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Author Topic: Hopeful1's post-op!  (Read 21129 times)

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Offline Holly

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Re: Hopeful1's post-op!
« Reply #60 on: June 07, 2004, 10:18:07 PM »
Wow, L, you and I are on the EXACT SAME PATH!

I'm going in 2 days (on Wednesday) to discuss the VERY SAME THING with my OS.  I have the same symptoms and, although I can get to about 115d active ROM in PT, I have tremendous swelling all the time, lots of severe popping and locking and a constant feeling like there is duct tape strapped across my knee cap and PAIN!  I just have no more patience with this and must go back to work, so I want the MUA and lyses (sp?) NOW so I can get on with my life!! >:(  I love my OS, but he's always telling me to be patient...that I'm pushing myself too hard.  That was O.K. in the first few weeks, but now I really have to get going!  My husband is about to lose his job (the end of June), and I can't AFFORD to be out of work any longer! :o

Aaanywaaay...You'll be having your procedure before me, I'm sure, and I wish you the very best of luck!  I'm sure it will go well and that you will have great results.  I have read a lot about this procedure, and I think it will really address your problems.  Remember, though, that this IS another surgery.  Make sure that you have people to help you and that you give yourself permission to TAKE IT EASY!

I'll be looking to hear from you post-op...and sending you lots of warm, gentle hugs and best wishes!

Holly
1998 run over by car;Rt knee lat menisc/med menisc tear, ACL/MCL tear, patella frx, tib frx, femur frx, 4 scopes repr menisc/repr lig/debride pat, open MCL rpr, dbl osteot3/04;MUA,lysis6/04;scope10/04

Offline Heather M.

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Re: Hopeful1's post-op!
« Reply #61 on: June 07, 2004, 10:59:43 PM »
L and Holly,

Go down to the soft tissue healing problems section, which is where the scar tissue sufferers lurk.  You can do a search on 'lysis of adhesions' and 'scar tissue surgery' and you will find at least 5 very long threads.  

I just urge you to go slow and be patient.  Scar tissue does NOT respond well to being pushed.  In fact, usually that is the WORST thing you can do.  Unfortunately, arthrofibrosis (excessive scar tissue) is a very rare condition.  Less than .05% of knee scope patients develop this condition, so not a lot of doctors have had experience with it.  It's important to see a doctor who has dealt with the scar tissue before.  Most OS's would do a manipulation, which isn't necessarily the most effective way to take care of the adhesions.  I'm encouraged that both your doctors are doing the scope first, then manipulation--that is a much safer way to do things, and more effective, too.  The trick now will be to make sure that your adhesions don't return.  I had 4 surgeries before we found the right PT regimen (and new doctor!) that prevented the adhesions from coming back.

However, most people develop scar tissue because of traumatic procedures like the ones you both have had, and so they are usually okay after the lysis of adhesions.  I have a genetic problem with forming too much scar tissue, so it's tougher in my case to keep the stuff from coming back.  In all cases, it's important to remember that the PT after is just as important as the surgery itself--if not more so.  Please follow the doctor's instructions regrading being non-weight-bearing--I was on crutches for over 5 weeks last time, because every time I tried to put more weight on the knee it ballooned up and really hurt.  The gentle, non-weight-bearing and passive PT stuff is vital to getting the knee ROM back without forming more adhesions.  The rule of thumb is to get the ROM up and swelling down, then SLOWLY add in weight-bearing activities.

Anyway, go down to the scar tissue section and read up on the condition called arthrofibrosis.  It can cause a lot of permanent damage, so you two are lucky that your doctors are addressing it quickly.  My OS waited over 5 months (doing conservative stuff the whole time) before he went in again with the scope and found a TON of scar tissue.  He kept saying "I've never seen anything like this," and that should have been a warning to me!  I finally got in with a doctor who does lots of work with scar tissue and has written several seminal articles on dealing with arthrofibrosis and keeping it from returning.  Unfortunately, by then I had permanent and irreversible changes in my patellar tendon, which has led to bone on bone contact in my knee.  I'm so glad that both of your OS's are dealing with things proactively!

Take care and be sure to ask questions.  There is literally days worth of reading on scar tissue in the soft tissue problems section, so don't be overwhelmed.

Heather
« Last Edit: June 07, 2004, 11:54:48 PM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline hopeful1

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Re: Hopeful1's post-op!
« Reply #62 on: June 07, 2004, 11:21:44 PM »
Thanks, Holly and Heather!

I feel pretty confident with my Dr.  He was aware that I had a problem with my last surgery, so he had said early on that if I was "still stiff at all, and not to AT LEAST 90 by 6 weeks", he was going back in .  He admitted that he's only had a couple of patients get "frozen", but he said he just had the feeling after my surgery that he'd have to go back in, so he's already consulted a few "sepcialists" about scar tissue, and feels confident in his treatment.  I appreciate his honesty and his pro-active approach!  He said he did not even want to wait another week.  He believes in using techonolgy to the fullest, and in being agressive with treatment.  AMEN! I am just so surprised he wnats to do it THIS WEEK!!!  I don't have much time to prepare!  And, wouldn't you know it - I have promised to write an article for my boss - due by Monday.  Grrrrr.  He said I have time to get it done before Thursday!!

I have been reading the threads since my PT mentioned it a week or so ago.  I am AWFULLY discouraged, but I am SO GLAD that my OS and his PA were kind, and not at all judgemental.  They were both hopeful, but "matter-of-fact" about it, and the OS was almost appologetic, as he hoped he wouldn't have to "go back in ". :-/

I DO have a BIG case of the blues (still), and am trying not to label myself as a failure.  My boyfriend is being more supportive, and optimistic so far - he knows I was TERRIFIED of having to get a second scope!  He's been through this before with me, now, so he knows what to expect.  He requested that I get a spinal instead of genreal anesthesia!!  If you recall, I PUKED all over my car and HIM, and he had to clean it up!!  HeHeHe!!  I told him he has to be extra-nice, or I'll do an encore!!  :o :P

Hopefully yours,

L.
Fell 3/02
TTT, lateral release, VMO transfer & meniscus repair on 4/20/04
Lysis of adhesions/MUA on 6/10/04
FULL ROM by 7/19/04
Normal minimal function (ie, stairs, walking, etc) by 8/23/04
NO probelms since!!
Pregnant spring 05 - Due 9/05!!!

Offline Holly

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Re: Hopeful1's post-op!
« Reply #63 on: June 08, 2004, 04:42:00 PM »
Heather:

Thanks so much for you advice and recommendations for further reading!  As it happens, I have been reading up in that section about arthrofibrosis and all the threads concerning lyses of adhesions and MUA's because, although I have had many surgeries, this is the first time I've been "frozen."  I figured it was because of the extensive nature of this particular last surgery.  Even though my OS and my PT were pleased initially with how far I was coming with ROM, and certainly with how HARD I was working at it, I haven't progressed more than an additional 5-10d in ROM over the last month and that is a "red flag" to both of them.  I do nearly 4-5 hrs A DAY of PT, both at home and with my PT, and it is quite gruelling and painful, but seem to have hit a standstill no matter what anyone does.  That's why my OS is talking about scoping out the scar tissue and possibly doing the MUA.

Last night in PT, I had a long talk with my PT, Kim, who is absolutely WONDERFUL!!! ;D ;D ;D  She cautioned me about the possible consequences of MUA, the ligament and tendon issues, her belief that some doctors use it as a "fix-all" rather than using it in conjunction with a scope, the fact that it is not without a somewhat painful rehab and that rehab is PARAMOUNT to the success of the procedure (as you said, Heather).  Kim is probably the most knowledgeable PT I have EVER worked with and I wouldn't be as far as I am without her. (Not to mention she's the sweetest woman ON EARTH!  She can actually make me laugh when I really want to SCREAM :o)

Anyway, I feel pretty well prepared for the whole thing, and actually WANT to go ahead with it and hope my OS will schedule me SOON!

Again, Heather, thanks so much for your wonderful words of wisdom.  And Linda, a spinal sounds like a good idea - that much puke sounds pretty awful!  Be sure you get sufficient pain meds to handle things post-op and to h*ll with what the boyfriend thinks about that (if I remember correctly, he's given you some sh*t about that before!)  You take very good care of yourself, and make sure he does too...or I'll come down there and kick some *ss, even if I have to do it with just my one good leg! ::) ;D ;)

Love and hugs!

Holly
1998 run over by car;Rt knee lat menisc/med menisc tear, ACL/MCL tear, patella frx, tib frx, femur frx, 4 scopes repr menisc/repr lig/debride pat, open MCL rpr, dbl osteot3/04;MUA,lysis6/04;scope10/04

Offline hopeful1

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Re: Hopeful1's post-op!
« Reply #64 on: June 08, 2004, 11:55:21 PM »
Oh, Holly - what a great memory!  YES - I had a LONG chat with the guy about the medication issues.  He is actually worried about me, but just has a sort of backward way of showing it!!  I gave him the choice of 1) staying off my back about meds or 2) CONTINUAL back foot rubs for me, while he listens to my cry about the pain.  He is opting for #1.

He wonders what the CPM what will like...where it will go.  That is a good question.  Can that thing be set up on a couch??  Is it loud??  Will I have to sleep alone for awhile??  I should have asked the OS yesterday, - but I was SO STUNNED by the proposition of a second scope!!!

L.
Fell 3/02
TTT, lateral release, VMO transfer & meniscus repair on 4/20/04
Lysis of adhesions/MUA on 6/10/04
FULL ROM by 7/19/04
Normal minimal function (ie, stairs, walking, etc) by 8/23/04
NO probelms since!!
Pregnant spring 05 - Due 9/05!!!

Offline Holly

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Re: Hopeful1's post-op!
« Reply #65 on: June 09, 2004, 12:07:59 AM »
Hi Linda...of COURSE I remember, you had such a hard time!

Anyway, the CPM (at least the one I have) is about 4 feet long and about 1 foot wide and you CAN set it up on your couch.  You can also set it up on your bed, which is what I did in the first couple of weeks after my surgery when I wasn't ready to be downstairs among REAL PEOPLE quite yet.  You have to be able to plug it into a socket, and it has a little "remote" thingy to adjust ROM (flexion/extension), which I upped each day by 5 degrees flexion.  Mine was VERY QUIET and I had to be on mine 8 hrs a day, so I did it in 2 hr. shifts 4x a day.  Since I was VERY TIRED (and somewhat drugged), I was able to sleep through some of the shifts - had someone wake me up when my "shift" was over.  When you get into the higher degrees of flexion you DEFINITELY CAN'T SLEEP, since you're really feeling the PUSH - but that's later on.  So...no, you don't have to sleep alone if you don't want to.  My husband wouldn't sleep with my after this last surgery...but that was because he was afraid he'd "snap me like a twig" (you remember, I had that awful double osteotomy - tibia and femur right leg...my hubby's a BIG GUY...so on and so on...), but he finally came back to cuddle me and "you know" about 6 weeks ago.  WOO-HOO!!! ;D ;) ;D

Aaanywaaay...the CPM is a wonderful thing.  You don't have to work so hard, and your knee is kept moving so you don't build up scar tissue all over again.

Talk to you soon!

Hugs.

Holly
1998 run over by car;Rt knee lat menisc/med menisc tear, ACL/MCL tear, patella frx, tib frx, femur frx, 4 scopes repr menisc/repr lig/debride pat, open MCL rpr, dbl osteot3/04;MUA,lysis6/04;scope10/04

Offline Heather M.

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Re: Hopeful1's post-op!
« Reply #66 on: June 09, 2004, 01:46:59 AM »
Linda,

The CPM will be a lifesaver.  The usage has varied from doctor to doctor.  Here's what I was instructed to do--keep in mind that other patients of the same doctor had different regimens as well!

I was told to stay in the CPM whenever I was not in the shower, eating, in PT or on the way to PT.  I figure I spent 18-20 hours a day in it.  I slept in it all night, and had to ask my doctor for Ambien to help me stay asleep--otherwise it just wasn't an option.  With the Ambien, I slept 8 straight hours in the CPM without any problems, pure unconscious bliss.

When I was awake, I was told to keep the CPM at 0-70 degrees.  While sleeping I was told to set it to 30-70 degrees, because the motion was more important than the range.  *Keep in mind,* however, that I had 135 degrees of flexion the day after my surgery, and got to 145 within a week.  My extension from the time I woke up was -2 (not that CPM does anything for extension).  Again, my OS stressed that the real benefit of the CPM was for flexion (it keeps bands of scar tissue from forming and reducing bend) and for stimulating the production of synovial fluid and lubricating the knee, keeping it loose and limber.

The other things I did to keep the scar tissue from coming back included:

1.  patellar mobilizations--these are critical
2.  ROM work including CPM, wall slides, towel exercises, recumbent bike with 0 resistance
3.  Delayed strength training--only straight leg raises and quad sets allowed.
4.  formal PT within 2 hours of waking up from surgery (UGGH!)
5.  PRO-ACTIVE PAIN MANAGEMENT (this is critical), along with other medications like Advil or Celebrex.  Others got cortisone, but OS refused to use it on me  :'( because of previous infections.
6.  ice and more ice--get a Breg Polar Care unit and keep it stocked.  You can control the temp of the water and keep cool water moving around the knee around the clock at the beginning.
7.  being completely non-weight-bearing for over 10 days, then on crutches for 5 weeks.  Every time we added a bit of weight-bearing, the PT and OS were all over me checking for increased swelling and pain.  If I had these, it was back on crutches.

You can find a lot of stuff in my posts from after the last surgery--I put a lot of details there.  Janet also has great info in her posts, as do Soccermom, Sarah, Jennifer, Margaret, and I can't remember how many more post-op threads there are.  There is so much good information there.

Anyway, back to the CPM--it's a lifesaver.  It absolutely makes all the difference in the world in my opinion.  Last time I had it for 4 weeks, and the only reason I gave it up was I returned to my home state and had to leave the unit in Colorado.  I called the CPM the "Rack of Death" and "the Torture Rack" but it really helped.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Holly

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Re: Hopeful1's post-op!
« Reply #67 on: June 12, 2004, 12:48:10 AM »
Linda? Are you back?  Are you O.K.?

Hope your MUA and lysis went well...

Heather:  Thanks for the detailed advice for post MUA and lysis care...I think it will really help.  I saw my OS yesterday, and he went ahead and scheduled my surgery for Monday (3 days from now).  While he's "in there," he's going to take out my tibial screws.  I've never been unscrewed before - this should be fun! ;)  Anyway, he knows I want to be back at work in about 3 weeks and he thinks I can do it.  I'll be having PT 5xweek after this op, a CPM at home, and doing lots of praying and finger crossing.

Not much else I can do, since I'll be the only breadwinner come July...

Wishing everyone great knee days and happy recoveries!

Holly
1998 run over by car;Rt knee lat menisc/med menisc tear, ACL/MCL tear, patella frx, tib frx, femur frx, 4 scopes repr menisc/repr lig/debride pat, open MCL rpr, dbl osteot3/04;MUA,lysis6/04;scope10/04

Offline hopeful1

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Re: Hopeful1's post-op!
« Reply #68 on: June 12, 2004, 07:09:14 AM »
So, I did it!

I posted a brief update on my other thread, but thought I'd post an up-date here.

All went well with the MUA, I guess there lots of adhesions, but not a ton of scar tissue.  That's curious to me, because I thought scar tissue formed the adhesions???.  Pain control is GREAT!  CMP is great, too!  I like the slow rhythm - it feels  very soothing - ecept for the little while after I've increased the flex.  I am -5 and 70 dg.  I am to do this about 6 hours a day - more if I can take it.  ALso I am to increase the flexion by 5 dg/day, tiny bit more, if I can tolerate it.  On my own, I get 60 with NO problems or stiffness (that right there is a HUGE difference.)  I have not tried to push it yet, but will by Sunday!!

Thanks to all of you for your support!!

Linda
Fell 3/02
TTT, lateral release, VMO transfer & meniscus repair on 4/20/04
Lysis of adhesions/MUA on 6/10/04
FULL ROM by 7/19/04
Normal minimal function (ie, stairs, walking, etc) by 8/23/04
NO probelms since!!
Pregnant spring 05 - Due 9/05!!!

Offline cat

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Re: Hopeful1's post-op!
« Reply #69 on: June 14, 2004, 01:30:15 AM »
 Linda,
Glad you're back and doing well.
;D cat  ;D
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline hopeful1

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Re: Hopeful1's post-op!
« Reply #70 on: June 15, 2004, 05:57:31 AM »
THANK YOU THANK YOU!  To ALL of you who answered questions about CPM, MUA and infections. And thanks for all your prayers!

I went to my first PT session after the MUA.  I got to 85 with NO problem or stiffness, and to 100 with my own force, and encouragement from PT.  What a huge difference!! I can move my knee so freely now!  PT didn't want to push it today, because it did start to get warm and swollen, so we stopped, and iced!  I am now plugged into the CPM, with my cryocuff on!  And in about ten minutes, the mepergan will kick in and I'll be off to mars! HeHe.

My OS wants me to be weight bearing ASAP, but I find I get pretty swollen when I put even a little weight in it.  I am choosing to take Heathers advice and keep the weight off.  I am WAY more concerned about ROM, and will deal with proper walking later!

Flexibly yours,

L.



Fell 3/02
TTT, lateral release, VMO transfer & meniscus repair on 4/20/04
Lysis of adhesions/MUA on 6/10/04
FULL ROM by 7/19/04
Normal minimal function (ie, stairs, walking, etc) by 8/23/04
NO probelms since!!
Pregnant spring 05 - Due 9/05!!!

Offline Heather M.

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Re: Hopeful1's post-op!
« Reply #71 on: June 15, 2004, 11:56:22 AM »
L,

You may want to talk to Jennifer about the weight-bearing as well.  She's one month post op for lysis of adhesions, and I'm not sure if she's walking on it yet or not--I don't think so.  I'm sorry you're getting swelling if you put weight on it--is the increase noticeable, or is it more of a difference in the way it feels?

All in all, it sounds like you're doing much better than before the surgery.  I know it's hard to figure out what to do with all this advice and stuff--some of it contradictory.  I know Jennifer is having PT at the same exact place I did, for the same surgery, yet our protocols have been quite different.  The common denominators have been focus on ROM, passive exercises (i.e. seated or lying down, no resistance), and non-weight-bearing on crutches  But you should definitely talk to your doctor and most importantly, listen to your body.  I think you're really in tune with it--it takes a lot to recognize that PT isn't working and push for answers to the questions you have about that.

Keep it up.  And I'd really be interested in knowing the pain level comparisons between osteotomy and lysis if adhesions...I may be facing an osteotomy to deal with the mechanical changes scar tissue has caused in my knee (how ironic is that--you get scar tissue from a TTT, and I may need a TTT to fix the damage the scar tissue did!).

How's the SO doing in terms of supporting you?  Hopefully you two have worked it all out.  We won't talk about things like pets....

Heather
« Last Edit: June 15, 2004, 11:57:30 AM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Holly

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Re: Hopeful1's post-op!
« Reply #72 on: June 15, 2004, 06:09:26 PM »
Hey Linda!

I've been so excited to read about your post-MUA progress!  It sounds like you're really moving along well and taking very good care of yourself...listening to what your body needs and not worrying about meeting anyone's pre-set expectations.  I agree with you about taking care of the ROM issue first and foremost, since that was the reason for your MUA in the first place.  You'll get to the walking in due time!  Like you, I've relied quite a bit on Heather's great advice on this issue, and even printed out the post-op procedures she followed so I would have it handy when I got home yesterday.

I hope you are as proud of yourself as I am proud of you.  I know you've had a very rough go of it, but you've stuck it out and persevered and look how far you've come!  I've always said that I didn't want to just be a survivor...I wanted to be a PREVAILER!  And now I have you as an example to follow.  Keep up the good work, and I'll try to do the same! ;)

Just for laughs, did I tell you about my screw removal joke and my incredibly HOT orthopedist?  I'm always kind of flirting with him (I can't help it...he's really THAT HOT!).  During this surgery, he was also going to remove my 2 tibial screws so I told him I'd never been "unscrewed" before and wondered how that would feel? (wink, wink!).  Apparently, he told my husband while I was in recovery to ask me if I enjoyed "unsmoking" a cigarette afterward! ;D  Thank god he's got a good sense of humor!

Be well, honey.  Hugs!

Holly
1998 run over by car;Rt knee lat menisc/med menisc tear, ACL/MCL tear, patella frx, tib frx, femur frx, 4 scopes repr menisc/repr lig/debride pat, open MCL rpr, dbl osteot3/04;MUA,lysis6/04;scope10/04

Offline cat

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Re: Hopeful1's post-op!
« Reply #73 on: June 15, 2004, 10:01:00 PM »
Holly,
You crack me up! That' s hilarious!  ;D ;D
cat
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline hopeful1

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Re: Hopeful1's post-op!
« Reply #74 on: June 15, 2004, 10:44:31 PM »
Holly, you tell some great stories!  

So, today I'm pretty swollen!  Must have over done it yesterday.  I woke up twice in the night, needing pain meds.  Bummer.  It has taken a few hours on the CPM to get back to 80.  Oh, well - I STILL better of than before!

The SO has been supportive, in that he is just staying out my way.  I REALLY lit into him for taking the CPM control away from me.  He is worried that I'll have to have another scope.  Under it all, he believes is helping me, and looses sight of what is important to ME (like pain control - or just control in general). He is still worried about addiction, especially now, since this new stuff WORKS.  And I've noticed I behave differently on this stuff - more like I'm drunk.  If I'm not sleeping, I am sort of "chatty", I slur my words and have trouble following a conversation.  I know that scares him.  I think it also bugs hime that our hose looks more like hospital now.  We live in a small 3 room  duplex, with 2 bedrooms an open kitchen/living room.  When you walk in the door, you see the CPM and Cryocuff set up on one of the couches.  It's GOT to bother him!  Also, he took last friday off to take care of me, and his office was closed yesteday, so he was here 4 days with only a few hours out to hit the mountain bike trails.  He is back to work today, and I am sure he's relieved!!;)  I know I am!  :o

Going mobile,

L.
Fell 3/02
TTT, lateral release, VMO transfer & meniscus repair on 4/20/04
Lysis of adhesions/MUA on 6/10/04
FULL ROM by 7/19/04
Normal minimal function (ie, stairs, walking, etc) by 8/23/04
NO probelms since!!
Pregnant spring 05 - Due 9/05!!!