(Always) Under Construction- ACL Reconstruction: Days 1-11
Updated: Jun 7, 2020
In February this year, I was working as the track coach at the middle school. I might not be a spring chicken but I'm not in terrible shape, so I thought, what the heck! Let's train kids. I had a group of kids working on special events- hurdles and high jump- since I knew a thing or two from having done them myself (we just won't talk about how long it's been.)
--Back story-- I have a "bad knee". One that has given me fits for the last few years. I had an MRI done a few years back that just said I had an old injury, nothing new or acute. Likely from several years of being a rough teenager. My Rheumatologist would give me a steroid shot every now and then when I maybe had gone too hard on it and the swelling was getting bad. There didn't seem to be any reason to be concerned.
Then bam! one day... it would fail me... hard!
Anyway! I had this group of kids working and I walked a demo for them on leg placement for their high jumps. I walked the demo, y'all. I instructed them to plant the inside leg and jump, lean back and their body will follow over the pole. When I leaned forward, I turned to look at them to ask if everyone understood. And down. I thought maybe I hit a divet in the ground, maybe just stumbled really fast. There was no instant pain or swelling or a loud popping noise. I simply fell.
Slightly confused, and now surrounded by a group of middle school-ers yelling "Coach!", I thought... WTH!? I said, I'm okay. And I stood up. I took a step forward and promptly went back down. I then said, I'm not okay. Someone grab Coach Ferg.
Long story short- some phone calls and rearrangements of plans for a few people later- My pastor had me and I was in the ER. At this point, I'm in a fair amount of pain and you can visibly watch my leg swell. Sitting in the waiting room at the ER, I told Brother David, "You're the pastor, place your healing hands upon me!" and he (probably) rolled his eyes. The ER did an X-ray and there was no fracture. The attending said, I think you ruptured your ACL but we don't do MRI's here, you'll have to see the Ortho team. They gave me Tylenol and Phenergan and I went home.
I had the MRI, saw the Ortho, and was finally given the official.
I had completely torn my ACL. Walking, y'all... you following. I wish there was some really cool story, like I blew it out at CrossFit or was being chased by ravenous wolves...
No. I was walking a demo on the high jump technique.
That was February. 02/20/2020.
I didn't get to meet with the surgeon until 31 March. Over a month later.
School has been cancelled for Covid-19 by this point. Life is basically all in limbo. Nothing happenin' for nobody nowhere.
Surgeon says I need pre-hab and that hopefully by May 1, we can get a schedule for surgery.
I did 6 weeks of pre-habilitation. Got full ROM (range of motion) and was doing really well. Beginning to question if I need the repair, only to be reminded every time I try to run or move fast or turn, that I indeed do.
My advice if you've torn your ACL:
NO BRACE! Stay off the crutches. My ortho recommended that I continue to use the brace for stability. So wrong. It left me with extra work as I had to get my hamstring and quads to fire and do more work to be as strong as they could be before surgery. If you find yourself in this boat, the ACL tearing and all, start Hamstring work ASAP. Hamstring curls, band work, clamshells, side stepping, toe touches. All of it. Ride a bike!! All of that. Get into PT as soon as you can to be ahead of the game.
It is now May and I have finally had my surgery.
The plan was for an autograft, where they take a tendon from your body and replace the torn one. Mine was going to be a patellar tendon bone to bone autograft.
Something went wrong, I don't know what, and that didn't happen.
I have a follow up in June, where I hope to get the answer to why we couldn't use mine. Ronnie said they also told him they had to do some reconstruction, but he doesn't ask questions so I have no idea what went on. I trust this surgeon though, he's the go-to guy for the FSU Football team and that says a lot to me.
My advice for you, as I sit here on day 1 of recovery.
Have lots of pillows. Lots of books. Things to do. And water.
The CPM machine sucks. More on that later.
So does the cooler pack.
I'm off to rest again. Because I'm exhausted.
We'll talk about this tomorrow.
Days 2 and 3
Okay. Backing up a little.
Prior to surgery, you get 2 nerve blocks. One of them goes in your inguinal nerve, thus blocking any sensation to your leg. The next block is a little closer to the knee. You are awake when those go in but they are ultrasound guided and honestly, I don't remember much. There was a sting, obviously, but no excruciating pain or anything. It takes effect rather quickly too. By the time I made it into the operating theatre, I couldn't feel my leg. It's almost like at the dentist, when they numb your mouth and your tongue grows 10x... that's how it felt.
We got into the operating theatre and they said here's some oxygen, and then Dr Taylor said, "we're going to go to sleep now." And I did.
The first thing I said when I woke up was "Ouch". The nurse said, I know honey. Ouch isn't quite the word. More like "UGH!" I was definitely sore, kind of felt like I had holes drilled in my legs or something. (I kid, kinda.)
So coming home, the nerve block is still in. It's there for 3 days via a little balloon pump and catheter in my stomach. Which must have been done while I was asleep because I definitely don't remember that one going in.I have control of the amount of block going in, I've kept it on 4, they do not recommend going lower than that. But if you leave it on 6-8, you could run out too quickly.
You do come home with pain meds, I have taken 1 since I came home and it was after my first round on the CPM machine. Which we'll talk about now.
Okay, this guy. The CPM machine. What a monster. Seriously, it looks like an archaic torture device. Feels like one, too.
24 hours after surgery, you're going to put your leg in this and it's going to bend your knee to 90 degrees.
It has 5 speeds, I tried it out before surgery and speed 1 was agonizingly slow. I was like, probably put this baby on a 3 and go for it.
No. Let me emphasize that word. NO. No, you will not put it on a 3. You will put it on 1 and curse your lineage.
Speed 1 moves at about 1 degree per second, so it takes you roughly 2.5 minutes to get to the full 90 degree bend. I am good until about 75 degrees and then I hate everyone and everything and regret all of the decisions that led to this moment in my life.
There is no pause though, once it gets to 90 it immediately begins to lower back down. You'll do this for 1 hour, 4-6 times a day. Basically, every 4- 5 hours you're in the machine.
WEAR THE COLD PACK (will talk about it later.)
Guys. When I tell you that I give this whole thing 0 out of 10 stars, I mean, -5 stars. If there was a Google review for an ACL repair, I'd be leaving nasty comments.
Following that beauty routine, someone who loves and cares about you is going to come force you to hate them. I threatened violence. I might have hit him.
Ronnie comes in, rolls a towel and puts it under my ankle. Then he does this amazing routine where he presses down on my knee for 5 seconds, 5 times. This, they tell me, is to stretch the tendon to full extension. This, I tell them, is grounds for divorce.
You're going to want something to hold onto or bite down on. If you are not good with pain, you should take a pain medication 30 minutes before you start the machine. I did the 1st one without medication and I ended it in tears, sobbing. I took one for the 2nd time and was able to tolerate it. That was the only one I took, I have been fine since then.
I'm not even sure what my leg looks like. I have the brace, under the brace is the cold pack, under the cold pack is an ace wrap. Under the ace wrap is gauze.
There is a little stocking on my upper thigh, to keep the cold tubing off my skin, since I can't feel my skin, it's probably a safety thing. There is also a compression sock on my calf. Under all that other stuff.
I do know there is a lot of betadine and chloroprep, my leg is a very nice orange color in several areas.
Heads up guys. You're going to be on some stuff. You get the pain pump, you're coming out of anesthesia after several hours and that's heavy, then you have narcotic pain medication, and you have 2 days of antibiotics. You will need a stool softener of some sort. With no physical activity, you're confined to bed for no weight bearing, you will get constipated. Black coffee and a stool softener will help you from adding one more issue to your plate. Seriously, no one enjoys that. We don't want to talk about poo but it's just me being real. Do the things, okay, and I won't say "I told ya so."
Second heads up. Put your bed near the toilet. I am 6 crutch steps from the bathroom and it was a near death experience the first time there. Ronnie had to help me lay down in the bathroom floor because I knew I was going to faint.
Don't be a hero y'all. You cannot get into the bathroom, pull your pants down, lower yourself to the toilet, wipe, and get back up and dressed on your own. Modesty to the wayside here, someone will have to help you the first day or 2.
I keep saying that we will talk about the cold pack, so I guess we'll get right down to it.
It was recommended to me to ask for one during recovery and it was covered by insurance so I did.
It's a cooler, with tubing that leads out to a wrap that straps to your body part (the grey tubing in the photos above is the "Cold Rush"). You fill the bottom 2 inches or so with water and the rest with ice. We would buy 5lb ice bags from the grocery store because our freezer couldn't keep up with the amount it took to fill for those first 3 days. (Hack! Fill tupperware with water and freeze, 2 cool-whip containers is good enough to keep the water cold.)
Day 1-3, I basically kept it on. All. The. Time. Definitely keep it on during your CPM sessions. It helps massively, I think because at some point it goes numb from the cold.
Anyway... my DME company said that they leave it with you for at least the first 3 days but as long as it's not needed somewhere else, they'll let you keep it for the 14 days that you have the CPM.
That's all, it's nothing major. It's really helpful though. I found that it's helped a lot with pain control, which is probably mostly related to the inflammation.
Day 5 was by far the WORST day. Today is day 8 and I'm still sticking to it that 5 was a nightmare. I have taken 3 pain pills in 8 days and 2 of them were on day 5.
I think that the irritability of being laid up for 5 straight days, being mentally over my inability to do anything independently, the swelling was at a peak and my wraps was tight. My leg itched from not having shaved in 5 days (TMI? No, not nearly) and the healing wounds.
I couldn't (still can't) get in and out of bed by myself, I can't sit on the couch unless my leg is up in the air, etc etc. It's frustrating.
I have been to Physical Therapy twice since surgery. The first day was passive stretching really. Checking on swelling and making sure I was good. Then Dr Josh gave me a list of at home exercises (if you've ever been to PT, that's a common practice) and encouraged me to work hard on my quads. It's easy to do and something that is very important.
Second day of PT was 6 days post-op and I was grumpy. I see no visible difference in my swelling and as much work as I had been doing on my quads, I felt like I wasn't making progress.
Let me tell you what "not making progress" does to me. I am not pleasant. I want things to progress, I want to have quantifiable, measurable success on things. I despise feeling like my wheels are spinning. Want to aggravate me? Delay a project. I'm a monster for doing well.
After 40 minutes of work and frustration and obvious agitation, Dr Josh suggested we do some electro-therapy on the quads to see if we could get some spasms out of them, get the blood and nerves moving. Quad weakness means that I can't raise my leg. I can't pull my leg into a bend by myself. I am . Not. A. Fan.
I had to do this for pre-hab too and honestly, I enjoy it. Dr Josh says that's weird, I say... whatever.
So they put these pads on you (see left) and start an electric current. They turn it up until a muscle spasms/reacts. Then it goes on for 30 seconds and you have to contract your muscle against the current. Rest for 10 seconds, repeat. It's exhausting but satisfying. I am not allowed to remove the brace completely until I can lateral leg lift without knee lag... ugh.
Day 7 was my post-op visit with Ortho.
Ms Carolanna explained why they chose to do the Anterolateral Ligament (ALL) reconstruction because I had a 3+ pivot shift (it's a test done while you're asleep, YouTube a video...looks not pleasant.)
I had 6 incisions and 12 stitches. They removed the stitches and placed steri-strips on the incisions, YAY! I can shower now.
She gave me a few more at-home exercises to do to help get quads going. She said that her main concern is making sure my knee is straight because if the first surgery is terrible, I definitely don't want a second one to fix the bend in my knee.
Carolanna said that it looks great, and I'll be honest, it looks a lot better than I was expecting. I'm purple and yellow from about an inch above my knee to my ankle. My whole shin is bruised.
She said there is very little protection on top of out shin- and anyone who has a shin can tell you that- so it's extremely sensitive- also not new information. Luckily, I have great skin coloring so the bruising isn't hideous. (Thanks Mom and Dad.)
I'm fine to take regular doses of Ibuprofen, which is great because I think anti-inflammatory will help me more than Hydrocodone.
She said that I can walk using 2 crutches and weight-bare to tolerated. In a few weeks I can move down to 1 crutch on the opposite side. After a few more, Dr Josh will start unlocking my brace for walking.
Swim in 6 weeks.
Run in 22.
That's what I'm holding out for... Running!!
Days 9 through 11
So I was supposed to have therapy twice a week, right. Some at home exercises and in-clinic therapy.
Thursday I was feeling really good, I had a shower and I was not too sore and I missed the sunshine. I went outside. I walked around in the yard for about 15 minutes and then I was exhausted. So I went in to sit until it was time to go to therapy because I didn't want to be fatigued for that.
We get to therapy and I'm now hitting about 8 on the pain scale. Tears in my eyes, holding my breath, the works for top notch pain. It felt like my shin was on fire and it was just radiating up and down my leg. The back of me knee was so tender and painful to walk.
Lacey sent me home, she said you can't start therapy if you are already at the top of the pain scale. She was concerned about some of the heat on my leg, said to monitor it for a day or 2 and call Ortho. Dr Josh called the next day to check on me and said, check your temperature a few times today and if you have anything over 99.5 you need to call in to Ortho or go to Urgent Care.
Well Thursday night it was like instant onset. My face flushed and I was freezing. It was 73 in the house and I turned it to 77, put on 3 blankets and was shivering. We couldn't find the thermometer dangit but safe to say I was well over 100 at this point. Around 3am, after a round of Tylenol, it broke. I woke up in a sweat and burning up under the blankets.
Friday was about the same. Sore and tender and one of the incisions was weeping (it had been since they took the stitches out.) About 6pm that night, again it was just instant. My face flushed and I was freezing. Our new handy dandy thermometer said 99.7. Then near 8pm it said 100.1. Then at 10:30 it said 100.5.
Saturday morning we went to the Orthopedic Urgent Care (so glad they have it!) and told them what was going on. PA Jared came in and peeled off the steristrip where it was oozing. He was like, aw. Yea. Shouldn't look like that. He said that this particular incision site is usually the one that it happens too. When a wound heals, it's like a zipper pulling 2 sides together. My bottom layer had healed but the top had not and when the stitches were removed it came open. Then the MA had put steristrips across it and it just kept moisture in. He said my scar is going to be a little bigger than was originally intended, I'm okay with that. Scars are tattoos with better stories, right?!
I have autoimmune Rheumatoid Arthritis, though. I take an immunosuppressive (Methotrexate) at it's highest dose to keep it under control. This means that I heal a little slower because we're trying to keep my immune system from attacking my fingers hahaha. I was concerned because maybe I need to stop that medication in order to get better. But it's a double edged sword. I can stop it to let the wounds heal and then hope that my RA doesn't flare up and bring the rest of my body into the picture and possibly bring in septic arthritis, or I can stay on it to keep my joint pain under control and the healing take several weeks longer.
Game plan for now is to do 10 days of Cephalexin (Keflex), the surgeon wants to see me Monday (PA Jared sent him a picture of it and he said to get me in ASAP), and I'm to shower every day and keep the wound covered with dry gauze.
Stay tuned for "as Samantha's knee falls apart" episode 2 ;)
Light and Love,