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.