So Thankful

This time of year I can't help but be greatful for all the good things that I have going for me in my life. Particularly...

#1 My husband, Aaron. Because without him I would not have made it through these past few months when things have been the hardest. He has taken on more than his fair share of the household chores (cooking, cleaning, dog walking). He has dealt with my grumpiness (from not being able to run for the past 4 months) and celebrated the highs and commiserated with me on the lows. Love you Aaron!

#2 I am thankful that the snow has melted... at least for a little while. This place has been a huge sheet of ice for the past couple weeks. And since I still can't quite bend my knee all the way, climbing over snow drifts on my way from the car to the house, store, anywhere has been a challenge.

#3 That my knee tolerated a 4 hour round trip drive to visit family on Christmas day. I really thought I would have to sit this year out but with some recent improvements to my range I decided to risk it. I managed to make it through the day with some moderate stiffness but not too much pain.

We started our Christmas at home opening up gifts on Christmas Eve. The cats got catnip toys in which they got thoroughly engrossed in.

My favorite gift is a toss-up between my new profile water bottle with a splashproof lid for my bike (no more getting soaked when I hit a rough patch!) and a collection of the 50 different US state quarters. My grandmother started collecting them for all her grandchildren (there are about a dozen of us) back when the first ones came out. This year they were finally done and we each got them in a book along with a few coins from my grandfather's coin collection. One of mine is a silver dollar from 1979.


It is apparently a Radlinski tradition to forget about some gifts until Christmas day. Here, Aaron is wrapping some gifts for his brother that he found in his closet. Strider is again... helping.

Then it is off to the relatives...

I only have photos from the Radlinski family because I was the only one with a working camera that morning. The other two places we went, I forgot to bring it in.

I wasn't very good at letting Justin (Aaron's bro) what I wanted for Christmas so I got a packet of zucchini seeds.

Aaron got a pack as well. I guess I know what we'll be eating in 2009.

I noticed when going through these photos, Sparta was a very involved dog in the whole gift giving process. It's only her second Christmas so I don't think she entirely understands it all.

Happy Holidays!!!

It's Snowing Again

I can't remember the last time we got so much snow in December. And it's cold. Usually, the heavy stuff waits until January to fall. Last January, we didn't have a full week of classes for about 3 weeks due to the amount that got dumped on us at one time. This is my first winter here in Ann Arbor so I wasn't sure what to expect as far as roads and snowfall amounts. Last Friday though, we got at least 8-10 inches. There wasn't one highway around here that didn't have an accident on it. The roads haven't gotten much better since. Sure, the highways are pretty clear but the main roads in town are still covered and frozen over. I've heard lots of reasons for this: MDOT has no money and won't pay the plowers overtime, there is a lack of road salt, etc. But if this is just the start of winter, what is the rest going to look like?

I came home from the clinic yesterday to find that in my absense Aaron had decorated the whole house for Christmas. He had gone to out house in Mount Pleasant (by the way, the driveway probably won't be seen until spring there) and brought back as many decorations as he could carry. So our house looks so much more festive. We have stocking and more Christmas ornaments and my holiday stuffed cat that plays "Have a Holly, Jolly Christmas".

More decorations, however, means that my cat Strider has more to play with. I have never had this problem with a cat before. He just can't leave the tree alone. Sure, a lot of the ornaments are soft and resemble his pet toys... And Aaron did put a catnip toy in his stocking (which is in a location he can't get to). But still, how many times do I have to pull him away from the tree before he gets the idea?

This afternoon I am off to the gym to do some weights and spend a little time in the steam room. I just want to be somewhere that the temperature is over 80 degress.

And I'm... There!

Yesterday I got an early Christmas gift. I finally got to fully bend my knee. I was hoping to do it by the 3 month anniversary of my surgery, but I was a couple days late. Aaron was able to bend it all the way to my butt while I was lying on my stomach. Now, all that is left is to be able to do it under my own power. My hamstring is still incredibly weak but it is getting better. I notice it the most when I am on an exercise bike. I just don't feel like I can control my leg that well and I have no power in the downstroke. Because of this my foot likes to stop at the top of the pedal and I have this choppy cadence. It's just going to take time to smooth all this out.

Last night, Aaron and I celebrated this victory with a small bottle of champagne. I'll be posting pictures of this at some point but at the time I wasn't going to have Aaron hold my leg there long enough to take a photo.

No Fear

No fear here either... Johan's Trifest 2006?

This weekend I swam... twice. I haven't been to the pool in two months after I realized that my left leg wasn't nearly strong enough to help propel me across the pool. It was more like a lead weight. This time was different. I could actually pull off a decent kick for a while. In the deep end I even let go of the wall for a short time so I could try treading water. I can do it, although I can tell that my left leg is probably only at 50% of the strength of the right. I think that I have gotten over my fear of drowning.

Things continue to progress on the work, health and home fronts. Sparta went to doggy daycare again this week. I work long days (12.5 hours!) on Thursdays and Aaron had a lot going on at work last week. So Sparta went and played with 53 other canines for 8+ hours. 53! I can't believe that they allow that many dogs in one space. The dogcare place is in what looks like a large warehouse. It is separated into 3 different areas for different size dogs. As I understand it, they tend to rotate the dogs into different areas throughout the day. I feel kind of bad for Sparta. She has so much energy, yet she is stuck in an apartment for most of the day. Aaron walks her in the morning and when he gets home, but she hasn't been run as much as she is used to. I guess she'll learn to stay away from my bike tires from now on!

My knee continues to slowly improve. We're continueing to be able to bend it to about 2.5 inches from my butt. It really irritates the scar tissue. I can't think of anything else that I have gone through that is this painful. The pain reminds me of the one time I pulled my hamstring in 3 spots trying to do the splits (I slipped!). It's an intense burning sensation. When were bending it, the pain will radiate down into my calf and up my thigh. As I undertand it, this will continue until I get my motion back and all the scar tissue is remodeled. The only way to do that is to keep bending the knee.

Spiraling Out Of The Hole

I've mentioned before about the situation with my knee. Because I didn't get full extension within 3 weeks of surgery I've been fighting a battle to get better. Basically, without full extension, the quadriceps muscle won't get all it's strength back. Quad strength helps to push out the swelling in the knee. Having swelling in the knee makes it more difficult to get your leg straightened. It is a cycle that is difficult to get out of once you're in it. Not being sent to physical therapy right after surgery is what really put me in this hole.

Finally... I may be digging myself out. My extension is now full. It doesn't go easily, but it gets there and it is getting better. 3 sessions of week in the chair for the past month or so has really made a difference. Swelling is going down in the knee as well, but still very slowly. This will be helped as I continue to bend my knee. Aaron has been pushing on it every night again. I had to take a break after that awful cortisol shot but now that we're working on it again, I've noticed that it is bending a lot easier. It doesn't hurt as much and it takes less work to get it bent to an angle that used to make me cry before. As of Sunday, we hit 2.5 inches from my butt. Soon... it will go all the way. I can feel that we are really working the scar tissue loose because the knee is extremely irritated. I keep hoping for the scar tissue to just tear apart and to get a good pop out of it. It really wants to, I can tell.

I'm estimated that it will be another month to get full motion back in my knee... that is, if I keep working it everyday and don't have any other major setbacks.

Week 11: Christmas wrapping was a lot easier... before I got the grey cat.

Aaron is a drill this weekend so I thought it was a fine time to start wrapping his Christmas presents. This year we're keeping things a bit smaller due to the fact that we're currently paying on two residences and I'm not working due to clinicals. We've even got a smaller tree. I'm allergic to pine so we always have an artificial one. All our Christmas decorations are still 2 hours away at our house in Mount Pleasant so we picked up this little one at Mejier for 16 bucks (fully lit!) and a few decorations from a shop downtown. Usually we end up tying the tree down because of Strider, our current grey cat. Christmas seems to be his favorite time of year. He is constantly in and under the tree and lying on the wrapping paper as I try to wrap. It seems that no matter how many times I shoo him away... he always comes back. This year may be a little different. He has still been all over the wrapping paper but he has only knocked down the tree once. We didn't have anything to tie it down to and none of the ornaments are breakable so we just let it be. However, today I did try to bolster around it with Aaron's gifts so maybe it would keep it from falling.

I've decided that December is definitely a transition month. My leg is getting stronger but it is still a long way off from being ready for any serious training. My main focus is still building up leg strength and endurance (and getting these two legs to match). I do want to start doing some more structured training though. Right now I am doing close to two hours of heavy leg training including 40 minutes which involves working on my knee extension alone. The leg extension is getting better so I am hoping that I'll be out of the chair after another month. Other than that and working on my range of motion, I've been riding an exercise bike when I have the time and continuing to work on bending my knee so that my heel touches my but. Last night, Aaron and I hit 3 inches which is the best since Dale last bent my knee over a month ago (which was before that stupid cortisol shot). I'm running out of time on the knee bending so that has to be my primary concern outside of strength training. However, I do want to start working on my cardiovascular training so I'm going to try to get two swims in each week as well as at least 3 bike rides. The bike rides are either going to take place on an exercise cycle at the gym or on my trainer which will hopefully get here this week. Finally!!! I'm nervous about the swimming part. I haven't gone to the pool in at least 6 weeks since I realized that I didn't have enough strength in my legs to tread water. That scared me. I haven't been that vulnerable in a pool since I was probably eight. I chickened out on my trip yesterday but I do plan on making it over there today.

120 Pounds Today!

One thing about rehab: it is making me stronger mentally than I have ever been before. I used to think that I could deal with pain -- I don't think that I knew what pain was until I got injured. I've had to endure pain for a lot longer than I imagined I would have to. The delay in my recovery has taught me to be patient and to be able to look more long term. Shortly after my surgery I was more rushed to get back to walking and to be as normal as possible. Now, I am taking my time. I'm not as worried that my knee can't bend as far as I want it to. I know it will get there. I'll keep working it until it is. Today, while sitting in the chair, I made the comment to a collegue that I'll continue sticking myself in there until 1) the extension of my left knee matched my right or 2) until my internship end on January 23.

Today, I reached a major goal. I was able to leg press my weight on my left leg: 120lbs. I did 3 sets of 10 reps. It was hard. However, this is one of the benchmarks that I have to reach before I am able to start running again. I used to be able to leg press 300 lbs. with both legs. A lot of people don't believe me so I'm working towards proving them wrong as well.

Sparta also apparently passed her temperment test today at doggie daycare. Aaron said that she had already made a couple friends by the time he had finished filling out the paperwork.

Slow and Steady (Me, Not The Dog)

Yesterday we took Sparta to the indoor dog park. I tried to take a few photos but the bright lights coupled with Sparta's lightening fast speed made for a lot of blurry images. The dog park used to be a horse run. It is in a large polebarn attached to a stable with a sand floor and lots of toys. There are a couple large tunnels and some hoops and poles for jumping. We decided to start bringing Sparta here because I can't run and she needs a way to burn off some energy. Also, Michigan winters can get so cold and even though the barn isn't heated, it is still better than dealing with the wind outside. There was only one other dog, Harper, that showed up while we were there. Luckily the two play well together.

I had another visit with my surgeon today. He said that in the grand scheme of things, my knee isn't doing that bad. Based on what he saw today, I'm a little slower than average (about one standard deviation to be exact). My extension is nearly normal and my flexion was about 110 degrees. I'm improving but it is at snail pace. Dr. A then told me a story to help put things in perspective. This took place years ago (in the stone age of ACL surgeries) when he had a guy come to him with a torn ACL. Dr. A told him that he could have either of two things: stability (if they did the surgery) or mobility (if they did not). The man told him that he had surgery on his other leg and it turned out just fine. However, he could not even bend his knee to 90 degrees. Dr. A also told me about how they used to cast people after an ACL and how if I had as much motion as I had now, I'd be way ahead of schedule. So I guess things could be much, much worse.

Week 10: Two Steps Forward, One Step Back

I've realized after this holiday weekend that my knee is definitely NOT close to be normal yet. I think it was the combination of 4 hours of driving and trudging over concrete and through slush to go midnight Christmas shopping. Oh, and I also tried to wear a pair of "normal" shoes. Up until then I had only worn my running shoes. I figured that if I could walk around at home without shoes, I should be able to manage walking in a nice pair of flats. Wrong! So now I am paying for it with a sore knee.
I am still noticing improvements. I can now use a strap around my ankle and pull my foot toward my butt. I'm within 7 inches and it seems to be getting easier each day. Someday soon, my heel will touch my but again. If I am having any trouble, it is with extending my knee. I have gotten it there with lots of stretching and sitting in "the chair" but it just doesn't stay. Also, sitting in the car, my knee stays in this slightly bent position and gets stiff and doesn't want to straighten. I think this is just going to be an ongoing battle until my strength gets better.

Week 9: 100 Pounds

Yesterday I lifted 100 lbs on the leg press... with only one leg (the one with my reconstructed knee). I am very thrilled. This means I am closer to my goal of leg pressing my bodyweight 20 times. This is a PT goal which will mean that I am closer to getting back to racing. At the rate I am going, I should hit that mark within 2 weeks.

I have been lifting for that past month and not seeing a large change in my knee... until this week. The swelling is going down. All that I have left is what is right around and under my kneecap. My muscle tone in my quad is also looking better. The leg is now looking like a slightly smaller version of it's non-injured partner. I also have most of my extension back (thanks to over three weeks of the extension chair of which I have become quite accustomed to).

Just for anyone who is wondering, this is pretty much the schedule I have been following for the past 5 weeks or so. I have a lifting routine that I do 3 days a week and a balance/functional routine that I do two days a week. It varies a bit if I have to miss a day due to school/work/doctor appointment. Weekends, I take it easy and do some light cycling, stretching and starting this weekend... backwards treadmill walking.

I am just listing my Mon/Wed/Fri strength workout this time. It is the more important of the two right now. I'll give out my Tues/Thurs workout at another time. All exercises are done 3 sets of 15 reps unless otherwise stated. Most of this is one workout although often I do the straight leg raises and wall slides at home while I am watching TV.

Warm-up: Nustep or exercise bike 10 min

Calf stretch on incline board 5 x 30 secs
Hamstring stretch (sitting up, leg out in front, sitting tall and lean forward) 5 X 30 secs
Hamstring stretch with strap (laying on your back, lift leg with strap around foot, pull down on strap with one hand and push above knee with other) 5 X 30 secs
Supine wall slide 30 times
Prone quad stretch (lie on stomach, strap around foot, pull foot towards your butt) 5 X 30 secs

Standing knee extenstion (theraband around leg above knee and attached to wall or door, lift heel and then press heel down and contract quad strongly) 3 X 25
Leg press 2 legs
Leg press l leg
Leg press eccentric (2 legs up, 1 leg down)
Heel raises off a step

Squats on a two bosu balls holding a 6 lb medicine ball
slideboard squats (one leg on ground, other on smooth surface, squat on one leg while sliding other leg out)
Hip adduction maching
Hip abduction machine
Hip flexion machine
Shuttle hip extensions (using a shuttle machine but standing and pushing back on it with one leg)

Single leg raises in flexion and abduction
Nustep intervals (switching between moderate and hard levels every 30 secs) 5 minutes
Shuttle endurance (squats on one leg) 5 minutes

Knee extender chair 18-20 minutes (depends on how long I can tolerate that day)
Ice and electric stim. 15-20 minutes

This entire thing can take me up to two hours. However, the last 30-40 is spent sitting. I wouldn't recommend this to everyone but doing this intense of a workout consistently is really starting to pay off. The results haven't come instantly and it has been discouraging going into a weight room to do this day after day and not seeing results. The important thing that I have to continually remind myself is that the healing process does not follow a straight line. It is more like a bumpy road.

Week 8: Cortisol- Not A Miracle Cure (not even close)

Well, it turns out that the cortisol shot was not the miracle that I was hoping for. For the first couple days, I thought that I might see some improvement because it looked like the swelling was decreasing. Except for right around the kneecap, it looks like I have a normal left leg. The unfortunate part is that I think the cortisol irritated the joint. Since the shot, I haven't been able to bend my knee as far. It is slowly getting better now but I won't ever do that again.

Now that I have had my knee injury, I feel like I have admittance to a special club. I have had so many people come up to me since my surgery to ask me how it happen and then tell me about their knee injuries. This morning, at Starbucks, I met a guy who tore both his ACLs in a car accident. This was back in the mid-80s when reconstruction was not what it is today so he never got his replaced. He suggested using a combination of epsom salts and hydrogen peroxide to soak the knee in. It is supposed to help with swelling. I don't have either of those but I do have a bottle of "Tired Old Ass" soak which I think has salt in it. I'm going to try that to see if it helps.

I've set 4 small mini-goals for this week
1) Achieve full extension of the knee 3 days in a row
2) Be able to get my knee within 2 inches of my butt
3) Perform 20 leg presses with my left knee at a setting of 95 pounds
4) Be able to descend the stairs at my apartment without having to lean half my weight on the handrail

Knee Watch: Day 1

It has been a little over 24 hours since I got the shot in my knee. Overall, it doesn't look that different from yesterday. I have noticed that I had less pain in my leg last night. No cramping in the calf or back of the knee. Usually I wake up around 4 every morning with it. I have also noticed that my knee has been creaking a lot more. I was exercising after work and I swear I could feel something jelly-like sloshing around my kneecap. Maybe the swelling is starting to go down.

Week 7: A Large Needle Full Of Hope

I'm feeling like life is dumping on me right now. This process is so excruciatingly slow. Everyday is a fight for movement in my knee and then when I go to bed I just hope that some of it remains the next morning. Overall, I'm still moving in a positive direction. Just very... very... slowly.

I had a follow-up with my surgeon today. He says that he has not seen a knee act quite like mine. He says that I have beautiful stability but less than stellar movement and gait. Granted, I had just spent over an hour to get there so I was a little stiff. My knee only actively went to 90 degrees. Usually, I can get it to about a 100 or a little more. My extension is also lacking again after a long weekend without the extension device. He'd like to see me have full extension and flexion by the time I hit the 2 month mark on November 19.

At my best, my passive flexion has been at 3 and 1/2 inches from my butt (yesterday) and nearly full extension (last Friday). Aaron has been helping me by bending my knee each night. It took us about 25 tries to get it down that far. And that is 3 and 1/2 without screaming. Our best the week before was around 4 and 1/2 inches. I cried so loud that we worried that our neighbors might call the police for a domestic disturbance. It is slowly getting easier my hope is that by next weekend that I'll have that foot down to my butt.

To help with the range of my range, my doctor's suggested steroids. I'm not a big fan of drugs, especially steroids, but with the problems I am having with my motion I decided to take the risk. I opted for the cortisol shot since it seems to have the fewer side effects than a pill. Although long term use of steroids can disrupt and inhibit healing in the joint, risks with just one shot are minimal. It is not a permanent fix in any way. I am just hoping it buys me some time and brings down the swelling long enough for me to get the rest of the range and build up my quads a little more. Once I achieve this, it's unlikely that this swelling will come back. Now I just have to hope that this works: cortisol shots don't have a positive effect on everyone.

Unfortunately, one of the drawbacks to injecting a fluid into the knee joint space is that there is a temporary (hopefully) reduction in range for my already deficient knee. Aaron and I got it only to 8 and 1/2 inches tonight. It's not sore to the touch though and it feels like some of the heat has left the knee. Usually there is a marked difference in temperature between the two with my swollen knee being several degrees warmer. It is supposed to take a couple days for shot to fully take effect so I'll just have to wait and see how it turns out.

My Knee Still Looks Like Crap

Apparently, I have been being going too easy on myself. I've been seeing modest improvements in my knee: swelling has decreased, range and strength are returning. My quad is still quite mushy though and my knee extension is still lacking. It is time to hit it really hard.

I've realized that a lot of what has been holding me back so far has been fear. Fear that I am going to damage the graft with all this lifting. Even though I know that the only way this would happen is if I fell on it like I did when I injured it or if something flew into my knee knocking me off my feet (like a galloping Sparta dog). Today I think that I got past that fear. I pushed 160 pounds on the leg press with no problems and 70 with just my injured leg. It was hard, it felt good and I had no lingering issues afterward. I also spent 20 minutes in the extension chair (counting the time down, unfortunately, no other people nearby to talk to) and then another 20 with ice and Russian stim on my leg. I've used the Russian before. You put electrodes on two motor points on your thigh. Then you turn up the juice until you get a strong contraction. It is set to an on/off timing sequence. When the electricity is on, you try to contract your quad as hard as you can. When it is off, you relax. Amazing, after all this, it looked like I had a new leg. This looks like it will be my protocol for the next two weeks until I can get my tone and hyperextension back. Without those, it won't matter how much weight I push, I'll still have puny quads.

Week 6: Chasing Pain

If there is one thing that I have figured out over these past few weeks is that rehab is not pain-free. It is work, work, work, everyday for just a little improvement. Sometimes I wish that I didn't have to sleep so that I wouldn't stiffen up overnight. Joints like motion and if you don't have full motion it is going to keep hurting until you do.

I'm not saying that I'm not getting better. This week, I've noticed a lot less pain. I've only really been taking Tylenol before I work out. I don't know if it does a lot for pain but I'm afraid to work my knee without it.

I'm in a tough spot with my knee right now because I didn't have full range in it before I had surgery. I can get my heel to within about 8 inches of my butt (with help) before the serious pain kicks in. Last night, Aaron helped me to get it to within 4 inches. We tried for 2 inches but that was a bit too much for me. It's better than last week but we really have to keep working it because I'm running out of time and it will only get harder.

My real problem though is with my knee extension. I'm lacking a fair amount so this past week I got stuck in "the chair" again. Dale wanted to stick me in it for 20. I wanted 10, so we settled on 15 instead. Friday, I spent 18 minutes in it. The last 2-3 minutes are always the worst. As soon as the timer goes off I am lashing at the straps and kicking at the hooks that keep the device hooked to the ground to get them undone. Forget waiting for any help. One of the other interns told me that at the other clinic he was at, the longest they ever stuck someone in it was 10 minutes. I can bet on another 8 trials with this thing but it seems to be working. Saturday morning I walked the best that I have since before my injury. Even though it is uncomfortable, I much prefer it to bending my knee.

So I'm resolving to push myself harder over these next few weeks to both increase my strength and my range back in my knee. The further it gets, the less pain I've been having even though it hurts like hell when I'm working it. This was the first week that I've noticed a strong increase in strength in my legs. I can now easily leg press 40 lbs with my one leg. Range-wise, Dale got my knee bent to within 2 inches of my butt on Thursday (the closest it has been) and extension I am expecting to improve with continued use of the chair. So good improvement. I am hoping to have full range within the next two weeks.

Pain: Why you should see a physical therapist after ACL surgery.

I decided to write another post in light of the situation that I am currently in. This is all I have to say... If you ever experience and ACL tear (especially if you plan to have surgery) run to a physical therapist. Preferably, both before and after surgery. I was in a tricky spot because I was in the middle of moving when I should have been doing pre-op work. However, after surgery, it is my opinion that Physical Therapy is NOT an option. It is a necessity. Unfortunately, your surgeon may not know this or believe this. I feel that in my case, I made a huge mistake of listening to my doctor. He doesn't like to send people to therapy right away because there is the risk of hurting the graft. When talking to him, I didn't think that I was doing too badly. I'm just a little slower than average, I was told.

Sure, if you don't receive therapy right away, you can still make a full recovery. However, the amount of pain you will go through is going to be much, much worse. What happens is after 4 weeks scar tissue starts to lay down more quickly. Once that happens, all you can do is push through it. I have noticed a big difference coming into my fifth week. My leg is harder to bend, like thick taffy. Today, I asked Dale to bend it for me because I have been having difficulty getting it very far on my own. I'm telling you, it hurt. I cried a bit, chewed through a towel and gripped the table so tightly that my shoulder and chest muscles wouldn't stop quivering. I'd like to think that I have a decent pain tolerance. You don't do marathons and Ironmans without one. But this type of pain is different. It feels much like it did when I first injured it. Also, because it is hard to relax, your hamstrings will start to guard making the motion harder to get. Still, I guess I am not the worst of the worst cases. Dale says that the barrier is still soft so it is easier to get through. Sometimes, it is hard and that is when he has had to put all his weight into it (to the point where he is black-and blue from pushing). But getting the motion in the knee is only part of the solution. Keeping it is the other. Every day that you will work at it, you will gain a certain amount of motion. However, overnight, things will stiffen up and you'll be back to square one. So going through the process of having someone bend your knee is not a one-time deal. It is a daily process. Since, mine has gotten so bad, I'm working against the clock to get the motion back and get through the scar tissue before it hardens even worse. THis means more days on the table having my knee forcibly pushed into a new range. Unfortunately, this is a scene that is too commonly seen among PTs. I've been told that over my 16 weeks at the clinic I will probably see other cases similar to mine. Although it can't be totally prevented, some things can help:
1. Pre-operative strengthing and work to get full knee flexion and extension back
2. Post-operative physical therapy. The clinic that I'm at sees their patients the day after surgery.
3. Following the guidelines set by both your surgeon and PT. (Weight-bearing restrictions, completion of home exercises)

There are certain cases where getting range back after surgery isn't possible. I'm thinking of one person who isn't allowed to bend her knee much for th first four weeks. Still, she has good leg strength and started physical therapy immediately afterward.

This has been my first experience with an ACL injury both as a person and as a student physical therapist. I wish I had known more going into this process because maybe I wouldn't be in the position I'm in now. I wish I would have demanded to be seen by a PT starting the day after surgery. In Michigan, by law, you can't go and see a physical therapist without a doctor's prescription. This is different from most other states where there is some form of direct-access to physical therapy. It's kind of funny how all these issues that we have talked about in school are currently hitting right in the face.

I'll recover. It is just going to be a very tough couple weeks ahead. As Dale has said to a collegue, "She'll let me bend her knee because she wants to be able to run again."

Week 5: Yay Aaron!

My husband, Aaron, finished the Detroit Half-Marathon this past weekend. His finishing time was 1:45. I thought this was great since he had to start at the very back of the pack in section T and have to pass many much slower runners and walkers. In past years we have run the marathon and we are typically in the first section right behind the wheelers and handbikes. This was an interesting experience for me because I was there only as a spectator. I don't usually go to races to watch. My knee still gets pretty sore at times so I had to be careful and limit my time standing on the concrete. Detroit has this people-mover system that links various areas of the downtown area. After I left him at the start (only a couple blocks from our hotel) I jumped on and rode it to the GM headquarters. After getting coffee (I always have to know where the nearest Starbucks is) I got to wait for the runners to exit the tunnel from Canada. In the Detroit Marathon, a good part of the first half of the race is run through Winsor, Ontario. The runners start in Detroit and go over the Ambassador Bridge. From there, the route goes along the Detroit river to the tunnel which the runners take back to the other side. I have raced the Marathon many times. It has such a great variety of sites on the course and the view from the bridge is always beautiful because you are going over as the sun is coming up. Spectacular.

I was worried at first that I had missed Aaron because I didn't see him when I though I would. He was wearing red so that I could spot him but unfortunately, a number of racers were also wearing either red or orange so it really didn't help that much. When he did come out he was pretty easy to spot in the crowd. He was the only one zigzagging and cutting long diagonals through the crowd in an attempt to pass. He spotted me and yelled something about me finding my coffee. I cheered him on and then headed back to the people-mover to get to the finishe before he did. After getting lost, I managed to make my way to Mile 13 just minutes before Aaron turned the corner on his way to the finish. Not too bad for someone with a bum leg, huh?

I was glad to go and see him run this. He was really excited and had a great race. It also made me sad because I couldn't be out there with him running. It has now been almost 2 months since I have ran and I miss it so much. It's frustrating, but I know that I will be out there again.

Week 4: Just Shy Of Average

I had another Doctor's visit today. Overall, it was positive news. The swelling has gone down a lot. The only area left is a ring around my actual kneecap (and probably some underneath). I have neutral extension and could move my knee past 90 degrees for the exam. I can move it much farther but it is an hour to the Dr.'s office and my leg tends to stiffen up during car long rides.

The negatives are that my quads are a mess and my progress is just on the lower end of average. Why? Who knows, my doc told me. Everyone is different. Prior to this, I've always healed really fast from scrapes, pains and even a shoulder sprain. But I'm getting older and with the stress of being able to start clinicals, maybe it is affecting things.

I have been working out a ton now. I probably average 1-2 hours a day of stretching, weight-lifting and icing of this leg. Dale has helped me with the strength-training aspect. I have been doing the leg-press, hip flexion machine, calf raises among other things. It has become part of my learning experience here at my clinical. Anything that gets put on a patient, also gets done to me. One example is this thing called "the chair". Apparently, at the old clinic, it sat in the middle of the room so everyone could see you squirm. Basically, it is a device that forces your knee into extension. You sit in the chair with your foot up on another chair. There are straps that go across your knee and hooks that attach to a board on the floor. After you are strapped in, the straps are tightened forcing your knee into extension. It hurts a lot like a bad muscle pull. Basically, your hamstrings will fight for about five minutes, after that, they relax and the straps are tightened again. In total, you start out sitting in it for 10 minutes working up to 20 minutes in total. I'm told that you're leg goes numb if you sit in it that long. Normally, this thing is used for people who cannot completely straighten the knee. I was put in it more for educational purposes (I guess this is what happens when your clinical instructor is former military)

Also, I had the privilege of having Dale bend my knee. It was a miserable feeling but not as bad as the chair. I didn't feel like crying but it hurt. In the beginning, I just kept saying, "Please Dale, no. Don't do it." I was on a table in the gym with about 5 other people (staff, interns, other patients) watching me. It is sometimes a little embarrassing. I'm a coworker and at the same time a patient. I can't fuss or break down because I'm being watched on both sides. I've got to be tough. Everything I'm doing must be working because I'm not limping like I was two weeks ago and I'm starting to see a little new muscle. I'm told that I won't see a lot of strength gains for at least 4 weeks.

A Little Inspiration...

I felt that I needed a little help on my road to recovery. Some superhero power will due. I had this idea prior to getting my surgery but had put it on the backburner because I couldn't decide between Wonder Woman or Supergirl. The Amazonian won out. After the rough week I have had, I decided that I wanted to get inked as a reminder of where I've been and where I can be in time. I chose just a simple black and white version because my back takes a lot of abuse from the sun and colors fade faster. As you can see from the photo, I still have my summer tan lines.

I'm feeling a little better after today. My clinical instructor is helping me with my rehab goals (he'll be my go-to person so I can do my PT on my own time). The swelling is also going down more after spending most of the weekend off my feet. I can now clearly see the entire outline of my kneecap! That, and I'm starting to see a little new muscle in my right quad. It's the little successes that matter most right now.

Post-op Week 3: The Lowest Point (I Think)

I have been pretty down this past week. Unfortunately, there hasn't been a lot of good news about my progress. But it is what it is, and hopefully I have just reached a short plateau and will start seeing some real improvement soon.

At my Doctor's visit last week (Oct. 2) he thought that I was doing pretty well for only being two weeks out and gave the OK to start my clinicals the following Monday. So I did part-time (20hrs) and I love, love, love it. I am at the Ann Arbor Medsport complex. It is such a cool clinic. They have a huge gym, a room for post-surgical patients, a casting room, a pool, batting cage, basketball hoop. You need it, they have it for rehabbing sports injuries. The funny thing is that about half the people being seen at the clinic have had some sort of knee injury. My clinical instructor, Dale, has been in the profession for 18 years and has worked all over. I'm totally confident that I'll learn a lot from him.

One clue that I had that things were not going well for me was my clinical instructor. Dale is concerned about the state of my quads. Their shot. For example, I went to the pool on Wednesday and realized that I had forgotten my goggles. No sweat, I thought. I'll just kick back and forth for a while with a kickboard instead. Honestly, if I hadn't had that board, I would have sunk like a rock to the bottom of the pool. I haven't felt that uneasy in the water since the time I had to swim through a rapid on the Colorado river.

I'm lucky that I am in such a great place right now working with an instructor who has probably seen thousands of ACL injuries. So if he says something isn't right, then it isn't. Dale has been immensely helpful: giving my new stretches and exercises to try. I knew it was definitely serious though when yesterday he hooked me up to the Russian stim. Russian stim is a form of electric stimulation that is primarily used to get a strong contract out of a muscle that is too weak to do it on its own. In my case, my wasted quads. I had two large electrodes placed on my thigh, one over the VMO (medial thigh) and one across the top of the thigh. Then before he upped the power, he told me that I couldn't cry. All, I can say is that this hurt like hell. I have been hooked up to electric stim in one of our patient care classes (I've even been given a nice electrical burn because of it) but I have never had to endure it for 20 minutes. It would cause my muscle to contract for 10 seconds and then let off for 30 seconds. When the contraction is occurring, you also have to try to contract your quad on your own and try to push the back of the knee into the table. At first I thought, how am I going to make it through this? What I found though was that your body does adjust to the feeling and after a while, I was even able to turn up the amplitude a bit on my own. Apparently normal muscle should be able to handle a normal amplitude of around 80. I am around 55. Also, I noted, the harder you push down into the table and contract the muscle on your own, the less it hurts as well.

So how did I get in this position. I have been thinking about this today and I have 3 possible reasons.

1. It was a month between the injury and surgical dates so my quads were wasted before I got the reconstruction done. Add another insult such as surgery on top of that and my quads are really, really gone.

2. I got off my crutches too soon. I was feeling pretty good. No pain pills (not even Tylenol). But the added pounding from walking (in addition to weak muscles) means that the swelling isn't going down very fast leading to less mobility.

3. I am an abnormal case. My doctor doesn't normally send people to PT right after surgery. He says only a small number of patients that he has treated have had this problem. He says that he doesn't like to send people right away because of the issues of failure with too aggressive of PT at the beginning. Normally, he waits a few weeks and then sends them if he feels they need it.

So I am kind of in a tight spot right now. I have about 4 weeks from date of surgery to when scar tissues starts to form which is going to make moving my knee more difficult. I am starting to run out of time. I talked to my doctor yesterday and he is going to be having his office send a script for PT to a clinic here in Ann Arbor (Medsport it is!!!) I have also put myself back on crutches to try to get the swelling to go down faster. Also, I have Dale who told me yesterday that if my knee isn't bending well enough by Monday then he is sticking me in a room and bend it for me. One of the techs, Rachel, told me that they do that so you can scream and cry as loud as you want. I don't think that I can make it through something like that without crying.

So this weekend, instead of enjoying the homecoming festivities at CMU, I'll be spending it iceing and bending and exercising and re-icing my knee. In addition, I'll be listening to the Webcast of the Hawaiian Ironman because with all the cable channels that I have, there isn't one that carries the race live. Of course, there is about a dozen channels with football.

Week 2: More Work, More Doubt, and a Computrainer on Order

This week, I took my first steps to get myself back into shape. I got my membership at the local pool here in town. I am a bit slow. I can't push off the wall with both feet yet (the force is too much yet). I plan on building up slowly swimming 3-4 times a week so I can join a masters swim class in November.

I have been spending approximatley 30 minutes a day working on bending and strengthening my knee. I do quad sets, leg lifts and mini squats. In addition, I'm back lifting to strengthen my upper body. I'm also doing ab and core work as well.

I was pretty lenient on myself the first week after my surgery. This second week I have been expecting a lot more. Even though I'm progressing, I stll feel like it isn't enough. I'm impatient to be back to "normal". I realize that I'm putting a lot of unnecessary pressure on myself. A lot of this added pressure is due to the fact that I am planning to start my internship in physical therapy next Monday. I can't say that the staff at my college has been entirely supportive throughout everything. They have been able to arrange for me to start late and do the first two weeks part-time. Still, when I talk to any of them, I get the impression, that they don't think that I am up to it (which is a bit amusing since none of them have seen me in person). I think that I am doing as well or better than anyone who has been through knee surgery within the last two weeks. Their doubt only fuels the fire that is pushing me to get better.

Monday, Aaron and I went to Dearborn to put an order in for a Computrainer. After weighing the pros and cons, I decided that if I am going to only be allowed to ride a bike all winter, I want something that I know will keep me motivated to stay in the saddle.

Post-Op Week 1: Bend It Or Someone Will Bend It For You

I went for a follow-up visit with my surgeon yesterday. He's happy with my ability to walk (partial weight-bearing now with crutches) and with being able to straighten my leg. He doesn't think that I am progressing far enough with being able to bend it though. Truthfully, I have only been working on flexion since Wednesday. So he wants to see me again next week and if I can't increase the degree of flexion, then he is going to send me to physical therapy. If I can, he thinks I'll be fine to progress on my own.

I'll admit, I've been a little hesitant about moving it. It's not the pain, just the uneasiness about stressing the graft. But if my doctor since my doctor is so confident about this graft then I should be as well. So I have been bending my knee... a lot. This photo was taken last night as I watched TV and slid my leg down the wall in the process. I can get my knee to past 90 right now when I push. The biggest difference that I noticed is how fast the swelling went down when I started bending it. I can see my kneecap today. The pink sock is a compression stocking. I started out (the day after surgery) with a Jobst garment that went to my hip but it got really hot so I switched to this one from Zensah. It really helps having something over the calf keeping any swelling moving upward.

Sparta thinks it's great that I'm spending time on the floor. When I first had surgery I was worried that she would hurt me. She is a good size dog and when she plays she likes to be right under your feet. She also likes to sit and lean into your legs. Turns out though, the cats have been more of a problem. They like to walk right across my legs while I am asleep. My grey cat, Strider, once stepped right on my kneecap sending me flailing. It didn't really hurt. It's just now that I've had this surgery, I don't want anyone near it. I'm sure that this feeling will fade as it starts to feel more normal.

Life in the armchair

I knew that surgery was going to be tough. I had prepared myself for the pain, following my doctor's instructions and not pushing too hard and not being able to get back to my favorite activities for several months. Still... this was much harder than I expected in other ways. I can now see why doctors might be more causious about doing surgery on people who have other compounding ailments. I consider myself to be be pretty strong and healthy and this whole thing has knocked me right down. Today is actually the first day that I feel really good. Previously I have felt fine when I was sitting or laying down. Today though, I have been moving around (on crutches) much better and for a longer period of time and not feeling like I need to sit. I think that surgery is so overwhelming because you are being pounded with a number of drugs that you don't get on a regular basis: both those given for anesthesia and for pain. In addition, your body is being cut into and pieces are cut from one area and stitched into another. I can actually feel where the new acl has been sutured into place. I can feel a difference between how it was after I injured it and now.

Another thing I didn't realize was how bored I would get in just a few days. I have a cable with 200 channels and internet. I bought magazines and Aaron rented me some movies. But now I am so ready to be out and about.

"I need some books," I told Aaron last night.

"Which books?"

"Sugar Blues. It is about the harms of sugar addiction." I thought it sounded interesting.

Aaron said, "You need some fun books."

So tonight I am going to the bookstore to look for my book and maybe something that things like Aaron's fun reading.

The Grand Unveiling (Squeamish Beware)

These photos were taken last Saturday (the day after surgery). I was able to take the wrap off and cover the wounds with band-aids.

I was a little uneasy doing this, but really the wrap looked worse than the actual sutures.

It kind of looks like a smiley face. I had 3 poke holes from the scopes and such and one 2 inch long incision. I am not sure what the doctor used to seal it because I could not see any sutures. Superglue?
A comparision of both my knees. A lot of swelling that has gone down some since then. You can't really see where my kneecap is. It is actually underneath the blue marker which was the doc's signature so he would definitely be working on the correct knee. I was asked so many times what knee they were going to be working on that I was starting to doubt my judgement of left and right. Part of that could have been the drugs as well.

Drugs, Ice, Rest and Repeat

It seems that the first couple days after surgery are the worst. Saturday, I didn't do much except for getting up to use the bathroom and then go back to my chair. I was taking the maximum amount of Vicodin yet the pain was barely tolerable. Sunday was a little better. Today (Monday) I am off of the vicodin entirely using just the ice system and keeping my leg elevated. I don't like the the pain medicines because they are really easy to get addicted to. Each time I dropped down on the meds I found that I went into withdrawl which basically feels like having the flu. In addition to that, they disrupt my sleep and my appetite.

Right now, I am still on crutches using what is called toe-touch weight bearing. This basically means that I can put a slight amount of weight on my injured leg, about the amount that is required to put firm pressure on an egg but not crack it. I am getting around fairly well but showering is a bit difficult. Last night I broke the rack on the outside of the shower door while using it to pivot around in the bathroom. That sent Aaron running because I think he thought I had fallen.

I think I might actually be able to get out of the house tonight for a little while. There is a little dog park a few miles from our apartment. The parking is close by so I can watch Sparta play without leaving the car.

And Now Real Work Begins

Cosie wearing her bouffant cap.

I came across a really neat quote from Wayne Gretzsky- "I skate to where the puck is going to be, not to where it has been." I found this to be fitting to my current situation. I cannot continue to dwell on the accident and feel sorry for myself. I have to look toward where I want to be and take the steps everyday that are going to get me there.



The surgery was not really that bad. The anticipation of the surgery had me nerved up. We arrived at the surgical center around 11:30am. I had to wear the whole hospital gown ensemble complete with bouffant hat. This was the most annoying thing because it kept falling over my eyes. I couldn't push it out of the way because I had an IV in my right arm (so no bending it), a blood pressure cuff on my left as well as O2 saturation meter on my left index finger. I had three leads hooked up to a heart heart rate monitor as well. My surgery was scheduled for 1:30 but I don't think that it got started until after 2. I hadn't had anything to eat or drink since 11pm the night before so if Aaron wasn't there with me making me laugh, I think I would have been pretty miserable. I was given an anti-anxiety med and another one that causes amnesia so I don't remember actually getting wheeled in for surgery.




I am one of those people who doesn't as much as take Tylenol unless I am doubled over in pain. I was given so many drugs yesterday that my body wasn't very happy with me. So as soon as I was alert and given something to drink, I threw up. After that, I felt great and was fine and got dressed to go home.




My knee is currently wrapped up with an Ace bandage. I can take it off later. I just have to keep the sutures covered up with band-aids. Over that I have a Cryocuff. It is a system that involved a cuff that fits around the knee and tubes that run to a cooler filled with ice water. A compressor pumps the cold water through the cuff to help with pain and inflammation. I really like it. I think it will keep me from having to take as many pills for pain. I got a new set of crutches as well yesterday. They are a lot nicer than the ones I bought at Meijer. I am allowed to put some weight on my leg but due to the meniscus surgery, I'll probably be on crutches a little longer than if it was just the ACL.





I ended up having tears in both the medial and lateral menisci in addition to the ACL tear. I am still expected to make a full recovery. I was able to get some before and after photos of the inside of my knee so I'll be posting those later next week.

All I want for rehab is a CompuTrainer

The only way that I can keep myself sane this week is by starting to plan my recovery and comeback for next year. I've already planned out what I would like to be doing during the next couple months but it will all depend on input I get from my doctor. He said that I won't be running for about 6 months (maybe less) but that he would have me on a bike soon. Hmmmm... that got me thinking.


Michigan winters can be pretty brutal and that means indoor cycling (boring) on my trainer or at the gym. So I started looking into CompuTrainers. These are machines which give you feedback as you pedal for things such as cadence and stroke power. You can even download and train on race courses such as Kona and my comeback race: Ironman Louisville. According to Tom Demerly at Bikesport (the great place that I got my tri bike from) the computer courses are even tougher than the real thing. The trainer's website claims that it will increase your bikespeed anywhere from 2-4 mph and cycling power by 20-30%. This is a piece of equipment that will not only keep me motivated to bike throughout the winter, it will also be of use years down the road. Now if I can only find one that is on sale...



I had my pre-surgical interview this afternoon. Basically, I got asked tons of questions about my health history: allergies, clotting disorders, cancers, breathing problems. Basically anything that could be aggravated by anesthesia. I can't eat after midnight on Thursday so I plan on ordering a large pizza that evening to eat around 10pm. She asked if I had any questions about my upcoming surgery. The only thing I could think to ask was "Do I have to wear an ugly hospital gown since they are only operating on one leg?" The answer is Yes.

Moving on... to Ann Arbor, to surgery, rehab and recovery

I got my paperwork today!!! I am officially scheduled for surgery next week which means I'll finally be on my way to getting better (instead of simply trying to find ways to work around my bum knee).

I'll be having a hamstring acl reconstruction on Friday, September 19th at 1:30pm in Lansing. I'm excited but also more nervous than I thought I would be. I've been so intent on getting this surgery done and soon that now that it is happening, I'm scared. I still have some time to process it yet, so I'm sure that I'll be fine by then.

This will probably be my last entry for the next few days. Tomorrow, Aaron and I will be moving along with our furry family (1 dog, 2 cats and a bunny) to Ann Arbor. We got the apartment because of my clinicals in Ann Arbor and Chelsea.

As you can see, Aaron really loves packing.

Hoping No News Is Good News

It has been a several days since I last heard from the Doctor's office. I checked the mail. Nothing. I am hoping that it means that my surgery is still on for next week. Doc had said he'd fit me in somehow.

I get a great call though yesterday. Gayle, my clinical advisor, called to let me know that my clinical site is willing to work with me. They are going to allow me to start clinicals part time two weeks after surgery and then start back full time two weeks later. I'll be attending rehab of my own at this point as well, but with the work schedule I am supposed to have, it should be easy to fit everything in.

Physically, I am actually feeling very good at this point. I do think that part of the meniscus is poking me in the leg though. Occasionally get this feeling like I am being poked in the leg with a tiny pin. Very odd. It is in the same area as the meniscus tear so maybe I have a little flap hanging out. I am being very conservative with exercise at this point because of this. I have been swimming (now using my legs as well) and I have been steadily upping my cycling time. I have did 45 minutes on Tuesday but I think that was a little much so I am dropping it down to 40 minutes today. I am also going to do a lot of upper body lifting as well as some core training. I am considering adding some squats and step-downs as well but I don't want to irritate that meniscus too much. I'll probably do a little bit today and see how I feel.

Sparta is learning how to be an obedient dog. Today I worked on staying. She is only good for about 4-5 minutes at time right now. I think she likes the idea that she is getting treated for doing nothing.

A Donut A Day

I just wanted to share this card I got from Jen the other day. I especially enjoyed the little critters with their coffee mugs. For everyone who doesn't know, I have suffered from a coffee addiction ever since Aaron introduced me to "the elixir of life" back in college (the first time around).


http://www.hallmark.com/ECardWeb/ECV.jsp?a=EG5753402925121M271503244Y&product_id=

Give me a date, please?

I've got to learn to stop blogging late in the evening. I just can't think straight and then I tend to ramble on and forget to add the important stuff. To begin with, I don't have a surgical date yet. My surgeon is leaving today for a conference so the rest of this week is out. He did try though. He even checked to see what time his flight was leaving. Tenatively I'm going to get it done on the 19th. However, I got a call from his office this morning saying that they want to switch it to the 26th. Poor lady, I gave her so many reasons why this will not work. Clinicals, for that matter. I have to have two weeks off after the surgery. After that, I can work part-time (4-5 hrs at a time) for two more weeks. After that, I can be back at full time. But pushing back the surgery, means pushing back my start date, which could mean pushing my clinical far into January (or the possibility that it may not happen at all). Help!!! Still, it will get done this month and that is a whole lot better than anything later than September.

The photo above was taken around this time last year. Kathleen, Bree and I were the top 3 women at the Michigan Multisport Point Series (MMPS). These girls are my inspiration to get better and stronger and faster. Kathleen has an artificial hip but kicks my butt on many, many occasions. Bree has had numerous other knee injuries and is still such a fast runner. If I don't stay far ahead of these women early in the race, I'm beat.

I should know more about dates for surgery and clinicals later on this week! Thanks for the support everyone!!!

Finally, Some Good News

Today I had my appointment with the surgeon. Nice guy. I had to wait quite a while to see him but it was worth it. I was relieved that he didn't seem nearly as concerned about my injury as I was. (I suppose he has seen much worse.) Basically, the ACL is competely torn so that will require a repair. The MCL isn't too bad. The posteriolateral corner is still attached so it will heal. The meniscus is likely only a small tear. He couldn't really test much for it because I couldn't get my muscles to relax. I tried but I still have a bit of a contracture in that knee as well.

The only thing that I have mixed feelings about is the use of my hamstring tendon for the graft for the new ACL. I have heard many conflicting things about their use and whether those or bone-tendon-bone repairs are better. Bone-tendon-bone is where they that part of the patellar tendon (of your healthy knee) and use it as a replacement. What I don't like about that procedure is that they tend to take a little longer to heal and then you have damage to both knees in some way. In using the hamstring tendon, the incisions are smaller and the healing is faster.

I brought this up to the surgeon because I was told that bone-tendon-bone repairs had a tendency to stretch out less than the other grafts. He told me that something along the lines that it is like comparing Republicans to Democrats: they're all still politicians. He said that he started using hamstring the hamstring graft a lot but then switched to the bone-tendon-bone. Now that the hamstring technique is improved, he has switched back. He says that is all in who you talk to about which is better than the other.

I spent this evening looking up studies on both procedures. A lot of them conflict each other which is typical. Both types of grafts seem to have their positives and negatives. My feeling is, that this guy is a good surgeon and came highly recommended. This is the surgery the guy does most so I can expect a good surgical outcome. The rest will amount to how I take care of it: the rehab, strengthening, etc. I like the fact that this technique will have me on my feet fast and back in clinicals. I also was never too sure if I wanted someone attacking the kneecap on my "good" knee with a chisel.

I think there is a risk no matter which way that I go. In this instance, I am going to trust my surgeon. He was able to answer all my questions and even promised me I'll be back racing.

My Dr. House cane!

My husband, Aaron, order me a cane. It is not just any cane though. It is the same one that the title character in the T.V show "House" uses. It has flames going up the bottom to help me go super-fast. It is a little long so we might have to cut it down a bit. It does make a difference when I'm walking with it. I can go up stairs faster (although down is pretty much the same). Aaron thought it would be useful when I am on clinicals until I am back up to my normal speed.

I also found some great crutch covers for my post surgical status. They are leopard-print. I'll be the most stylish patient at PT!!! http://www.brokenbeauties.com/fashion-new/crutchcovers-buns.php

Looking Back... Who thought that this pup would be the catalyst for this entire mess?

Today marks two weeks from the date of my injury. Overall, I almost feel normal (even though some will continue not to treat me as such). I haven't experienced a lot of pain since the day I first injured it and had to be carried into the ER. The swelling is about 90% down and I can walk around without crutches, a cane or even a brace. The only thing that I notice is that the knee sometimes has a tendency to want to buckle slightly and I still can not full bend it.

The first day I had a lot of pain. That subsided by the time I saw the ER doc. After that, I developed a lot of swelling. My legs aren't that big and there isn't a lot of room for excess fluid to go. The first few days I tried to go about my normal activities as much as possible. I did have a brace and occasionally used a cane. I didn't fully realize (and was partially in denial) of how badly I had hurt myself and ended up developing pitting edema in my lower leg. This is when you get swelling and when you push a finger into the area, an indention remains. Wearing a compression stocking over the next few days fixed that but getting those things on is a real struggle especially if you have to do it yourself. I had a hard enough time reaching my foot let alone getting the thing over my ankle. The first time I got it on, I left it on for two days despite the fact that it was August and in the 80s. I rested a lot more in the coming days after that.

Ice was my pain-killer/anti-inflammatory of choice. I didn't use anything else these past 2 weeks. I tried to ice it about every 2 hours but this varied depending on what I was doing and availability of the frozen stuff. My husband came up with this idea to use one of those ice packs that are meant for coolers. The don't bend like the ones for limbs. But if you freeze it around a bottle, it will shape around the leg quite nicely. These things take a long time to thaw so you can take it with you if you are going somewhere and it is still very cold a couple hours later.

I don't like pain-killers is because I don't like taking drugs in general. Another reason is the uncertainty about whether anti-inflammatories may slow down the healing process. Rather than take the chance, I've opted out on the use.

Other than ice, I have tried to find a pre-operative protocol for ACL injuries. Since I had my mind made up after seeing my MRI results, I want my leg in the best possible condition for surgery. The one that I have been using is from the Chester Knee Clinic in Indianapolis who has been working with knee injuries for the past 15 years. This is what they have found what worked for them. See the site at: http://www.kneeclinic.info/rehab_markdecarlo.php

The reason that I chose this one is because it is a progressive program and is well-detailed with videos.

In between ice sessions (3-6+ a day for 20 minutes each) I did quad sets where you try to contract your thigh muscles.

http://images.google.com/imgres?imgurl=http://www.mcguiremd.com/img/rehab3.gif&imgrefurl=http://www.mcguiremd.com/exercises.htm&h=135&w=505&sz=26&hl=en&start=9&usg=__U8BoggMyuZ4_vOEZ30tiv2EH-tc=&tbnid=iOTz_drR9B9U1M:&tbnh=35&tbnw=130&prev=/images%3Fq%3Dquad%2Bsets%26gbv%3D2%26hl%3Den

In the beginning my leg did not want to work. I found that by contracting both at the same time was very helpful. I learned in my motor learning class last year that when you use one side of your body there is always some carry-over to the other side. Sure enough, soon I was contracting my quads like a pro.

Other than quad sets I also did leg lifts while sitting on the floor, on my stomach and on my side. I found this most helpful for general mobility. It is much easier for bed mobility (as well as getting into bed) if you can control the leg. Sleeping was the most difficult thing for me for the first few days. I tend to roll around a lot and I ached from having to lay on my back all night. I also developed the start of a pressure sore on my heel both from this and sitting while having my leg propped up on a chair. I experimented with pillows under my calf and as I got more mobile this problem went away.

The past couple weeks have been a bit of trial and error. My suggesting after going through an injury like this is to rest as much as possible for the first few days and use ice. Start doing quad sets immediately and leg lifts early because it really helps and it makes you feel like you are doing something for your situation. (Just don't do them immediately after icing because the muscle won't contract as well.)

After the swelling starts to go down start adding other activities. I began lifting with my upper body. I also found swimming to be beneficial. I used a pull bouy and pushed off from the wall with my healthy leg. I also started cycling on an exercise bike 3 days ago. This is excellent for improving your ability to bend your knee. I wish I had started it sooner. Set the seat high (it won't be as painful) and don't use any resistance on the machine. I couldn't make it all the way around at first so I had to rock: pedaling as far forward as I could and the back and then back forward, etc. Eventually my leg could make it all the way around. The first day I felt a slight release in the knee. I think that I just loosened up some scar tissue because after that pedaling got easier. Just don't expect to be able to pedal very fast at first. I have been trying to ride it every day and increasing the time each day I ride. I have been noticing that each time I do it, it gets easier.

In Perspective... (Two more strikes)

When I first injured my knee I felt pretty sorry for myself. In the beginning I was in denial but once the facts came in about how bad off I was, reality started to settle in. For the first 5 days or so I had moments where I would just break down and cry and scream "It's not fair!" My assumption was that sure an ACL tear is bad for everyone, but for an athlete it is even more devastating. I was in the best shape of my life. This is a fact that even though it frustrates me, it makes me believe that my recovery will happen that much faster.

Two things have happened in the past week that have made me look at my situation through a different light. The first was a death of a friend, Carrie Ann. It is a really sad story. She and her family were in a car accident last weekend. Carrie (who was pregnant with her second child) was killed instantly. Her son had some bumps and bruises. Her husband, Dan, has several injuries, was in a coma and not expected to survive with man brain cells intact. Some good news has come out of the situation since then. Dan's situation has improved (some vertebrae that were previously though of as crushed, only slipped out of place) and his head injury is turning out to be not as severe as well. I had known Carrie Ann since high school. We weren't close, just a friends of friends sort of thing, but I can tell you that everyone who knew her, loved her. She was just that kind of special person. She was friendly, always smiling, and had one of the most welcoming personalities of anyone I have ever met. It is sad and I will miss her. I have to believe though that Carrie Ann has fulfilled what she was put on earth to do, giving birth to a beautiful son and gracing us all with her companionship.

After hearing about her last Sunday, I have to say that my perspective has changed somewhat. I'm no longer complaining "why me", I'm thinking "how do I get myself back to where I need to be?" Mostly, I was worried that now that I have had this injury that it will affect my longevity in triathlon. I had originally been planning on racing into my 80s. I still am, but part of me knows that there is no guarantees in life. I may not even live that long. All I can affect is my situation right now. I know that I am going to want my knee surgically repaired, so I have to get myself in the best possible position to both make that happen and to successfully rehab afterward.

The second thing that occurred this week has to do with my education. I am a physical therapy student currently getting ready to start my final clinicals. When I first talked to the internship coordinator I got the impression that they would work with me and that I would still be able to participate. This is not turning out to be the case. Due to the fact that my injury is more severe, they are reluctant to give me the go ahead to begin. I found this out on Wednesday after my first day of pre-clinical classes. What a downer. First my knee and missing the Ironman, next Carrie Ann and now THIS. I almost didn't come back to class on Thursday. All I wanted to do was lay in bed and mourn my injury all over again. Their reasoning is that they don't think I would be effective with an injured knee and that I could pose more damage to myself by participating. I understand that yes, there are some things that I would have difficulty with: squatting and kneeling in particular. But my brain still works, I have both my arms and I can walk (although a bit slower than normal). And I am still getting better. The only accommodation I expect to need is a couple weeks to have surgery and recover. I have no problem making up the missed time at the end of the clinical.

I do understand the school's position in all this. I know that they just want to protect me. However, I don't think that they are taking my wants and needs very seriously. I am very tired of being treated like I'm fragile or an invalid when I'm not. It is very tough if you are a very independent person and suddenly you have to start relying on other people. It is also hard on your mental state when you go through an injury like this and people begin taking away your ability to make decisions. I like to think that I know what is best for myself. I lost the Ironman, I don't want to lose my clinical either.

This whole situation is contingent on the doctor that I am going to see on Monday. Although I am feeling a bit down, I am cheered by the fact that I am one step closer to getting back to top form.

The Accident

I guess the best way to start this blog is from the day I got injured 1 week ago.

It was a beautful Saturday morning. While my husband was making breakfast, I decided to take my dog for a run around the block a few times to tire her out. I was riding my bicycle and had her leash in my hand. I realize that this was a really dumb thing to do. I had done this several times before. My dog, Sparta is part Australian cattle dog and part German Shepherd. She is extremely active and my regular running partner. The problem was that even running the dog for an hour and half is not enough to tire her out. So that is where the bicycle came in. I had heard through Caesar Milan (Dog Whisperer) that this was a good thing to do. (by the way... I am never listening to him again.) Sparta has always been leary of bicycles and usually stays far away when we ride. This morning though, she was really hyper and jumping around the bicycle while I was getting ready to go. We were fine until we were a block from home. Sparta must have seen a bird or a squirrel because she ran in front of my tire. I turned to try and avoid her but went to far and fell. My foot came off the pedal and I landed on an angle. I heard a pop after I landed and felt a searing pain. I was on the side of the road, not able to do anything but hug my knee. I didn't even care if Sparta ran off. She didn't though and remained next to me until help arrived.
My husband had to come get me and take me to the ER. Luckily, a nice couple stopped within minutes of my falling and let me use their cell phone. Things were a little fuzzy at this point because I think I was in shock so I don't remember much more until we got to the ER. Except, of course, my husband came to pick me up in his hawaiian print boxers. I guess the first thing that I said to him when he showed up was "nice shorts."
I don't have a lot of good things to say about the ER except that the doctor was inept but nice. I had X-rays taken of my leg which looked fine. However, the doctor did a poor job on the physical exam. Thinking back on this now, I should have asked to see a PT or an Ortho because they would have probably have been better at looking for ligamentous injuries. At the point though, I just wasn't thinking about anything but whether I would be able to race the following weekend. I thought that I had just badly sprained the MCL because of where the pain was and the fact that it wasn't swelling very much. I had heard that if you tear your ACL, your knee swells out right away. I thought that I might be able wrap my knee and still do the Ironman swim and bike and then maybe walk the run portion. I was discharged from the ER without a brace or wrap and without crutches even though I had to be carried in and had to hobble out.
I went to my family physician that Monday. By this time, my knee was swollen. I could put full weight on it but I needed a cane and a brace to walk decently. She got me into the hospital for an MRI the next day. The results from the MRI came back the same day. The techs tried to push it through because they knew I had a race and wanted to know the severity of the damage. At this point, I still had hope that I might race, although I was now wondering if my injury might be worse than I had previously thought. I thought the MRI was pretty cool. I was given a set of headphones so I could listen to music while I had my test done. I realized at that point, 70s and 80s rock music is not the best choice if you are supposed to lie still. Also, metal really does stick to the MRI machine! I had a small safety pin that flew out of my pocket that stuck to the wall of the machine. After the test I stopped into school (I am a physical therapy student) and found one of my professors to examine it for me. That is where I first heard that I had an ACL tear. So by the time I got the actual MRI results, I wasn't incredibly shocked.
I am now scheduled for an appointment with an orthopedic surgeon for the 8th of September. I am going to have to go under the knife to get this repaired if I am going to be able to run again.