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Author Topic: ACI biopsy scheuled for this Monday, Jan. 4th.  (Read 14145 times)

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Offline Rennschnecke

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #60 on: November 10, 2010, 03:56:40 PM »
Sorry it's been so tough these first few days.  It's really good that your cells were growing very well in the lab – it's promising for the outcome.

It's good that your pain meds have been modified, but you sound like you could still do with a bit more relief.  Have you been icing regularly?  That can really help and if you can keep it going continuously during the early days you might be able to reduce the swelling and improve the final look of the scar.

Take care of yourself over the next few days.
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope – debridement, trochlear cartilage lesion (Gr4); 12/08 Scope – chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope – LOA, IPCS & patella infera; 9/10 Scope – AIR & LR.

cdubb

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #61 on: November 10, 2010, 04:06:01 PM »
Sorry to hear you had a rough night Melissa.  Hopefully, it will only be uphill from here!  You're only 2 days out of an op that has a really long recovery.  Hopefully, your pain from the procedure itself should improve pretty quickly since you were lucky enough to avoid the AMZ.  There still is a lot of soft tissue trauma though to get the kneecap flipped upside down.  Really stay on top of the pain meds those first few days.  I was diligent about taking them on a schedule for 2 days...I was extremely drugged up. I could still talk and articulate sentences clearly and the doc and nurse at urgent care (urinary retention issue visit) were surprised at how well I could relate my history on the amount of meds I told them I was one.  They thought I was a nurse with all the medical lingo I was using...I said nah..just a WC adjuster.... I actually had a rougher night last night too than I have had since my first night after surgery. I almost think last night was rougher though.  Odd since I'm a week out now.  I updated on my thread, so I won't talk too much here about it.  

I didn't ask for a coin equivalent comparison...I just know my defect was larger than the scope had estimated and was 2 cm x 2 cm and he said it was a pretty large defect. He also said that there was a spur under it that had to be ground down and that he needed to wait until that bleeding stopped before completing the patch because there can't be blood in with the cells. I plan on asking more about the significance of the spur at my next follow up and if it impacts any chances for success at all.   Really hoping I can see the pics at my Friday follow up.

Kinda jealous you don't have the CPM..it's hard to get 6 hours/day in. Although, my cpm has been set at 45 degrees since my 2nd day in it (started at 40 first day) and I have no issues getting to 45. I'm not supposed to move it up though until after I'm seen.  3-4 times per day I can also hang my leg off the side of the bed (completely passively and NO active movement) to 90. I can't quite get there...but close...

Offline Melissa S

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #62 on: November 10, 2010, 11:45:19 PM »
Thanks Renn, I am glad to hear your ice comment.  I ice using my cooler Ice Man almost constantly.  I was a little afraid that I might be using it too much but it is good to hear thats not possible but even helpful.
Thanks Courtney, I wish I could get my stomach problems under control with the pain meds and I would not feel so bad.  I just got a call from the company that supplies the portable E-stem unit and they said my insurance company approved it for purchase, so that was good news.  Hopefully this will help me get my muscle back faster.  I have used it twice today already.
I am already so tired of all this but I just have to keep reminding myself that this is a marathon not a sprint.
Injury with knee hitting concrete 7/07, partially torn ACL, and cartilage damage
Scope and debridement 2/08
2nd scope 1/10 with carticel biopsy
Carticel implant surgery on 11/8/10

Offline Rennschnecke

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #63 on: November 11, 2010, 01:24:32 AM »
Melissa, so long as you need the meds but they're upsetting your stomach ask about something to settle it.  I know that others have mentioned something which can stop nausea.  I've had something when I couldn't keep anything down, including water, but can't remember the name of the stuff.  It was brilliant, but clearly you need someone to check what would suit you.

The Ice Man doesn't involve direct contact with ice so you should be OK.  Besides, if you take it off I'll bet your knee gets warm quite quickly.

I keep on top of activities by having reminders on my phone.  Really annoying, but it ensures I get things done, take my meds etc.

Hope you get through this rough patch soon!
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope – debridement, trochlear cartilage lesion (Gr4); 12/08 Scope – chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope – LOA, IPCS & patella infera; 9/10 Scope – AIR & LR.

cdubb

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #64 on: November 11, 2010, 02:04:41 AM »
I was given promethazine or Phenergren (same thing) for nausea. I didn't have horrible nausea, but I also asked for something in my IV before I was ever even taken back to surgery and took the promethazine the first couple days.

I don't know about the Ice Man specifically, but I do know people who did get frostbite with other machines because the water circulating stays at the same temperature as ice without warming up like ice does because it's in a cooler.  My gameready has a temp control and never goes under 35 F, so it's not possible with that.  Unsure if the Ice Man has a protective feature like that.

Offline Melissa S

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #65 on: November 11, 2010, 04:36:20 AM »
The Ice man has a thermometer on the control too where I can see how cold the water is and it has never gotten below 45 degrees.  So there is not any danger of frostbite.  Plus my ted hose is against my skin with the ice pad against that.
I am going to call and ask for something for nausea tomorrow if I am still experiencing it.  Tonight I tried spacing out my pain pills instead of taking two at one time and going to see if that helps.

Thanks guys!
Injury with knee hitting concrete 7/07, partially torn ACL, and cartilage damage
Scope and debridement 2/08
2nd scope 1/10 with carticel biopsy
Carticel implant surgery on 11/8/10

Offline CR_UK

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #66 on: November 11, 2010, 11:21:45 AM »
Hi Melissa
Know just how you feel. 2 weeks ago I was desperate as a result of the pain but things have slowly started to settle , although at 5 week mark I haven't been able to reduce my meds yet but at least have better control and no breakthrough pain (unless after PT)
I initially was taking certain medications at same time and found myself at 3am in morning having used up my daily allowance and having peak pain at that time. I then started spacing them so that I was effectively taking something every 2 hours and this gave me cover for 24 hours. However still needed to add something which I did after posting  ie Tramadol. I woke up every hour at night so did not need to set alarm to remember. Now I have had the occasional 3 or 4 hour stretch which is bliss, but after PT I revert to the hourly waking and icing such as last night.
Not really sure what is deemed as an acceptable flare of pain after hydrotherapy. i manage doing it alright but then about 6 hours later have a flare that lasts overnight. Is this normal ? or does it imply too much for me. Seem to have a really irritable knee. I know "no pain no gain", but Renn your experience makes me anxious. I,ve always been someone who appears to have an excessive soft tissue inflammatory response, reacting to normal activity as if it were excessive. "Less is more "and a slower approach is always better for me. However despite knowing this and acting on it, "super cautious", including my physio, I seem to take a dip after PT.I would be grateful for any thoughts /experience in this.
Hang in there Melissa... hope you feel better soon.

Offline Rennschnecke

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #67 on: November 11, 2010, 11:51:43 AM »
Hi CR_UK,

I understand what you say about being sensitive and I'm going to give you that s***ing useless phrase 'Listen to your knee'.

I would probably err on the side of caution.  I had such a sharp reaction to my first hydrotherapy session that I never went back.  It set off a long period of sharp pain which I hadn't had until then and it's been downhill since then. 

Unless you really have masochistic tendencies I'd say don't go into pain.  Now the difficulty is that you will need to keep everything mobile and that may mean going into the discomfort range.  So the question is at what point does discomfort become pain?  I haven't found a satisfactory answer apart from the 'It's an individual thing' (more useless commentary!).

Having now worked my way through all sorts of variants, I'd say that discomfort is acceptable and should wear off after an acceptable period of time – I'd say within half-an-hour especially after some pain meds.  I used to have pain lasting for an hour and a half to two and half hours (post-MUA) and my OS emailed me telling me to back off.

I think at this stage you should keep on top of the pain using all the modalities available (meds & icing).  My understanding is that the base activities should include mobilizing the joint through CPM, any passive flexion exercises, patella mobilization (if allowed), quad sets and passive extension exercises with massage around the knee.  Although SLRs are often recommended, I recently learned that SLRs aren't necessary until the quad sets can get to full flexion easily.

I think the important thing to do is reduce the risk of forming adhesions which will limit your mobility later.  This means trying to get pain, heat and swelling under control.  I know it is easy to worry about losing strengthen, but I think that it's more important to get the joint settled down properly first.  However, you may feel better if you can manage to do some fitness work for the upper body and core at the gym.

I'm a long way out from my MACI now (16 months), but I'm still at the early stages of rehab following anterior interval and lateral releases, so still doing the same old stuff.  It is taking a long time for the knee to settle but I think that is because it's been irritated for a long time now.  I wonder whether this would have recovered more quickly if I hadn't worked it so hard post-MUA, which is why I think you should avoid irritating it too much.

Have you read Karen Hambly's articles on M/ACI rehab?  I found them very helpful.  Along with the info on http://www.cartilage-repair.co.uk/ you should have good guidance on the principles of rehab.  Clearly, you need to modify activities based on advice from your own surgeon for your particular defect.

Hope that helps!
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope – debridement, trochlear cartilage lesion (Gr4); 12/08 Scope – chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope – LOA, IPCS & patella infera; 9/10 Scope – AIR & LR.

Offline Melissa S

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #68 on: November 15, 2010, 04:44:14 AM »
Kind of have a new worry and wondering if anyone else has experienced this.  When I am sleeping in my brace I can feel myself jerk my knee or try to raise it or move it in my sleep.  It is painful and usually wakes me up.  I am worried that I will do something to the graft.  Should I not worry since I have my brace on?

Melissa
Injury with knee hitting concrete 7/07, partially torn ACL, and cartilage damage
Scope and debridement 2/08
2nd scope 1/10 with carticel biopsy
Carticel implant surgery on 11/8/10

cdubb

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #69 on: November 15, 2010, 06:22:29 AM »
Good question since as you know I was told I could sleep without the brace.  I haven't yet because I am really fearful of jerking or kicking the knee or even bending it in a potentially bad range.  I do loosen it up a bit to be more comfortable though than the snug fit I keep it at when ambulating.

Do you normally jerk your legs in your sleep or is that new?  I occasionally get restless legs (not often at all to ever seek treatment for- maybe 3-4 x's per year), but that generally actually just prevents me from getting to sleep vs. doing it in my sleep?

Offline Rennschnecke

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #70 on: November 15, 2010, 12:11:25 PM »
Melissa

I don't think you need to worry about your graft.  I think that is why we're advised to wear braces when we sleep as it is known that people do shift in their sleep.  It's perfectly normal.  Not convenient as it wakes you up with pain, but it will settle down.

Can you ice it through the night?
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope – debridement, trochlear cartilage lesion (Gr4); 12/08 Scope – chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope – LOA, IPCS & patella infera; 9/10 Scope – AIR & LR.

Offline CR_UK

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #71 on: November 15, 2010, 01:32:37 PM »
hi Melissa
Yes its normal to jerk your knee during sleep and like Renn said as long as you're wearing your brace, and I would ensure its not too loose ie allowing rotation causing a shearing force, it should be OK. Be sure to not have it too tight either as would compromise circulation with risk of DVT.
At my 3 week FU the OS said to rather continue sleeping in the brace although protocol allows for removing it at 2 weeks. So I'm going to continue for a while yet, at least until I see him at 7 weeks.

Offline Melissa S

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #72 on: November 15, 2010, 07:00:38 PM »
Thanks for all your responses.
I think it may be the sleeping on my back because it has happened before.  It is like when I am half asleep and my whole body jerks.  Then sometimes it is just my leg that will do it.
You know how it is, everything you do you worry about if it will hurt the knee graft.
I am a little surprised Courtney that your OS said you could sleep without the brace.  I think I would be so uneasy that I wouldn't be able to sleep.  I don't blame you for still sleeping in it.
Injury with knee hitting concrete 7/07, partially torn ACL, and cartilage damage
Scope and debridement 2/08
2nd scope 1/10 with carticel biopsy
Carticel implant surgery on 11/8/10

cdubb

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Re: ACI biopsy scheuled for this Monday, Jan. 4th.
« Reply #73 on: November 15, 2010, 08:26:50 PM »
It was my OS's PA, but it must be the protocol because someone above mentioned that protocol permits it at 2 weeks.  I'm still going to continue to sleep in it for now.















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