Stage 6: The Long Haul! Weeks 1-3: Baby Steps

November 3rd marks the 3 week post op mark!! Yay to completing little goals that feel huge!!! It has not been easy, but it would have been A LOT worse if my Mom wasn't here.  My mother has literally been my life saver the first 2 weeks post op. I literally could not have done it without her. She cooked, cleaned, walked Jake, pulled me up when I felt defeated,  brought me to PT, went grocery shopping, woke up in the middle of the night to check on me, and even tolerated my dog waking her up a million times (we still haven't figured out why he kept waking us up. Lol). I love you! Thank you Mom! For those of you who anticipate having surgery, make sure you have someone at home to help you. You initially can not do this alone.

Week 1: The first day, the day I came home from surgery, was surprisingly the easiest! You're probably sitting there wondering, how is that even possible? Shouldn't I have had the most pain the very first day, the day of surgery . . . or even the day after? Well, thank goodness we have advancements in medicine and the nerve block was invented. The anesthesiologist injects a long acting anesthetic, like Ropivcaine, in the anterior and proximal aspect of your leg. In English, that means the upper and front part of your thigh haha! The anesthetic temporarily shuts off your femoral nerve so you don't  feel anything for 1-2 days. It’s awesome . . . until it wears off. haha. 

The next 3 days, I was non weight bearing, ambulating with crushes, and had my knee locked in extension in the  brace. The only time I took my brace off was to spend countless hours on the CPM machine. This machine slowly and passively moves your leg into flexion and extension. I started at 30 degrees, but this didn't initially hurt because of the nerve block. Also, in the first 72 hours (or unless your doctor tells you otherwise)  showering is not advised. I know gross, right? However, with that being said, when you do finally get to shower, it usually requires so much effort that you question if it’s even worth attempting. Trust me, it is. 

For those of you ACLers reading this, here are a few tips: I have a tub so, that created a barrier with taking a shower without putting my leg down. If you have a stand-up shower ( I had one in my first house for my first ACL surgery)  it’s a little easier, but still a pain. My advice: buy a shower chair. Sitting makes it easier to avoid putting weight on your surgical leg. It even frees up your hands so you don't have to worry about balancing with crutches.  Getting in and out of the tub even becomes easier.  The chair allowed me to get up and out, by pivoting and resting my leg on the edge of the tub. This also enabled me to keep my leg straight the entire time.  I then put my good foot down, grabbed a crutch or used my hands to push off the tub, then balanced on my good leg. After a few attempts, I got the  system down and it became easier each time.

I was fortunatly  allowed to shower after 48 hours, but was not allowed to get my sutures wet. Some surgeons are different and do not want your dressing changed / touched until they see you. One method I used to keep my surgical site dry was covering the sutures with Tegaderm.  We use this in the ER to secure IVs, but it also works wonders for keeping surgical wounds dry. For my other two surgeries, Saran Wrap and tape worked well too.

After finally taking a shower, I realized how much it was worth it. I felt civilized and refreshed.

On day 3, my nerve block wore off in the middle of the night. You know that scene in the movie Jaws, where Brody blows up the shark? Well, that’s basically how my knee felt. My knee was the shark. My tibia and femur were NOT happy.  I took a total of 3 Percocet tablets over 2 days, but called it quits.  I went from breaking into sobbing tears without triggers, to felling numb, then got severe nausea and vomiting for hours. Sccrrreeewwww that!! Ibuprofen for the win on the pain control! Luckily, for me, the ibuprofen worked well.

Day 4 was the first day of PT!! Back to Center for Physical Therapy! Yay! Aside from showering, this was the first time I was allowed to take my brace off. Chris and I discussed my surgery, he examined my knee, made sure I was neurovascularly intact, then moved to the ROM (range of motion) assessment.  The excitement of being at PT came to an abrupt halt. Here comes the pain  *cough* I mean the evaluation of passive range of motion. This is when the therapist bends your knee and tells you to relax (yea right haha). Well, needless to say, the tears ran down my face and the pain took over. Bending your knee for the first time post OP, might be one of the most painful things you will endure besides the nerve block wearing off. Oh, wait. That just happened only hours before this very moment!!  Wah!  However, it needs to be done, and marks the true beginning of PT. We didn't do too much this particular session because it was my first day. Also, my post op follow up appointment wasn't until Thurday. Despite the pain, the therapy session ended with good news!! I was given permission to partially weight bear, as tolerated, and  with crutches!! Yay!! This was huge news and unexpected. 

Day 6: Aside from regaining  ROM after ACL surgery, learning how to activate your quad is another major component to therapy. If you've ever seen the movie Kill Bill, you have a pretty good idea of how the process begins. “Wiggle your big toe” is a quote that Beatrix Kiddo, played by Uma Thurman, repeats over and over again. After waking up from a 4 year coma, she discovered she has severe generalized muscle atrophy. She spends countless hours attempting to simply move her big toe. It was a start for her, but then she eventually gets revenge and kicks major ass. You must watch this movie if you don't know what I'm talking about! In this phase of therapy I found myself feeling like Beatrix, telling myself to activate my quad.  "Move your quad. Move your quad. Flex. Flex. Flex," were repeated in my head. Activating your quad after surgery is pretty difficult, but just like Beatrix Kiddo, it gets easier with practice and every day.

Day 7 and Day 8: Post op follow up: This visit was filled with awesome news. Dr. Nicholas stressed how happy he was with the surgery. He also chuckled and thanked me for my kind words post op (Ha ha, you must read the previous blog to understand the humor in this statement). On examine, my anterior drawer test was solid, my incision sites were clean, dry, intact, and without signs of infection. So, sutures came out! Drum roll please!!!! This is  the best part of the visit!!!  Dr. Nicolas said I was able to walk without crutches !!!! This was totally unexpected because  for my last surgery I was non weight bearing for 6 weeks! The catch: my knee had to stay in the brace while locked in extension. I was totally okay with this news! Anything was better than not being able to weight bear for 6 weeks. 

First day on the bike!

Day 8: Milestone spoiler alert!!! My third PT appointment was, by far, the best day since surgery.  We worked on progressing my ROM with, yup, you guessed it, the stationary bike!!!!  My therapist told me that my objective was to rock my feet back and forth on the pedals. This meant starting at  3 o'clock and 9 o clock and slowly increased flexion and extension in my knee. I didn't care how much it hurt, I had to make it all the way around. I was determined, but holy smokes, did that kill!!! It took me about 15 minutes (in agony) to do it yet, I managed to make a complete circle TWICE!! Yes, a FULL pedal stroke TWICE, but twice was enough. Ha! I completed my first week of PT and was officially one week post op!! 

Days 11- 22: The second week of PT was pretty similar to the first week, but we made gradual progressions and tweaks to each exercise.  We went from quad activation to working on gait training. We  eventually worked on marching in place.  Initially, this activity required me to hold on to the wall the entire time for balance.  By the end of the week, I began touching the wall every few seconds to not at all. Baby steps to little rewards.

My ability to balance each day improves. On the  third day, I was scared to even place my foot down on the ground to attempt walking. I needed to hold on to Chris’s or Lisa’s arms the entire time. I overcame this challenge and progressed to avoiding  “the peg leg.” What the hell is a peg leg you may ask? Well, Captain Ahab, might be my best visual description for you haha. Basically, I walking with my leg  straight and with little bend. This is BAD.   After ACL surgery, you not only lose muscle mass, but you lose your range of motion. Complete flexion and extension are extremely difficult, and most of of all, painful to achieve    Each day my range of motion and  ability to walk and pedal improves. Less pain, more degrees, quicker cadence, and a gradual increase in resistance. Every day, with baby steps, there are progressions . . . and with progression come rewards. On Friday, I was given permission to set up my bike on the trainer!! I am riding my bike with minimal resistance, but it was the best feeling. Riding the bike helps with range of motion, decreases the pain in my knee, and helps push the fluid out of the joint space. Most of all, it’s treating my sanity. Even though riding my bike is easier than walking at this point, I will leave you guys with this awesome reward: an easy spin.