My Patellar Realignment Surgery Nov 4, 2010

[Countess]

So starting this diary a little late in the game but wanted to write down everything I can remember to acknowledge how far I have come since this surgery and how far I still need to go. Hopefully it will help those out there considering this type of surgery or have already had it and are experiencing issues like me.

September 27, 2010 - Slipped and fell in the kitchen. When I fell my left knee went one way and I went the other. I heard a loud crunch coming from my knee. This is not normal. I have been experiencing dislocations since the age of 15 in this knee. The patella would dislocate to the lateral side and I had a severe case of maltracking. When it would dislocate I was usually able to straighten out the leg and put it back in place myself. However this time was different. I was not able to stand back up on my own and fell back down. The patella seemed to be hanging on the verge of dislcoation and would not go back into place.

September 28, 2010 - Black and blue on my left side I went to the Urgent Care center. I was swollen and in severe pain. I thought I might have broken something. The doctor who was on call said I tore my ACL and he had a great knee surgeon who fixed his knee so I should go see him. SO I asked if I could get by without surgery and he told me the bad news. I would need surgery to fix the damage. I dropped a very loud F bomb. He also took xrays to make sure I hadn't broken anything. Xrays were extremely painful and I said a lot of choice words through the ordeal. I was glad no children were within ear shot of this mess. Nothing broken so that was a bit of good news. The doctor gave me the number to the OS and said, "Call him as soon as you leave here."

September 29, 2010 - First appointment with my OS. He confirmed my knee acted like a torn ACL but ordered an MRI to see what was really going on inside the left knee. I told him I would like to know as well and didn't want him flying blind in the operating room.

October 4, 2010 - MRI after work. Tech says she is unable to comment on the results but says "It doesn't look that bad."

October 13, 2010 - Follow up with OS to discuss results of MRI. MRI confirms lateral patellar tilt and an abnormality wedged underneath medial side of patella. ACL is fine but stretched to capacity and looks more like a V than a U. LCL and meniscus both look great. OS and myself schedule surgery to remove abnormality and correct maltracking.

November 4, 2010 - The BIG DAY. Mom flies in the night before to help out (she is an orthopedic nurse thank God). When I wake up my OS is standing over me shaking his head. He had to do A LOT more than he thought.  He cleaned out the abnormality which was a chunk of cartilage. He had to open me up on the table. SO total count is patellar realignment, lateral release, open debridement, cartilage implant, medial reefing and patellar resurfacing. I would also be in a straight leg brace for 5 weeks which kept me immobile to protect the graft and implant.   I had a femoral block so I felt fine after surgery until later that evening when it started to wear off. The next few days were spent vomiting from the anesthesia and pain meds. My Mom changed my dressing for the first time the day after surgery and it hurt so bad I cried uncontrollably. I had an iceman ice machine (also called a cryocuff to some) which ran 24/7 for the first few days also. THIS MACHINE IS A GOD SEND. DO NOT HAVE SURGERY WITHOUT IT!!! Did frequent ankle pumps and had to wear TED stocking on good calf to prevent blood clots.

November 6, 2010 - Showered for the first time. It felt so good but I had to wear a trash bag over my straight leg brace which was weird. I was only able to stay in for 5 minutes as my good leg was starting to protest.

November 7, 2010 - My Mom flew back home in the morning and my Dad flew in that afternoon. Dad is a cardiopulminary specialist. I feel quite fortunate to have parents in the medical field...although Dad doesn't know Orthopedics like Mom.

November 10, 2010 - Dad takes me to my first post op with OS. OS explains what he has done (I was out of it when he was standing over me in recovery) and my Dad and him start chatting about medical mumbo jumbo. Dad asks if a cadaver implant was used for cartilage and OS says he used a new synthetic plug which yeilds much better results. Good thing to know. Glad I didn't have to sort out how I would feel about some dead person's cartilage implanted into the top of my tibia even though I am an organ/tissue donor myself.

Novemeber 17, 2010 - Back to the OS. Got the stitches out and it hurt like hell. Some of the skin had already started to grow over the stitches. His MA had to rip them out...and didn't use any numbing anesthetic whatsoever.  I am still on crutches and weight bearing but still in a lot of pain.

November 26, 2010 - Drove for the first time!! Went to go see a movie. The theater was wheelchair accessible so I was able to maneuver around ok but noticed things sure are different while in a wheelchair vs walking. Most folks are nice and offer to help by opening doors, etc.

November 29, 2010 - Back to work. In hindsight this was too soon even though I have a desk job. Still in straight leg brace and find it difficult to do daily tasks. Still in pain...still on crutches.

December 1, 2010 -  Back to the OS again to check progress. OS tried to bend my knee and I cry out in pain. Then he says I will have a "fun time" in PT and orders it.

December 6, 2010 - Meet with my physical therapist. She tries to put my leg up on the table and my thigh spasms so bad I almost cry. Finally get the leg on the table and she takes a bunch of measurements. She then has me do a bunch of stretching.

December 16, 2010 - Back sliding in PT. ROM is going backwards instead of forwards. While on wall slides my PT says she is going to take a measurement and drops my leg. It hurt so bad I cried uncontrollably and begged for the pain to stop. The whole gym is looking at me.  She tells me she doesn't like to lose. I told her between sobs that I don't either but that I have been doing all of my home exercises faithfully and I don't know what else to do. I left without ice this time and never wanted to go back there again. I hated my therapist and felt there were other ways to accomplish ROM without this barbaric treatment. However I went back because I knew I had to. I also bought a recumbent exercise bike to help at home.

December 22, 2010 - Another post op follow up with my OS to see how I am progressing in PT. He says progress is ok and he is worried about flexion. I was at 0 degrees extension and 50 degrees of flexion. He threatened that he wants me at 120 flexion by our next appointment or we will have to talk about an MUA. 

Right after the new year I started noticing little things that I was getting back. I ditched my brace, I could stand to put my pants on like a big girl and I could drive without the aid of a step stool to get in and out of my vehicle. (I drive an SUV so it's higher off the ground). I went from 2 crutches down to 1 crutch which made life a tad easier. Still in pain though. Still having problems with flexion. Therapist decides to order me a JAS device.

February 2, 2011 - Met with my OS again. Flexion at 75 and extension at 3. Still progressing in PT at a snail's pace but not back sliding. I told the OS progress is progress and he agrees...deciding to take a conservative approach and try the JAS. He tells me if things are still slow going by our next appointment an MUA is needed. I told him I had already been thinking about it and armed with knowledge from this site asked him how his MUA's are done. Found out it was a closed procedure and told him it was not recommended especially if I have developed secondary AF due to being immobilized for so long. He expressed his concern about going back in and causing more scar tissue. I told him I didn't want that either but if we are going to the operating room anyway then I want an LOA with a gentle MUA afterwards. He then said, "We will do it however you want. You have done your research and are making a good decision regarding your knee."...which quite frankly surprised me. I knew right then we were on the same page regarding my care and he really listened. He took his patient's well being into consideration.

So here I am today. As of last night's PT I was at 85 flexion and still at 3 extension. I have been walking with a cane for this past week and ditched the crutches completely. Last night my therapist took my cane from me and said "WALK...YOUR KNEE CAN BEND." I took my first steps unaided. Granted I have a severe limp but am walking around the office today without the use of my cane. Words cannot describe the sense of accomplishment I feel.       

This has been a long and painful journey. It has taken over my life. I live and breathe this knee. I still wake up every night in the wee hours in pain. Nothing has come easy and I have had to work hard for every little thing. I have bad days with a few good days sprinkled in. I get severely depressed. But no matter how bad it gets I still push forward through all the pain mentally and physically. I still have the willpower to say to myself "This will not beat me...I will beat this." Make yourselves that promise. No matter how bad it hurts you must continue on.

More to follow....

[cdubb]

Hey there,
I'm a day ahead of you with a ACI with a AMZ (Autologous chondrocyte implantation and anteromedialization of my tibial tuburcle).  My surgery was Nov. 3rd.  So, also a cartilage transplant and the tibial tuburcle osteotomy.  I had a LR done about 9 years ago on the knee.  Mine was not so traumatic as your initial injury and more caused by longer term maltracking.  I am much further ahead of you rehab wise though.  My ROM is about 133-134 ish. I ditched my brace exactly at 6 weeks and crutches about 5 days after that.  My gait was normal about 8-9 weeks post op.  I am told that I am recovering quite well though.

What did they use for the transplant?  I haven't heard of a synthetic plus? I know that Denovo is used sometimes when a transplant wasn't planned, but that is juvenile cells.  Mine transplant were my own cells harvested at a scope about 9 weeks prior to the ACI/TT. 

I have a diary also in the 100-300 post op diary section titled my Nov. 3rd ACI/AMZ.

Good luck w/ you ROM...glad mine came back. 

Whose your doc?

[kasia_ny]

Hello,
I also had a cartliage transplant and tibial tubercle osteotomy on December 15.  I actually had the Denovo, which is the juvenile tissue transplant that cdubb mentioned in her post.  I had a traumatic injury 15 years ago that resulted in a cartliage defect that got worse overtime. 

I am sorry to hear about your ROM.  Currently I am also struggling with this issue, my OS could only get me to 90 at my 8-week post op yesterday.  Today I reached 110 degrees by really forcing it, I was in tears and screaming in PT. 

My doctor says that 12 weeks post-op is the time to regain full range, after that it becomes very difficult.  I was also threatened by him yesterday that if I do not progress by the end of next week he will want to do MUA.   From what I see on the board, other doctors are not as concerned about it as mine.  PT's advice is to take drugs and push it as hard as I can...

[Countess]

Hi Everyone,

Thanks for the replies. I wish I was better off on flexion like you both and kasia_ny your OS is right...this has been the worst battle of my entire life to get flexion back because I am so far out in recovery. 5 weeks in a straight leg immobilizer did not help matters.

What did they use for the transplant? I haven't heard of a synthetic plus? I know that Denovo is used sometimes when a transplant wasn't planned, but that is juvenile cells. Mine transplant were my own cells harvested at a scope about 9 weeks prior to the ACI/TT.

Whose your doc?

Glad to hear you are progressing so well!! That's great!!  As far as the sythetic plug it is a new procedure where the OS drills out a bit of in my case the top of the tibia and inserts a PCA calcium phosphate implant. What the PCA does is promote new cartilage growth...so basically I am regrowing my own cartilage back. Pretty cool! My thereapist's assistant said my surgery is the first he has seen. I will look for your diary.

My OS is Dr. H Andrew Motz at Advanced Ortopedics and Sports Medicine here in Denver, CO. He is an amazing OS.

I was also threatened by him yesterday that if I do not progress by the end of next week he will want to do MUA. From what I see on the board, other doctors are not as concerned about it as mine. PT's advice is to take drugs and push it as hard as I can...

I am so sorry to hear about your difficulties as well. It seems flexion can be an ugly beast. I will relish the day I can get to 110 so keep at it and hopefully an MUA won't be needed. If it is though I suggest you read everything there is to know about an MUA on this site as well as the internet and make your decision. Ultimately it is your body. As far as pushing it...let your knee tell you how far you can go. My therapist only pushes me as far as she knows my knee will allow. I am screaming and hanging onto the bed for dear life whenever she manipulates it.  I don't take perscription pain meds anymore just over the counter stuff. Even though I am still in a lot of pain my OS cut me off of those a while ago unfortunately. I feel as though my pain is not being managed properly and am about ready to go see a pain management specialist to see what else I can do for relief. It hurts most on my medial side where the reefing was done. **Sigh**

[Countess]

February 12, 2010 - Just got back from being fitted for my JAS device. I wore it for about 10 minutes while being fitted and being shown how to use it. Initial impression is it is pretty simple to operate. It is rather bulky but if it gets the job done who cares. They want me to start using it 1 time a day for 30 minutes for a week. Then at the two week mark 2 times a day for 30 minutes. Then 3 times a day for 30 minutes until my therapist or OS tells me to stop using it. I told the gal who was fitting me it will be a glorious day when they tell me to stop using it cos that means I will be good to go again and she just smiled. The only thing I would have liked that it doesn't have is a built in measuring device to track flexion progress. She said they used to have it on there but took it off because people were hurting themselves trying to push too hard. She says using the device faithfully can get me back to full ROM in about 1-2 months. I am hoping it is much sooner than that and can see why people push themselves. They just want it over with already like me!! However I will listen to my knee (seems that's all I ever do) and go at its pace.

I will post more on here once I actually use the darn thing and give my overall impressions once my leg is strapped in this tortureous contraption.

[cdubb]

I actually know of Dr. Motz. I handled CO WC claims before and he was a surgeon we often used. Didn't know he did cartilage restoration procedures though. It sounds almost like you had an oats. It is not a common WC sort of procedure though. Did have some OATS claimant's though and an allograft patient. One saw a Dr. Hughgate at CO Limb Consultants. I'll ask my doc about your plug thing at my next visit...hadn't heard of it.  Also know Steadman Hawkins does a lot of cartilage restoration. I'm here in Chicago though, so my doc is Dr. Brian Cole at Midwest Ortho at Rush.

Hope he Jas works for you to get ROM. I am really lucky with my progress for ROM. I did spend 6 hours day in a cpm for 6 weeks, but only at 45 for 4 weeks and never had it set past 90. 

[Countess]

So after 3 days on the JAS device I can say that it is very bulky. It takes me some time to set up the chair and actually get into it. Once I am in there it's ok...but a bit uncomfortable having to sit there for 30 minutes on the edge of a straight back dining room chair. My other leg falls asleep from where the chair is hitting the pressure point. Then I have to wiggle around to try and get the feeling back in it. Quite annoying. I tried the couch but that didn't work as well because it was too low...so back to the uncomfortable chair. 

In PT last night I made it to 80 degrees unassisted and 87 degrees assisted flexion. Still hovering around 3 to 4 extension. Tomorrow it is officially two weeks till D Day. Gotta have 110 by then or OS will order LOA with MUA so it's crunch time...literally.

I have also been limping around without the cane in my office and at home. I am about ready to ditch it alltogether. I am worried about my gait but know it will come back when my thigh gets a bit stronger. I had a lot of wasting. The weather is supposed to be nice all week with no snow in the forecast. Ice is my biggest nemesis living up here in snow country and I have this huge fear of slipping.

cdubb - Small world that you know of my OS. He is a great surgeon. I looked up the OATS procedure and that is definitely not what I had done. I called my Dad to confirm what Dr. Motz told him and he said synthetic calcium plug implant to regrow my own cartilage. He said it was a new procedure and they have had excellent results with it. I went to Dr. Steadman when I lived up in the Vail area on my other knee when I tore my meniscus (it was a micro tear so no surgery & healed up fine) so I know he is one of the best in the world.

I really hope the JAS works for me as well to regain ROM. I didn't have a choice for a CPM machine because of the 5 week immobilization so that has really hindered my knee from coming back so cdubb you are really lucky with your progress. Keep it up!! I hope I can hit my goal of 110 in two weeks. 

More to follow...
 

[Countess]

Yesterday I ditched my cane for the first time and left it at home. I have been noticing that my right knee is now protesting on the medial side a bit due to the workload. I am still limping...but not as bad. I am trying to make a concious effort to keep telling myself "Heel toe heel toe" and shifting my wieght to my left side. I have also noticed that when I walk I lean forward so I have been trying not to do that as well. I started walking backwards to try to help my gait. Last night on the way to bed I walked backwards down the hall. My chocolate lab Jake thought it was rather odd but was still behind me...walking backwards with me. It was quite amuzing to see the dog mimicking mom and I had quite a good laugh.

I dropped a letter opener under my desk today. I was able to slide it out from underneath with my left leg!  This is the first time I have been able to do that. My calf was not responsive before. I would try to move it or kick out and it wouldn't...no matter how hard I tried so this is another small accomplishment!!

I have been using the JAS faithfully. I will find out tonight if it is making a difference when I go to PT. My hamstring is still giving me problems with tightening up so I have been taking a rolling pin to the back of my leg to try to loosen it. It works for a little while but then tightens back up with extended use. I wish all of my muscles would cooperate. My thigh muscle that connects to my patellar tendon still gets stiff every so often. It really is annoying. Still having pain where the medial reefing was done but everywhere else is now ok. Yesterday I did notice a clunk clunk clunk feeling and catch then pop when my patella would move up and down in the femoral groove. It was not a smooth motion. Today is much better. Every so often it does this so I am chalking it up to scar tissue. Also still having a bit of swelling which makes the knee stiff especially in the mornings when I first get up or in the afternoons at work. It doesn't help that I sit at a desk all day. I try to get up every hour but if it's super busy I just don't have that option.

To Be Continued...   

[kasia_ny]

Hi there,
I am curious to find out about your results with the JAS device.  I hope it helps.  That is a funny story about your dog.  We have a cat, but he is a mean one and totally ignores me since the my surgery.  Before, he'd occasionally sleep on the bed, but now he does not even visit my room!  Not a great pet.

My OS will decide on my MUA tomorrow.  I have a gut feeling I am getting it.  I was really working on my ROM like crazy for the past week.  On Monday we were able to push it to 115 degrees, but yesterday in PT I only measured 95 :-( I am going back again to PT today, so this will be the final measurement before speaking to the OS.  I have a different therapist on Wednesdays now and she is not as aggressive as my usual guy, so maybe today I can get more.  Also, I teach on Wednesdays and yesterday I ended up walking for 2 hours crutchless in class since I needed to write a lot on the board... so I had more swelling than usual.  Now I am sitting on my CPM cranked up to the max and preparing for my PT session...

Are you in a lot of pain from working on your ROM?  My pain levels increased significantly this week, I ended up back on percocet a few times. 

[Countess]

So last night at PT was brutal. I did all the exercises then my therapist came over and said "So are we getting to 90 degrees tonight?" I should have known then it was going to be bad times. She didn't get what she wanted with me sitting up on the table so she had me lay down on my back. Her assistant had the measuring device. She put one hand underneath the back of my knee and one hand on top of my calf. This time...it hurt just as bad if not worse when she dropped my leg very early on. I screamed at the top of my lungs "OW OW OW OW" over and over again. I had a death grip on the bed. Everyone stopped...and stared at the train wreck happening right in front of them. Just when I thought I was going to puke from the sheer agony and burst into tears someone shouted 90! and it all stopped. I thought I was going to die...or rather...I wished I was dead so I didn't have to feel this pain. I felt something give way in my knee during the bend. I am hoping it was scar tissue. Today I am in horrible pain. I am swollen really bad from my knee to my ankle. My calf feels like a sausage. My knee is hot again. I thought that I would be able to bend it better after last night. Yeh...right.

My therapist also took the stick (it has all these 1" rollers on it and is literally called the stick) to the back of my leg cos I have been getting so knotted up in the hamstring area. She caught one of those knots and I almost jumped right off the table. She said I was badly knotted up back there. So I am swollen back there as well today.

My knee hates me. My muscles hate me. I am stiff. I am in pain. I have to work all day today. I would rather be home putting my leg up on ice. I hate my life. Something has got to give here. Maybe I should just get it over with and call the OS for the LOA with MUA. I feel like giving up. I'm so damned tired of fighting. I am doing everything I can to work on this knee so it's not from lack of trying. When do I say enough is enough? I can't handle much more of this.

I am curious to find out about your results with the JAS device. I hope it helps. 

Hey kasia_ny-thanks for replying. I don't know if the JAS is helping or not. I use it faithfully but still slow going in PT. Still making progress but it's the same as before. 3-5 degrees here or there. Granted I have only been using it for a week so I hope it helps. I don't really like it. Too bulky for my small frame and even though they claim to have had it "custom fit for me" there sure is a good gap in the calf cup.

My OS will decide on my MUA tomorrow.  I have a gut feeling I am getting it. Are you in a lot of pain from working on your ROM?  My pain levels increased significantly this week, I ended up back on percocet a few times.   

Let me know how the meeting goes with your OS. My therapist told me yes an MUA hurts a hell of a lot right afterwards but it's kind of like a shortcut. You get your life back and heal much sooner. Still though...it is scary and the outcome is uncertian. 115 degrees is great!! I wish I had that so keep going and hopefully your OS will be happy with the progress. As far as in a lot of pain from working on ROM....YES!!  I am in so much pain today that taking Advil with Tylenol is not even touching it. I wish I had more percocet. My OS won't perscribe me any more. 

That is a funny story about your dog.  We have a cat, but he is a mean one and totally ignores me since my surgery.  Before, he'd occasionally sleep on the bed, but now he does not even visit my room!  Not a great pet.

My dog Jake is quite a character. Every time I get down on the floor to do my exercises he is right by my side. He also lays by the top brackets of the recumbent bike. Whenever I am done and start to ice he feels he needs a little ice too.  He has always been that way though since he was a puppy. He always has to be right near me. Pets can sense when you are hurt but they deal with it in their own way. Maybe your cat is waiting for the it's ok sign from you. Then again...some pets aren't very touchy feely.  

[Countess]

It would be helpful to write down my PT protocol as it stands now. I am usually there 2 1/2 hours per session.

Recumbent Bike - Warmup 15 minutes
Box Sits - I sit on a box and bend my leg till I can't stand it. Readjust every so often. 3 minutes
Wall Squats - 10 times for 10 seconds each
Hamstring Stretch - 3 times for 1 minute each
Heel Slides - 5 minutes
Wall Slides - 6 minutes
Heel Digs - 20 times
Prone Knee Flexion/Quad Stretch - 3 Minutes
Table Crank - (Not sure what it's called really. I sit at the edge of the table. Assistant straps my leg to table leg with a seatbelt and cranks it towards the table leg.) 5 times for 30 seconds each **Note** This is also my least favorite and hurts the most. Talk about pain and torture! 
Heel Props - 5 minutes with a 7.5 lb weight over my knee
Kickouts - 20 times
Quad stretch - 3 times for 1 minute each
Chair Prop - 5 minutes with a 7.5 lb weight over my knee
EStim with Kickouts - 10 minutes

In among all this is my therapist who manipulates and massages....which makes me cry. 

[kasia_ny]

Hi Countess,

I am sorry you are having such a hard time at PT.  I totally understand.  Yesterday at PT I was screaming and crying when the therapist was working on my ROM.  I had to ask for a towel to wipe my face because the tears were coming down my cheeks.  Good news is, he got to measure 120 degrees by the end of the session.  He spoke to my OS today and the OS said that in this case he will give me another week to keep working on my ROM and we will re-evaluate my progress next Friday.  So the torture continues but I am somewhat relieved...  but I am not off the hook for the MUA yet. 

I am sorry to hear you do not have access to painkillers.  This sucks, because it is so painful to work the ROM.  My OS does not have a problem prescribing them... at least not yet. 

Your PT sessions are so long... I am usually done in about 1.5 hours.  But I do not get to do the bike yet.   Table cranks sound awful - I do not do that, but I sit on the edge of the table and the therapist is pushing my leg under the table grabbing by the shin and at the same time pressing above my knee with the other hand.  That hurts!

Custom fit... I think it is called that to justify a higher price... They probably have two or three sizes of those things. 

Get some rest this weekend and hang in there!
Kasia

 

[Countess]

Thanks Kasia. It is comforting to know I am not the only one who is going through so much pain to gain my ROM back. At least you got to 120!! Congrats!! That is a HUGE accomplishment despite the pain. Also great to hear no MUA for now!! YAY!! I am wondering what my OS is going to say next Wed when we have our meeting.

Yes it does suck that my OS won't perscribe me any more painkillers. I really think it would help with my pain management and progress in PT. He is more worried about his license though because the last time I asked for them he said he would give them to me one more time and to not ask again because he wants me off of them.  So I just have to suck it up. I switched from Advil to Aleve. That seems to be helping out better and less pills to take. My tummy gets upset every now and then.

My PT sessions are the epitomy of Pain & Torture. I can't go all the way around on the bike unless I cheat by hiking my hip. When I do that I get yelled at cos that is a big no no. My therapist does the same with the edge of the table thing and yes...it hurts. But I have a feeling she will stop doing that and make me lie on my back. The table crank sucks and now I am thinking they are going to start prone hangs too. Last Thurs the assistant asked me if I had done them and I'm like What are you talking about?? I don't do those. That's when he said they are coming. 

I have been using the JAS and moving it around to different positions to see if that will help with the fit. It seems to gap more when I try to crank on it. I don't understand that cos I am moving my leg back with it so 

I did rest this weekend but Jake was sick so my poor big boy was throwing up. He slept most of the day yesterday and seems to be feeling a lot better. I got worried about him though. I wish they could tell you what is wrong when they get like that.

I am not looking forward to PT this evening and have been struggling with trying to stay in good spirits. I get so depressed sometimes and I wonder when I will get better. On a positive note I was able to walk around WalMart for a good 1.5 hours yesterday (I use the shopping cart as a walker) without getting fatigued and not feeling too much pain. Another thing I could not do before. I would last maybe 20 minutes and it would hurt so bad I had to head for the car.

Here is to hoping I have gained ROM. They want to try for 95 tonight. Ugh.

More to follow...

[Countess]

PT last night was painful but surprising. This past Sunday I think I overdid the walking thing in WalMart for 1.5 hours. My heel slides and wall slides were extremely painful and with each stretch I would wince. My thigh muscle right above my patella protested the most and when my therapist came over and immobilized the joint it sent me over the edge. Normally when she moves the joint around it doesn't hurt at all. This time was different. When she has me flip over to my back I asked her if we could go really slow cos I was super sore. She asked me what I did so I was honest and told her. She said she knew her limitations and seeing as I was already fighting her at 50 degrees there was no sense in pushing it. I told her that I didn't mean to strain the knee so much. I was just feeling really good and wasn't in pain till I got into my SUV after shopping. Also, I think I cranked my JAS up more than I should have as well Sunday evening. I am trying to push too hard I think and now my knee is fighting back with a vengeance. She said that's ok but no more of that and she will be nice just this once. So no crying last night at least. I got to 80 degrees unassisted on wall slides which is a first for that and I actually got to 0 on extenision last night.

Today I am still sore...still in pain but it's a different kind of pain. It's the I did too much and need to rest/ice pain. My knee is a little hot but not swollen too much.

My boss had to go home sick today and seeing as I am his only employee you can imagine what kind of day I am having. I am trying to cut back on the amount of Tylenol I am taking because I am concerned about my liver but I can't seem to get the pain under control. I have to do something in order to even function. Before when I had percocet I would cut them in half and that would work really well. Now that I have to take over the counter crap it's a lot more pills that don't even come close and it can't be good for my liver. I basically have to deal with the pain on my own or run the risk of raising toxic levels in my bloodstream. On really bad pain days I get irritated easily. Today is one of those days.

I also overslept this morning. I still wake up every night in pain and it takes a bit to find a comfortable position and fall back asleep. This morning I must have hit a button on the alarm which set it an hour ahead. I am so tired all of the time as my sleep is interrupted every night. When I started back to work I have to get up an extra hour and work out before I even think about a shower or getting dressed. This morning it was bike for 5 minutes and JAS for 10 which is all I had time for.

I have a feeling next Wed my OS will order the LOA with MUA. My Dad says the outcome of a second surgery is never good. At least I know I have done everything I can. **Sigh**

[Countess]

Today is better pain wise. The knee feels looser and not so tight. A bit more swollen today though. I thought of a great idea to get the knee moving whilst sitting at my desk all day. I placed a tennis ball on the carpet and am rocking it back and forth with my foot which creates the kind of motion I need. I figure every little bit helps.

Today while doing my exercises in the lunch room area (I do them every day at lunch after eating) I thought to myself why am I even doing this? I have been dedicated to my PT regimen for 3 months now and although I have come a long way...I still have quite a ways to go. My knee still won't bend past a certian point no matter how hard I try. If I have to have an LOA with MUA that will be like starting over for the first week. I just want my knee back...I just want my life back. When I first found out I needed surgery I saw all these people walking around fine 7 weeks post op and thought that will be me...I will be fine...and I am not fine. I have had nothing but pain and torture ever since. It is hard not to get depressed. I used to be able to do so many things. What were once simple tasks are difficult to accomplish now. My quality of life is severely affected. I face the mental and physical battles every day and I wonder...will I ever get better? Doubt creeps into the tiniest corners of my mind that I will be like this for a long time...perhaps for the rest of my life. These are the things no one tells you about. No one tells you that you are battling for your life.

I know there are a lot of people on this site who have similar problems. It has been a long and painful journey for them as well. There is no sense in asking why me. It is counter productive. Therefore, I must put on my happy mask and face the crowd when I would rather sink into a hole. Unfortunately life goes on and in the very back of my mind I hear a whisper..."I will beat this...it will not beat me." I finish my exercises.

We shall see how I do in PT tomorrow.

Until then...