ACL revision (6/7/2010)

[clarky_vl]

Hey,
Starting a new diary as on Tuesday I will be going in for the second stage of my ACL revision, and my last diary covered 3 of my last 4 surgeries, so probably a little confusing (and boring!) if someone wanted to read it!

This will be my fifth knee surgery since october 2007, including 3 ACL reconstructions and the first stage of this one (removal of screws/staples and bone grafts) all of which have been on my left knee, so this will be my fourth ACL reconstruction on my Left knee, which just sounds ridiculous... Oh and I originally tore it back in November 2006 playing netball in school PE (when I was 14!!).

My previous grafts have been Hamstring from injured leg, hamstring from the opposite leg with a LARS and Quad tendon from the injured leg also with a LARS, in february I had all this removed and filled in with bone grafted from my hip, which has healed fairly well

It has been decided that my grafts keep failing because of my hypermobility, particularly bad in my knees, which places too much stress on the graft causing it to stretch/break and become useless. This happens very early on and my knee becomes completely useless at normal daily things- as it is I cannot walk up stairs on it and even step on to that leg if it is slightly bend because the tibia literally just slips forward, along with all the normal ACL restrictions, so it is very limiting to me (unfortunately I have always had to wiat ages to have surgeries in the summer due to school exams!). Not surprisingly this has also caused a fair bit of damage over the years resulting in several lateral and medial meniscus trims leaving me with very little, and microfracture of cartilage on the lateral femoral condyle. Last surgery I was told I had yet more damage which I would expect will be sorted out on Tuesday too  . This all means I have a very unstable knee which often gives way, I can always feel 'moving', and which swells and is painful all the time.

This surgery I know for sure I will be having an ACL revision using patella tendon allograft (used all my other suitable grafts up according to the surgeon) no LARS this time, and I will also be placed in a full leg cast in slight flexion for 6 weeks, which is going to be fun this summer! However, my surgeon has also spoken of other procedures which he will decide upon 'once in there', such as the old fashioned antero-lateral extra-articular reconstructions which sound pretty big but I would rather this be my last ACL reconstuction-the more i can throw at it the better!!! I will have two consultants performing the surgery, and I know I am scheduled as first in the morning so will have to be in for 7am!

I am feeling pretty well prepared, and at least that is the advantage of having been though this a fair bit- I know what to expect!! Still nervous though, and that is really begining to kick in! Tomorow I will be spending the day with some friends, and then going to a party with my friends in the evening, so I have a lovely day planned for my last day before the op! I also got a new puppy at the weekend, bad timing perhaps but he is very cute we will see how that goes with negotiating crutches as he is a bit little!

I have been booked to stay overnight after the op, but we will see what my pain is like,especially as I am a wimp! And also as I wont know what has been done until after 

Vicky

Oh and if anyone wants to read through my previous diary, here is the link: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=44619.0

[Snowy]

Best of luck, Vicky! I know from reading your diary just how much you've been through, and I have nothing but admiration and respect for how well you've coped with the repeated graft failures and the frustration of yet more surgeries. I really, really hope that this is the last time you need to go through this.

Will be keeping my fingers crossed for you, and sending good thoughts your way on Tuesday.

Kay

[Kaputt_Knee]

Go for it this time Vicky!

In plaster in summer  no joy, especially if the summer is hot! I was in one for 3 months way back in the mists of time after my first knee surgery. Should have only been for 8 weeks but the docs in the UK in their wisdom decided to replace my plaster knee tube from Austria with a full length hip to including toe jobby weighing a tonne and a half. So 3 months later we returned the wheelchair and fought to get my muscles to even move let alone do anything! I had lost so much muscle mass I could almost slip in and out of the plaster like a over-sized plaster Wellington boot!

Sue 

[lis1]

Good luck Vicky, hope this one goes well and works!!

Lisa

[mollyc]

Fingers crossed that this procedure does the trick! Keep us posted when you're back at home. I'm picturing you with your leg elevated and the puppy nestled at your side! Molly

[zaiemk]

Good luck Vicky, I really hope this starts to improve things for you.
Zaiem

[vinnic]

Hey Vicky, hope things went well yesterday!  Wishing you a successful and speedy recovery.  Hopefully you're already back home and resting.  Take care and post when you feel up to it.  Best of luck with everything.  Nikki 

[clarky_vl]

Hey,
Just a quick message because I am feeling pretty crappy, but back home and managing thankfully which I am pretty proud of.

So he only did the basic 'normal' one which is fine if it works, but i dont think i am too happy with, but i shall talk more about that tomorrow. for recovery he has literally said totally NWB and to pretty much 'stay in bed' lol and not move for the next 6-8 weeks unless necessary!! was sort of surprised, also seemed like a backhanded way of passing the blame for the others onto me, in fact he said several 'cover my back' things while i was there which i found a little odd, we dont usually do the blame game we just do the what next, also he knows i'm not the 'up-to-do-sports-the-next-day' type, so I feel personally offended a bit... but anyway whatever, he also has given me two weeks of blood thinning injections in my tummy for this (fun!) and have to have blood tests also to check platelets

There was however some confusion as his notes are rubbish and he appeared to put down PWB despite at the same time to me and my parents emphasising the NWB and rest aspect, so the nurses rang around to seek clarification, although i think his notes are mistaken

he sai din the morning were he spent a good long time with us talking about medical and no medical stuff lol, that he was actually using an english graft, so i guess he changed companies

said he had been talking to more colleagues too...

more damage found in joint, but TBH not as much as i was expecting there to be based on how it was feeling and the accidents i keep having

cast is huge, and well lets just say ortho surgeons are not very good at putting on a decent cast, already had to have it altered at the ankle, and it is quite um lumpy lol and had bits of fluff on it from where they kept accidentally leaning over it when it was setting and leaving fluff. still it does the job THEY want it too, holds it at a few degrees flexed.

My surgeon actually brought a digital camera and aked to take pics of the surgery and the graft, so i guess he hasnt used allo before or wanted to take pictures of my surgery or something, but hopefully he will show them too me soon.

Appointment with senior physio lady (who i hooed not to have to see again) in 5 days, not too sure what she will be checking as it isnt like i should be walking or flexing lol.... and appointment with him in 2 weeks. he hasnt decided if he will remove and replace the cast to allow stitches to come out etc.

i had a catheter inserted into knee that could be accessed from the outside of the cast wih local anaesthetic ijected in fairly regularly, bascially they described it as aepidural directly into knee-soooooo good, but hurt when yanked out, also didnt last too long!

he seemed genuinely plelased with how surgery went= graft had nice big bone blocks and my own grafts had healed well making a nice hard bone tunnel. surgery lasted a good couple of hours

sorry i dont think this particularly makes sense but will write a more concise account some other time to tie all this together (and with better spelling/grammar etc)

Also, thanks to everyone for all the mlovely messages, really made me feel happy to read them all, this website and people on it are just great

Vicky

[Cosmicsnuffle]

Hey Vicky -

I was going to bed (every post I have done tonight says that - but I just wanted to say WEY-HEY - you're on the other side. You are another one of the posters on KG who deals with all their trials and tribulations with such gentle resolve.....  you have an insight and depth well beyond your teen years....

I so hope this one works for you. Fingers crossed xx
 

[Kaputt_Knee]

Hi Vicky,

good to see you on the other side.

Take it easy and update us when you know more.

I would make sure that one or both of your parents are with you when you see him again if you are not happy about what he is saying. If it seems to them that he is more concerned with covering his back as well, then a little trick I used in the UK was to ask "ever so politely"  if my consultant minded if I recorded the consultations. I used the excuse that I was having difficulty remembering everything and did not want to get anything wrong (i.e. played the ditzy female). I had a dictophone which I did use when he said it was OK but he was suddenly much clearer and precise in his instructions/advice and opinions. I used to bring it a record the consultations but he obviously was fazed by it and continued to be very clear and helpful. What he didn't know was that often there was no tape in it!

As for the plaster - if it is uncomfortable you can return the A&E department and the plaster technicians can make adjustments. They were probably the people who put it on in the post op room while you were still out of it. I went back several times with mine and had the whole thing removed and replaced with a lighter fibre-glass one in the end.

Talk to you soon on IM or whatever

Sue 

[zaiemk]

Nice advice Sue - I think I may have to pick up on that - my OS was really good and polite, but vague.
I tend to think of the questions I need to ask after, and not at the time.
I think I may use your tactic with my OS.

Cheers
Zaiem

[Snowy]

Fantastic to see you on the other side! That's pretty tough about 6-8 weeks in bed, especially over the summer; would that have been any different if he'd done a more complex reconstruction? Will be keeping my fingers crossed for you, and hope that you get some better answers from the OS next time you see him.

[clarky_vl]

Hey,
Bit more now my mind is feeling slightly clearer.

In the morning before the op he did a complete flip turn from what he had said before that basically he would keep doing surgery etc. Now he is saying I should be prepared to accept what my knee is like now, but it was like he was asking me to put up with and not make a fuss about a mild thing as if this doesn't effect everything in my life and that it was unreasonable to expect at the least a functional knee. Trust me I am more than reasonable and willing to compromise with this, I dont complain to him about every little thing and if I could even just have a knee stable enough to do normal things I would be happy, but I so can't deal with continued instability like this. I dunno, he didn't explicitly say this stuff, maybe I look into things too much, but it is just something I picked up on. He claimed not to have any further ideas on a what next, but he himself had compiled a list of possibles before rejecting them for what I considered not really good reasons, without even trying them.... Would I really be any worse off if they failed too?

He says if this next one fails he'd be looking to refer me to Andy Williams which I guess would be a positive, but I am not even going to think about that stuff now. I guess I was kind of just let down a bit... But then such is his nature that I bet next time I see him he'll be saying something completely different again. Perhaps your idea is a good one after all Sue, maybe he should also start doing it so he remembers what he tells people too!  He was nice and stuff this was just the kind of vibe I was getting...

Also sounds like he has been talking to way more people about it, the registrar was there before he arrived and trying to make sense of what was happeneing by looking through all the notes he had written from people he has asked and there were loads of them, he looked pretty confused lol! Then when the surgeon arrived he said he had spoken to way more people and at conferences and asked them about the possible procedures but that to the anterolateral and osteotomy ideas, they had been 'muted'.... it seemed like he has confused things by asking so many different oppinions that now he doesnt know what is best.... Maybe I am wrong, but it seemed like when he had only asked a couple of colleagues he respected the oppinion of he had a clearer idea and it made me feel quite confident that things were happening in the right direction. Now I feel like we've just repeated the same mistakes maybe?

Anyway he says my cartilage had more damage (he sais there was wear and some tears) again and that it was 'Consistent with continuous pivot' yeah.... He and the other surgeons put the cast on themselves in theatre and I know he is going to be dead against taking it off before its time as he said he would be worried about something happening to it when it was off lol, but also they have put it on at a specific angle and exactly the leg position they wanted. However, the plaster people I saw after an adjustment at the ankle predict they'll be seeing me soon to have it changed lol! To be fair the surgeons did warn me that they were a bit crap at putting on casts compared to the technicians but well, lets just say it has character!

I think they definitely will need to replace the cast anyway, if not to look at/remove stitches then because I have had some more wound oozing today, like after my surgery in feb. I moved my leg earlier and felt the familiar rip of the wound on the medial side of knee and then that gross warm wet feeling of the blood in the bandages, obviously cant see or check, but luckily the district nurse was there at the time, she says to tell them when I go for my first appointment. It still feels wet and a bit gushy at times. He used the same wound as last time so it is no great surprise it has happened again just a bit of a shock when it happened.

um, I think I have written down everything important from surgery day here or in the earlier post.... It was pretty painful, certainly when I woke up, I have no recollection now but apparently was in a lot of pain so they kept me in recovery for a good couple of hours giving me morphine and something stronger, then topping up the local in the knee, then one of them gave me some reaction or something.... Don't remember but my recovery nurses were lovely and so much help. They even got the pain specialists to come down and sort things out for me on the ward, and they came to visit me the folowing day! But waking up was definitely the worst pain I have had so far.

Pain at the moment isn't too nice but I also have my usual drugs at home including the Oramorph, the bone pain is quite severe (loving not having graft/muscley pain though!), especially with the leg being pressed on by the cast and of course the leg being bent and restricted with no weight is difficult, but I am being good and not doing a lot (whereas of course by this stage normally I would be marathon running  ) I know this is a reeeeeeally conservative post op protocol, but wow it is a bit extreme, rightfully so I guess...

My grandparents have been down from Basingstoke visiting, and Molly, you are kind of right, my puppy has pretty much spent the enitire time curled up asleep on the sofa with me, luckily he is only 7 weeks old so small enough to get away with it!!

The district nurse came yesterday to give me my injection, she taught me how to do it today so I did it myself today, and she will supervise me tomorow too, then she won't need to come except for the blood test on monday. not actually too bad they sting a bit though and my tummy is getting sore and feels a bit like a pin cushion. I feel like I am getting quite fed up of being poked and prodded now,  but I suppose from now it can only get better right? today I was getting quite emotional looking at my classmates photographs from leavers prom and feeling quite left out, but then at least it was for a good reason and I am moving on through this knee stuff. I guess it is another small sacrifice I have made for it but they do all add up after a while.

Sorry I realise this is still a bit rambley I guess it has been an eventful and full on couple of days. What do you guys think about the surgeon and his 'new' attitude? Like I said though, maybe I got it wrong (think I have been a bit harsh to him on here actually!), I just would be very upset if I got it right and this was what he meant by some of the things he said. He has been so good but this time I do sort of feel a bit weird about what has happened I suppose. Maybe this is me getting fed up!

Thanks again Snowy, good luck for your surgery, I believe it is tomorrow? You are going to be absolutely fine, I remember reading about how well prepared you were getting!! Try to relax and I really hope all goes well. I will certainly read your posts afterwards!

Hi Cosmic, thankyou for reading and your comments, and I hope you did get to bed in the end!! I read you diary anyway because it always makes me giggle, but I hope you are still doing well.

You know what.... I think I may actually suggest the dictophone thing to my parents! May make him more consistent!! We have ften joked about recording him and playing it back when he contradicts himself or goes all 'jekyll and hyde' as my mum says! The plaster people I saw were lovely and gave me their numbers if there is a problem, and all the cast care the surgeons forgot to tell me! I have ordered like a clear case thing they suggested which will keep it dry for showers when I feel like them!

Oh! No appointments through yet, but I know I had them booked before I left, so they should come soon! (Did I say I had one with physio woman 5 days post op and one with surgeon 2 weeks?)

Vicky

[vinnic]

Good to see you're home and resting!  Hopefully the cast isn't too cumbersome, but if so that's great if they can make adjustments!  Had four in the past myself for various broken bones as a child, and I remember how annoying they could be at times.  The lightweight, fiberglass ones sound promising if this one bothers you too much.  Hopefully this time'll fly though and you'll be out of the plaster before you know it!  As far as the surgeon, that's brilliant to record the conversations.  That way, there'll be no mistaking what's been said or what you're to do.  Your doc should be very open to it if he's a true professional.  In the meantime until you see him or your physio, take it easy and keep us updated.  May your weekend be as pain-free and relaxing as possible!   

[Kaputt_Knee]

Hi Vicky

sorry he seems to be doing metaphorical back flips - don't you just hate it when they do that! Either they are so damned sure they've done THE most brilliant work (so if it goes pear-shaped YOU'RE to blame) or they did more/less and it was difficult/lots of damage/blah blah (if it goes pear-shaped the previous people AND YOU are to blame)  Whatever they do we are initially euphoric and then we start the "what ifs" and worry in case their predictions come true!!!

What I have learnt over the course of my surgeries is that they ALL WITHOUT exception "cover their backs". Unfortunately it seems to be getting worse as patients become more informed and are able to question more intelligently and pointedly. I think the fear of litigation has become the clay feet that can topple the great god-like edifice they've built around themselves.

Don't be surprised about the bone pain - it is the worst I have ever felt; like toothache but a million times worse. But it does go quite quickly back to a dull ache. Make sure that you always have your pain meds and keep them up to schedule. Once it goes down you'll be amazed how quickly the other pains normalise, you probably won't notice them in comparison to the other times.

I love his attitude to his "plaster work"!!! Has he signed it or chiselled his siggie like Banksy in the knee area? 
If it is uncomfortable or causes pressure points, get it changed END OF SUBJECT!!! He's not the one having to suffer in it, you are. The technicians will be able to do a much better AND more comfortable job anyway. It is moving up to the hottest part of the summer, so if your wounds are leaking into the bandages and it is yucky in there, get a new one! Don't even think about hesitating! They won't put you in fibreglass just yet but as soon as the wounds close up and stop leaking and the stitches are out you can ask for one. They tend to be sweatier but are lighter. I used the old pillow between the legs trick for sleeping. And I'm a stomach sleeper so I slipped down the bed and let my foot hang over the end so I could still sleep in my favourite position. Sleeping on my back meant I woke up every hour so and ended up very sleep-deprived until I worked out the foot out of bed trick.

I have had the injections in the stomach after every operation here in Germany. We have to have them for as long as we are not even remotely mobile to prevent the formation of any thromboses. I have a fear of needles and had to have hypnotherapy years ago in order to receive even the most mundane injections. The hypnotist put a block in that stops me from injecting myself (so I could not become a junkie - as if!) But it means that the nurses have to do it when everyone else learns to do their own - my stomach was a multi-coloured pincushion by the end of the first fortnight each time. They obviously do not like the extra duty!    After my last revision I had the injections for over a month and they were running out of space - the one time I was feeling lucky that the large wobbly bit was so large and wobbly! 

If you feel like chatting at any time, then I've got little or no work this week and next and can chat in IM or on FB if you want. I'll PM you the details for FB.

Is the PT lady the rather short tempered and impatient lady who more or less called you a wimp last time? I think you have more than a moral victory as far as she is concerned. Just remind her of her unacceptable attitude last time if she starts off again. Otherwise she is probably the most experienced person and it is good to start at the top with your treatment. Just remember that she is there to help you and if she gets uppity - tell her to put that in her pipe and smoke it! 

Who are you supporting in the Final on Sunday? We have to play the Loser's Final tomorrow and are hoping that Klose will be able to put several goals into the back of the Uruguayan net so that he at least gets the title as the player who has scored the most goals. As for the Finals - the PE teacher in me says that Spain should win as they play such a beautiful game. But I support Bayern Munich and our captain and main goalscorer (von Bommel and Robben) are in the Dutch team, so my Bavarian heart says I have to support the Netherlands. So I win regardless of who actually lifts the trophy!   

Long rambling post - sorry - told you I don't have much work 

Sue