Easter Sunday here in the Big Sandy and I had a physio therapy session today.
My post Operative goals for the first 6 weeks were: by the end of week 2 bending to 40 degrees, end of week 4 bending to 60 degrees, and the end of week 6 bending to 90 degrees.
Today was 6 weeks and 2 days post op - I was bending to 110 degrees!!!
Big milestones in my therapy are things like full weight bearing, no crutches, no brace, straight leg lifts, functional quadricep muscles (no driving a vehicle without those!), pedalling on a stationary bike, having a bath, having a shower.... all fairly mundane things but huge steps in my recovery.
I've been full weight bearing for a couple of weeks now; crutch and brace free (using a cane when I am outside my apartment) for 10 days (bath was achieved at 9 days post op and shower was achieved at 5 weeks). ALL big steps to independence and knee health.
I have not been able to activate my quadriceps successfully - until today. (big grin). Today I was able to contract my quads (I still have good, strong muscle contractions) while seated in a chair and with effort straighten my lower leg and raise it to a 45 degree angle! This is huge. I managed to do 10, slow, steady lower leg raises!!!! WOOO HOOO!!!!!
Today was also a big step in the bending department in only 7 days I have gone from 95 degrees (with tension and some discomfort) to 110 degrees (much less tension and decreased discomfort!). This increased Range of Motion (ROM) meant I was able to get full forward rotation on the pedals of the stationary bike (and while pedalling my ROM was closer to 115 degrees). My knee is still tight so no stationary bike at home this week and a retry next week during physio MIGHT mean I am cleared to stationary bike at home 10 - 15 minutes a day. This biking will help restore my poor atrophied quads, lubricate my hip and knee joints, and move that step closer to functional quads (and independence!)
I am super pleased that things are going well.
It is easy to get frustrated and down when something as simple and mundane as getting yourself a cup of coffee ( difficult to carry while on crutches) or rolling over in bed (atrophied quads make this a difficulty) are big challenges. But, remembering that each day is a bit better than the last and, in my case, I have been there / done this only a few months ago when I "kicked butt and didn't take prisoners" on that recovery so, I can do this again (pfft, no biggie).
Sunday, April 5, 2015
Friday, April 3, 2015
My not so adventure filled life
So, it has been awhile since I have been here... basically things have been pretty quiet and therefore not much to write about.
Well, except for the last 6 months...
In October 2014 I had knee surgery to replace a problematic Medial Patella Femoral Ligament (MPFL) on my right leg. Things went pretty smoothly with that process. I opted for a regional / spinal / epidural type anesthetic so I was able to watch the arthroscopy and the rest of the surgery.
The operation involved: harvesting a semitendinous hamstring and inserting the new "ligament" in to the patella with 2 swivel locks and the opposing end in to the femur with a screw - the swivel locks and screw are bio-absorbable and don't show up on X-rays. All in all I was in the operating room for a bit over 90 minutes.
The Hospital was really nice - more akin to a 5 star hotel than a typical hospital. The bathroom had a bath, shower, and all the little travel amenities that you find in a hotel.
I stayed in hospital for 2 nights and was sent home with 3 nights of "significant" pain medication .... there is a great concern where I am that pain medication (Doctor prescribed Morphine while in hospital for example) will cause addiction so, any medication you are sent home with isn't very strong UNLESS several pages of paperwork are completed for a MAXIMUM of 3 days of medication.
The first few days went ok... sleep was a challenge - hip to ankle knee immobilizer and compression stocking 24 / 7.... and then it was time for my first physio appointment. I had a good therapist ( I'd seen her prior to the surgery to try to prevent surgery...) and I mentioned that my knee hurt more than was usual -- but then again, what is usually? I hadn't had this type of surgery before. After a call to the surgeon to clarify my treatment regimen and a brief discussion about my pain it was decided that is pain did not get better to see the surgeon that evening.... the pain did not get better.
In the evening I saw the surgeon and it was discovered that I had developed Synovitis - NOT FUN AT ALL!!! - an inflammation of the synovial sacs in my knee. Treatment? Well, first it had to be determined if it was 1) due to infection or 2) irritation from all that had been happening to my knee lately. This determination is made by drawing out some of the fluid and testing it..... USING A REALLY BIG NEEDLE.
My synovia was so inflammed that the needle touching it drove me mad with pain... screaming, crying, almost hitting, finger crushing MAD with pain.... Then some blessed LIDOCAINE was injected along with some steroids, an X-ray taken and blood tests. After 2 and a half hours I was on my way home... my leg in a temporary cast (hip to ankle) to prevent ANY movement of the knee in the hope that things would settle down, a prescription for antibiotics, and bed rest for a week.... Thankfully all the tests showed no infection and after a week I was back in the immobilizer and allowed to move about once again. All in I spent 6 weeks at home recuperating before I was ready/cleared to return to work.
The next weeks, after the synovitis bed rest week, went by smoothly with gains in Range of Motion (ROM) and muscle recovery. By 4 months I was walking assistance free (no crutches, canes, or immobilizer) and hitting 6 month milestones! YAY!!!!!! I was doing well.
I went in on the evening of Tuesday February 17th 2015 to start the next phase of my recuperation - Hyalgan injections in to my knee to help rehydrate the cartilage. This injection was done using the same size - REALLY BIG - needle but it didn't hurt in the least. :-)
The Doctor told me I was a star patient - my hard work and dedication helping me make such a good comeback. :-) :-)
Wednesday February 18th I went to my scheduled physio session and the Therapist told me much the same as the doctor had the evening before... my hard work and dedication were helping me come back and I was amazing. :-)
I was pleased on all fronts - my medical team was happy, my leg muscles were almost back to what they had been before the surgery, I was back to regular exercising (while being cautious of my knee)... things were looking GREAT!
Then while doing squats in that physio session there was a UNBELIEVABLY loud crack and it felt like one of those REALLY BIG NEEDLES was injecting liquid fire in to my knee. NOT a pleasant experience.
My surgeon was not at the clinic so I was seen by another surgeon (in-between his scheduled patients) and nearly 4 hours later I was sent home -- MY AMAZING therapist drove me home AFTER I had more lidocaine and steroids injected in to my knee, followed by the application of a hip to ankle, and instructions to see my surgeon as a walk in the next evening. On the way home I realized that my house keys were locked in my vehicle at the clinic... I called the one person who had a spare and they graciously drove across the city in the middle of the night (in their PJs) to let me in to my apartment.
I managed some sleep that evening.. then a day at work. Well, I was physically present at work and doing my best but my keys were in my vehicle at the clinic and I was limited as all my materials were locked in my office.
Another friend went to the clinic with me on the evening of Thursday February 19th and did some shopping while I saw the surgeon.
The surgeons (my regular surgeon and the one I had seen the evening before as an emergency) thought I had soft tissue damage - ligament or tendon... The Ultrasound showed nothing unusual.... now, the decision was to send me for X-rays... my surgeon had revised his thought of a ligament tear to a QUADRICEPS TENDON rupture and the surgeon from the evening before thought it was a PATELLAR TENDON rupture....
When the X-rays came back they showed my patella sitting right where it should be in the joint - ruling out either of the tendon ruptures - but, showing a displaced fracture of the superior pole ( top portion) of the patella. This would require surgery.
I was sent directly to the hospital - my shopping friend was going to have to drive me to the hospital in my vehicle and then drive my vehicle to my place... in conjunction with collecting things from the apartment for my stay in hospital.
I checked in to the hospital through the Emergency Department (A&E) and eventually got to a room around midnight. The surgery was scheduled for 8AM Friday February 20th 2015 (the next morning).
I was put in a semi-isolated room as I had been hospitalized in the last 6 months and there was a concern that I MIGHT have a Methicillin-resitant Staphylococcus aureus (MRSA) infection. Precautions were taken, tests run, and all my meals were brought on disposable dishes with plastic cutlery...
The operation went as scheduled Friday morning. Again I opted for a regional anesthetic and was able to have up to date information as the surgery went on.
The surgeon had to install a figure 8 tension wire and 4 K-Wires to support the fracture once the pieces were realigned. This operation took almost as long as the MPFL surgery because the normal procedure for K-wires wasn't working and extra K-wires had to be used.
2 more nights in hospital and then home for 2 weeks of limited weight bearing recovery.
After 2 weeks at home I was back to work with 2 crutches and the hip to ankle immobilizer.
Today, April 3 2015 (Good Friday), I am at 6 weeks post op for the patella fracture and recovery is going well. A week and a half ago I had X-rays which show all the wires in the correct locations and the 2 parts of the patella where the surgeon had left them . I am able to weight bear in my apartment without mobility aids (no crutches or cane) and no longer require the immobilizer. BUT, I still get to wear the compression stocking (in +30C temperatures and rising it is even less enjoyable than it was before). Outside the apartment I still use a cane - in part to let people know to give me a bit more consideration and room and in part to help my leg muscles and balance.
I still have a long way to go with recovery from quadriceps atrophy - I lost every thing I had gained back after the first op and I still can not do a straight leg raise (SLR). Quad contractions are strong so it will just take more dedication and hard work.
I know that I will need another op on the right knee - probably in August - to remove the K-wires and tension band (Look at your knee. There isn't much flesh or padding there so you feel the wires all the time - can't 'see' my wires yet, but that will happen). I've done my research and know that this next op should be fairly simple and straight forward and be a lot easier to come back from.
Well, except for the last 6 months...
In October 2014 I had knee surgery to replace a problematic Medial Patella Femoral Ligament (MPFL) on my right leg. Things went pretty smoothly with that process. I opted for a regional / spinal / epidural type anesthetic so I was able to watch the arthroscopy and the rest of the surgery.
The operation involved: harvesting a semitendinous hamstring and inserting the new "ligament" in to the patella with 2 swivel locks and the opposing end in to the femur with a screw - the swivel locks and screw are bio-absorbable and don't show up on X-rays. All in all I was in the operating room for a bit over 90 minutes.
The Hospital was really nice - more akin to a 5 star hotel than a typical hospital. The bathroom had a bath, shower, and all the little travel amenities that you find in a hotel.
I stayed in hospital for 2 nights and was sent home with 3 nights of "significant" pain medication .... there is a great concern where I am that pain medication (Doctor prescribed Morphine while in hospital for example) will cause addiction so, any medication you are sent home with isn't very strong UNLESS several pages of paperwork are completed for a MAXIMUM of 3 days of medication.
The first few days went ok... sleep was a challenge - hip to ankle knee immobilizer and compression stocking 24 / 7.... and then it was time for my first physio appointment. I had a good therapist ( I'd seen her prior to the surgery to try to prevent surgery...) and I mentioned that my knee hurt more than was usual -- but then again, what is usually? I hadn't had this type of surgery before. After a call to the surgeon to clarify my treatment regimen and a brief discussion about my pain it was decided that is pain did not get better to see the surgeon that evening.... the pain did not get better.
In the evening I saw the surgeon and it was discovered that I had developed Synovitis - NOT FUN AT ALL!!! - an inflammation of the synovial sacs in my knee. Treatment? Well, first it had to be determined if it was 1) due to infection or 2) irritation from all that had been happening to my knee lately. This determination is made by drawing out some of the fluid and testing it..... USING A REALLY BIG NEEDLE.
My synovia was so inflammed that the needle touching it drove me mad with pain... screaming, crying, almost hitting, finger crushing MAD with pain.... Then some blessed LIDOCAINE was injected along with some steroids, an X-ray taken and blood tests. After 2 and a half hours I was on my way home... my leg in a temporary cast (hip to ankle) to prevent ANY movement of the knee in the hope that things would settle down, a prescription for antibiotics, and bed rest for a week.... Thankfully all the tests showed no infection and after a week I was back in the immobilizer and allowed to move about once again. All in I spent 6 weeks at home recuperating before I was ready/cleared to return to work.
The next weeks, after the synovitis bed rest week, went by smoothly with gains in Range of Motion (ROM) and muscle recovery. By 4 months I was walking assistance free (no crutches, canes, or immobilizer) and hitting 6 month milestones! YAY!!!!!! I was doing well.
I went in on the evening of Tuesday February 17th 2015 to start the next phase of my recuperation - Hyalgan injections in to my knee to help rehydrate the cartilage. This injection was done using the same size - REALLY BIG - needle but it didn't hurt in the least. :-)
The Doctor told me I was a star patient - my hard work and dedication helping me make such a good comeback. :-) :-)
Wednesday February 18th I went to my scheduled physio session and the Therapist told me much the same as the doctor had the evening before... my hard work and dedication were helping me come back and I was amazing. :-)
I was pleased on all fronts - my medical team was happy, my leg muscles were almost back to what they had been before the surgery, I was back to regular exercising (while being cautious of my knee)... things were looking GREAT!
Then while doing squats in that physio session there was a UNBELIEVABLY loud crack and it felt like one of those REALLY BIG NEEDLES was injecting liquid fire in to my knee. NOT a pleasant experience.
My surgeon was not at the clinic so I was seen by another surgeon (in-between his scheduled patients) and nearly 4 hours later I was sent home -- MY AMAZING therapist drove me home AFTER I had more lidocaine and steroids injected in to my knee, followed by the application of a hip to ankle, and instructions to see my surgeon as a walk in the next evening. On the way home I realized that my house keys were locked in my vehicle at the clinic... I called the one person who had a spare and they graciously drove across the city in the middle of the night (in their PJs) to let me in to my apartment.
I managed some sleep that evening.. then a day at work. Well, I was physically present at work and doing my best but my keys were in my vehicle at the clinic and I was limited as all my materials were locked in my office.
Another friend went to the clinic with me on the evening of Thursday February 19th and did some shopping while I saw the surgeon.
The surgeons (my regular surgeon and the one I had seen the evening before as an emergency) thought I had soft tissue damage - ligament or tendon... The Ultrasound showed nothing unusual.... now, the decision was to send me for X-rays... my surgeon had revised his thought of a ligament tear to a QUADRICEPS TENDON rupture and the surgeon from the evening before thought it was a PATELLAR TENDON rupture....
When the X-rays came back they showed my patella sitting right where it should be in the joint - ruling out either of the tendon ruptures - but, showing a displaced fracture of the superior pole ( top portion) of the patella. This would require surgery.
I was sent directly to the hospital - my shopping friend was going to have to drive me to the hospital in my vehicle and then drive my vehicle to my place... in conjunction with collecting things from the apartment for my stay in hospital.
I checked in to the hospital through the Emergency Department (A&E) and eventually got to a room around midnight. The surgery was scheduled for 8AM Friday February 20th 2015 (the next morning).
I was put in a semi-isolated room as I had been hospitalized in the last 6 months and there was a concern that I MIGHT have a Methicillin-resitant Staphylococcus aureus (MRSA) infection. Precautions were taken, tests run, and all my meals were brought on disposable dishes with plastic cutlery...
The operation went as scheduled Friday morning. Again I opted for a regional anesthetic and was able to have up to date information as the surgery went on.
The surgeon had to install a figure 8 tension wire and 4 K-Wires to support the fracture once the pieces were realigned. This operation took almost as long as the MPFL surgery because the normal procedure for K-wires wasn't working and extra K-wires had to be used.
2 more nights in hospital and then home for 2 weeks of limited weight bearing recovery.
After 2 weeks at home I was back to work with 2 crutches and the hip to ankle immobilizer.
Today, April 3 2015 (Good Friday), I am at 6 weeks post op for the patella fracture and recovery is going well. A week and a half ago I had X-rays which show all the wires in the correct locations and the 2 parts of the patella where the surgeon had left them . I am able to weight bear in my apartment without mobility aids (no crutches or cane) and no longer require the immobilizer. BUT, I still get to wear the compression stocking (in +30C temperatures and rising it is even less enjoyable than it was before). Outside the apartment I still use a cane - in part to let people know to give me a bit more consideration and room and in part to help my leg muscles and balance.
I still have a long way to go with recovery from quadriceps atrophy - I lost every thing I had gained back after the first op and I still can not do a straight leg raise (SLR). Quad contractions are strong so it will just take more dedication and hard work.
I know that I will need another op on the right knee - probably in August - to remove the K-wires and tension band (Look at your knee. There isn't much flesh or padding there so you feel the wires all the time - can't 'see' my wires yet, but that will happen). I've done my research and know that this next op should be fairly simple and straight forward and be a lot easier to come back from.
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