church to ask them to teach my Sunday School class. I feel bad about it because I've had a substitute teach three of the four classes since I hurt my leg and we're only going to be here for another couple of months, and I really love teaching this class, but I don't want to overdo it either.
On a completely different subject, our family got the Disney version of the game "Scene it?" for Christmas and we have really enjoyed playing it together as a family. In fact last night, it was the only time all day where I was able to keep my mind off the fact that my leg had been hurting all day. One side effect of playing the game together has been that our family's Netflix queue keeps getting old Disney movies added to it as Anne and I go, "hey - I remember that one - we should rent that one and watch it again..."
If I were Netflix, I'd try to get a trial membership postcard included in all new boxes of "Scene it?"
Today also marked my big "unveiling" ceremony where I got to take the big gauze dressing off and replace it with band-aids. Oh - and I got to take a shower - which I'm sure the rest of the family appreciated...no matter how much people say they love you, it has got to be preferable for people to bathe more often than every 48 hours! I was actually surprised at how minimal the evidence is of my surgery in terms of a) stitches, b) staples, and c) swelling. I have about a 2 1/2 inch incision in my lower leg that is stapled closed and then two small incisions (technically, I think they're punctures) slightly above them with a couple of stitches in each of them.
Before I put band-aids on, I asked the kids if they wanted to come see, which of course they did. Chase (aka Spiderman) pointed to the stitches and said "why do you have those webs on your knee, Daddy?" and then insisted that I put Spiderman band-aids on them...
Anyway, like I said, so far today is better than yesterday, but just in case I'm still out of it tomorrow, I called someone at church to ask them to teach my Sunday School class. I feel bad about it because I've had a substitute teach three of the four classes since I hurt my leg and we're only going to be here for another couple of months, and I really love teaching this class, but I don't want to overdo it either.
On a completely different subject, our family got the Disney version of the game "Scene it?" for Christmas and we have really enjoyed playing it together as a family. In fact last night, it was the only time all day where I was able to keep my mind off the fact that my leg had been hurting all day. One side effect of playing the game together has been that our family's Netflix queue keeps getting old Disney movies added to it as Anne and I go, "hey - I remember that one - we should rent that one and watch it again..."
If I were Netflix, I'd try to get a trial membership postcard included in all new boxes of "Scene it?"
Friday, March 10, 2006
So this is what it feels like when the block wears off...
Wow! Well, early this morning, I was doing pretty well. I had set my alarm for 5:30 to remind me to take my pain medication at the designated time (the post-op instructions said to start taking the pain meds on schedule even if you weren't having pain so you didn't get caught off-guard when the anesthesia wore off). I figured it was a good sign that my alarm woke me up and not my pain. I also discovered that I had regained the full use of my leg muscles and I could now do my leg lifts without having to lock the brace. I took my meds and did a full set of all my leg exercises and was feeling pretty good when I went back to sleep around 6:15.
When I got up for the day around 8:30 or so, I noticed that my leg was sore - really sore, actually. For the next couple of hours, it got worse and worse. Apparently when they say that the femoral block will last 12-24 hours, they really mean it! Not that I will ever have any way of ever comparing this first-hand, but if that femoral block is the equivalent of a woman having an epidural during childbirth, then I can't imagine how women ever managed before the epidural was invented!
I was supposed to have my first physical therapy visit today, but just as I was starting to get my clothes changed to get ready to go, the therapist's office called and told me that he had come down with a virus and that they didn't think it was a good idea for me to come in today. I was able to talk to him and describe the exercises that I was able to do as well as my increased level of pain now that the block had worn off. He suggested I speak with my surgeon's office to see if they had any additional instructions for me since I wouldn't be seeing the PT until Monday.
When I spoke with the athletic trainer at my surgeon's office, I described the kinds of movements I have been able to do and how my pain has increased since last night. He seemed pleased with the level of motion that I described and also said that the pain level I was describing was (unfortunately) not unexpected. He told me to keep doing as many exercises as I could over the weekend and to use the CPM machine as much as possible. Even though it didn't make my leg feel any better, it was reassuring to know that my range of motion and levels of pain are within normal limits (though now at 2:30pm as my most recent dosage of pain meds begins to wear off, I'm starting to question the definition of "normal")
Anyway, I wanted to post the picture that Anne took of my knees the night before surgery when she drew the "warning label" on my good knee (my surgeon is a UT alum):
When I got up for the day around 8:30 or so, I noticed that my leg was sore - really sore, actually. For the next couple of hours, it got worse and worse. Apparently when they say that the femoral block will last 12-24 hours, they really mean it! Not that I will ever have any way of ever comparing this first-hand, but if that femoral block is the equivalent of a woman having an epidural during childbirth, then I can't imagine how women ever managed before the epidural was invented!
I was supposed to have my first physical therapy visit today, but just as I was starting to get my clothes changed to get ready to go, the therapist's office called and told me that he had come down with a virus and that they didn't think it was a good idea for me to come in today. I was able to talk to him and describe the exercises that I was able to do as well as my increased level of pain now that the block had worn off. He suggested I speak with my surgeon's office to see if they had any additional instructions for me since I wouldn't be seeing the PT until Monday.
When I spoke with the athletic trainer at my surgeon's office, I described the kinds of movements I have been able to do and how my pain has increased since last night. He seemed pleased with the level of motion that I described and also said that the pain level I was describing was (unfortunately) not unexpected. He told me to keep doing as many exercises as I could over the weekend and to use the CPM machine as much as possible. Even though it didn't make my leg feel any better, it was reassuring to know that my range of motion and levels of pain are within normal limits (though now at 2:30pm as my most recent dosage of pain meds begins to wear off, I'm starting to question the definition of "normal")
Anyway, I wanted to post the picture that Anne took of my knees the night before surgery when she drew the "warning label" on my good knee (my surgeon is a UT alum):
I was going to post some more pictures taken through the surgeon's scope during surgery, but I didn't want to gross anyone out. Being the former EMT, I thought they were cool, but I'm sure others will appreciate my discretion.
Thursday, March 09, 2006
Under the knife
The fact that I'm posting this tonight means that I'm in pretty decent shape as of right now. I'm still a little groggy and I'm starting to feel my leg again as the anesthesia continues to wear off, but so far, it seems like things have gone well.
I didn't sleep very well last night - a combination of anticipation (kind of like the night before you go to Disneyland when you're a kid, except in this instance, Mickey beats you up and sends you home with a big ice pack) and a lot of muscle soreness that has been building up in my shoulders and back over the past few weeks while I've been on the crutches. I woke up before my alarm and did a final set of pre-op leg exercises...may as well get my quads as strong as possible before-hand, right?
Anne took me over to the surgery center where we were the second ones in line. After some minimal paperwork (they had me fill out most of the stuff online earlier in the week), they took me back to the pre-op area and presented me with a very fashionable hospital gown, mesh cap, and non-slip socks to change into. Then, they got my IV started and the anesthesiologist came in to explain the sedation process and to offer me a "block" on my femoral nerve, which sounded like a good deal to me...
Meanwhile - and I should have figured out this was coming - a nurse got to work shaving my leg...only the way she did it, I now have a wide stripe of even-whiter-than-usual hairlessness running from the middle of my thigh to the middle of my calf on my right leg - nice! I might just decide to wear the brace a little longer until everything grows back...
Anne left at this point to go relieve her mom (who was headed out of town today) and get the kids taken to the various familes who had agreed to keep an eye on them today.
The anasthesiologist came in next to start the femoral block, which was a pretty interesting (and eerie) procedure. To find the femoral nerve, they inserted a small needle in the front of my hip just to the side of my femoral artery. The needle had an electrical stimulator on it which they fired to stimulate the nerve. They knew they were getting close to the nerve when my quadriceps muscle started to twitch with the electrical pulse. Then, they would reduce the stimulation to a lower level and repeat the process until they were close enough to the nerve to administer the block. Once that was in, it only took a few minutes before my leg was completely unresponsive to anything my brain told it to do...pretty freaky.
From there, they wheeled me in to the operating room and someone started to administer something to me via a breathing mask, but I never had a chance to ask what it was because within about 10 seconds, I was completely out. The next thing I knew, I was in the recovery room with people busy all around me checking numbers and writing stuff on charts. The pre-op documentation suggested bringing a book, but as soon as I opened my eyes in the recovery room, I realized that that would have been a collosal waste of time, since I couldn't seem to focus on anything for more than a second or two. Luckily, Anne had thought to suggest that since I would probably be able to hear sooner than I was able to read, I should bring my iPod, so I had one of the nurses help me get that set up. That turned out to be a good suggestion.
They let Anne come back and sit with me about this time since I was starting to feel a little more awake, but I don't remember a whole lot - just that I had a hard time completing sentences and for some reason, I kept wanting to crane my neck around and look at my pulse rate and blood pressure readings. I still couldn't feel my right leg, but apparently with a femoral block, that isn't uncommon and even now as I write this tonight, I'm just now starting to get feeling back in my leg...which is not an entirely good thing, but more on that in a minute...
At this point, the only evidence I could see of the surgery was that my leg was heavily bandaged underneath the leg brace that I've been wearing for several weeks now. They had wrapped an ice-water pad inside the dressing and it was connected to the "Iceman" pump circulating cold water through it. So as of right now, I have no idea what my leg looks like.
About the time I was able to complete some sentences, they started to get me ready to check out. It was about 10:30am by then, so the whole process from admissions to discharge had taken less than 5 hours and the surgery itself had probably been an hour or an hour and a half. When my surgeon talked with Anne after the surgery, he said that everything had gone very well and that we should have every reason to be optimistic for a good recovery. He sent me home with a bunch of pictures and a CD with a copy of the video taken through the scope during the procedure (maybe I'll post a few of the pictures later if people aren't too squeamish - they're really cool and you can really see the "before" and "after" effect).
When I got home, one of the things I noticed was that I was very light-headed, so I went up the stairs sliding backwards on my good leg. This of course meant that Anne had to bring all the "equipment" that they had sent me home with in from the car. And boy do I mean equipment - in addition to the leg brace, I have the "Iceman" ice machine that continuously circulates cold water through a special pad in my knee dressing, plus a great big contraption called a CPM (continuous passive motion) machine that keeps my knee moving by constantly flexing and extending it. Anne got me set up with all that and I think I promptly fell asleep for most of the afternoon - no wait - I ate some eggs and toast first because I was starving, then I fell asleep for the better part of the afternoon.
When I woke up, Isabelle & Chase were home, but they had friends over to play with, so they didn't feel like hanging out with dad and the giant contraption on his leg. Isabelle was playing with a friend from her preschool whose father had recently had almost the same surgery as mine, so Anne and Isabelle's friend's mom compared notes on our respective surgery experiences. Apparently, I've had a pretty good go of it so far. I guess his surgeon or anathesiologist did not give him the option of a femoral block and they did not use a CPM machine to immediately start the process of restoring his range of motion. He also had a really rough time with post-operative nausea, and (so far) I haven't had any such symptoms.
This afternoon, I felt well enough to sit up in bed. I looked through the pictures from my surgery and called my family to let them know how things had gone. It is especially helpful to have a brother that's a pharmacist to ask questions about medications and drug interactions.
By this evening, I was still unable to feel the top part of my leg, so the block must still be working, but I did finally manage to regain control of my quadriceps muscle after dinner, so I was able to do my leg lift exercises. The only problem was that I must not have had full use of the muscle, since I was unable to lock my knee on my own and had to rely on locking the brace in order to do my leg lifts. The other thing I noticed as the block began to wear off is that I am having gradually more and more pain. I've been taking the pain medication as directed though, such that so far it has been manageable.
Anne has been wonderful through this whole thing, from getting up at a crazy early hour to take me to the surgery center to schlepping all the surgical equipment up the stairs to bringing meals and various other requests as needed.
All in all, I feel very blessed tonight that things have so far gone well. I'm a little bit apprehensive about how things are going to be once this femoral block wears off, but I guess at this point, there's nothing I can do about that, is there?
I'll probably post again tomorrow and hopefully include some pictures...
I didn't sleep very well last night - a combination of anticipation (kind of like the night before you go to Disneyland when you're a kid, except in this instance, Mickey beats you up and sends you home with a big ice pack) and a lot of muscle soreness that has been building up in my shoulders and back over the past few weeks while I've been on the crutches. I woke up before my alarm and did a final set of pre-op leg exercises...may as well get my quads as strong as possible before-hand, right?
Anne took me over to the surgery center where we were the second ones in line. After some minimal paperwork (they had me fill out most of the stuff online earlier in the week), they took me back to the pre-op area and presented me with a very fashionable hospital gown, mesh cap, and non-slip socks to change into. Then, they got my IV started and the anesthesiologist came in to explain the sedation process and to offer me a "block" on my femoral nerve, which sounded like a good deal to me...
Meanwhile - and I should have figured out this was coming - a nurse got to work shaving my leg...only the way she did it, I now have a wide stripe of even-whiter-than-usual hairlessness running from the middle of my thigh to the middle of my calf on my right leg - nice! I might just decide to wear the brace a little longer until everything grows back...
Anne left at this point to go relieve her mom (who was headed out of town today) and get the kids taken to the various familes who had agreed to keep an eye on them today.
The anasthesiologist came in next to start the femoral block, which was a pretty interesting (and eerie) procedure. To find the femoral nerve, they inserted a small needle in the front of my hip just to the side of my femoral artery. The needle had an electrical stimulator on it which they fired to stimulate the nerve. They knew they were getting close to the nerve when my quadriceps muscle started to twitch with the electrical pulse. Then, they would reduce the stimulation to a lower level and repeat the process until they were close enough to the nerve to administer the block. Once that was in, it only took a few minutes before my leg was completely unresponsive to anything my brain told it to do...pretty freaky.
From there, they wheeled me in to the operating room and someone started to administer something to me via a breathing mask, but I never had a chance to ask what it was because within about 10 seconds, I was completely out. The next thing I knew, I was in the recovery room with people busy all around me checking numbers and writing stuff on charts. The pre-op documentation suggested bringing a book, but as soon as I opened my eyes in the recovery room, I realized that that would have been a collosal waste of time, since I couldn't seem to focus on anything for more than a second or two. Luckily, Anne had thought to suggest that since I would probably be able to hear sooner than I was able to read, I should bring my iPod, so I had one of the nurses help me get that set up. That turned out to be a good suggestion.
They let Anne come back and sit with me about this time since I was starting to feel a little more awake, but I don't remember a whole lot - just that I had a hard time completing sentences and for some reason, I kept wanting to crane my neck around and look at my pulse rate and blood pressure readings. I still couldn't feel my right leg, but apparently with a femoral block, that isn't uncommon and even now as I write this tonight, I'm just now starting to get feeling back in my leg...which is not an entirely good thing, but more on that in a minute...
At this point, the only evidence I could see of the surgery was that my leg was heavily bandaged underneath the leg brace that I've been wearing for several weeks now. They had wrapped an ice-water pad inside the dressing and it was connected to the "Iceman" pump circulating cold water through it. So as of right now, I have no idea what my leg looks like.
About the time I was able to complete some sentences, they started to get me ready to check out. It was about 10:30am by then, so the whole process from admissions to discharge had taken less than 5 hours and the surgery itself had probably been an hour or an hour and a half. When my surgeon talked with Anne after the surgery, he said that everything had gone very well and that we should have every reason to be optimistic for a good recovery. He sent me home with a bunch of pictures and a CD with a copy of the video taken through the scope during the procedure (maybe I'll post a few of the pictures later if people aren't too squeamish - they're really cool and you can really see the "before" and "after" effect).
When I got home, one of the things I noticed was that I was very light-headed, so I went up the stairs sliding backwards on my good leg. This of course meant that Anne had to bring all the "equipment" that they had sent me home with in from the car. And boy do I mean equipment - in addition to the leg brace, I have the "Iceman" ice machine that continuously circulates cold water through a special pad in my knee dressing, plus a great big contraption called a CPM (continuous passive motion) machine that keeps my knee moving by constantly flexing and extending it. Anne got me set up with all that and I think I promptly fell asleep for most of the afternoon - no wait - I ate some eggs and toast first because I was starving, then I fell asleep for the better part of the afternoon.
When I woke up, Isabelle & Chase were home, but they had friends over to play with, so they didn't feel like hanging out with dad and the giant contraption on his leg. Isabelle was playing with a friend from her preschool whose father had recently had almost the same surgery as mine, so Anne and Isabelle's friend's mom compared notes on our respective surgery experiences. Apparently, I've had a pretty good go of it so far. I guess his surgeon or anathesiologist did not give him the option of a femoral block and they did not use a CPM machine to immediately start the process of restoring his range of motion. He also had a really rough time with post-operative nausea, and (so far) I haven't had any such symptoms.
This afternoon, I felt well enough to sit up in bed. I looked through the pictures from my surgery and called my family to let them know how things had gone. It is especially helpful to have a brother that's a pharmacist to ask questions about medications and drug interactions.
By this evening, I was still unable to feel the top part of my leg, so the block must still be working, but I did finally manage to regain control of my quadriceps muscle after dinner, so I was able to do my leg lift exercises. The only problem was that I must not have had full use of the muscle, since I was unable to lock my knee on my own and had to rely on locking the brace in order to do my leg lifts. The other thing I noticed as the block began to wear off is that I am having gradually more and more pain. I've been taking the pain medication as directed though, such that so far it has been manageable.
Anne has been wonderful through this whole thing, from getting up at a crazy early hour to take me to the surgery center to schlepping all the surgical equipment up the stairs to bringing meals and various other requests as needed.
All in all, I feel very blessed tonight that things have so far gone well. I'm a little bit apprehensive about how things are going to be once this femoral block wears off, but I guess at this point, there's nothing I can do about that, is there?
I'll probably post again tomorrow and hopefully include some pictures...
Wednesday, March 08, 2006
Big day tomorrow
Well, tomorrow is the big day, the day where I get to find out if they'll be able to put my knee back together. I was originally scheduled for a mid-day appointment, but yesterday they called me back and told me they'd rescheduled me for the first time slot of the day - 7:30am, which means I have to be at the surgery center by 6:00am...yikes!
Several people have asked me if I am nervous, but up until today, I guess I really haven't stopped to think about it. Now that I think about it, I wonder if I should be more nervous. I think I just figure that at this point, I know that this surgery is absolutely necessary, I feel confident with the doctor and medical team that I've been working with, and I'm ready to get on with it, so being nervous doesn't seem to provide me with anything useful...
...still - not wanting to take any chances - I'm having Anne write "the OTHER knee" on my good knee before we leave for the surgery center!
Several people have asked me if I am nervous, but up until today, I guess I really haven't stopped to think about it. Now that I think about it, I wonder if I should be more nervous. I think I just figure that at this point, I know that this surgery is absolutely necessary, I feel confident with the doctor and medical team that I've been working with, and I'm ready to get on with it, so being nervous doesn't seem to provide me with anything useful...
...still - not wanting to take any chances - I'm having Anne write "the OTHER knee" on my good knee before we leave for the surgery center!
Monday, February 27, 2006
What's the big deal with your knee?
Let's see - one month between posts - that's OK, right? Well, I guess when right now I only have one reader, I'm not disappointing too many people, right?
To bring you up to date, it has been a rough couple of weeks here since the 16th. Before that, things were cooking along just fine...busy, but fine. On the night of the 16th, however, I was playing basketball at church like I do any other week (sometimes twice a week). In the last five minutes of what was going to be my last game of the year (I was supposed to be out of town for the rest of the games), I came down for a rebound at the same time that someone either hit my knee from the side or came down on top of me, depending on which witness you ask, my knee buckled, and it was all over from there. I was down on the ground in lots of pain and everyone was wondering what to do.
You know, the funny thing is, my very first thought after I thought "Ow, this really hurts" was "Man, I just don't have time for this right now. I've got to go to Dallas tomorrow to check on the progress of my house. I've got to go to California next week to visit my parents and so my son can celebrate his birthday with them. I'm supposed to go to China in two weeks. I hope this isn't serious. But ow, this really hurts". I was telling my wife about it in the ER later and she said, "so it really is true that your life flashes before your eyes, but not in reverse - it happens in fast forward".
Anyway, someone from my team took me to the ER and then was nice enough to have his wife follow him back to the church and drive my car home so that my wife could come and meet me at the ER. It didn't take very long to get seen (the benefits of NOT going to the big hospital downtown on a holiday weekend, I guess - that was the case the last time we went to the ER). They took some x-rays of my knee, gave me some ice and some Vicodin, put an immobilizer on it, gave me some crutches and sent me on my way. The doctor said the x-rays were negative for any fractures, but that I'd need to see an orthopedist and probably get an MRI done so they could see what kind of soft tissue injuries there were. He also said that based on the degree of swelling, he would be surprised if it was anything to do with my ACL, since that usually has a lot more swelling associated with it, but again, the orthopedist would be able to give me a better assessment.
So far, so good, right? I'm thinking at the worst I've got a bad sprain, maybe I'm on crutches and pain meds for a week or so, but nothing to mess up all my plans. So the next day, we load up the whole family in the Explorer and head to Dallas to check on the progress of the house. We put part of the back seat down and had me ride backwards with some pillows for my leg. Being on Vicodin, I ended up sleeping most of the way there and back. The house is coming along very nicely and other than my knee hurting, it was a good trip. I stayed home from church on Sunday to keep my leg elevated, but really by Saturday night, I wasn't taking the Vicodin anymore, because there was almost no pain anymore. I was only taking Advil for the swelling. I was even starting to use one crutch instead of two because I was able to tolerate a little bit of weight on my bad knee.
Side note on crutches: OK, I had no idea how much of a pain they are to get around on! My hats off to those who have spent extended periods of time on crutches. They are NO fun! I guess I should consider myself lucky that I've made it 31 years without having to use them before.
Monday morning, I went to see the orthopedist. She did some range of motion tests on my knee and ordered an MRI. She suggested that it could be my ACL after all, but the fact that I was not having any pain in my bad knee probably meant that I could start putting weight on my leg as tolerated. This was a big deal to me because if this was truly the case, then I could probably make it on the China trip with the least amount of disruption. She ordered an MRI so they could determine whether surgery was necessary, and gave me some more instructions on how to use crutches properly. Overall, a pretty good visit.
Later that day, I went to have an MRI done, another first for me. I'm not claustrophobic, but I can totally see where people would be disturbed by those machines. They are big and noisy and there is not a whole lot of space for you. The tech said that it would probably be Wednesday or Thursday before my films got read, so I was thinking everything would remain status quo until then.
The next morning however, there was a voice mail for me from the orthopedist's office. When I called back, they had received my films and wanted to get back in touch with me ASAP, first of all to tell me that I should not be putting any weight on my bad leg at all, since the MRI indicated there was a small fracture in my tibia and weightbearing could make that injury worse. In addition, the MRI showed a full thickness ACL tear and a "bucket handle" tear to my lateral meniscus (the pad of cartilage between your femur and your tibia), what they called a "full meal deal". Anyway, they wanted to have me come back in the next day to meet with the surgeon and discuss my options. Overall, not a great way to start the day, but still, I was not in too much pain and everything to this point seemed to indicate that I could still go to China if I really wanted to.
That day, I went to my classes and once again realized how difficult crutches made it to get around. When we had our final pre-China class, all of a sudden those awesome places like Tienanmen Square, the Forbidden Palace, and the Great Wall looked so much bigger now that I knew how tough it would be to get around them on crutches... Later that night, I started doing some research on ACL surgery and realized that wow, this was going to be a really big deal and the recovery was likely to be a long and demanding process. Suddenly, going to China started to make a little less sense.
When I met with the surgeon the next day, it became even more apparent that going to China would be an unnecessarily risky thing to do, especially since I would be halfway around the world and my knee would be very unstable until I had surgery. Plus, given the time of year, it was likely to still be rainy or icy in Beijing and maybe Shanghai, so that could make getting around even more difficult on crutches. My professor had told me that we could still make accomodations such as taking a taxi back to the hotel if I felt too tired, taking the tram instead of walking up to the Great Wall, etc., but that still didn't address the risk of postponing surgery and getting started on my recovery... When I put all these things together, my wife and I determined that canceling my trip was the wisest thing to do, even though I have wanted to go to China for probably fifteen years now.
So, as things stand now, I will have surgery next week (they want you to wait about three weeks between the injury and the surgery so you can get your range of motion back and strengthen your leg muscles, both of which help increase the success rate of the surgery). They'll repair my ACL and attempt to repair the meniscus (though they won't be able to determine until they get in there what type of repair they'll be able to do). In the mean time, I will be on crutches and in a leg brace until surgery.
We made our trip to California this past weekend and celebrated both my son's and my mother-in-law's birthdays with my parents. My son is turning three and my mother-in-law turned...well...she doesn't like to say, but let's just say it was a year with a zero after it. It was a nice visit and we got to see lots of friends in Morgan Hill. My wife and I celebrated the tenth anniversary of our first date and I joked that I liked the way the second ten years were starting off: she is now opening doors for me, carrying things for me, driving most everywhere we go, etc.
She threatened to break my other knee... :-)
To bring you up to date, it has been a rough couple of weeks here since the 16th. Before that, things were cooking along just fine...busy, but fine. On the night of the 16th, however, I was playing basketball at church like I do any other week (sometimes twice a week). In the last five minutes of what was going to be my last game of the year (I was supposed to be out of town for the rest of the games), I came down for a rebound at the same time that someone either hit my knee from the side or came down on top of me, depending on which witness you ask, my knee buckled, and it was all over from there. I was down on the ground in lots of pain and everyone was wondering what to do.
You know, the funny thing is, my very first thought after I thought "Ow, this really hurts" was "Man, I just don't have time for this right now. I've got to go to Dallas tomorrow to check on the progress of my house. I've got to go to California next week to visit my parents and so my son can celebrate his birthday with them. I'm supposed to go to China in two weeks. I hope this isn't serious. But ow, this really hurts". I was telling my wife about it in the ER later and she said, "so it really is true that your life flashes before your eyes, but not in reverse - it happens in fast forward".
Anyway, someone from my team took me to the ER and then was nice enough to have his wife follow him back to the church and drive my car home so that my wife could come and meet me at the ER. It didn't take very long to get seen (the benefits of NOT going to the big hospital downtown on a holiday weekend, I guess - that was the case the last time we went to the ER). They took some x-rays of my knee, gave me some ice and some Vicodin, put an immobilizer on it, gave me some crutches and sent me on my way. The doctor said the x-rays were negative for any fractures, but that I'd need to see an orthopedist and probably get an MRI done so they could see what kind of soft tissue injuries there were. He also said that based on the degree of swelling, he would be surprised if it was anything to do with my ACL, since that usually has a lot more swelling associated with it, but again, the orthopedist would be able to give me a better assessment.
So far, so good, right? I'm thinking at the worst I've got a bad sprain, maybe I'm on crutches and pain meds for a week or so, but nothing to mess up all my plans. So the next day, we load up the whole family in the Explorer and head to Dallas to check on the progress of the house. We put part of the back seat down and had me ride backwards with some pillows for my leg. Being on Vicodin, I ended up sleeping most of the way there and back. The house is coming along very nicely and other than my knee hurting, it was a good trip. I stayed home from church on Sunday to keep my leg elevated, but really by Saturday night, I wasn't taking the Vicodin anymore, because there was almost no pain anymore. I was only taking Advil for the swelling. I was even starting to use one crutch instead of two because I was able to tolerate a little bit of weight on my bad knee.
Side note on crutches: OK, I had no idea how much of a pain they are to get around on! My hats off to those who have spent extended periods of time on crutches. They are NO fun! I guess I should consider myself lucky that I've made it 31 years without having to use them before.
Monday morning, I went to see the orthopedist. She did some range of motion tests on my knee and ordered an MRI. She suggested that it could be my ACL after all, but the fact that I was not having any pain in my bad knee probably meant that I could start putting weight on my leg as tolerated. This was a big deal to me because if this was truly the case, then I could probably make it on the China trip with the least amount of disruption. She ordered an MRI so they could determine whether surgery was necessary, and gave me some more instructions on how to use crutches properly. Overall, a pretty good visit.
Later that day, I went to have an MRI done, another first for me. I'm not claustrophobic, but I can totally see where people would be disturbed by those machines. They are big and noisy and there is not a whole lot of space for you. The tech said that it would probably be Wednesday or Thursday before my films got read, so I was thinking everything would remain status quo until then.
The next morning however, there was a voice mail for me from the orthopedist's office. When I called back, they had received my films and wanted to get back in touch with me ASAP, first of all to tell me that I should not be putting any weight on my bad leg at all, since the MRI indicated there was a small fracture in my tibia and weightbearing could make that injury worse. In addition, the MRI showed a full thickness ACL tear and a "bucket handle" tear to my lateral meniscus (the pad of cartilage between your femur and your tibia), what they called a "full meal deal". Anyway, they wanted to have me come back in the next day to meet with the surgeon and discuss my options. Overall, not a great way to start the day, but still, I was not in too much pain and everything to this point seemed to indicate that I could still go to China if I really wanted to.
That day, I went to my classes and once again realized how difficult crutches made it to get around. When we had our final pre-China class, all of a sudden those awesome places like Tienanmen Square, the Forbidden Palace, and the Great Wall looked so much bigger now that I knew how tough it would be to get around them on crutches... Later that night, I started doing some research on ACL surgery and realized that wow, this was going to be a really big deal and the recovery was likely to be a long and demanding process. Suddenly, going to China started to make a little less sense.
When I met with the surgeon the next day, it became even more apparent that going to China would be an unnecessarily risky thing to do, especially since I would be halfway around the world and my knee would be very unstable until I had surgery. Plus, given the time of year, it was likely to still be rainy or icy in Beijing and maybe Shanghai, so that could make getting around even more difficult on crutches. My professor had told me that we could still make accomodations such as taking a taxi back to the hotel if I felt too tired, taking the tram instead of walking up to the Great Wall, etc., but that still didn't address the risk of postponing surgery and getting started on my recovery... When I put all these things together, my wife and I determined that canceling my trip was the wisest thing to do, even though I have wanted to go to China for probably fifteen years now.
So, as things stand now, I will have surgery next week (they want you to wait about three weeks between the injury and the surgery so you can get your range of motion back and strengthen your leg muscles, both of which help increase the success rate of the surgery). They'll repair my ACL and attempt to repair the meniscus (though they won't be able to determine until they get in there what type of repair they'll be able to do). In the mean time, I will be on crutches and in a leg brace until surgery.
We made our trip to California this past weekend and celebrated both my son's and my mother-in-law's birthdays with my parents. My son is turning three and my mother-in-law turned...well...she doesn't like to say, but let's just say it was a year with a zero after it. It was a nice visit and we got to see lots of friends in Morgan Hill. My wife and I celebrated the tenth anniversary of our first date and I joked that I liked the way the second ten years were starting off: she is now opening doors for me, carrying things for me, driving most everywhere we go, etc.
She threatened to break my other knee... :-)
Thursday, January 12, 2006
Bush to enter draft, another fight for No. 1 with Young
Am I the only one that thinks that LenDale White will be a better NFL back than Reggie Bush? I mean, Bush is very talented, has great vision, and has great speed, but I think White's size and strength will make him the better running back when we look back on them in a few years' time.
And another thing - I'm getting sick of all this talk about the supposed "unprecedented third consecutive national title". Last I checked, the Trojans had only one BCS championship trophy!
Read more at sports.espn.go.com/nfl/...LOS ANGELES -- Reggie Bush is skipping his senior season at Southern California to enter the NFL draft.
The Heisman Trophy winner made the expected announcement Thursday, a day after running mate LenDale White made his decision to leave early and turn pro.
Bush is expected to be one of the first players taken in the draft, with many projecting him going to the Houston Texans with the No. 1 pick.
The electrifying running back had 1,740 yards rushing and 2,890 all-purpose yards this season for the Trojans, who fell short of an unprecedented third national title when they lost 41-38 to Texas in the Rose Bowl last week.
And another thing - I'm getting sick of all this talk about the supposed "unprecedented third consecutive national title". Last I checked, the Trojans had only one BCS championship trophy!
Wednesday, January 11, 2006
Kids say the darndest things
Just to get things started, I'll start with a couple of cute things my kids have said in the past week:
Before I tell the first story, I have to give some backgrou
nd. My wife and I have always said "I love you" in sign language to both our kids as we close their bedroom door for the night, a family tradition we picked up from some deaf family friends of ours. Part of the reason we do this (apart from the obvious reason that we really do love our kids) is that it is really fun to see them struggle to get their little fingers to obey the commands their brain sends them as they try to get their hands to return the gesture. If you aren't familiar with the gesture, it combines the "I", "L", and "Y" signs from the finger-spelling alphabet (see picture at right). When we went to Hawaii last time, we had fun showing them how similar the sign for "hang loose" was, and then when we moved to Texas last year for me to start b-school at UT, we showed them how similar it was to the "Hook 'em Horns" sign.
So, about a week before Texas won the national championship (Yea Orange! Yea White! Yea Longhorns! Fight, fight, fight!), I was putting my son to bed and told him "I love you" in sign language as I was closing the door. Completely out of the blue, he yelled out, "NO DADDY! Hook 'em Horns!!" and flashed the Hook 'em Horns sign at me. I had to close the door to keep from laughing and getting him all excited at bedtime.
Then, a few days ago, I had just come back from running to Home Depot to pick up some painting supplies. When I came in, my daughter asked me where I had been. When I told her, she asked if next time I was out, would I please buy her and my son a surprise? Of course, I answered like most parents of a five year-old probably would in this situation would and said "Oh I don't know, we'll have to see..." When I said this, however, she got really excited and said "Oh thank you, thank you, Daddy!".
I explained to her that "We'll see" does not mean the same as "Yes," but she looked at me very matter-of-factly and said, "Well, Daddy, it was a 'restorical question'".
After suppressing a chuckle and explaining that the word I thought she was looking for (you never can tell with five year-olds) was "rhetorical", I asked "So what is a rhetorical question?"
"Silly Daddy," came her reply, "A rhetorical question is one to which the answer is 'Why yes, I would be happy to!'"
This time I did laugh out loud. And hard. You can't make this stuff up.
Before I tell the first story, I have to give some backgrou
nd. My wife and I have always said "I love you" in sign language to both our kids as we close their bedroom door for the night, a family tradition we picked up from some deaf family friends of ours. Part of the reason we do this (apart from the obvious reason that we really do love our kids) is that it is really fun to see them struggle to get their little fingers to obey the commands their brain sends them as they try to get their hands to return the gesture. If you aren't familiar with the gesture, it combines the "I", "L", and "Y" signs from the finger-spelling alphabet (see picture at right). When we went to Hawaii last time, we had fun showing them how similar the sign for "hang loose" was, and then when we moved to Texas last year for me to start b-school at UT, we showed them how similar it was to the "Hook 'em Horns" sign.
So, about a week before Texas won the national championship (Yea Orange! Yea White! Yea Longhorns! Fight, fight, fight!), I was putting my son to bed and told him "I love you" in sign language as I was closing the door. Completely out of the blue, he yelled out, "NO DADDY! Hook 'em Horns!!" and flashed the Hook 'em Horns sign at me. I had to close the door to keep from laughing and getting him all excited at bedtime.Then, a few days ago, I had just come back from running to Home Depot to pick up some painting supplies. When I came in, my daughter asked me where I had been. When I told her, she asked if next time I was out, would I please buy her and my son a surprise? Of course, I answered like most parents of a five year-old probably would in this situation would and said "Oh I don't know, we'll have to see..." When I said this, however, she got really excited and said "Oh thank you, thank you, Daddy!".
I explained to her that "We'll see" does not mean the same as "Yes," but she looked at me very matter-of-factly and said, "Well, Daddy, it was a 'restorical question'".
After suppressing a chuckle and explaining that the word I thought she was looking for (you never can tell with five year-olds) was "rhetorical", I asked "So what is a rhetorical question?"
"Silly Daddy," came her reply, "A rhetorical question is one to which the answer is 'Why yes, I would be happy to!'"
This time I did laugh out loud. And hard. You can't make this stuff up.
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