Post-Op DIARY of ACL Allograft #3 - June 14th-2007

[knee-will-be-great]

Well, Here I am getting ready for the ACL Allograft.  I am not in as good form or shape as I should be, having gained approximately 15 pounds since last September (2006).  The knee has a huge popliteal cyst that needs to be removed - and no doubt some floating bodies (knee mice - <in colloquial parlance>).

I am looking forward to this surgery in that the knee has been the rate-limiting step in many of my activities and professional endeavours. 

So ... I am to be operated on at 08:00 hours tomorrow.  Will report on results et al as time permits.

Cheers from Knee-will-be-great!

[Plumb]

Tons of luck.  The 15 pounds or so will come off when you knee/leg is not feeling like crap anymore.

[sazzle1]

Hay kneewillbegreat!!  Good luck for tomorrows op. Hope it all goes well for you. You will be fine i'm sure. All the best, post back soon after to let us know how you are doing :)sazzle1

[knee-will-be-great]

ACL DONE June 14, 2007

DAY OF SURGERY - IMMEDIATELY POST-OP

Woke up from anaesthesia at 1:30 pm.  Surgery started at 8 am - ended somehwere between 10 am and 11 am.

Knee was fitted with an interesting contraption; not the Cyro Cuff, but a cuff with two pouches and therefore room for two cooling bags.  Two other cooling bags are kept in the freezer; you interchange the two that are wrapped around your knee with the freezer-bound ones - every 2 hours!  Good grief; that means that I will have to spend my nights on the couch if I am to follow that protocol.

Very drowsy from the general anaesthetic - as well as from the pain meds provided to me.  Was given a prescription for Percoset, but decided not to go with that perscription in that narcotics make me very drowsy, nauseous and cause me to gag.

Got home at 4:15 pm and started vomiting sour water.  Slept on the couch; better that going up the flight of stairs to the bedroom.  Knee actually hurt more that it did with my High Tibial Osteotomy surgery.  Fell asleep at approximately 6:15 pm - and slept until 7 am the next morning.

___________________________________________________________________

[jb-knee-geek]

hey KWBG - congratulations! you're one stpe closer to a stable - keep the swelling down and best of luck in rehab.

[sazzle1]

Hi KWBG Glad you are back and surgery is all done, you sound fairly 'chirpy'. Keep us posted sazzle1

[Nola]

Wishing you well!!! Hope you're feeling better today!

[Abs]

Good luck with rehab.

Sorry you vomited after surgery.  If it's any help I had a monster asthma attack and was back in casualty 2 days after surgery, so now not allowed to take any anti-inflammatories.  So you're not the only sickly child post-op.

I've put on approx 10lbs since injuring knee last august.  I am convinced it will come flying off once I can step up a gear.  Luckily most my clothes just about fit, so can't put on any more or it will cost my wardrobe.

All the best
Abs

[knee-will-be-great]

ACL DONE June 14, 2007

DAY I - POST-SURGERY

Woke up at 7 am and felt very naseous, weak and dizzy.

Got a ride to my orthopaedic surgeon's office for an 8:15 am appointment to have my "hemovac" removed.  For all of you uninitiated ACL allograft / other ligament replacement patients and wannabe's , the hemovac is a device designed to suction the blood out of your incision post-surgery.  The hemovac is a cylinder-shaped container with plastic end-plates about the size of Compact Discs.  A tube is attached to the hemovac; the end of the tube is in your knee - close to an incision site.  My hemovac tube was placed in an incision site approximately 15 centimetres (3 inches) above my knee.  The incision site in itself was very small; approximately 1 centimetre across. 

The sides od the hemovac are made of a flexible, clear plastic.  Inside the hemovac are a number of metal coils that can be compressed.  Compressing these coils creates an air vacuum, which results in suction force being exerted within the knee; the hemovac essentially "sucks" up some or all of the residual blood in your knee and general surgical area that has resulted from your surgeon's cutting tissue, bone, etcetera.

You can open a little plug on the top of the hemovac to remove the blood yourself (if the hemovac is near to overflowing), but generally it is expected that your blood loss will not be such that you will have the hemovac fill to the maximum.  But every situtation is different. 

My hemovac filled to approximately 7/8th fullness. 

At the OS clinic
My surgeon's nurse removed the hemovac tube from my leg ... She said "Okay, now on the count of three, I am going to remove the tube ... one, two, three !!!."  And out it came!  Whew, not as bad as I expected.  Not even painful; just uncomfortable - like, having (and feeling) some foreign object moving inside of your body - close to your skin.  On examination of my knee at that time, I had minimal swelling; (I actually could see my knee and patella quite well thank you very much).  In terms of incisions, I have three small 1 centimetre long incisions above my knee, no doubt created to accomodate the orthroscopic cameras and surgical instruments used.

Back at home
Attempted doing the list prescribed ACL allograft physiotherapy exercises that one MUST start on Day One - after the hemovac tube is taken out.  I was surprised that the pain in my knee truly prevented me from doing the exercises - because I am a person who can withstand significant amounts of pain.  But this pain was exquisite in nature.  So I gave myself a mental break and did not beat myself up about not being able to do the exercises.  Instead I tested my ability to weight-bear per tolerated ability on the leg (also required immediately post-surgery).  I did weight-bear as per my tolerance.  All in all, I am happy that this knee is looking up and will be better after the healing is done and over with.  God bless my surgeon and his staff - and my family and friends; I love you all!

Went to sleep at 6:15 pm and woke up a few times during the night because of the need to reposition my operated knee - and to replace the warmed gel-packs enveloping my knee with freezer-cold gel-packs!

Cheers to all from Knee-Will-Be-Great!  Keep your spirits up folks!

[knee-will-be-great]

ACL DONE June 14, 2007

DAY 2 - POST-SURGERY
Woke up at 7 am and again felt very naseous, weak and dizzy - but knew that I had to get UP and GO, GO, GO! (or at least make a reasonable effort to do so).  Still not at the point whereby taking a shower or bath is adviseable - because I still feel woozy.  I neglected to set up the plastic resin lawn chair in my bath tub - that I would need to sit on while showering.  The legs of the chair were just a bit too wide for the tub - and would have scratched the sides of the tub, but folks, don't let that stop you from finding a small resin chair to accomodate the dimensions of your tub / shower enclosure.  Make sure to take a tape measure with you when purchasing a resin "shower chair".  Measure the inner dimensions (width) of your tub - and then measure the outer reaches of the leg span of your proposed chair prior to buying it.  This will ensure that you purchase a "shower chair" that fits. 

In my case, I will expect to take a bath (possibly Day 4 or Day 5); lying down, with my operated leg well wrapped in a garbage bag - from ankle to top of thigh - with the tops (and open bottom) of the garbage bag secured against my skin with duct tape to create a water-resistant, sealed environment for the operated knee.  I cannot get the incision(s) wet until 10 days post-surgery. 

Primary Incision Site
In my DAY 1 - POST SURGERY comments, I had mentioned that I had three small 1 centimetre incisions above the knee.  I do have another larger incision - approximately 15 to 17 cm long - a vertical incision 10 cm below the knee and 7 cm to the left of the patella (if you are looking down at your knee).  The incision was used to access my Open-Wedge High Tibial Ostetomy hardware from my January 2006 surgery.  The surgeon had to remove all of this hardware prior to starting the ACL allograft procedure - in that the very area that he needed to use to drill through and/or affix the ACLr hardware to - was the area covered by the HTO hardware.  So out with the old (hardware) and in with the new (hardware).  Kind of a Happy New Year - of sorts.  At least, happy for me, because I am waiting for a positive end to all of this. 

This incision is closed with steri-strips which will peel off during my first, official, sanctioned non-garbage bag knee protecting shower - 10 days post-surgery.  The steri-strips will then peel off of their own accord and I wll be able to shower or bathe as per usual.

Painkillers
I was prescribed "Percoset" as a post-surgery pain reliever.  I elected not to fill the scipt because the stuff quite frankly makes my ill; in fact ingesting any narcotic makes me ill, nauseous, sometimesto the point of vomiting.  I had indicated this to my OS's nurse during my DAT 1 visit; she asked a resident at the OS's office to suggest another pain killer.  The residetn wrote me a script for the brand name "Tramacet" - a pain reliever without any narcotic agent.  I was given a few "Advil" samples and a few "Tramacet" samples to try.  So yes, Kneegeeks, I have not used any pain relief post-surgery, except a few Advil and some sample Tramacet - both of which still made me feel woozy and nauseous.  Now having said this about wooziness and nausea, I cannot isolate post-surgical, anaesthetic-related nausea from nausea associated with the ingestion of pain killers.  So I am attributing a bit of the nausea from the pain killers and a bit (still) from surgical anaesthetic.

Adviseable - Do This Often
Drink a lot of fluid to flush out the anaesthesia from your system.  Drink at least 12 250 ml (8 ounce glasses) a day. 

Out and About
Being on one's legs and walking / undertaking some degree of ambulatory activity (as tolerated) is promoted by my orthopaedic surgeon, his nursing staff and the physiotherapists.  It is not considered logical for an otherwise fully functioning person to sit on his or her bottom and do nothing; not healthy ofr the body - and ceetainly not helpful for the ACLr recovery process.  With that in mind, I went out to pick up an item of clothing with a dear one.  We subsequently went to a bistro to eat and talk.  Irrespective of my continuing cognitive fuzziness, I was happy to be in the 27 Celcius degree sun, albeit shaded by a lovely parasol.  I had been invited to a graduation party that evening, but decided not to go - owing to the fact that I would in close quarters and around at least 20 - 30 active kids aged 1 year to 17 years of age, their parents (30 -40) (my friends) - and I was tired and woozy - still an issue.  I DID want to go, but owing to the fact that I fell asleep at 6:15 pm that evening - and the party had started at 6 pm, I beleive that I chose wisely and pragmatically.  One outing on DAY 2 POST-OP is enough, two outings is stretching it!

Note of Caution
RE: Crutches:  The wingnut which secures one of the screws holding my crutches together fell off - and the screw came loos at the bistro.  The crutch collapsed.  Had I not been mentally acute enough to restabilze my body position, and remain standing, I would have been on my bottom - on the ground.  LESSON LEANRED:  Check the wingnuts on your crutches to ensure they are all tight against the crutch.  Wouldn't want to see any of you Kneegeeks end up falling and possibly injuring yourselves because of a crutch malfunction!

Sorry Geeks, I won't be spell-checking anything - just posting ... bear with me ...

Love you all,

Cheers from Knee-will-be-great!

[knee-will-be-great]

ACL DONE June 14, 2007

DAY 3 - POST-SURGERY

Woke up at 4:30 am but officially rose from the couch at 7:00 am.  Nauseous as all heck.  I had decided to try two Tylenol 3 tablets (with codeine) at 11 pm the night previous.  I woke up feeling quite out of it.

Still have not done any knee straightening exercises prescribed to me by the physiotherapist, but I started doing some leg extension exercises.  I have a minimal amount of swelling - save around the knee; no other complaints.

Painkillers - A "No Go" for my system
Ingested two Tamacet (non-narcotic) pain killers, which essentailly had the same effect on my system as the narcotic-laced Tylenol 3s - extreme dizziness and nausea.  Oh well, looks like I will have to go through this rehab process with very little or no painkillers.  Went the no-painkiller route for all of my other knee surgeries - so I think that will (logically) have to be the case for me during this current process. 

Dietary Considerations
I am eating protein, dark green leafy veggies and light non-sweetened juice as can be tolerated.  A friend brought over some excellent chocolate cake in the pm - great stuff!  My dear one made me ribs, chicken and an excellent salad - yum!

Ate supper - protein only (ribs) and pure, non-sweetened juice.  Still couldn't eat a lot of food owing to the general, (albeit gradually) dissipating sense of nausea.

I lay around all day and feel that I must get out and walk around the neighbourhood to regain some of the quadriceps and hamstring muscle strength.  That will be on DAY 4.

After some much-welcomed visits and time on the telephone with friends and relatives, I was more or less ready for bed by 9 pm.

Got up the stairs and went to bed at 11 pm.

Another calm and uneventful day in the life of a post-ACL surgery Kneegeek!

Cheers to all from Knee-will-be-great! 

[miltonc]

I read in a different thread that you are already walking with 1 crutch from Day 3.  Wow!  Is that possible?  Are you wearing a knee brace at least.  Also, did you climb upstairs?  Too many questions.  Sorry.  But I am 18 days post op and I am still struggling to walk without crutches. 

[Nola]

Hi knee-will-be-great.  Hope you feeling a bit better.  Just wanted to give you a little insight on your analgesics.  Tramacet is a combination of Tramadol and Acetaminophen.  Actually Tramadol is a centrally acting synthetic opioid analgesic.  I was looking through the mail a couple of weeks ago and it was amazing the number of physicians who have lost their medical licenses over abusing narcotics and Tramadol (Ultram) was listed as one of the most often abused by medical personnel.  So if you are having the same reaction of N/V with Tramacet, that is because it is an opioid and obviously you are extremely sensitive to opioids. Rather than suffer with pain and not take the narcotics or suffer with the nausea and vomiting, why not call your OS and ask for either phenergan, compazine, or reglan to assist with the N/V?  I feel for you.  Hope you work through this.  Oh one other point, I am not sure how much acetaminophen your Rx of Tramocet has in it, but be careful not to take too much acetaminophen in addition to the combination drug.  Tylenol (acetaminophen) is very toxic to the liver.

[knee-will-be-great]

I read in a different thread that you are already walking with 1 crutch from Day 3.  Wow!  Is that possible?  Are you wearing a knee brace at least.  Also, did you climb upstairs?  Too many questions.  Sorry.  But I am 18 days post op and I am still struggling to walk without crutches. 

Hello MiltonC,

I will respond to all of your questions!

1)  RE: already walking with 1 crutch from Day 3
Answer:  Yes I am already walking with one crutch from Day 3 (yesterday).  I was told to start walking on the knee immediately post surgery as tolerated because walking on the knee would help me regain muscle strenth and therefore knee strength.  This is slow walking - not fast walking - or "normal walking" as one would expect if one was walking form the subway / bus / parking lot garage to one's place of work - but yes, I repeat, it is still walking with one crutch.

2)  RE: Are you wearing a knee brace at least?
Answer:  Yes, I am wearing a knee-brace of sorts, but the brace does not have any plastic components.  It is more or less a "neoprene wrap" secured around the leg by three bands - one band is below the knee - one band is at the knee - and one band is above the knee.  The "neoprene wrap" has two pockets into which gel-packs are put.  The gel packs cool the knee.  I have a total of four gel packs; tow to use for two hours - the other two to keep in the freezer as replacements when the tow hour time frame is up!  Essentially that is the only knee brace that I was given.  That is my OS's protocol - a soft, neoprene sleeve that, when affixed properly and contains two icy-cold gel-packs, holds your knee in position at all times.

3)  RE:  Did you climb upstairs?  
Answer:   Yes, I did up the stairs on DAY 3; in fact I did climb up the stairs on DAY 2 once - but felt too woozy to repeat this again that day.  Today (DAY 4), I am climbing up and down the stairs.  I find that using one crutch is easier than using two for either the climb up - or the climb down the stairs.  

Stair ascent: For the climb upstairs, I always put the crutch against my "good" non-operated knee side.  I hold the stair railing using the hand on my operated knee side - and I ascend the stairs one at a time.

Stair descent:  Forthe climb downstairs, I again have my crutch against my "good knee" side.  I am holding the stair railing using the hand on my operated knee side - and I carefully descend the stairs one at a time.

Cheers from Knee-Will-Be-Great!

In terms of time frames to achieve all of these land marks/expectations, I am of the opinion that the knee healing process involves but is not limited to a combination of factors as follow:
1.  The pre-operative and post-operative physical abilities and general fortitude of the patient.  Also, if the patient is taking narcotic-laced pain meds it is my humble opinion that one will feel poorly longer than one not taking narcotic-laced pain meds.  It depends on one's bondy's ability to incorporate the pain meds into one's system.  But that is my opinion according to my experiences; (narcotics and I do not get along - so I just will not use them.)  I would prefer to tolerate "good pain" from a healing process rather than being dozy and nauseous.  Sometimes even normal, non-narcotic pain relievers can make a person lethargic as well - and affect their physical as well as cognitive abilities.  Also, people perceive and feel pain differently.  It depends on our inherent biology, how many pain receptors we have per afflicted are, etc.  It also depends on our physical/sprots-related/dance/work-related training and background.  If your were trained to not think about pain and / or visualise pain as a blob - and then you compartmentalize the blob of pain in a box - and put it away in a visualised shelf (thus shelving the pain), you may perceive your pain to be less than what you actuall do in fact have.

2.  The mental fortitude and post-operative cognitive/intellectual/emotional state and general fortitude of the patient.  Sometimes fear of the procedure and worry about the sequela post-surgery affect out mid set and therefore our ability to "get up and go".  Sometimes other family, financial, professional, educational issues - or a combination thereof affect us - and therefore our ability to regain ground.  Let's face it; for some of us Kneegeeks, thour injuries/reuperation time and possible/permanent physical limitations may have had significant personal and professional ramifications - so we are or may be somewhat scattered/upset/nervous/depressed.  This is only natural.  But I heartily advise you to be in league with people who do not whine about their situtation - but instead find and surround yourself with people who look for positive solutions.  Staying down only keeps you down.  Let's face it, we still have our legs; they haven't been blown off in Iran or on some random minefield in another war-torn part of the world.  And two of my Canadian heores (Terry Fox and Rick Hansen) both travelled suboptimally (Terry from coast to coast across the span of Canada on one leg <the other was removed at the groin because of cancer> raising money for cancer treatment research ) - and Rick travelled across the world in a wheelchair (see Man in Motion) <Rick became paralysed from the waist down at 17-18 years of age - and THEN got a degree in Physical Education/Kinesiology as a paraplegic> and then went on a mission - raising $ for spinal cord research).

3. Expectations of one's surgeon.  (i) Surgical and Post-Surgical Protocols.  If your surgeon is at a teaching hospital, he or she may be self-motivated to be invovled in various and sundry "best practises" in terms of what works/what doesn't work.  This applies to your surgeon's nurses and the physiotherapists as well.  Individuals who formally study and follow the outcomes of sports injuries (over and above simply treating sports injuries) are (in my humble opinion) better positioned to evaluate what has worked and not worked in the past and what is working/not working in the present.  In my case, my first ACL allograft was undertaken in 1993.  My knee was put in a locked plastic/metal knee brace.  At that time, I was in hospital for four days.  I was not allowed out of bed for three days - and even after those three days I felt absolutely awful!  I would attribute feeling awful to being fed a patient controlled morphine drip, which subsided the pain from my surgical wound, but produced a myriad of problems such as constipation and a general ability to void urine.  Also, I was not moving around - another bad thing!  Hence I had to be catheterized and given stool softeners.  After four days in hospital, I had to be in bed for another for another four days straight - only leaving the bed to go to the washroom.  As I recall, I was instructed not to weight bear for at least two and one half to three months, thereafter I was given open chain as well as closed chain exercises.  Not a good combination - but my [physiotherapist was not directly affiliated with the OS who performed my initial ACLr.  Today, even with my being 17 years older, I have sprung back from ACL allograft surgery with a vigour I did not have in 1993.

3.  Expectations of one's surgeon regarding patient healing time / time lines / landmarks etc.  (ii) Involvement in Sports Medicine and Invovlement with Professional Sports People.  If your surgeon is involved with a professional sports team, or has habitually treated (as part of his/her ongoing practise), the expectations are that a sports professional rehabilitate quickly and safely with a minimum of muss and fuss.  So the surgeons work towards getting these people back on the road to repair and good health as quickly as possible - so I would imagine (logically) that the benefits of observing leading edge male/female sporters in their prime of life adds to our respective surgeons' abilities to work out practicable solutions for we weekend warrior athletes and others injured during the day-to-day rigours of life.

4)  Surgical Complications.  You may get an infection in the wound, deep vein thrombosis, Vancomyosin Resistant Staphlococcus Aureus (VRSA), or, you may get a cold/flu virus while in hospital, feel generally run down, etc., as a result of surgery.  This may endure for a few weeks post-surgery.

5)  Family / Friends Support.  Support by yor family and firends is good - but being babied sometimes keeps us in a patient mode too long relative to what our surgeon's expectations are.

6)  Other factors not specified at this point.  All in all, any treatment involves a partnership between the patient, the surgeon/surgical team and the physiotherapist.  A positive attitude on the part of the patient not only helps their physical and mental well-being - but motivates your surgical and post-surgical team.  And if you can't do it, then fake the positivity until it in fact becomes who you are.  It does work!  It can't harm you.  At least in my humble opinion.

Cheers from Knee-Will-Be-Great ... probably should change my name ot Knee-Is-Getting-Greater!!! or Knee-Is Great!!!

[knee-will-be-great]

Hi knee-will-be-great.  Hope you feeling a bit better.  Just wanted to give you a little insight on your analgesics.  Tramacet is a combination of Tramadol and Acetaminophen.  Actually Tramadol is a centrally acting synthetic opioid analgesic.  I was looking through the mail a couple of weeks ago and it was amazing the number of physicians who have lost their medical licenses over abusing narcotics and Tramadol (Ultram) was listed as one of the most often abused by medical personnel.  So if you are having the same reaction of N/V with Tramacet, that is because it is an opioid and obviously you are extremely sensitive to opioids. Rather than suffer with pain and not take the narcotics or suffer with the nausea and vomiting, why not call your OS and ask for either phenergan, compazine, or reglan to assist with the N/V?  I feel for you.  Hope you work through this.  Oh one other point, I am not sure how much acetaminophen your Rx of Tramocet has in it, but be careful not to take too much acetaminophen in addition to the combination drug.  Tylenol (acetaminophen) is very toxic to the liver.

____________________________

Dear Nola, thank you very much re: the informarion on Tramacet!  I did think that something was amiss - in that I was flying - and again nauseous.

What is your perspective re: Advil and other over-the-counter pain remedies?

Having stopped taking any type of pain meds 2.5 days after my last surgery prior to the ACL allograft #3 (a High Tibial Osteotomy done in June 2006), I am of the opinion that I again will simply stop ingesting pain meds.  Yes, I do believe that I am one of the population who is hypersensitive to opiods.  That has been my consistent experience - extreme nausea, dizziness et al - irrespective of whether I had knee surgery or dental implants (for molar affixation) surgery.  Essentially my post surgical protocol did not include pain killers, notwithstanding their being prescribed.

Cheers to you and many thanks for you input!!!

From Knee-Will-Be-Great!!!