February 2003

Tue, 11 February 2003

Pre-op appointments

As scheduled, I had two pre-op appointments yesterday (Monday 10th): with the doctor and with the hospital. Charlene Abbott came with me, primarily for moral support (Kiron is in Las Vegas this week), but also to write down all the answers to our questions, so I didn't have to. I'm glad she did, because I have a memory like a sieve.

Actually the first one was with Ling Yu, a colleague (perhaps an assistant?), and not Dr Kobs afterall. She checked the strength of the knee and answered some of my questions. She also mentioned something about a large cut down the front of my knee (perhaps 2-3 inches??). Upon reflection, that discussion worried me a bit, I guess because I thought this was to be arthroscopic ACL surgery.

Charlene and I had coffee at Starbucks in between.

The second appointment was at the hospital. We went through a bit of paperwork and we met with the anesthesiologist who's going to be putting me under. No blood tests which was somewhat surprising.

I'm glad they showed us the paperwork they'd printed out -- it reported that I was to have "medial stitcher tray" surgery. I queried this because its my ACL (anterior collateral ligament), not my MCL (medial collateral).  Turns out the entire diagnosis was an error: this tray really is a tray -- its the steel tray that the surgical instruments are placed on during surgery! Needless to say they intended to correct that.

We then met Bob (Charlene's husband) at Bear Rock Cafe and had lunch there, then I went off to work.

Wed, 12 February 2003

Last physiotheraphy session before surgery

Well it's 1 week and 1 day before my ACL surgery. My surgery is scheduled for 8am on Thursday, 20 February. I had another physiotherapy session this afternoon, the last one before it.

The session went well -- both Jodi and Chuck (the therapists) were there and put me through the bank of exercises.  I've been to ProActive about a half-dozen times now, each an hour. A few times the exercises have hurt for a day or two afterwards, but I think that means that my leg is getting stronger.  I've been told that will speed up the recovery.

I set appointments for the Monday, Wednesday and Friday after the surgery.  Dr Kobs said that I will need to do physio three times a week, starting 2 days after surgery.

I'm also meeting with Dr Kobs this week. After meeting with Ling Yu, on the 10th, I felt I needed to talk directly with Dr Kobs to understand exactly what he's going to do during surgery. I'd previously arranged to meet with him on Friday, but I got a call today asking if we can meet tomorrow, Thursday, instead. Hopefully all my questions will get answered.

Thu, 13 February 2003

Met with Dr Kobs today. Basically I had some questions as a result of the appointment with Ling Yu (one of the Physician Assistants at Raleigh Orthopedic).

I had taken a digital photo of my knee and printed it out with the aim of getting Dr Kobs to mark on the page where he planned to do the incisions. Instead, he did one better: he popped next door and ask one of his other patients if I could come in a have a look at the results of his ACL surgery from two weeks ago. Most excellent.

So now I know: the surgery will be arthroscopic. I have two small incisions below my knee (where the camera and tools are inserted, I'm assuming), one to the side where the screw will be inserted and a 0.25" cut above my knee and to the side where a drain will be inserted. A larger cut (looked like about 1.5") will be made below my knee and to the side where they'll go in to harvest a bit of my hamstring (to replace the torn ACL).

So that's good. He said they rarely do open surgery any more. Thinking back to the session with Ling Yu, I think I simply misinterpreted what she was saying.

The other patient said he was off his crutches after 4 days or so. I saw him walk in earlier and he seemed to be OK - hobbling but not particularly slowly. He had his left knee done, hence he was able to drive himself to the office. I won't be so lucky since its my right knee.

I also asked Dr Kobs about these passive motion machines (see Figure 10 here). He said that the physical theraphy will be better than using one of them, and he normally only uses those types of machines for total knee replacements or for older people that can't exercise as much.

Other info he told me:

• No showers for 3 days, just "bird bathing"
• Keep the brace on, except for exercising, for the first 3 days at least (will be more comfortable he says, due to the support it provides)
• Showers after 3 days are OK, no need to cover up the wounds
• After a week, might be OK to sleep without the brace (provided it doesn't hurt)
• The stitches will be taken out after 10 days (my next appointment with him)

My first physio appointment is Monday morning.

Sat, 15 February 2003

Well the countdown continues.  My surgery at Rex Hospital is set for 8am Thursday. I have to be there at 6am for check-in.  I've been told:

• No food or drink (including water) from Wednesday night at midnight
• No ibuprofen or aspirin (or other anti-inflammatory products) 1 week before surgery

Other info about my surgery:

• Surgery should take 2-3 hours
• I'll be given a general anesthetic and a femoral nerve block (to ease the pain after surgery)
• I'll go into recovery after that
• Kiron should be able to see me about 1pm
• I get to go home about 5pm

Thu, 20 February 2003

Surgery was a success

Well I had my surgery today. It went very well.

Before we left the house, I put two temporary tattoos on my right knee -- the doctor gave me them so that they wouldn't work on the wrong leg. Kiron also wrote "Not this knee :-)" on my left leg, just to be sure!

Click for a larger version

They poked a needle into me with some sedative, so after 5 minutes, things started to get a bit fuzzy. They also put an IV drip into my right hand which was feeding some type of saline fluid into me. My mouth started to get very dry -- they told me that was an effect of the drugs I was getting. About 7:55am, I bid farewell to Kiron and they wheeled me into the operating room. There were about 6 people there, including Dr Kobs (how about that!).  They all said hello.

Click for a larger version

The next thing I know, I was back in a recovery room. It was about 10:40am or so. Kiron came in a few minutes later, so it must have been Recovery 2 (they told us she couldn't see me until then, and not Recovery 1). I already had the brace on, so someone must have put it on me while I was asleep. The doctor handed Kiron photos of my knee during the surgery.

Click for a larger version

We left the hospital about 2:30pm. I'd attempted to leave earlier, but felt a bit nausea, so they gave me more drugs and waited for them to leave. They wheeled me to the car in a wheelchair. It was fun getting into the car.  The brace meant that I couldn't bend my knee (not that I wanted to), so I had to have the seat all the way back and the seat back tilted as far as possible. I then slip up the seat back until my leg was in the car.

Kiron took excellent care of me. She put me in bed and brought me water, and some cheese and bickies (crackers). I had a bit of trouble swallowing -- I guess the drugs were the reason for that.

I woke up every few hours and had some water. Kiron also brought me some grapes. I took some more pain drugs. They prescribed Oxycontin (for pain) and Oxycodon (for "breakthrough" pain).

So here we are. The pain's not too bad (maybe a 4/10) but the brace prevents any movement and I haven't moved it much.

Fri, 21 February 2003

I've been resting in bed all day today. The pain drugs I'm taking (Oxycontin and Oxycodone) are making me feel a bit dopey, so its a good thing that I'm "avoiding making important decisions" (as the discharge instructions puts it).  I guess I should put off selling the house for a day or two.

Throughout the night and today, Kiron's been changing the water in the Cryo Cuff I have wrapped around my knee (the blue thing in the left photo below).  Basically its a cold pack that contains water to reduce swelling in the knee. The way it works is this: once the cold pack warms up, connect the cooler (there's a click-in valve at the top, just below the top brace strap) and put the cooler below the knee so that the water drains into the cooler using gravity. The cooler has ice & water in it. Then after a few seconds, lift the cooler up above the knee and gravity fills up the knee pack again.

My left leg is also hurting a bit, but that's because of the needle they jabbed in my thigh yesterday for nausea. Haven't had any nausea since I left hosptial fortunately.

Sat, 22 February 2003

I added the arthroscopic photos today. When I meet with the doctor on March 3rd, I'll ask him to elaborate some more on what's in each photo.

The pain hasn't been too bad today. I'm taking the pain drugs as prescribed, so I guess its all progressing to plan. I've been helping Kiron with the laundry, getting up on my feet to fold the clothes that she washed.

I'm very glad I have the brace on still. Certainly it prevents any movement at all on the knee, but thinking back to the pain I was in the first week after I injured it, not being able to move it is a good thing.

There's a severe thunderstorm warning here this afternoon. Doesn't look too severe outside, though. Raining, with a bit of lightning and thunder, but no 58+ mph winds though (which is the definition of severe). 

Sun, 23 February 2003

I had my first visitors yesterday! Carmen, Anna Banana, and Linnea came over for a little while. Very nice of them. Linnea is just back from Scotland - she was there for auditions into the Royal College of Arts (plus another place).  Unfortunately, she didn't make it in this time.  Hopefully next year.

We had fun last night, although I may have over done it a bit. Went to Haskell Fitz-Simmons' 20th anniversary celebration of him being the Artistic Director at RLT.  It was a complete surprise to him and the evening was an evening of reminiscing and "roasting".

Unfortunately, after 2-3 hours of sitting with my leg resting on the chair in front, my knee was killing me towards the end. The cold pack around knee was most assuredly warm. Fortunately, wonderful Kiron had brought my drugs, so all was not lost.  However, I'll be taking it easy today.

Tomorrow is my first post-op physiotherapy session at Pro Active.  I think the plan is that they will remove the bandage that currently runs from my ankle to my thigh.  With a bit of luck I'll bring my camera to take snaps.  With the bandage removed, the next thing is a shower!. Yes I'll be looking forward to that. 

Mon, 24 February 2003

Bandages off!

This morning was my first physio therapy session since the operation. Kiron took me there.

First the therapist Evelyn removed the brace, cold pack and bandages. And this was what it looked like:

The therapist told me the swelling wasn't bad -- less than most people apparently. That sounds like good news.

Then with Evelyn's guidance, I did some exercises with the brace removed:

• Lying on my back, bending the knee (see below)
  
  
  
  
• Lying on my good side, bending the knee -- she measured how far I could bend it - 73°.
• Lying on my back, pushing down on a rolled up towel tucked under my knee
• Lying on my back, lifting my leg up to about 35-40° off the table
• Standing on my good leg (no weight at all on the bad leg), lift my leg to the side about 20° off the vertical

She asked Kiron if she would help me do some of those exercises, a couple of times a day.

At the end of the session, she put ice on the knee for 10 minutes then put the bandage and brace back on again. She said the bandage will help control the swelling so its best to leave that on most of the time.

Evelyn said I shouldn't get the wounds wet until Friday.  Until then, if I shower, I should cover the knee with a plastic bag.  That wasn't what the doctor said (he said that I could let water run over them after 3 days), but I didn't argue. I figured that the longer I leave it the better.

My next appointment is Wednesday.

For the rest of the day, I laid on the sofa, with my brace and bandage still on, and did work on the computer. My knee was fairly sore (pain level maybe 6/10) and I took more drugs mid afternoon. Evelyn said I should take drugs enough time before the next session so that they will kick in.

Wed, 26 February 2003

I had my second post-op physical therapy session today. It went well, but I was in a fair bit of pain from the various exercises he put me through.

I asked why my calf muscle is so sore. It seems that after I've been on the sofa or in bed for a while, then when I get up, the first 5 minutes, my calf muscle is very painful. As a result I have trouble walking, even with crutches. Its sore even to touch. The therapist (today it was Toby) said that I probably bled into that area of my leg as a result of the surgery and there's bruising there too. He said there's also "waste products" in there too. He said that it will go away, but I should exercise it by making circles with my foot and flexing the muscle. ]

Wrapping my knee in Glad Wrap prior to having a shower

He also suggested that I try and get up and walk around throughout the day (but don't over do it). After the first few minutes of pain, I can walk around quite easily, even with only one crutch. In fact, if I'm careful, I can get around the house without crutches at all, so that's good.

I asked about having a shower. He recommended I not get the wounds wet until after the staples are removed on Monday (they are staples, not stitches). He said the best way is to use Glad Wrap to wrap the leg so that water doesn't get in. Much better than using a big garbage bag. I tried it tonight and it was a success.

Thu, 27 February 2003

Added some photos in the Week 1 section of the Photo archive.

Had a shower at night after dinner (the Glad Wrap method), but my calf muscle was killing me, so it was a quick and painful one. 

Fri, 28 February 2003

I had another physio session today. In summary, so much pain in so little time, but afterwards, wow - hardly any pain at all!

Before they started, they got me to take off the brace and the compression ("Ace") bandage and to do some leg raises, first on my back, then on my side.

Then Chuck worked on me. He first wanted to see how much I could bend my knee, so he was getting me to compress it as much as possible and was using force himself to help me get there. Talk about pain! He said afterwards that he didn't really try and push it (thank goodness!). He also wanted to see how far I could straighten my leg, and got me to push down on the knee with my leg outstretched. I'm out by 4° apparently.

Next, I stood and did more leg raises, to the side and to the back.  Next standing on my tippytoes for 10. That was hurting. Then doing crouches using the parallel bars for support, for 10. He wanted me to couch and go backwards, like I was about to sit in a chair, not just straight down.  This was to keep the weight of the knee. For now, its all about bending it. Now that hurt!

OK, next was the bike. He didn't expect me to be able to turn the pedals all the way round, just to use the good leg to stretch the limits of my flexibility of my bad leg. He got me to turn the pedal slowly until my knee prevented it from going further, then relax, and try and turn it a bit more, then to hold it for a few seconds. Then go the other direction. I did that for about 10 minutes. Ouch a lot!  He brought me a towel as I was sweating a fair bit.

I was wasted at the end.

Next was the good stuff. Chuck got me to lie down on my stomach on the bench and he started massaging my calf muscle and behind my knee. Wow was that good. It hurt at times, but he was really doing wonders. He also worked on one of the big bruises at the back of my knee. He kept going back to it. Then he iced my leg above and below for 10 minutes.

After that, the pain had mostly gone away. He put the bandages back on again, a bit more tight than the others had put it on, but it felt good. I could walk quite easily.

So, its seems that the pain in my calf muscle can be controlled with massage. I'll get him to do that again on Monday.