Amys AMZ/TTT postop diary 11-8-11

[meemers]

Good Morning Day 5 PostOp

Last night I slept well - just up once at 3:30. My mother in law came we had to move my husband into my bed down here. It's just a full size and with the CPM it was a tight fit, but we all slept. My husband is 6'1", but only 150 lbs, so he just lined the edges of the bed. LOL!.

My routine is to sleep out of my brace - I rest it in the CPM with the icing sleeve on it. I don't put on the CPM strap, but the leg is fully extended and so then I lay still the whole night. So far I've slept okay like that, I love not sleeping with the brace on as it digs in on one side when my leg is elevated.

When I wake up I take a potty run, take pain meds, eat something and then strap into the CPM for a couple hours.
Then out of the CPM, potty run, walker around the 1st floor, back into the bed, ice and elevate.
Lunch time - pain meds, eat, cpm  - doze. Get up, walker around, back to ice/elevate - nap or chit chat with the kids.
thus repeats the cycle until it's time for bed. I CPM, potty run, hook up ice/elevate and then sleep.

Things I'm wondering about...
1- I don't have my postop appt for another 8 days (seems like a long way out there! I might try to bump it up), but currently I do the CPM but that's it. OS said we'd talk about PT at my postop visit. The diaries of others sound like they got started right away ie- postop day 3 going to PT. So should I be fine to wait or should I start doing a few things at home? I"m scared to do exercises without a brace on! I do anklepumps too - not that those are much of anything. What did you all start doing while at PT? several people mention the bike - don't you have to already have 100 on ROM for that?!
2- How much should I be up?down? Currently I'm laid up in bed most of the day except for potty runs and do a little walker run around the 1st floor. Is that about right or should I be trying to be up more? I know my body needs to heal but sometimes they say that the bones heal better in response to some weightbearing. 
3. My OS said I could be full weight bearing only with the brace in the locked position. Does that mean he expects I'm walking around on it?! My impression from reading is that you can break your tibia by weight bearing too much too soon, so I've been NWB or TTWB and thats it.
4. Did any of you do exercises for your upper body? I didn't for my LR as I wasn't down as long, but this is a longer time. If you did some arms, what did you do? did you use bands? I'm open to suggestions!

On the laptop I check my email, facebook and kneegeeks a few times a day. I check woot, kids.woot, and slickdeals daily. Sometimes I check the groupon for the day. I watch wimp.com daily videos, I have about 20 books - it's hard to focus, so I've only read 1 1/2 books so far. I try to read scriptures/religious article once a day.  I've watched SPY on hulu to try a new show. I watch things on netflix (I always check on rottentomatoes.com first to see if the movie is a total waste of time first)... Autumn Spring - crazy czech movie aobut an old guy wanting to live life to the fullest while his wife is obsessed with dying, planning funerals, etc. Another random Netflix show was Mad Hot Ballroom - a documentary about teaching5th graders in the Bronx/Queens ballroom dancing.

Last night we watched Cars 2 as a family - I sat on the couch for a change of scenery. We love PIXAR shows.  Cute - but they way overthought that show - it's for little kids and they had no idea what was going on.

[KW]

Let's see if I can help you out with some of your questions...Remember that everyone has a different experience with this surgery and even if you have this surgery more then once your experience will be difference each time.

1- I don't have my postop appt for another 8 days (seems like a long way out there! I might try to bump it up), but currently I do the CPM but that's it. OS said we'd talk about PT at my postop visit. The diaries of others sound like they got started right away ie- postop day 3 going to PT. So should I be fine to wait or should I start doing a few things at home? I"m scared to do exercises without a brace on! I do anklepumps too - not that those are much of anything. What did you all start doing while at PT? several people mention the bike - don't you have to already have 100 on ROM for that

 

Please don't read other PO diaries and think because your OS is following a different PO protocol something is going to be wrong.  There is no "written in stone" protocol for when certain things should be started (PT) or when you should have reached certain milestones.  Each surgery is different and this will effect the timeframe for the PO Protocol. I have had 3 TTT's and started PT anywhere from 2 weeks PO to 11 weeks PO.  All depended on the situation.   Follow the instructions given by your OS and all will work out well in the end.

2- How much should I be up?down? Currently I'm laid up in bed most of the day except for potty runs and do a little walker run around the 1st floor. Is that about right or should I be trying to be up more? I know my body needs to heal but sometimes they say that the bones heal better in response to some weightbearing.

You should be up and down as much as you are comfortable. Yes,  bone healing is stimulated by weight bearing but there are still plenty of OS's that use a NWB protocol despite of the variation of TTT surgery done.  Some variations of TTT require NWB due to factors in the surgery...others do not. Some people are in a considerable amount of pain after this surgery and some are not (I was not).  I was back to work (in my office) 11 days PO after my 1st TTT and working from home 2 days PO after 2 and 3.  I was also up and around doing small things around my house (live alone).  Everyone responds differently.  If you are comfortable being up and around then just take it slow and be careful.

3. My OS said I could be full weight bearing only with the brace in the locked position. Does that mean he expects I'm walking around on it?! My impression from reading is that you can break your tibia by weight bearing too much too soon, so I've been NWB or TTWB and thats it.

I have to ask...what does TTWB mean??  Did you mean Toe Touch or Partial Weight Bearing (PWB)

Yes,  You can FWB.  You are not going to break your tibia. That is a very very rear complication.  Your OS is allowing you to weight bear to a) allow the muscles to work and b) encourage bone growth.  If you are comfortable put weight on the leg.  There is a method to the madness that is your PO Protocol! 


Remember when you read around KG that you will read more horror stories then success stories.  Don't read about all these problems and panic that they are going to happen to you.  Follow your PO Protocol and all will work out well in the end.  It when we don't follow these instruction things go wrong!

Best of luck,
Karen
     

[cdubb]

I agree. Don't compare to much to others PO protocols, just abide by the one your doc has given you. You selected your doctor for a reason...trust that he can direct you in the post op protocol appropriately and not just in the technical surgical piece.  I was heel/toe touch (20-30%) WB for 4 weeks then 50% and FWB at 6 weeks.  As your doc and KW's doc allow FWB, I'd take advantage of it. I certainly felt I could have handled more weight, but I didn't want to deviate from what my doc directed me to do. 

 I started PT about 12 days post op. This next time it probably won't be until about 17-20 day post op since my initial post op visit is on day 16 post op vs day 9 last time. Probably due to having surgery during holiday seaskn. As for when you do begin biking, even if you can't make a full revolution, it helps rocking back and forth and then magically one day, you'll just be able to go around.

Hang in there...the days do all blend together and you'll find that your body gets incredibly achey from the inactivity. Just remember....this too shall pass!

[meemers]

Thanks Karen and Cdubb! it's nice to have things brought into perspective. I think I have too much time on my hands and get neurotic! 

Just got back from taking my first shower - it was lovely! I feel much more stable with the walker than crutches - they tended to slip on the floor. My 5 y-o won't look at my knee with the staples - the first time he saw it you could see the sheer horror. I told him they aren't like the ones in school and that they will be taken out in little while.

I had to remind my 10y-o that he was a csection and they do that to tummies.  I don't think I ever mentioned, I'm a labor and delivery nurse. I just work once a week normally on Saturdays as I consider myself a full-time mom. Just moonlight as a nurse. In some of my downtime I was going to learn/review Spanish OB/nursing vocab.

[cdubb]

Bummer...you have staples? I was closed with internal dissolvable sutures and glue, so no staples or sutures to remove. My c-section was closed  similarly  where I had a pink line from day 1. Unsure what else they did with that because I could even get the csection closure wet the following day vs. the knee that I had to wait until I had my post op giving me the all clear to get it wet. 

A walker probably is a good idea for stability purposes. I never used one, but getting in and out of the shower with crutches was quite treacherous with the crutch tips.

[MamaAce]

I know your questions were already answered but I wanted to agree with Cdubb, when I had my proximal realignment done on my right knee, I didn't have 100% ROM when they got me on the bike and I could only go back and forth and then on the 3rd visit with the bike I was all of a sudden able to go all the way around, it was pretty neat to see the progress in such a short time.  I had my TTT done the day after yours, so it's kind of fun for me to compare our post op diaries.  I am envious of the fact you got to take a shower!  I am not supposed to take off the brace or any bandages until my post op visit, which is exactly one week after my surgery so this Wednesday, but still.  I miss my shower....and I am sure my bf does too!!!!!  LOL

[meemers]

It's nearing the end of postop day 5 - I'm really doing much better than I thought I would be doing. So far I would say its going better than my LR back in April. I'm guessing better pain meds, ice machine are contributing factors. I was alert more of the day and now at 7 pm I'm exhausted. The CPM is going fine, as per someone's suggestion I start at 25 degrees, let it run for 15 min, bump up to 30, let it go another 15, then bump it up to 35 and leave it there for awhile.

I just hope it continues to go well! Happy thoughts!

[Fathead D]

Sounds like you are doing pretty good.  I go in on Wednesday to see my new OS.  Hopefully his eval gives me a good feeling and we can move forward with getting my knee fixed.

[meemers]

Post op Day 6
Another good night - hurray! Last night I creeped the CPM up from 35 degrees to 37. I'm now beginning to wonder when to start increasing intervals between pain meds. Currently I take a percocet or lortab every 4 hours, depending on how much pain I'm in or anticipate being in while in the CPM/ambulating. So I take lortab more at night. My husband is really concerned that I will become dependent - not that he doesn't trust me, he just doesn't want to have to go though one more thing.

I read older posts on kneegeeks last night, esp from dr mark and think i got onto kneegeeks too late in the game. There is a lot of useful knowledge that is good to have going into your dr appt. I esp liked this from dr mark:

This aint rocket science. If someone is disabled secondary to a dislocating patella, then surgery is indicated.

If the Tibial tubericle-Trochlear groove offset is >20mm, or there is patella alta then a TTT is indicated.

If the patella moves laterally more than one half its width at 30 degrees of flexion, than a MPFL repair or reconstruction is indicated.

If there are rotational or  deformities of the bone(s), then corrective osteotomy of the bone(s) are indicated.  Trochleoplasty is included in this group.

If the knee is loose than a lateral release is NOT indicated.
 
I wish I had read this prior to deciding on my initial surgery back in April - Lateral release that predictably failed as I had cartilage damage under the patella.  I switched OS based on a PT's recommendation and didn't get 3rd and 4th opinions and just did the TTT he recommended. But he didn't talk about TT-TG ratio or rotational forces or take anything beyond a couple knee xrays in his office.  His focus is not a PF but typically puts people together after traumas. Now I am hoping the TTT was the correct surgery. The thing that makes me worry is that after surgery he said the backside of the patella had more damage than he thought. Does that mean that the medial and proximal surfaces are damaged as well? You better believe that's what I'm going to ask when I go to my postop.  If so, does that me I'm doomed to a knee replacement?

Right now though I just need to focus on healing from the surgery and know I need to stop obsessing about it.

[MamaAce]

Meemers I think you have the same problem that I do, you read too much! Lol. My OS also said I had a lot more damage than he thought, I guess he cleaned it out a lot more than he was expecting to.   I had a lateral release done several times on both knees over the years. I guess I figured they only had to do it once but I guess not. I have some questions to ask at my post op as well.

[meemers]

Day 6
Yesterday I was feeling pretty good so in the afternoon I started cutting to half dose of narcotic and increased the cPM by 5 degrees. By 8 pm I was miserable. Never mind- back up on full dose on the pain meds. Highs and lows...

[cdubb]

You definitely have the right idea about tapering the dose.  I felt pretty good one morning about 10 days post op, so I didn't take anything.  I went to my son's basketball that morning and was doing fine and then I got home and felt like I had the flu.  My whole body was aching.  About 5 pm, I took a Norco and the flu like symptoms resolved within 30 minutes.  I was totally having some mild withdrawal. 

[meemers]

Postop day 7

In the evening yesterday I started feeling like a fever was coming on and felt a bit like the flu - I was debating whether it was a disease as two of my kids had diarrhea yesterday afternoon or if it was pain med related as I've been trying to go to half doses. My night went alright - I was freezing, just couldn't get warm even though it wasn't cold.  I didn't take pain meds from 12 to 7am, then I just took 1 percoet as I really want to start weaning off the meds. The constipation issues are so bothersome. I thought once I got it started again I would be fine - but it's been stop -go- stop- go. Bleh, I knew it would be an issue and have been taking stool softeners, metamucil and eating high fiber foods.

I also have been trying to put more weight on my leg as I walker around.  Tomorrow is my postop visit and I'm eager to go. Why? I'm curious how long he'll let me continue to use crutches, also because of the reefing what restrictions are there? what does he think my chances are of this being successful since there was add'l patella cartilage damage.  When do I start PT? How am I to progress with the CPM machine.?

I don't know where the day goes... I feel like I don't watch that much tv, only read a little... I do get on the web a bunch. Plus a nap, while moments are slow, the days go by fairly quickly.

[cdubb]

Ask specifics about the cartilage damage. Grade- II, III, IV, Location - distal, proximal, central, lateral, medial?, Size - mm x mm and if any possible restoration options like ACI or DeNovot NT possible if isolates AMZ provides inadequate relief.  I know my doc said isolated AMZ would have had a high failure rate for the size, depth and location of my defects, so to optimize results, I needed the additional restoration procedures.

[meemers]

Post op Day 8

Today at 3pm I have my postop visit which I'm greatly looking forward to. I actually haven't left the house besides getting the mail since the surgery. Partially because my mother in law is home with me and the younger kids all day - I think that would push her over the edge. 

CDUBB - thanks so much for the specifics I should be asking - I'm always a big fan of being prepared when going in otherwise you forget what you wanted to ask and then you don't see them for weeks on end.

Last night I had my first rough night - just couldn't sleep well. I kept waking up and not being able to get comfortable. I'm not a fan of sleeping on my back - I currently sleep with my leg in the brace elevated in the CPM.

I've been trying to cut down significantly on narcotics. I took 3 doses - Am, after lunch, and before bed. Hopefully today I cut down more.