I haven’t had this much free time since I back-packed around Europe after the Bar Exam. Unfortunately, this past month hasn’t been nearly as fun, because, you know, this little knee surgery thing has gotten in the way. But I’ve still managed to fill my time with more than just SportsCenter, Tyra Banks and reality TV. This is probably the most informed I’ve ever been, having read more news articles and watched more news programming in the past 30 days than I have the previous 6 months combined. My gut might be growing from inactivity, but so is my brain. Along those lines, here two observations/rants on current events:
The stimulus bill, hypocrisy, and politicians. I’m not an economist, so I have no clue whether $800 billion of gov’t spending will lead us out of this recession or hurt our country in the long-term. However, I find it troubling that the same people who blast John Thain for spending $35,000 to renovate a toilet remain conspicuously silent when some Congressman tries to sneak a $50 million pet pork project into a job creation bill. Along those same lines, the Illinois governor gets indicted for soliciting campaign donations in exchange for a Senate appointment, yet the New York governor openly touts the fundraising potential of Caroline Kennedy if she got appointed Senator. I realize the situations aren’t exactly identical, but, in my opinion, only a fine line separates them. Likewise, I don’t see a heckuva lot of difference between the governors’ Senate bartering and Jack Abramhoff seeking quid pro quos for his lobbying efforts or President Clinton pardoning Marc Rich after Rich’s wife’s donated millions to the Clinton Foundation, other than some were a bit more brazen and specific about their demands. Oh, and some of them got caught on tape.
This isn’t a Republican or Democratic thing, but rather a politician thing. It gets annoying when one side grandstands about the other political party’s shortcomings, while conveniently glossing over similar misdeeds by their political colleagues. While the Republicans dominated Congress from 2000-2006, the Democrats bitched that the Republicans shut them out of the legislative process and repeatedly bemoaned the lack of “bi-partisan” negotiations. The Republicans responded that they won the elections and, hence, to the victors go the spoils, much like an athlete saying, “scoreboard.” Well, times have changed and now the Democrats control Congress. And whaddya know, the roles are reversed. This time, the Republicans are complaining about not being able to help draft the stimulus bill, while the Democrats are responding, “tough cookies. You had your chance, now it’s our turn,” ironically cloaking their strong-arm tactics under the guise of “Change.” The faces change, but the complaints remain the same. Instead of wasting time – and insulting the public’s intelligence – by playing the spin game, I just wish politicians would craft solutions, instead of blaming the other side for the country’s problems.
Donovan McNabb chokes again. I’ve long-believed that McNabb was an above-average QB who benefitted from a phenomenal defense and the lack of a dominant NFC team, like the Pats, Colts and Steelers have been in the AFC this decade. He was just good enough to get his team to the playoffs, but not nearly good enough to win a big game on his own. He’s way too erratic, and never seemed capable of rallying his team when it counted. Plus, he was the master of putting up big numbers in ugly performances, which helped disguise his shortcomings.
His performance against the Cards in the NFC Conference Game symbolized McChunky Soup’s career. Look at McNabb’s numbers: 28 of 47 for 375 yards, 3 TDs, 1 INT, and 31 rushing yards. You’d think he was all-world in this game. Think again. He stunk up the joint in the first half, putting Philly in a major hole. When his team got down big and the Cards started playing prevent defense, McNabb chalked up monster numbers as Philly caught up, just like he did in his lone Super Bowl appearance against the Pats. Actually, his Super Bowl stats are eerily similar to the ones he put up in the Cards’ game, both games Philly lost. Anyway, his deep ball to Kevin Curtis and the TD bomb to DeSean Jackson against Arizona were things of beauty, a prime example of what McNabb can do when he’s hot. But those are simply flashes of brilliance that McNabb can never sustain. When Philly got the ball back with less than 3 minutes to go, did anybody seriously think McNabb would lead Philly for the game-tying score? Of course not. He’s the anti-clutch. The A-Rod of football, except Donovan can’t match A-Rod’s regular season accomplishments. By consistently missing open WRs on that final drive and failing to lead the Eagles to a TD with the game on the line, McNabb once again proved he doesn’t belong in the top tier of QBs. Unlike the earlier playoff games against the Vikings and Giants, Philly’s defense couldn’t bail out McNabb this time. People credit McNabb for consistently leading the Eagles deep into the playoffs, but there’s a reason the Eagles are 1-5 in Conference Championships and Super Bowls under McNabb’s watch.
Thursday, January 29, 2009
Monday, January 26, 2009
OS Follow-Up #2 -- The Letdown
Man, what a roller coaster day. This morning, I had another PT session. Therapy went well. I performed all of my exercises with minimal difficulty, and exhibited greater control of my quadriceps. Judy was pleased with my overall leg strength. My hamstrings remain tight, but that probably won’t ever change unless I spend one month at a yoga retreat. Critically, I improved my free-standing flexion to 92 degrees, a 12-degree improvement from Thursday. This satisfies my goal for the week, and keeps me slightly ahead of my ROM schedule. At the end of therapy, I discovered that I was placing about 110 pounds of pressure on my right leg, which was just shy of where I’m supposed to be. I then practiced walking with just one crutch on my left side. No issues there. All in all, a promising session filled with progress.
Christina and I celebrated my successful PT by grabbing lunch at the NorthPark Corner Bakery. We arrived about 30 minutes before what we thought would be the lunch crowd rush, yet the place was dead. Actually, the entire mall was dead. Not sure if that’s just a Monday thing. Lunch was uneventful. I was able to rest my leg on the railing next to my chair, and enjoyed a relaxing sandwich with my wife without the kids. The restaurant (and mall) was still empty when we left 45 minutes later. I hope that’s not a sign that the economy is about to take another nosedive.
My momentary high quickly disappeared after my afternoon visit with Turgeon. At this visit, I had hoped that Turgeon would allow me to open the brace 0-30 degrees, at least when sleeping. That’s what we discussed at our last visit. He took two x-rays of my osteotomy. Since I tweaked the osteotomy on Day 2, I haven’t had any pain in the shin. The x-rays revealed the tibia break and the 2 implanted crews are healing just fine. However, Turgeon wants to “see more of the bone” on the tibia before he allows me to open the brace. He acknowledged the lack of pain confirms the bone is healing satisfactory, but emphasized he wants to be overly cautious, again reminding me that this is a marathon, not a sprint. Turgeon reiterated we’re only 4 weeks into the recovery. The first 6-12 weeks are the most important period, and he doesn’t want to risk me shattering the osteotomy and thus ruining the surgery. He did, however, approve the use of one crutch, and told me I could go crutch-less if I felt comfortable.
Unfortunately, I will remain locked in my brace at 0 degrees until my next visit in 16 days, meaning I’ve got another 2 weeks of sleepless nights and dead legs. I’m not gonna lie. The visit was demoralizing. If this were a chick flick, this would be the scene where I grab a spoon and a carton of ice cream, and watch sappy movies under a blanket by myself. Ok, it’s not that bad. But I’m still bummed out. I don’t mind wearing the brace. In fact, I’ll probably wear it longer than necessary as much for the mental comfort as the physical support the brace provides. However, I just want to be able to bend my knee like a normal person again. That’s not asking a lot. Feel free to leave plenty of pick-me-ups in the comments section. I promise to put down the Haagen-Daz to read them.
Christina and I celebrated my successful PT by grabbing lunch at the NorthPark Corner Bakery. We arrived about 30 minutes before what we thought would be the lunch crowd rush, yet the place was dead. Actually, the entire mall was dead. Not sure if that’s just a Monday thing. Lunch was uneventful. I was able to rest my leg on the railing next to my chair, and enjoyed a relaxing sandwich with my wife without the kids. The restaurant (and mall) was still empty when we left 45 minutes later. I hope that’s not a sign that the economy is about to take another nosedive.
My momentary high quickly disappeared after my afternoon visit with Turgeon. At this visit, I had hoped that Turgeon would allow me to open the brace 0-30 degrees, at least when sleeping. That’s what we discussed at our last visit. He took two x-rays of my osteotomy. Since I tweaked the osteotomy on Day 2, I haven’t had any pain in the shin. The x-rays revealed the tibia break and the 2 implanted crews are healing just fine. However, Turgeon wants to “see more of the bone” on the tibia before he allows me to open the brace. He acknowledged the lack of pain confirms the bone is healing satisfactory, but emphasized he wants to be overly cautious, again reminding me that this is a marathon, not a sprint. Turgeon reiterated we’re only 4 weeks into the recovery. The first 6-12 weeks are the most important period, and he doesn’t want to risk me shattering the osteotomy and thus ruining the surgery. He did, however, approve the use of one crutch, and told me I could go crutch-less if I felt comfortable.
Unfortunately, I will remain locked in my brace at 0 degrees until my next visit in 16 days, meaning I’ve got another 2 weeks of sleepless nights and dead legs. I’m not gonna lie. The visit was demoralizing. If this were a chick flick, this would be the scene where I grab a spoon and a carton of ice cream, and watch sappy movies under a blanket by myself. Ok, it’s not that bad. But I’m still bummed out. I don’t mind wearing the brace. In fact, I’ll probably wear it longer than necessary as much for the mental comfort as the physical support the brace provides. However, I just want to be able to bend my knee like a normal person again. That’s not asking a lot. Feel free to leave plenty of pick-me-ups in the comments section. I promise to put down the Haagen-Daz to read them.
Friday, January 23, 2009
PT Session Recap
I recently completed the equivalent of two-a-days, heading to PT on Wednesday and Thursday. Thursday started poorly, as I felt drained shortly before PT. I’m not sure why. I didn’t do much, other than heading outside for a little sun for the first time in awhile. But basking in 80-degree sunshine in a lounge chair for 10 minutes shouldn’t deplete a person’s energy. Can’t explain that one.
The PT session went well. I graduated to 2lb ankle weights, and the difference is telling. I’m almost embarrassed by my new muscles. Even extra large gym shorts can’t contain my legs.
I improved my free-standing flexion 3 degrees overnight, reaching 80 degrees. My thigh, however, suffered immensely to achieve this small gain. Dayna – one of Judy’s excellent assistants – was tasked with pinning my right thigh to the table while my gimpy knee dangled over the table edge, allowing Judy to slowly raise and lower the leg to measure my flexion. Apparently, my quads like to explode as my leg contracts, requiring Dayna to press down really hard to keep my knee immobile. Dayna might have a future as a grape crusher, as she generated enough pressure with her hands to make at least 4 bottles of wine. Her handprint remained on my thigh 24 hours later. Of course, she rightfully blames me for squirming too much (I did). Besides, the discomfort in my thigh was a welcome distraction from the soreness in my knee.
At the end of PT, I hopped onto the scale to measure how much weight I was placing on my bum wheel. I’m supposed to be at 50% of my body weight, and reach 75% before next week. For the first time since the surgery, I weighed myself. Wearing tennis shoes and workout attire, I was 152 pounds, a 6-10 pound drop from 3 weeks ago. That kind of weight loss probably would’ve kept me above the yellow line on The Biggest Loser. Of course, I also weigh less than most contestants’ elbows. Anyway, after pressing down on the scale with my right leg, I learned that I was averaging between 80-100 pounds of pressure. I need to reach 115 pounds soon. Pressing down that hard with a straight leg, however, feels unnatural. It contradicts everything you’re taught about avoiding knee injuries. Indeed, people frequently blow their knees by awkwardly landing straight-legged, snapping their ligaments like twigs. I realize that can’t (well, shouldn’t; never say can’t) happen with the brace locked, but it’s difficult to overcome those instincts. It’s just counter-intuitive. But that’s my new challenge for the next several days.
The PT session went well. I graduated to 2lb ankle weights, and the difference is telling. I’m almost embarrassed by my new muscles. Even extra large gym shorts can’t contain my legs.
I improved my free-standing flexion 3 degrees overnight, reaching 80 degrees. My thigh, however, suffered immensely to achieve this small gain. Dayna – one of Judy’s excellent assistants – was tasked with pinning my right thigh to the table while my gimpy knee dangled over the table edge, allowing Judy to slowly raise and lower the leg to measure my flexion. Apparently, my quads like to explode as my leg contracts, requiring Dayna to press down really hard to keep my knee immobile. Dayna might have a future as a grape crusher, as she generated enough pressure with her hands to make at least 4 bottles of wine. Her handprint remained on my thigh 24 hours later. Of course, she rightfully blames me for squirming too much (I did). Besides, the discomfort in my thigh was a welcome distraction from the soreness in my knee.
At the end of PT, I hopped onto the scale to measure how much weight I was placing on my bum wheel. I’m supposed to be at 50% of my body weight, and reach 75% before next week. For the first time since the surgery, I weighed myself. Wearing tennis shoes and workout attire, I was 152 pounds, a 6-10 pound drop from 3 weeks ago. That kind of weight loss probably would’ve kept me above the yellow line on The Biggest Loser. Of course, I also weigh less than most contestants’ elbows. Anyway, after pressing down on the scale with my right leg, I learned that I was averaging between 80-100 pounds of pressure. I need to reach 115 pounds soon. Pressing down that hard with a straight leg, however, feels unnatural. It contradicts everything you’re taught about avoiding knee injuries. Indeed, people frequently blow their knees by awkwardly landing straight-legged, snapping their ligaments like twigs. I realize that can’t (well, shouldn’t; never say can’t) happen with the brace locked, but it’s difficult to overcome those instincts. It’s just counter-intuitive. But that’s my new challenge for the next several days.
Wednesday, January 21, 2009
3-Week Update
3 weeks down. 75 more to go. That’s how long it’ll take me to reach the 1 ½ year mark, when, hopefully, I’ll be 100% “normal” again. Well, I’ve never been considered, “normal,” but you know what I mean.
I had another PT session today. Things went fine. My free-standing flexion was 77 degrees. At this point, the goal was 75, so I’m slightly ahead of schedule. However, I was a bit disappointed. I just increased my CPM to 87 degrees today. Even though I understand my free-standing flexion will be less than my CPM number, I was hoping to hit 80 today. In any event, I’m supposed to be at 90 degrees free-standing by next Friday, which will be just over 4 weeks since the surgery. I also learned today that I won’t be able to start biking until the 6-week mark, regardless of when I reach 90 degrees, because of the osteotomy. Once again, my Tour de France dreams are on hold.
Judy manipulated my leg with the usual push and pulls, before adding a new wrinkle. For an extra layer of difficulty on my leg raises, she strapped on a massive, 1-lb ankle weight. Hoisting that 1-pound green boulder 3-6 inches off the trainer’s table generated a rare Hulk-like adrenaline rush. This must have been what Roger Clemens felt like after taking HGH. After cranking out 30 leg raises, I almost hopped off the table to flex in front of the mirror. But then I remembered I’m in no position to hop off anything or show off my guns.
Judy also removed the gauze bandaging on my knee, exposing the Franken-scar. The steri-strips still cover most of the incision, but the scar is gloriously prominent, especially when the knee rises in the CPM. It’s almost like the Franken-scar wants to smack me in the forehead. I can’t wait to show off the Franken-scar by wearing shorts on my next mall walk. I predict 3 people will pass out, and 2 will lose their lunch.
So far, there’s been no bruising on the shin or knee, and just a little swelling. I’ve rarely experienced pain in the knee, other than an occasional pinprick. The knee aches a bit first thing in the morning and after completion of my rehab exercises, but thankfully those are the only times. I do feel discomfort in my foot – the top part as well as the heel and ankle – because it remains flexed in the brace 24/7. I’ve been able to shower braceless every night without incident. Sleep remains elusive, though last night I almost made it through the entire night. I hope this marks the start of a new trend, but that’s doubtful. Oddly, I’m not tired despite getting no more than 2-3 hour bursts of sleep. Perhaps I should’ve been a stake-out guy instead of a lawyer. I wish I would’ve felt this good without regular sleep when my kids were newborns.
One final comment that’s completely un-related to my knee; something I’ve just gotta get off my chest. I watched most of the inauguration festivities yesterday. Like most Americans, I was moved by the historic moment, and it renewed my faith in our country. But what the fuck was Michele Obama wearing during the swearing-in ceremony? Did her “superstar designer” steal some shower curtains from the 1950’s? My 3-year old draws better-looking dresses, and she can’t stay between the lines yet. Michele would’ve better off wearing something from Zoolander.
It pained me to hear TV commentators rationalize the “beauty” of her dress as some kind of bold fashion statement. All I kept thinking was whether anybody would notice if somebody puked on her. Where was Mr. Blackstone when you really need him? Her dress was goony. Just say so. Speaking the truth about her dress doesn’t detract from the moment, but putting lipstick on a pig makes you look silly. Finally, the word “irony” doesn’t do justice to those who criticized car executives for flying on private jets to Congressional hearings, but then celebrated by throwing 10 ballroom functions. Ok, I’m done ranting.
I had another PT session today. Things went fine. My free-standing flexion was 77 degrees. At this point, the goal was 75, so I’m slightly ahead of schedule. However, I was a bit disappointed. I just increased my CPM to 87 degrees today. Even though I understand my free-standing flexion will be less than my CPM number, I was hoping to hit 80 today. In any event, I’m supposed to be at 90 degrees free-standing by next Friday, which will be just over 4 weeks since the surgery. I also learned today that I won’t be able to start biking until the 6-week mark, regardless of when I reach 90 degrees, because of the osteotomy. Once again, my Tour de France dreams are on hold.
Judy manipulated my leg with the usual push and pulls, before adding a new wrinkle. For an extra layer of difficulty on my leg raises, she strapped on a massive, 1-lb ankle weight. Hoisting that 1-pound green boulder 3-6 inches off the trainer’s table generated a rare Hulk-like adrenaline rush. This must have been what Roger Clemens felt like after taking HGH. After cranking out 30 leg raises, I almost hopped off the table to flex in front of the mirror. But then I remembered I’m in no position to hop off anything or show off my guns.
Judy also removed the gauze bandaging on my knee, exposing the Franken-scar. The steri-strips still cover most of the incision, but the scar is gloriously prominent, especially when the knee rises in the CPM. It’s almost like the Franken-scar wants to smack me in the forehead. I can’t wait to show off the Franken-scar by wearing shorts on my next mall walk. I predict 3 people will pass out, and 2 will lose their lunch.
So far, there’s been no bruising on the shin or knee, and just a little swelling. I’ve rarely experienced pain in the knee, other than an occasional pinprick. The knee aches a bit first thing in the morning and after completion of my rehab exercises, but thankfully those are the only times. I do feel discomfort in my foot – the top part as well as the heel and ankle – because it remains flexed in the brace 24/7. I’ve been able to shower braceless every night without incident. Sleep remains elusive, though last night I almost made it through the entire night. I hope this marks the start of a new trend, but that’s doubtful. Oddly, I’m not tired despite getting no more than 2-3 hour bursts of sleep. Perhaps I should’ve been a stake-out guy instead of a lawyer. I wish I would’ve felt this good without regular sleep when my kids were newborns.
One final comment that’s completely un-related to my knee; something I’ve just gotta get off my chest. I watched most of the inauguration festivities yesterday. Like most Americans, I was moved by the historic moment, and it renewed my faith in our country. But what the fuck was Michele Obama wearing during the swearing-in ceremony? Did her “superstar designer” steal some shower curtains from the 1950’s? My 3-year old draws better-looking dresses, and she can’t stay between the lines yet. Michele would’ve better off wearing something from Zoolander.
It pained me to hear TV commentators rationalize the “beauty” of her dress as some kind of bold fashion statement. All I kept thinking was whether anybody would notice if somebody puked on her. Where was Mr. Blackstone when you really need him? Her dress was goony. Just say so. Speaking the truth about her dress doesn’t detract from the moment, but putting lipstick on a pig makes you look silly. Finally, the word “irony” doesn’t do justice to those who criticized car executives for flying on private jets to Congressional hearings, but then celebrated by throwing 10 ballroom functions. Ok, I’m done ranting.
Monday, January 19, 2009
Tips for ACI Patients
I wanted to pass along some observations and lessons learned during these initial weeks to others who might be planning ACI knee surgery. In no particular order, here they are:
Stockpile tons of reading material and movies. For the first 7-10 days, you’ll likely spend most of the day in bed. To pass the time, I plowed through 2 books and tons of feature articles I had gathered in anticipation of the surgery. I also watched most of Season 1 of Mad Men, as well as a couple movies with Christina once I was able to move to the living room couch. I probably would’ve watched more movies if the portable DVD player hadn’t broken down.
Get married. I can’t imagine going through this experience without a spouse, or at least a very serious significant other. You’ll need someone to change ice packs, load ice into your ice machines, help you with your brace and the CPM, fix you dinner, and generally fetch all of your stuff. In the early days, you’ll also need help going to the bathroom, as well as showering. While a parent might love you unconditionally, I don’t think you want to pee or wash your private parts in front of Mom. You will quickly lose all dignity. Don’t fight it. Just make sure you have someone with whom you’re comfortable enough to let down your guard.
Get a laptop with WiFi. My laptop hasn’t left my bedside table since the surgery. I use it for everything, from surfing the web, to blogging about the surgery, to working part-time from home. Staying connected has been critical to maintaining my sanity.
Exercise and stretch before the surgery. Your body will suffer tremendously. It’s inevitable. But the recovery will be easier if you’re in decent shape beforehand. Plus, the intense rehab exercises won’t be as much of a shock to your body if you’re accustomed to working out hard. Looking back, I wish I had added some of the ACI rehab exercises to my normal workout routine before the surgery. I also wish I had spent more time improving my flexibility. My hamstring actually hurts worse than my knee.
Provide work with a realistic assessment of your work load and expected absence. I gave my bosses at least 4 months’ notice about my surgery and anticipated absence. I outlined the status of each of my cases, and all upcoming deadlines. We agreed which case I would hold onto, and which case (or task) needed to be transitioned to others. My office has been great about my situation. I told them I likely wouldn’t be in the office for at least 1 month, and possibly 6 weeks. Every patient recovers differently, of course. Some ACI patients have returned to work 2 weeks after their surgery. Even though I have a traditional “desk job,” there’s no way I could last an entire day at the office right now. My knee still occasionally aches and I get tired very easily. Also, I can’t drive, and can’t lug my workpapers back and forth between home and the office. Plus, there’s no way I could squeeze in the 6-8 hours daily I still need to spend in the CPM if I went to the office. My boss agreed to let me work from home as often as I’d like, as long as I send him a detailed summary of how many hours I worked and what I accomplished. I’ve also remained accessible via remote access email and cell phone.
Find a nearby PT with ACI experience before the surgery. This is an obvious point, but, after reading blogs by other ACI patients, it seems like some overlooked it. ACI is a highly specialized procedure, and success is dependent on the rehab. Find a PT who’s worked with plenty of ACI patients, especially one whose office is nearby. Right now, I go to PT twice/week for 1 hour per visit, and probably will continue to do so for several months. That’s a huge time commitment. Patients actually spend more time with the PT than the surgeon. Also, make sure the PT and the surgeon communicate regularly about your rehab progress.
Understand it’s a marathon, not a sprint. The first few days, perhaps weeks, after the surgery will really suck. I’m not kidding. There will be a few times when you are absolutely miserable. It’s human nature to question, even regret, the surgery while you’re wallowing in pain and self-pity. I know I did. But, like the overdone cliché, there is a light at the end of the tunnel. Better days are ahead. Remain resilient. Take some advice from the New Kids on the Block and Hang Tough. Good Lord. I can’t believe I just quoted the New Kids.
Develop a routine. Full disclosure: I’m a creature of habit. I like planning out my days. If I don’t, I forget to do stuff. Following a routine will help you get through the day and complete all the necessary home rehab. Patients spend 6-8 hours/day in the CPM, usually in 3 separate two-hour+ sessions, plus they spend another 15-30 minutes doing home PT. That basically wipes out your day. If you miss one of your CPM sessions, it’s difficult to make up those 2-3 hours. If you head back to work, it’s even more difficult to sneak in the required CPM time. Think about it. If you’re gone from the house from 8am – 6pm, you either have to wake up a few extra hours earlier than normal or you’re going to spend your entire evening in the CPM, leaving no time for the family. Plus, it’s taxing to spend more than 3 hours in the CPM.
Here’s a rough timeline of my normal day:
6–7 Wake up and eat breakfast
7-9:30 CPM
9:30-1 Relax, work, etc. Eat lunch.
1-3:30 CPM
3:30-5:30 Spend time with kids, work, relax. Eat dinner.
5:30-6 Playtime with kids.
6-8 CPM
8-8:30 Relax
8:30-9 PT exercises
9-10 Relax
10 Shower and sleep
Trust me. My day’s as boring as this timeline suggests. But at least I’m able to carve out enough time for the CPM and PT, which, at this point in the recovery, is critical.
Buy a shower seat and toilet seat riser with handles. As soon as you’re physically ready, you’ll want to shower. Your injured leg will quickly become engulfed with dead skin. It’s just nasty. However, you won’t be able to shower standing up. I bought a simple bench with a handle; that’s worked just fine. You’ll also want to keep your shampoo, etc. in a basket within reach of the bench. The toilet seat riser is also necessary, especially for women. I recommend getting one with handles, which make it easier to push off back to your feet. Plus, I plan on leaving the Cadillac on our guest crapper during all future parties. That should make for great conversation.
Don’t hesitate to call in favors from friends/family. You’re going to need help. Lots of help, especially if you have kids. You’ll need to arrange rides to school and sports practice. During those first few days, somebody will need to remain with you 24/7 in case you need assistance. If your spouse needs to run an errand or takes a deserved break, you’ll need a replacement adult to watch the kids. Guys hate asking for help. It’s genetic. It’s why we refuse to ask for directions, no matter how lost we are. Set aside your pride and ask for help. Don’t play hero. I learned most folks are more than willing to chip in. We’ve been fortunate, with several friends inviting our kids over for playdates, taking them to basketball practice, and bringing over dinner. You’ll have plenty of time to “make it up” after your knee heals.
Familiarize yourself with your insurance benefits. ACI is pricey. There are several cost components to the surgery. The cloning. The surgery center. Anaestesiologist. Surgeon fee. PT. The rental of the CPM and ice machines. Know how much insurance covers. Examine the exclusions provisions. Study the pre-certification and appeals process. Organize all communication and bills relating to the surgery. Save all EOBs. Document all contacts with your insurance carrier. Insurance companies make money by screwing people over. That’s their business model. Hopefully that won’t happen, but accepting this fact will provide a dose of realism. The surgery center initially asked for almost $9,000 before it would schedule the procedure. Luckily, I understood my coverage, refused to pay and directed her to the surgeon’s and Genzyme’s insurance liaisons. Perhaps this was a simple mistake by an unknowledgeable billing clerk, but a lesser-educated patient might’ve mistakenly paid the bill. And everybody knows how difficult it is to collect a refund once that money’s gone. The lesson: wait until all the bills arrive and insurance discounts have been applied before paying anything.
Stockpile tons of reading material and movies. For the first 7-10 days, you’ll likely spend most of the day in bed. To pass the time, I plowed through 2 books and tons of feature articles I had gathered in anticipation of the surgery. I also watched most of Season 1 of Mad Men, as well as a couple movies with Christina once I was able to move to the living room couch. I probably would’ve watched more movies if the portable DVD player hadn’t broken down.
Get married. I can’t imagine going through this experience without a spouse, or at least a very serious significant other. You’ll need someone to change ice packs, load ice into your ice machines, help you with your brace and the CPM, fix you dinner, and generally fetch all of your stuff. In the early days, you’ll also need help going to the bathroom, as well as showering. While a parent might love you unconditionally, I don’t think you want to pee or wash your private parts in front of Mom. You will quickly lose all dignity. Don’t fight it. Just make sure you have someone with whom you’re comfortable enough to let down your guard.
Get a laptop with WiFi. My laptop hasn’t left my bedside table since the surgery. I use it for everything, from surfing the web, to blogging about the surgery, to working part-time from home. Staying connected has been critical to maintaining my sanity.
Exercise and stretch before the surgery. Your body will suffer tremendously. It’s inevitable. But the recovery will be easier if you’re in decent shape beforehand. Plus, the intense rehab exercises won’t be as much of a shock to your body if you’re accustomed to working out hard. Looking back, I wish I had added some of the ACI rehab exercises to my normal workout routine before the surgery. I also wish I had spent more time improving my flexibility. My hamstring actually hurts worse than my knee.
Provide work with a realistic assessment of your work load and expected absence. I gave my bosses at least 4 months’ notice about my surgery and anticipated absence. I outlined the status of each of my cases, and all upcoming deadlines. We agreed which case I would hold onto, and which case (or task) needed to be transitioned to others. My office has been great about my situation. I told them I likely wouldn’t be in the office for at least 1 month, and possibly 6 weeks. Every patient recovers differently, of course. Some ACI patients have returned to work 2 weeks after their surgery. Even though I have a traditional “desk job,” there’s no way I could last an entire day at the office right now. My knee still occasionally aches and I get tired very easily. Also, I can’t drive, and can’t lug my workpapers back and forth between home and the office. Plus, there’s no way I could squeeze in the 6-8 hours daily I still need to spend in the CPM if I went to the office. My boss agreed to let me work from home as often as I’d like, as long as I send him a detailed summary of how many hours I worked and what I accomplished. I’ve also remained accessible via remote access email and cell phone.
Find a nearby PT with ACI experience before the surgery. This is an obvious point, but, after reading blogs by other ACI patients, it seems like some overlooked it. ACI is a highly specialized procedure, and success is dependent on the rehab. Find a PT who’s worked with plenty of ACI patients, especially one whose office is nearby. Right now, I go to PT twice/week for 1 hour per visit, and probably will continue to do so for several months. That’s a huge time commitment. Patients actually spend more time with the PT than the surgeon. Also, make sure the PT and the surgeon communicate regularly about your rehab progress.
Understand it’s a marathon, not a sprint. The first few days, perhaps weeks, after the surgery will really suck. I’m not kidding. There will be a few times when you are absolutely miserable. It’s human nature to question, even regret, the surgery while you’re wallowing in pain and self-pity. I know I did. But, like the overdone cliché, there is a light at the end of the tunnel. Better days are ahead. Remain resilient. Take some advice from the New Kids on the Block and Hang Tough. Good Lord. I can’t believe I just quoted the New Kids.
Develop a routine. Full disclosure: I’m a creature of habit. I like planning out my days. If I don’t, I forget to do stuff. Following a routine will help you get through the day and complete all the necessary home rehab. Patients spend 6-8 hours/day in the CPM, usually in 3 separate two-hour+ sessions, plus they spend another 15-30 minutes doing home PT. That basically wipes out your day. If you miss one of your CPM sessions, it’s difficult to make up those 2-3 hours. If you head back to work, it’s even more difficult to sneak in the required CPM time. Think about it. If you’re gone from the house from 8am – 6pm, you either have to wake up a few extra hours earlier than normal or you’re going to spend your entire evening in the CPM, leaving no time for the family. Plus, it’s taxing to spend more than 3 hours in the CPM.
Here’s a rough timeline of my normal day:
6–7 Wake up and eat breakfast
7-9:30 CPM
9:30-1 Relax, work, etc. Eat lunch.
1-3:30 CPM
3:30-5:30 Spend time with kids, work, relax. Eat dinner.
5:30-6 Playtime with kids.
6-8 CPM
8-8:30 Relax
8:30-9 PT exercises
9-10 Relax
10 Shower and sleep
Trust me. My day’s as boring as this timeline suggests. But at least I’m able to carve out enough time for the CPM and PT, which, at this point in the recovery, is critical.
Buy a shower seat and toilet seat riser with handles. As soon as you’re physically ready, you’ll want to shower. Your injured leg will quickly become engulfed with dead skin. It’s just nasty. However, you won’t be able to shower standing up. I bought a simple bench with a handle; that’s worked just fine. You’ll also want to keep your shampoo, etc. in a basket within reach of the bench. The toilet seat riser is also necessary, especially for women. I recommend getting one with handles, which make it easier to push off back to your feet. Plus, I plan on leaving the Cadillac on our guest crapper during all future parties. That should make for great conversation.
Don’t hesitate to call in favors from friends/family. You’re going to need help. Lots of help, especially if you have kids. You’ll need to arrange rides to school and sports practice. During those first few days, somebody will need to remain with you 24/7 in case you need assistance. If your spouse needs to run an errand or takes a deserved break, you’ll need a replacement adult to watch the kids. Guys hate asking for help. It’s genetic. It’s why we refuse to ask for directions, no matter how lost we are. Set aside your pride and ask for help. Don’t play hero. I learned most folks are more than willing to chip in. We’ve been fortunate, with several friends inviting our kids over for playdates, taking them to basketball practice, and bringing over dinner. You’ll have plenty of time to “make it up” after your knee heals.
Familiarize yourself with your insurance benefits. ACI is pricey. There are several cost components to the surgery. The cloning. The surgery center. Anaestesiologist. Surgeon fee. PT. The rental of the CPM and ice machines. Know how much insurance covers. Examine the exclusions provisions. Study the pre-certification and appeals process. Organize all communication and bills relating to the surgery. Save all EOBs. Document all contacts with your insurance carrier. Insurance companies make money by screwing people over. That’s their business model. Hopefully that won’t happen, but accepting this fact will provide a dose of realism. The surgery center initially asked for almost $9,000 before it would schedule the procedure. Luckily, I understood my coverage, refused to pay and directed her to the surgeon’s and Genzyme’s insurance liaisons. Perhaps this was a simple mistake by an unknowledgeable billing clerk, but a lesser-educated patient might’ve mistakenly paid the bill. And everybody knows how difficult it is to collect a refund once that money’s gone. The lesson: wait until all the bills arrive and insurance discounts have been applied before paying anything.
Saturday, January 17, 2009
Physical Regression
Before I begin, what the fuck happened to global warming? I don’t care if it’s January, it’s not supposed to be 25 degrees, ever, in Dallas, which, by the way, feels like -30 does to Chicagoans. Like most Americans, the cold weather is beating me down, and I can’t shake this nasty hacking cough and constant green snot. This isn’t helping my rehab.
17 days. That’s all it took to wipe out 4 months of solid exercise and healthy eating. The soulless combination of surgery and inactivity has inflicted serious damage to my body. Before the surgery, I wasn’t about to win any bodybuilding competitions, but I was in fairly decent shape. Now, the little bulging veins that once proudly rippled across my arms are gone, as are the 1- and 2-pack abs I developed. (The closest I got to a 6-pack was the Amstel in the fridge). My right quadriceps is flimsier than jello, to the point where the outside of my thigh is actually sunken in like a crackhead’s cheeks. In fact, my entire right leg looks homelier than an orphaned chicken. It’s shriveled up so much that the brace already is starting to slide off. The PT told me yesterday that my leg strength was “pathetic,” though that’s normal for folks at my stage. I haven’t stepped onto a scale, but I’ve probably lost 5-10 pounds, mainly because I lost all muscle definition in my upper and lower body. Plus, I eat less than a French super-model addicted to heroin. My body transformation is like the reverse Super Size Me.
To combat my Benjamin Button-like renovation, I resumed lifting weights today, in addition to my regular rehab exercises. I’m finally comfortable enough sitting up without putting any pressure on my outstretched gimpy leg. Using light dumbbells (10lbs), I did a variety of curls, military presses and delt raises. It’s not much, but hopefully it’ll stave off any further deterioration. This past week, I started taking regular showers again, and each glimpse at my new body humbles me. I’m just trying to hang on until the doctor clears me to resume normal exercise, which, unfortunately, probably won’t happen for at least another month. Once I reach 90 degrees flexion in my knee (I’m at 75 degrees now; hopefully I’ll hit 90 by the end of January), I’ll be able to start riding a stationary bike with no resistance. Nobody will mistake the biking I do for the Tour de France, but at least it's a form of cardio. At first, I’ll peddle for just a few minutes at a time, before slowly increasing the duration and eventually adding some resistance.
Around the 6-week mark, I also expect to ditch the brace and start water therapy. I’ll likely just walk the length of the pool, perhaps adding gentle straight-leg kicks to my routine. According to the rehab protocol, “the buoyancy of the water decreases the amount of weight-bearing forces” on the injured areas of the knee. Even before I hurt my knee, nobody ever confused my swimming prowess with Michael Phelps’s, so I’ll be curious to see how pathetic I’ll function in the water with my bum wheel. I might even wear floaties just to be safe.
17 days. That’s all it took to wipe out 4 months of solid exercise and healthy eating. The soulless combination of surgery and inactivity has inflicted serious damage to my body. Before the surgery, I wasn’t about to win any bodybuilding competitions, but I was in fairly decent shape. Now, the little bulging veins that once proudly rippled across my arms are gone, as are the 1- and 2-pack abs I developed. (The closest I got to a 6-pack was the Amstel in the fridge). My right quadriceps is flimsier than jello, to the point where the outside of my thigh is actually sunken in like a crackhead’s cheeks. In fact, my entire right leg looks homelier than an orphaned chicken. It’s shriveled up so much that the brace already is starting to slide off. The PT told me yesterday that my leg strength was “pathetic,” though that’s normal for folks at my stage. I haven’t stepped onto a scale, but I’ve probably lost 5-10 pounds, mainly because I lost all muscle definition in my upper and lower body. Plus, I eat less than a French super-model addicted to heroin. My body transformation is like the reverse Super Size Me.
To combat my Benjamin Button-like renovation, I resumed lifting weights today, in addition to my regular rehab exercises. I’m finally comfortable enough sitting up without putting any pressure on my outstretched gimpy leg. Using light dumbbells (10lbs), I did a variety of curls, military presses and delt raises. It’s not much, but hopefully it’ll stave off any further deterioration. This past week, I started taking regular showers again, and each glimpse at my new body humbles me. I’m just trying to hang on until the doctor clears me to resume normal exercise, which, unfortunately, probably won’t happen for at least another month. Once I reach 90 degrees flexion in my knee (I’m at 75 degrees now; hopefully I’ll hit 90 by the end of January), I’ll be able to start riding a stationary bike with no resistance. Nobody will mistake the biking I do for the Tour de France, but at least it's a form of cardio. At first, I’ll peddle for just a few minutes at a time, before slowly increasing the duration and eventually adding some resistance.
Around the 6-week mark, I also expect to ditch the brace and start water therapy. I’ll likely just walk the length of the pool, perhaps adding gentle straight-leg kicks to my routine. According to the rehab protocol, “the buoyancy of the water decreases the amount of weight-bearing forces” on the injured areas of the knee. Even before I hurt my knee, nobody ever confused my swimming prowess with Michael Phelps’s, so I’ll be curious to see how pathetic I’ll function in the water with my bum wheel. I might even wear floaties just to be safe.
Thursday, January 15, 2009
Two Week Update
It’s been 2 weeks since my ACI surgery. I can’t say time’s flown by, because there have been plenty of grueling moments to prolong most days. It also hasn’t helped that I’ve thrown 1 or 2 pity parties, temporarily cursing my decision to undergo this procedure. At the same time, the surgery feels like it happened ages ago, and, though I’ve got a long way to go, at least I know I’ve made some progress. In any event, remaining almost exclusively at home, spending most of the early days in bed, has jacked up my sense of time. Plus, I’ve been watching way too much Dora the Explorer, and that can’t be too good for my brain…
From a physical standpoint, I’m probably ahead of schedule. I realize it’s only been 2 weeks, but achieving these initial rehab goals has elevated my spirits. Trust me. I’ve been beaten down plenty of times, and I’m sure I’ll hit the wall at some point during rehab. However, having some accomplishments under my belt will facilitate my climb over those temporary obstacles. Wow. I’ve really embraced my inner philosopher. Call me SocrateJims. Or Homer Jim. No, wait, that’s too Simpsons-like. Let’s go with Aristotle Jim. Much better. Very regal-sounding.
I just started increasing my CPM again. I hit 75 degrees at the 1 ½ week mark, a relatively rapid rise. Because of the osteotomy, I’m supposed to remain at 75 until Week 3. Since today marks the start of week 3, I resumed my ROM increase. So far, the extra 5 degrees hasn’t felt any different. Indeed, the last 5 degrees of any target number are difficult. As the knee reaches the apex, the tension on the knee cap grows tighter than Joan Rivers’s face (as you can tell, I'm a big fan of face-lift jokes). Along the way, my knee’s “popped” several times. The popping didn’t hurt. To the contrary, it provided relief, much like you feel the moment after cracking your back first thing in the morning. I likely just worked through some adhesions, or scar tissue.
As I mentioned in earlier post, my OS left his practice group to open his own shop as of January 1st. Unfortunately, it was not a friendly split. Just like the practice of law isn’t strictly about providing legal advice, doctors also face business issues as well as dispensing medical advice. I don’t know the details of their split, and frankly I don’t care, except to the extent it impacts the quality of medical care I receive. Sadly, it did.
Turgeon’s old practice, Texas Sports Medicine and Orthopaedic Group, ignored 3 of my requests to transfer my medical files, as well as Turgeon’s request. Not only is this illegal and potentially exposes them to liability if something happens to my knee, it’s a stupid business decision. I’m a long-time patient of the practice group. The head doctor, Tarek Souryal, performed my shoulder surgery and evaluated my fractured vertebrae 14 years ago when I was still an SMU Law Student. Christina recently visited a different doctor within the practice to treat her wrist. Despite my long-standing relationship, the practice held my medical records hostage as part of its battle with Turgeon. My welfare, however, is not some bargaining chip to be leveraged. And it’s just fucking stupid to piss off a patient who also happens to be a lawyer. My personal legal skirmishes are legendary. Just ask the local dry cleaner who lost 7 custom-made shirts, and eventually had to cut me a check 10x greater than my initial settlement demand. There’s never been an idiot more deserving of his punishment.
On Wednesday, I stopped by the practice group to demand my records in-person. If they dicked me around, I was prepared to send them a nasty, “give me my records or suffer the consequences” letter. Although the office manager treated me coldly, she handed over my medical jacket, after charging me $25. Apparently, Texas law allows medical providers to charge patients a fee to retrieve and copy their medical records. While I think Dr. Souryal is a fantastic orthopedic surgeon, his group’s handling of this situation has poisoned my opinion of his practice.
From a physical standpoint, I’m probably ahead of schedule. I realize it’s only been 2 weeks, but achieving these initial rehab goals has elevated my spirits. Trust me. I’ve been beaten down plenty of times, and I’m sure I’ll hit the wall at some point during rehab. However, having some accomplishments under my belt will facilitate my climb over those temporary obstacles. Wow. I’ve really embraced my inner philosopher. Call me SocrateJims. Or Homer Jim. No, wait, that’s too Simpsons-like. Let’s go with Aristotle Jim. Much better. Very regal-sounding.
I just started increasing my CPM again. I hit 75 degrees at the 1 ½ week mark, a relatively rapid rise. Because of the osteotomy, I’m supposed to remain at 75 until Week 3. Since today marks the start of week 3, I resumed my ROM increase. So far, the extra 5 degrees hasn’t felt any different. Indeed, the last 5 degrees of any target number are difficult. As the knee reaches the apex, the tension on the knee cap grows tighter than Joan Rivers’s face (as you can tell, I'm a big fan of face-lift jokes). Along the way, my knee’s “popped” several times. The popping didn’t hurt. To the contrary, it provided relief, much like you feel the moment after cracking your back first thing in the morning. I likely just worked through some adhesions, or scar tissue.
As I mentioned in earlier post, my OS left his practice group to open his own shop as of January 1st. Unfortunately, it was not a friendly split. Just like the practice of law isn’t strictly about providing legal advice, doctors also face business issues as well as dispensing medical advice. I don’t know the details of their split, and frankly I don’t care, except to the extent it impacts the quality of medical care I receive. Sadly, it did.
Turgeon’s old practice, Texas Sports Medicine and Orthopaedic Group, ignored 3 of my requests to transfer my medical files, as well as Turgeon’s request. Not only is this illegal and potentially exposes them to liability if something happens to my knee, it’s a stupid business decision. I’m a long-time patient of the practice group. The head doctor, Tarek Souryal, performed my shoulder surgery and evaluated my fractured vertebrae 14 years ago when I was still an SMU Law Student. Christina recently visited a different doctor within the practice to treat her wrist. Despite my long-standing relationship, the practice held my medical records hostage as part of its battle with Turgeon. My welfare, however, is not some bargaining chip to be leveraged. And it’s just fucking stupid to piss off a patient who also happens to be a lawyer. My personal legal skirmishes are legendary. Just ask the local dry cleaner who lost 7 custom-made shirts, and eventually had to cut me a check 10x greater than my initial settlement demand. There’s never been an idiot more deserving of his punishment.
On Wednesday, I stopped by the practice group to demand my records in-person. If they dicked me around, I was prepared to send them a nasty, “give me my records or suffer the consequences” letter. Although the office manager treated me coldly, she handed over my medical jacket, after charging me $25. Apparently, Texas law allows medical providers to charge patients a fee to retrieve and copy their medical records. While I think Dr. Souryal is a fantastic orthopedic surgeon, his group’s handling of this situation has poisoned my opinion of his practice.
Tuesday, January 13, 2009
My First Outing
It was Road Trip time today. The first adventure for the bionic knee. Christina, Livi and I piled into Christina’s Sequoia for a trip to Northpark Mall. This was the first time I loaded myself into the Sequoia. Christina’s been driving her sister’s Subaru Impreza, which is much lower to the ground and thus easier to enter. But I deftly managed to yank on the “oh, shit” handles to pull myself up to the running boards, before butt-scooting across the back seat. Livi sat in the 3rd row. We conveniently found front-row parking at the mall, or, as a confused former colleague calls it, “porn star parking.” Don’t ask.
It was a pathetically short trip to the mall. I practiced placing 25% of my weight on my gimpy knee, which means octogenarians in walkers sped past me. I half-crutched, half-lumbered my way through Nordstrom’s and about 40 feet to the elevator. Totally wiped out. Livi grew frustrated waiting for my slow ass to catch up. After another 30 or so feet, I needed to rest on one of the wooden benches. I propped up my leg and struggled to gather my strength. 3-minute breather, I told myself. That’s all I need. I crutched another 30 feet before realizing I was done for the day. I felt like I had just finished one of those legendary workouts from the movie, “300.” And all I did was drag my gimpy knee a few hundred feet. Brutal.
The trip back to the car was deliberate and uneventful. Nobody plowed me over, and I didn’t face-plant at the mall. Feeling that exhausted was depressing, but I do feel a slight sense of accomplishment for making it out of the house. Baby steps. This is a marathon, no, an Ironman, and 13 days into the journey isn’t even a blip on the race course. At least that’s what I keep telling myself.
It was a pathetically short trip to the mall. I practiced placing 25% of my weight on my gimpy knee, which means octogenarians in walkers sped past me. I half-crutched, half-lumbered my way through Nordstrom’s and about 40 feet to the elevator. Totally wiped out. Livi grew frustrated waiting for my slow ass to catch up. After another 30 or so feet, I needed to rest on one of the wooden benches. I propped up my leg and struggled to gather my strength. 3-minute breather, I told myself. That’s all I need. I crutched another 30 feet before realizing I was done for the day. I felt like I had just finished one of those legendary workouts from the movie, “300.” And all I did was drag my gimpy knee a few hundred feet. Brutal.
The trip back to the car was deliberate and uneventful. Nobody plowed me over, and I didn’t face-plant at the mall. Feeling that exhausted was depressing, but I do feel a slight sense of accomplishment for making it out of the house. Baby steps. This is a marathon, no, an Ironman, and 13 days into the journey isn’t even a blip on the race course. At least that’s what I keep telling myself.
My First Follow-up with the OS
Real quick. You might’ve noticed the new profile picture. I haven’t shaved since the surgery, almost 2 weeks ago. This is my “Rocky training in Siberia for the Drago fight” look. It makes me feel tougher. And like a hobo, all at the same time. Amazing, huh? We’ll see how long the beard lasts.
12 days after the surgery, I met with Turgeon for my first follow-up. He says the knee looks good. No swelling. No bruising. I’m a fast healer, I guess. I asked if the implanted cartilage cells were working. He shrugged. At this point, he said, there’s no way to tell. He joked about simply letting the black box inside my knee work its magic. I liked that expression, and added it to my profile description. Turgeon plucked out about 25 staples from my knee. In rapid fire motion, he started with the staples near my shin and worked his way up to the ones on my thigh. It didn’t really hurt. A few times, the staple didn’t come out smoothly and some of the skin surrounding the staple got ripped out, like somebody who gets a bit overaggressive removing stapled pages of paper and winds up tearing off the top corner. Next, Turgeon lathered iodine up-and-down the incision to sterilize the wound, making my leg felt like a baby back rib. He then placed a number of steri-strips across the leg. The knee looks nasty. Let’s hope the expression, “chicks dig scars,” is true.
I attached 2 photos of my knee after the staples were removed. In the first photo, sans steri-strips, the scar looks off-center. I think that's just the camera angle. At least that's what I'm hoping.
Sleep is difficult, at best. If I’m lucky, I manage a 3-4 hour block of sleep. Most times, I wake up every 2 hours, sometimes with my knee in discomfort, sometimes because I simply can’t find an acceptable sleeping position. I’m not used to sleeping flat on my back. Last night, for example, I couldn’t fall asleep despite getting some long overdue nookie. Like most guys, stick a fork in me after nookie; I’m done. Content. Relaxed. Ready to enjoy a solid 8-hours’ worth of sleep. But not last night. My hamstring throbbed uncontrollably, likely the result of some strenuous stretching by my PT that morning. She told me my hamstring got tighter over the weekend. Not sure how that happened, but it’s not a good sign. Anyway, after failing to loosen up my hamstring (note: never a fun thing to try at 11:30pm with a sleep-deprived wife), I alternated between whining and crutching around the bedroom. Neither worked. Finally, at 3am I decided to hop into the CPM machine. I hoped the CPM would alleviate the hamstring discomfort, and perhaps rock me to sleep. Well, the CPM went 1-for-2. My hamstring stopped throbbing, but I could never fall asleep, no matter how many times my leg rhythmically rose up-and-down. After an hour in the machine, I woke up Christina to turn it off. I also asked her to grab me a vicodin. Poor Christina. She’s suffering as bad as me. Thank god our pre-nup is iron-clad or she would’ve walked out days ago. I jostled around for another thirty minutes before finally finding a comfortable position. I slept for 90 minutes until the alarm woke me up. Luckily, I don’t have to be anywhere, so I fell back to sleep for another 90 minutes, finally grabbing my morning coffee at 8am.
12 days after the surgery, I met with Turgeon for my first follow-up. He says the knee looks good. No swelling. No bruising. I’m a fast healer, I guess. I asked if the implanted cartilage cells were working. He shrugged. At this point, he said, there’s no way to tell. He joked about simply letting the black box inside my knee work its magic. I liked that expression, and added it to my profile description. Turgeon plucked out about 25 staples from my knee. In rapid fire motion, he started with the staples near my shin and worked his way up to the ones on my thigh. It didn’t really hurt. A few times, the staple didn’t come out smoothly and some of the skin surrounding the staple got ripped out, like somebody who gets a bit overaggressive removing stapled pages of paper and winds up tearing off the top corner. Next, Turgeon lathered iodine up-and-down the incision to sterilize the wound, making my leg felt like a baby back rib. He then placed a number of steri-strips across the leg. The knee looks nasty. Let’s hope the expression, “chicks dig scars,” is true.
I attached 2 photos of my knee after the staples were removed. In the first photo, sans steri-strips, the scar looks off-center. I think that's just the camera angle. At least that's what I'm hoping.
Sleep is difficult, at best. If I’m lucky, I manage a 3-4 hour block of sleep. Most times, I wake up every 2 hours, sometimes with my knee in discomfort, sometimes because I simply can’t find an acceptable sleeping position. I’m not used to sleeping flat on my back. Last night, for example, I couldn’t fall asleep despite getting some long overdue nookie. Like most guys, stick a fork in me after nookie; I’m done. Content. Relaxed. Ready to enjoy a solid 8-hours’ worth of sleep. But not last night. My hamstring throbbed uncontrollably, likely the result of some strenuous stretching by my PT that morning. She told me my hamstring got tighter over the weekend. Not sure how that happened, but it’s not a good sign. Anyway, after failing to loosen up my hamstring (note: never a fun thing to try at 11:30pm with a sleep-deprived wife), I alternated between whining and crutching around the bedroom. Neither worked. Finally, at 3am I decided to hop into the CPM machine. I hoped the CPM would alleviate the hamstring discomfort, and perhaps rock me to sleep. Well, the CPM went 1-for-2. My hamstring stopped throbbing, but I could never fall asleep, no matter how many times my leg rhythmically rose up-and-down. After an hour in the machine, I woke up Christina to turn it off. I also asked her to grab me a vicodin. Poor Christina. She’s suffering as bad as me. Thank god our pre-nup is iron-clad or she would’ve walked out days ago. I jostled around for another thirty minutes before finally finding a comfortable position. I slept for 90 minutes until the alarm woke me up. Luckily, I don’t have to be anywhere, so I fell back to sleep for another 90 minutes, finally grabbing my morning coffee at 8am.
Saturday, January 10, 2009
More Ramblings
• I had my second PT session. More leg bending and stretching. The PT also massaged my patella, which really weirds me out. Ever since I first hurt my knee back in high school, I get squeamish anytime somebody even brushes against my knee. I just do. In a few weeks, I’ll be expected to massage my own patella on a daily basis, something I’m dreading. The PT also performed a basic hamstring stretch. Pinning my left leg to the table, she slowly raised my straightened right leg as close to an L-shape as I could tolerate. Well, my hamstrings are tighter than Jerry Jones’s face. Even before my surgery I wasn’t flexible. I guess I should’ve taken yoga with Christina. Right now, I fear the hamstring stretches more than anything else during rehab. At the end of the session, my PT hooked me up an electro-shock stimulator. After wrapping my knee in cellophane and suffocating it in an ice pack, the stimulator sent a steady barrage of electric pricks and bolts to both sides of my knee for 15 minutes. It sounds very East German, and I wouldn’t be surprised to learn the SS used something similar. Luckily for me, I wasn’t being tortured.
• On Friday night, I got a change of scenery, moving from the bed to the living room couch so Christina and I could watch, Forgetting Sarah Marshall. Solid movie, though the guy’s excessive whining early in the movie initially made him unlikable. Plus, it didn’t help he was frontally naked in a few early scenes. Caught me totally off-guard. Movies should contain warnings about this. Thankfully, both the female stars – Mila Kunis and Kristen Bell – were extremely good-looking, Mila in particular.
• I spend 6-8 hours in the CPM machine every day. I’ve previously described the CPM as a motorized, oversizes knee bends that mechanically bends my knee. I made that description before I actually used the machine. The description remains accurate, but a better analogy would be a motorized, open-faced walking boot/cast with carpet lining. I usually use my CPM in bed. Christina lifts the machine (which isn’t exactly light) onto the bed, and slowly slides it forward until my foot rests flush against the walking boot/cast. Each day, I increase the ROM by 5 degrees. Today, I’m at 75 degrees, where I’ll remain until I see my OS on Monday. I need his clearance before going beyond 75 degrees. I can’t just turn on the machine and let the bending begin. I have to slowly work my way up to the final ROM number. I typically start at a ROM 5 degrees less than my target number, and increase it 2-3 degrees, until I reach my final ROM. It takes about 20 seconds for the CPM machine to rise 75 degrees, and another 20 seconds to descend. The first few knee bends are difficult. As my knee reaches its ROM apex, my body tenses despite my best efforts to remain relaxed, forcing a grimace during those final few degrees. After all, my knee is grinding its way through scar tissue, or whatever junk lingers inside my surgically repaired knee. After 30 or so minutes, my knee warms up. I eventually relax, seduced by the gentle swaying of the CPM, like my knee’s a baby in a rocking chair. Sometimes I read during CPM time; sometimes I nap. The other day, we took our CPM show on the road to the living room floor. Christina needed to do some PTA work on the desktop computer. Because the portable DVD player wasn’t working, I did my CPM on the floor in front of the living room TV. I watched 2 more episodes of Mad Men. Great show. Anyway, the floor is far less forgiving than my bed. While the bed “gives” a little when my knee lowers to 0 degrees, the floor holds steady. Consequently, my knee hyperextends fully. It’s like having a UFC fighter slap on a knee bar. And this discomfort doesn’t go away no matter how warmed up my knee gets. Not good times. I don’t think I’ll be doing my CPM on the floor anytime soon.
• On Friday night, I got a change of scenery, moving from the bed to the living room couch so Christina and I could watch, Forgetting Sarah Marshall. Solid movie, though the guy’s excessive whining early in the movie initially made him unlikable. Plus, it didn’t help he was frontally naked in a few early scenes. Caught me totally off-guard. Movies should contain warnings about this. Thankfully, both the female stars – Mila Kunis and Kristen Bell – were extremely good-looking, Mila in particular.
• I spend 6-8 hours in the CPM machine every day. I’ve previously described the CPM as a motorized, oversizes knee bends that mechanically bends my knee. I made that description before I actually used the machine. The description remains accurate, but a better analogy would be a motorized, open-faced walking boot/cast with carpet lining. I usually use my CPM in bed. Christina lifts the machine (which isn’t exactly light) onto the bed, and slowly slides it forward until my foot rests flush against the walking boot/cast. Each day, I increase the ROM by 5 degrees. Today, I’m at 75 degrees, where I’ll remain until I see my OS on Monday. I need his clearance before going beyond 75 degrees. I can’t just turn on the machine and let the bending begin. I have to slowly work my way up to the final ROM number. I typically start at a ROM 5 degrees less than my target number, and increase it 2-3 degrees, until I reach my final ROM. It takes about 20 seconds for the CPM machine to rise 75 degrees, and another 20 seconds to descend. The first few knee bends are difficult. As my knee reaches its ROM apex, my body tenses despite my best efforts to remain relaxed, forcing a grimace during those final few degrees. After all, my knee is grinding its way through scar tissue, or whatever junk lingers inside my surgically repaired knee. After 30 or so minutes, my knee warms up. I eventually relax, seduced by the gentle swaying of the CPM, like my knee’s a baby in a rocking chair. Sometimes I read during CPM time; sometimes I nap. The other day, we took our CPM show on the road to the living room floor. Christina needed to do some PTA work on the desktop computer. Because the portable DVD player wasn’t working, I did my CPM on the floor in front of the living room TV. I watched 2 more episodes of Mad Men. Great show. Anyway, the floor is far less forgiving than my bed. While the bed “gives” a little when my knee lowers to 0 degrees, the floor holds steady. Consequently, my knee hyperextends fully. It’s like having a UFC fighter slap on a knee bar. And this discomfort doesn’t go away no matter how warmed up my knee gets. Not good times. I don’t think I’ll be doing my CPM on the floor anytime soon.
Friday, January 9, 2009
Random Musings
I’ve got a couple of un-related things to share. Actually, they’re all related to my bum knee, but that’s pretty obvious at this point. I just can’t combine them in the same neat, packaged story as my previous posts, and alone they aren’t worthy of “feature” status as a stand-alone blog entry. But they’re still important enough (relatively, of course; “everything in life is relative” is one of my favorite expressions) that I wanted to share them.
• Fierce independence – On Thursday I continued my series of “firsts.” I got in and out of the bed on my own for the first time. I brushed my teeth in my own sink for the first time (previously Christina had brought a toothbrush and cup of water to bed). I used the grown-up potty for the first time (though I missed my urinal bottle, which is frightening). Later that day, I used the Cadillac of toilet seat risers for my first poop. I’m not sure which was odder – dumping on an elderly crapper without incident, or going 8 days between poops. And, drumroll please, I showered for the first time. Major adventure. I had to disrobe before crutching from the bed to the shower. There’s nothing more humiliating than naked crutching. We inserted a shower seat in the middle of the shower, held down by special adhesive bubbling. The seat is basically a white, plastic bench about as tall as a desk chair. There’s a red handle on the side furthest away from the shower head. I sat on the seat facing the shower door, with my left side closest to the shower head, using my right hand to grip the handle and leverage my bum knee. Getting into the shower was difficult. The doorway is fairly narrow, there’s a slight step up into the shower, and the shower seat is 1 foot away from the shower entrance. The placement alone is difficult to maneuver to, but then I’ve got to do it going sideways and backwards, on a potentially slippery surface, while keeping my right leg – which is encased in a multiple hefty bags to keep dry – elevated, and avoid banging it against things. This easily could be an Olympic sport. The shower itself was uneventful, though I felt bad for Christina because she had to sit just outside the shower, holding my right leg just off the ground. I did the best job possible. I still stink, but I’ll no longer turn heads. I figure I did no worse cleaning myself than little kids.
• Recurrence of shin pain. For the first time since Day 2, my osteotomy hurt. Perhaps the pain was a gentle reminder that I pushed myself too much during the day. Whatever the reason, I realized that life really sucks when your shin throbs uncontrollably.
• Home PT. With Christina’s help, I completed my first round of home exercises. After postponing the start of PT an hour or so because my shin hurt, we removed the knee brace on our own for the first time. Christina was more nervous handling my heavily bandaged knee than holding our oldest child as a newborn. We should’ve stuck on my leg a large “FRAGILE” sticker.
• Fierce independence – On Thursday I continued my series of “firsts.” I got in and out of the bed on my own for the first time. I brushed my teeth in my own sink for the first time (previously Christina had brought a toothbrush and cup of water to bed). I used the grown-up potty for the first time (though I missed my urinal bottle, which is frightening). Later that day, I used the Cadillac of toilet seat risers for my first poop. I’m not sure which was odder – dumping on an elderly crapper without incident, or going 8 days between poops. And, drumroll please, I showered for the first time. Major adventure. I had to disrobe before crutching from the bed to the shower. There’s nothing more humiliating than naked crutching. We inserted a shower seat in the middle of the shower, held down by special adhesive bubbling. The seat is basically a white, plastic bench about as tall as a desk chair. There’s a red handle on the side furthest away from the shower head. I sat on the seat facing the shower door, with my left side closest to the shower head, using my right hand to grip the handle and leverage my bum knee. Getting into the shower was difficult. The doorway is fairly narrow, there’s a slight step up into the shower, and the shower seat is 1 foot away from the shower entrance. The placement alone is difficult to maneuver to, but then I’ve got to do it going sideways and backwards, on a potentially slippery surface, while keeping my right leg – which is encased in a multiple hefty bags to keep dry – elevated, and avoid banging it against things. This easily could be an Olympic sport. The shower itself was uneventful, though I felt bad for Christina because she had to sit just outside the shower, holding my right leg just off the ground. I did the best job possible. I still stink, but I’ll no longer turn heads. I figure I did no worse cleaning myself than little kids.
• Recurrence of shin pain. For the first time since Day 2, my osteotomy hurt. Perhaps the pain was a gentle reminder that I pushed myself too much during the day. Whatever the reason, I realized that life really sucks when your shin throbs uncontrollably.
• Home PT. With Christina’s help, I completed my first round of home exercises. After postponing the start of PT an hour or so because my shin hurt, we removed the knee brace on our own for the first time. Christina was more nervous handling my heavily bandaged knee than holding our oldest child as a newborn. We should’ve stuck on my leg a large “FRAGILE” sticker.
Thursday, January 8, 2009
PT Session #1
I accomplished a series of “firsts” today. First week post-surgery. First trip out of the house. First PT session. First time surfing one of those websites (ok, that one’s not true). And, first time seeing the Franken-Scar. That’s right – the PT removed all of the knee bandages, and I got a birds-eye peek at that monstrosity. Christina snapped a few shots on her cell phone, and those pictures are posted below. Christina and I agreed that the knee looks much worse on camera.
My PT is a 50-ish lady, Judy Holmes. My OS described her as the tough-loving type, though he said she always dishes the pain with a smile. Sadistic Judy might emerge over the next year, but I met a polite, polished, well-traveled woman who manipulated my knee while simultaneously sharing her German travel adventures. Christina, who lived in Germany for several years, remained with me during PT. Imagine the joys of hearing about Wurzburg, Neuschwanstein, and Stuttgard, or some other place I can’t pronounce or spell, while my knee is grinding through 14 layers of scar tissue. (Not that there’s anything wrong with German cities). At one point, I thought Judy got so engrossed in her conversation with Christina that she forgot about my gimpy knee. But then I remembered nobody could ignore my foul body odor. I haven’t showered since the surgery, exactly 1 week ago. I’ve had a couple of “baths” with baby wipes and hot towels, but trust me -- I need a full-fledged hosing; the kind of shower where you burn through two bottles of shampoo. We’re definitely throwing away every bed sheet used this past week. Today, I was so stinky (chorus: How stinky were you?). I was so stinky that I scared away the bums panhandling outside the PT building. Buh-dum-bum.
The PT session went well. My knee has little swelling and minimal bruising, all pretty shocking considering it’s only been 1 week since my knee endured a significant amount of trauma. Judy thought the knee is healing well. The scar, in all its glory, was a freaky sight to behold. The doctor can warn you about winding up with a 13-inch scar. But, with the staples still in, you can never be prepared for the sight of a metallic bolt snaking up from your shin to your lower thigh. My scar looked like miniature railway tracks. Or a zipper on a kid’s coat. Seriously, you could zip up my 3-year old with that thing.
Ok, here are 2 pictures of the scar, one showing it vertically, the other a horizontal angle. The yellow string running parallel to the scar below the knee is just leftover tape. In the horizontal picture, I think my leg looks creepy, like the leg of a really old man or something out of a morgue. My leg still has a solid tinge of yellow-orange iodine which clashes with my really pasty undersurface. I think that actually distorts the photo’s coloring a bit. I also think my leg looks weird shaved, even more so because it’s partially-shaved. In the vertical scar photo, you can see the hair growth on the top of my thigh. Anyway, enjoy the pictures. I’ll post another batch after Turgeon removes the staples.
Judy says my flexion and leg strength are greater than most people at 1 week out. (I asked her to put the gold-star on my brace). I’m currently at 60 degrees on the CPM. Today, she measured my flexion “free-standing” – which means bending the knee over the edge of the table on my own. I hit 55 degrees without effort. Judy says most people fall well short of their CPM number, especially early on, so she was pleased with my progress. She demonstrated a host of various ankle bends (with and without bands), leg raises, and side abductor moves, and gave me a list of 6 exercises to do each day on my own. I start my home therapy tomorrow. For the foreseeable future, I’m meeting Judy twice/week. And so the fun begins.
(Quick archiving/labeling note: From here forward, I plan to label my PT sessions by week, and probably note my OS visits by number. My first visit with Turgeon is on Monday. Each post will also contain a label for the post-op week number. This might help you search through postings or find an old one, assuming that’s possible. It will help me track the progress I’ve made)
My PT is a 50-ish lady, Judy Holmes. My OS described her as the tough-loving type, though he said she always dishes the pain with a smile. Sadistic Judy might emerge over the next year, but I met a polite, polished, well-traveled woman who manipulated my knee while simultaneously sharing her German travel adventures. Christina, who lived in Germany for several years, remained with me during PT. Imagine the joys of hearing about Wurzburg, Neuschwanstein, and Stuttgard, or some other place I can’t pronounce or spell, while my knee is grinding through 14 layers of scar tissue. (Not that there’s anything wrong with German cities). At one point, I thought Judy got so engrossed in her conversation with Christina that she forgot about my gimpy knee. But then I remembered nobody could ignore my foul body odor. I haven’t showered since the surgery, exactly 1 week ago. I’ve had a couple of “baths” with baby wipes and hot towels, but trust me -- I need a full-fledged hosing; the kind of shower where you burn through two bottles of shampoo. We’re definitely throwing away every bed sheet used this past week. Today, I was so stinky (chorus: How stinky were you?). I was so stinky that I scared away the bums panhandling outside the PT building. Buh-dum-bum.
The PT session went well. My knee has little swelling and minimal bruising, all pretty shocking considering it’s only been 1 week since my knee endured a significant amount of trauma. Judy thought the knee is healing well. The scar, in all its glory, was a freaky sight to behold. The doctor can warn you about winding up with a 13-inch scar. But, with the staples still in, you can never be prepared for the sight of a metallic bolt snaking up from your shin to your lower thigh. My scar looked like miniature railway tracks. Or a zipper on a kid’s coat. Seriously, you could zip up my 3-year old with that thing.
Ok, here are 2 pictures of the scar, one showing it vertically, the other a horizontal angle. The yellow string running parallel to the scar below the knee is just leftover tape. In the horizontal picture, I think my leg looks creepy, like the leg of a really old man or something out of a morgue. My leg still has a solid tinge of yellow-orange iodine which clashes with my really pasty undersurface. I think that actually distorts the photo’s coloring a bit. I also think my leg looks weird shaved, even more so because it’s partially-shaved. In the vertical scar photo, you can see the hair growth on the top of my thigh. Anyway, enjoy the pictures. I’ll post another batch after Turgeon removes the staples.
Judy says my flexion and leg strength are greater than most people at 1 week out. (I asked her to put the gold-star on my brace). I’m currently at 60 degrees on the CPM. Today, she measured my flexion “free-standing” – which means bending the knee over the edge of the table on my own. I hit 55 degrees without effort. Judy says most people fall well short of their CPM number, especially early on, so she was pleased with my progress. She demonstrated a host of various ankle bends (with and without bands), leg raises, and side abductor moves, and gave me a list of 6 exercises to do each day on my own. I start my home therapy tomorrow. For the foreseeable future, I’m meeting Judy twice/week. And so the fun begins.
(Quick archiving/labeling note: From here forward, I plan to label my PT sessions by week, and probably note my OS visits by number. My first visit with Turgeon is on Monday. Each post will also contain a label for the post-op week number. This might help you search through postings or find an old one, assuming that’s possible. It will help me track the progress I’ve made)
Tuesday, January 6, 2009
The Chills
Every morning or evening (sometimes both), I take a leisurely stroll around the bedroom. It’s kind of like mall walking, except that I’m on crutches and I don’t travel further than 20 yards. Plus, it takes about 10x as long to get ready for the walk and the subsequent “cool-down,” as it does to crutch around the room.
After 5 days, we’ve developed a pretty decent routine to get out of the bed. I sleep on the right side of the bed, closest to the door and the bathroom. When I roll out of bed (not literally, of course; that would hurt. Plus, I’m not 3 years old), I lead with my gimpy right knee.
First, Christina “clears the runway,” moving anything clogging up the area surrounding the bed. I slowly sit up completely erect. Christina gingerly places both hands under my right leg and, using my left leg as a propeller, I pivot my butt sideways until Christina guides the right leg to the edge of the bed. Sometimes we do this in one shot; sometimes it takes 2-3 slides/shuffles. Eventually I reach the edge of the side of the bed, with both feet dangling over. My right leg, however, is not allowed to touch the floor, or “bear weight.” The only time my right leg touches the floor is when I use my big toe for balance. Christina hands me both crutches, and, exploding off my left leg, I hoist myself up to my feet, keeping my crutches splayed at wider than normal angles for increased balance. I generally pause for a moment after standing up, to ensure I don’t immediately topple over with sudden dizziness. For normal, able-bodied folks, this process should take no more than 2 seconds; 3 tops. It takes me a little more than 2 minutes, and then another 30 seconds to recover before beginning my lap.
Standing up really isn’t that painful, so long as I avoid any odd tweaks to the knee. Or if Christina gets angry at me and drops my leg, which hasn’t happened. Yet. Standing up, however, releases all the pent-up blood flow that remained idle while I was flat on my back, creating a monotonous throbbing pain throughout my leg. Pain, I can handle. Even if my shin hurts, I simply find my happy place. Immediately. Like I’ve said before, the screws inserted during the osteotomy hurt the worst.
Once I regain the color to my face, it’s time to begin my leisurely crutching stroll. After gathering my composure, I slowly crutch my way left, down the side of the bed, squeezing my crutches between the edge of the bed post and the oversized green chair our neighbors gave us last year. Christina loves reading in this chair. From there, I continue my counter-clockwise movement to crutch along the foot of the bed, which stretches about 6 yards, or a good Adrian Peterson carry. I could turn left again back down the far side of the bed, but the alley there is a bit narrow and by this point I’m running out of gas.
It’s time to turn around. Looking like the talented hip-hop artist I secretly am, I pivot around 180 degrees on my left foot in 3 or 4 choreographed hops, until I’m facing the opposite direction. Actually, I’m really not that rhythmic, so this is when I fear falling down the most. I maneuver my way back to my starting point, with my butt resting on the side of the bed. Again, I take a few moments to recover from my strenuous outing. Phew, crutching back-and-forth across the bedroom really taxes the body. It’s my personal Ironman Challenge. I just don’t want to be the guy on the highlight shows who spasms across the finish line in complete darkness.
Normally, this activity is notable only for the times I tweak my knee or shin bone. Last night, however, was a different story. After I returned to my prone position on the bed, I suffered from a terrible case of the chills. My teeth chattered for 10 minutes, like one of those denture props given as gag gifts. The symptoms were so over-the-top that a stranger easily would’ve thought I was faking. I couldn’t stop shaking. My chest and legs convulsed uncontrollably. Even my bum knee shook, which frightened me, though it didn’t cause any pain. In some ways, it was kinda cute seeing my gimpy knee wiggle inside the mammoth knee brace, like watching a small child playfully struggle in the strong arms of a parent. For unknown reasons, I tried to picture my knee in a tuxedo t-shirt because, as Ricky Bobby said, a tuxedo t-shirt says “I want to be formal, but I’m here to party.” Like I said, drugs make people think of odd things. You can only imagine what the vicodin is doing to my already distorted mind.
My body just felt like it got pulled from the Artic. Not even the magical Tiger blanket Nanna gave me as a child could keep me warm. I mean, Tiger blanket cures all. Not this time.
Eventually the chills stopped, and life returned to normal. Well, as “normal” as ACI recovery can be. I guess my body finally exuded the yoga-esque calmness needed to end the shakes. A few minutes later I finished Disc 2 of Season One of Mad Men. Great show. Anyway, very odd way to end the day.
My first PT visit is tomorrow (Wednesday). I have no expectations, only that the actual therapy session will hurt, as will getting in and out of the car. So far, I’ve encountered no major difficulties with the CPM machine. I’ve steadily increased my ROM 5 degrees/day, as instructed, going from 30 degrees on the night of the surgery to 60 degrees today. In other words, I remain “on schedule” through week one of my anticipated 78-week rehab (1 ½ years) schedule.
After 5 days, we’ve developed a pretty decent routine to get out of the bed. I sleep on the right side of the bed, closest to the door and the bathroom. When I roll out of bed (not literally, of course; that would hurt. Plus, I’m not 3 years old), I lead with my gimpy right knee.
First, Christina “clears the runway,” moving anything clogging up the area surrounding the bed. I slowly sit up completely erect. Christina gingerly places both hands under my right leg and, using my left leg as a propeller, I pivot my butt sideways until Christina guides the right leg to the edge of the bed. Sometimes we do this in one shot; sometimes it takes 2-3 slides/shuffles. Eventually I reach the edge of the side of the bed, with both feet dangling over. My right leg, however, is not allowed to touch the floor, or “bear weight.” The only time my right leg touches the floor is when I use my big toe for balance. Christina hands me both crutches, and, exploding off my left leg, I hoist myself up to my feet, keeping my crutches splayed at wider than normal angles for increased balance. I generally pause for a moment after standing up, to ensure I don’t immediately topple over with sudden dizziness. For normal, able-bodied folks, this process should take no more than 2 seconds; 3 tops. It takes me a little more than 2 minutes, and then another 30 seconds to recover before beginning my lap.
Standing up really isn’t that painful, so long as I avoid any odd tweaks to the knee. Or if Christina gets angry at me and drops my leg, which hasn’t happened. Yet. Standing up, however, releases all the pent-up blood flow that remained idle while I was flat on my back, creating a monotonous throbbing pain throughout my leg. Pain, I can handle. Even if my shin hurts, I simply find my happy place. Immediately. Like I’ve said before, the screws inserted during the osteotomy hurt the worst.
Once I regain the color to my face, it’s time to begin my leisurely crutching stroll. After gathering my composure, I slowly crutch my way left, down the side of the bed, squeezing my crutches between the edge of the bed post and the oversized green chair our neighbors gave us last year. Christina loves reading in this chair. From there, I continue my counter-clockwise movement to crutch along the foot of the bed, which stretches about 6 yards, or a good Adrian Peterson carry. I could turn left again back down the far side of the bed, but the alley there is a bit narrow and by this point I’m running out of gas.
It’s time to turn around. Looking like the talented hip-hop artist I secretly am, I pivot around 180 degrees on my left foot in 3 or 4 choreographed hops, until I’m facing the opposite direction. Actually, I’m really not that rhythmic, so this is when I fear falling down the most. I maneuver my way back to my starting point, with my butt resting on the side of the bed. Again, I take a few moments to recover from my strenuous outing. Phew, crutching back-and-forth across the bedroom really taxes the body. It’s my personal Ironman Challenge. I just don’t want to be the guy on the highlight shows who spasms across the finish line in complete darkness.
Normally, this activity is notable only for the times I tweak my knee or shin bone. Last night, however, was a different story. After I returned to my prone position on the bed, I suffered from a terrible case of the chills. My teeth chattered for 10 minutes, like one of those denture props given as gag gifts. The symptoms were so over-the-top that a stranger easily would’ve thought I was faking. I couldn’t stop shaking. My chest and legs convulsed uncontrollably. Even my bum knee shook, which frightened me, though it didn’t cause any pain. In some ways, it was kinda cute seeing my gimpy knee wiggle inside the mammoth knee brace, like watching a small child playfully struggle in the strong arms of a parent. For unknown reasons, I tried to picture my knee in a tuxedo t-shirt because, as Ricky Bobby said, a tuxedo t-shirt says “I want to be formal, but I’m here to party.” Like I said, drugs make people think of odd things. You can only imagine what the vicodin is doing to my already distorted mind.
My body just felt like it got pulled from the Artic. Not even the magical Tiger blanket Nanna gave me as a child could keep me warm. I mean, Tiger blanket cures all. Not this time.
Eventually the chills stopped, and life returned to normal. Well, as “normal” as ACI recovery can be. I guess my body finally exuded the yoga-esque calmness needed to end the shakes. A few minutes later I finished Disc 2 of Season One of Mad Men. Great show. Anyway, very odd way to end the day.
My first PT visit is tomorrow (Wednesday). I have no expectations, only that the actual therapy session will hurt, as will getting in and out of the car. So far, I’ve encountered no major difficulties with the CPM machine. I’ve steadily increased my ROM 5 degrees/day, as instructed, going from 30 degrees on the night of the surgery to 60 degrees today. In other words, I remain “on schedule” through week one of my anticipated 78-week rehab (1 ½ years) schedule.
Monday, January 5, 2009
The Surgery Hangover
People historically spend New Year’s Eve under the influence, and then the following day they battle evil little gnomes playing ping-pong between their temples. My experience, frankly, wasn’t all that different. In fact, the evil gnomes inside my head kept me from blogging until Sunday night. Or maybe that really was Kathy Bates from Misery hovering over my blog and gimpy knee, declaring “I am your number one fan!” Drugs make you see weird shit, people.
But first, an important announcement. Over the past 4 days, I shattered Kobayashi’s world record for most Graham crackers consumed. I didn’t just break his record. I put up a number beyond the reach of even Joey Chestnut after a one-week fast. This was like Babe Ruth doubling the single season home run record in back-to-back years.
Ok, here’s the big picture -- the surgery went fine, at least as well as can be expected. The lesions were larger than they were during the scope, which was expected. I won’t know their exact size or particulars until my first follow-up appointment on Jan. 12. The OS did tell Christina in the waiting area that my knee was a mess. I’m a “knee-abuser,” he likes to say. I’m not sure if that’s his way of being funny or just his favorite adjective.
Anyway, here’s how the Dec. 31st surgery unfolded, as well as Jan. 1st, or what I like to call the single worst day of my life. The next few days kinda blended together, so I just summarized them collectively.
I arrived at the surgery center at 6am. A white cardboard box with a purple and green “Carticel” logo greeted me at the reception desk. Those were the vials of my knee cartilage. Somehow, I didn’t envision this process beginning with my cloned cells sitting in a non-descript box waiting to be checked in by a receptionist in desperate need of a second cup of coffee. Kinda took the sci-fi edge off the experience, you know? But at least I knew the surgical team wouldn’t be waiting around for the FedEx guy to show up.
This surgery got underway much faster than my scope did 6 weeks ago. The anesthesiologist walked me through the risks, etc., and began describing a femoral nerve block when the OS entered the room. Turgeon simply said, yes, you’re giving him the nerve block, told Christina to kiss me good-bye, and announced he was ready to go. All business. Turgeon had on his surgical game face.
During the last surgery, I remained awake as they wheeled me back into the OR. The anesthesiologist and I actually talked about the current economy and its impact on law firms before I went to sleep. Very sophisticated pre-op conversation. This time, I vaguely remember getting stuck with the needle used for the femoral nerve block, and I was out cold before we left the waiting room. The last thing I remembered before going under was how my left leg – the good leg – wouldn’t stop twitching. I don’t know why. Nerves, maybe? Buh-dum-bum. Thank you, thank you. I’ll be here all week.
The surgery lasted about 3 hours. I awoke in a haze of drugs and was unable to keep my eyes open for longer than 4 seconds. But I was able to cram down 2 packs of Graham crackers and a bottle of Sprite every 3 minutes. I was just starting my 4-minute mile pace. I thought the OR staff might leave a cloned hand in the bed next to me as a joke. I guess they don’t share my sense of humor.
At this point, I wasn’t in much pain. It turns out I just couldn’t feel any pain yet because the nerve block was still in effect. The pain – that sneaky bastard – was waiting until I left the hospital. It’s kinda like a car that stops rattling the second you arrive at the mechanic's shop. It’s not fixed; the car’s just playing coy. It was time to leave the safety of the surgery center for the very dangerous Casa de Etri.
FULL DISCLOSURE – TMI WARNING. I don’t get embarrassed, but the rest of the blog entry contains a smattering of Too Much Information. Fair warning.
We arrived home and our bedroom was set up like NORAD’s Command Center. Well, if NORAD had baby wipes and a plastic bottle urinal on a king-sized bed in the middle of the room. We did have walkie talkies, but they weren’t battle-field tested. Instead, they were the Walmart kind, designed for me to page Christina in the bedroom if I needed something. I surveyed the scene like an intrepid field general and quickly realized the next few weeks of recovery would provide a sneak preview of what Christina and I could expect when we’re 90, assuming she hasn’t traded me in for a younger cloned knee. Actually, now that I think about it, the army reference isn’t too far off. The evening before the surgery, I got the military haircut. I figured I wouldn’t be able to shower regularly, if at all, these first few weeks. The downside is that when I eventually emerge from hibernation with the shaved head and bandaged leg, I will look like an injured Gulf War veteran. That might lead to some awkward moments.
Since the surgery, I’ve spent 23 hours, 55 minutes of each day lying flat of my back. Incapable of performing even rudimentary functions, I now fully appreciate why the elderly quickly lose the will to live once their dignity goes. I can’t understate enough how totally useless I’ve been. Christina quite literally just had her 3rd baby, only I need more attention than the occasional breast-feeding and burping. Luckily for all involved, I haven’t needed a diaper change, but I’ll get to that shortly.
Let me state clearly that Christina has been a champ (she demanded that I acknowledge her assistance publicly). She’s easily the front-runner for 2009's Wife of the Year. I need Christina’s help to do anything. From propping me up so I can shovel down another batch of those record-setting Graham crackers, to loading me into the CPM machine for my 3 daily sessions, to replenishing the ice in my polar-care coolant. I can’t imagine going through this alone, or without somebody as unconditionally giving as Christina has been. For her handsome reward, I promise to get her some really swell hand lotion. Nothing says a combined, “thanks” and “I love you” more than the gift of hand lotion. Just kidding. The keys to the castle are yours; just remember we live in a gov’t-funded castle.
The first time I sat up in bed with Christina’s help, I turned whiter than a KKK rally. Since ghastly pale isn’t a good color for me, we agreed it would be wiser to use a urinal rather than battle excruciating pain every time I went potty. Honestly, I’m a bit disappointed I haven’t used the Cadillac of toilet seat risers just yet. I know you’re anxiously anticipating my first report. But the urinal has not been without its joys. One of the small pleasures I enjoy each day is using the walkie talkie to advise Christina that I have just gone potty, which is really just the polite way of telling her to empty my bed pan. I know she looks forward to those calls, too. One time, I must’ve taken too much glee because she “accidentally” failed to dry off the urinal, so I got a nice little treat the next time I peed. Women are evil, even those that provide unflappable care.
I was about to detail the moment the femoral nerve block wore off and I accidentally triggered the screws inserted during the oseteotomy by firing my quad muscles, but I won’t channel my inner-Stephen King to share the horrific details. I’ll just say it’s the worst pain I’ve ever felt, like a piping hot knife slowly slashing across your shin bone. The pain went away about 40 minutes later, after I called my OS and he berated me for being an idiot for tying to move my quads. Point taken, sir.
Ok, I think that’s enough to memorialize my surgical and immediate post-op experiences. They say each day the knee gets a little bit better, so, in my opinion, that first year can’t pass soon enough. Like Short Round famously said, “Hold on lady. We go for ride.”
But first, an important announcement. Over the past 4 days, I shattered Kobayashi’s world record for most Graham crackers consumed. I didn’t just break his record. I put up a number beyond the reach of even Joey Chestnut after a one-week fast. This was like Babe Ruth doubling the single season home run record in back-to-back years.
Ok, here’s the big picture -- the surgery went fine, at least as well as can be expected. The lesions were larger than they were during the scope, which was expected. I won’t know their exact size or particulars until my first follow-up appointment on Jan. 12. The OS did tell Christina in the waiting area that my knee was a mess. I’m a “knee-abuser,” he likes to say. I’m not sure if that’s his way of being funny or just his favorite adjective.
Anyway, here’s how the Dec. 31st surgery unfolded, as well as Jan. 1st, or what I like to call the single worst day of my life. The next few days kinda blended together, so I just summarized them collectively.
I arrived at the surgery center at 6am. A white cardboard box with a purple and green “Carticel” logo greeted me at the reception desk. Those were the vials of my knee cartilage. Somehow, I didn’t envision this process beginning with my cloned cells sitting in a non-descript box waiting to be checked in by a receptionist in desperate need of a second cup of coffee. Kinda took the sci-fi edge off the experience, you know? But at least I knew the surgical team wouldn’t be waiting around for the FedEx guy to show up.
This surgery got underway much faster than my scope did 6 weeks ago. The anesthesiologist walked me through the risks, etc., and began describing a femoral nerve block when the OS entered the room. Turgeon simply said, yes, you’re giving him the nerve block, told Christina to kiss me good-bye, and announced he was ready to go. All business. Turgeon had on his surgical game face.
During the last surgery, I remained awake as they wheeled me back into the OR. The anesthesiologist and I actually talked about the current economy and its impact on law firms before I went to sleep. Very sophisticated pre-op conversation. This time, I vaguely remember getting stuck with the needle used for the femoral nerve block, and I was out cold before we left the waiting room. The last thing I remembered before going under was how my left leg – the good leg – wouldn’t stop twitching. I don’t know why. Nerves, maybe? Buh-dum-bum. Thank you, thank you. I’ll be here all week.
The surgery lasted about 3 hours. I awoke in a haze of drugs and was unable to keep my eyes open for longer than 4 seconds. But I was able to cram down 2 packs of Graham crackers and a bottle of Sprite every 3 minutes. I was just starting my 4-minute mile pace. I thought the OR staff might leave a cloned hand in the bed next to me as a joke. I guess they don’t share my sense of humor.
At this point, I wasn’t in much pain. It turns out I just couldn’t feel any pain yet because the nerve block was still in effect. The pain – that sneaky bastard – was waiting until I left the hospital. It’s kinda like a car that stops rattling the second you arrive at the mechanic's shop. It’s not fixed; the car’s just playing coy. It was time to leave the safety of the surgery center for the very dangerous Casa de Etri.
FULL DISCLOSURE – TMI WARNING. I don’t get embarrassed, but the rest of the blog entry contains a smattering of Too Much Information. Fair warning.
We arrived home and our bedroom was set up like NORAD’s Command Center. Well, if NORAD had baby wipes and a plastic bottle urinal on a king-sized bed in the middle of the room. We did have walkie talkies, but they weren’t battle-field tested. Instead, they were the Walmart kind, designed for me to page Christina in the bedroom if I needed something. I surveyed the scene like an intrepid field general and quickly realized the next few weeks of recovery would provide a sneak preview of what Christina and I could expect when we’re 90, assuming she hasn’t traded me in for a younger cloned knee. Actually, now that I think about it, the army reference isn’t too far off. The evening before the surgery, I got the military haircut. I figured I wouldn’t be able to shower regularly, if at all, these first few weeks. The downside is that when I eventually emerge from hibernation with the shaved head and bandaged leg, I will look like an injured Gulf War veteran. That might lead to some awkward moments.
Since the surgery, I’ve spent 23 hours, 55 minutes of each day lying flat of my back. Incapable of performing even rudimentary functions, I now fully appreciate why the elderly quickly lose the will to live once their dignity goes. I can’t understate enough how totally useless I’ve been. Christina quite literally just had her 3rd baby, only I need more attention than the occasional breast-feeding and burping. Luckily for all involved, I haven’t needed a diaper change, but I’ll get to that shortly.
Let me state clearly that Christina has been a champ (she demanded that I acknowledge her assistance publicly). She’s easily the front-runner for 2009's Wife of the Year. I need Christina’s help to do anything. From propping me up so I can shovel down another batch of those record-setting Graham crackers, to loading me into the CPM machine for my 3 daily sessions, to replenishing the ice in my polar-care coolant. I can’t imagine going through this alone, or without somebody as unconditionally giving as Christina has been. For her handsome reward, I promise to get her some really swell hand lotion. Nothing says a combined, “thanks” and “I love you” more than the gift of hand lotion. Just kidding. The keys to the castle are yours; just remember we live in a gov’t-funded castle.
The first time I sat up in bed with Christina’s help, I turned whiter than a KKK rally. Since ghastly pale isn’t a good color for me, we agreed it would be wiser to use a urinal rather than battle excruciating pain every time I went potty. Honestly, I’m a bit disappointed I haven’t used the Cadillac of toilet seat risers just yet. I know you’re anxiously anticipating my first report. But the urinal has not been without its joys. One of the small pleasures I enjoy each day is using the walkie talkie to advise Christina that I have just gone potty, which is really just the polite way of telling her to empty my bed pan. I know she looks forward to those calls, too. One time, I must’ve taken too much glee because she “accidentally” failed to dry off the urinal, so I got a nice little treat the next time I peed. Women are evil, even those that provide unflappable care.
I was about to detail the moment the femoral nerve block wore off and I accidentally triggered the screws inserted during the oseteotomy by firing my quad muscles, but I won’t channel my inner-Stephen King to share the horrific details. I’ll just say it’s the worst pain I’ve ever felt, like a piping hot knife slowly slashing across your shin bone. The pain went away about 40 minutes later, after I called my OS and he berated me for being an idiot for tying to move my quads. Point taken, sir.
Ok, I think that’s enough to memorialize my surgical and immediate post-op experiences. They say each day the knee gets a little bit better, so, in my opinion, that first year can’t pass soon enough. Like Short Round famously said, “Hold on lady. We go for ride.”
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