Day 3 (Friday, Apr 29th)

I woke up feeling a bit clearer.  Still no significant pain so I decided to just stay off the Percocet and just take the muscle relaxant, thinking it must be helping somewhat with the hamstring Charlie-horse/spasms.  I got up and started walking down the hall to the living room.  Part way there I felt a very sharp pain in my left pectoral.  Was I crutching wrong?  Was it something else?  I stopped and touched the spot; it hurt like hell in one very specific point near the surface of the muscle as it rolls toward the armpit.  I took the left crutch out from my armpit and made my way over to the couch.  After I sat down the pain went away in a few seconds…weird.

I did my first PT of the day halfheartedly, not really feeling up to the task.

As Friday progressed it became clear that I was not feeling very well at all.  Every time I stood up I felt very light headed, plus had this same sharp pain in my left pectoral.  Additionally I was still constantly thirsty, had to go to the bathroom and was starting to realize I was constipated too.  On top of all that I noticed that my heart rate was quite high for ‘just sitting around’ and suspected my blood pressure was higher than normal too.  By the evening I got my hands on my blood pressure cuff and took a reading…150/95 with heart rate of 98.  I was quite uncomfortable by this time and decided to call my insurance nurse line.  After discussing for a few minutes she transferred me to the Tria on-call doctor.  While talking with the on-call doctor it became clear that all of this was fairly normal stages of purging out all of the anesthetic, pain meds, etc. that had been put in me in the past few days.  She did warn of other symptoms (that if they should arise) would indicate an immediate 911 call.  I figured I was also experiencing anxiety and took some anti-anxiety medication (which also reduces blood pressure/rate).  I felt much better within the hour.  I also managed to relieve the constipation which made a big difference in how I felt.  As the evening wound down I was feeling too dodgy still to attempt PT (which felt like a big failure).

At bedtime I set my muscle relaxant by the bedside, but forget to take it.

Posted by Greg on July 6th, 2011 :: Filed under ACL Files

Day 2 (Thursday, Apr 28th)

Honestly today and Wednesday and Tuesday for that matter have all jumbled together.  At my 11 am dose of Percocet, Kammy and I decide to cut me back to a ½ tablet to make me more lucid for my first PT Session.  Kammy drives, though I don’t remember much of it.

Physical Therapy (Plus redress & check-in)

At this first physical therapy appointment a Nurse comes to re-do my bandages, have a look to make sure there’s no infection, etc.  He also gives me the go-ahead to shower carefully (no soaking, no baths) but not to remove the water-proof bandages that are left on the various incisions and holes.  He says it looks perfect!

I’ve been careful to keep the same physical therapist that I’ve been working with since the beginning of my pre-hab.  He quickly checks my range of motion (not very much at all) and how I’m doing strength wise. He then explains the exercises for me to do this week: Standing weight-shift for 3-5 minutes; 3-5 minute passive extension; work up to 30 leg-raises each on back, side, stomach; 20 heel slides; hamstring stretch for 1 minute.  I’ve done ½ of these before in pre-hab so we don’t take a long time to demonstrate them.  My quads are in good enough shape that I can skip right past the quad-sets!

Since the pain is still totally manageable (except spasms which don’t seem to be helped by anything) we stick with ½ tablet of Percocet for the evening and bedtime dose.  I decide to set a ½ tablet by my bedside for the middle-of-the-night dose, but that I won’t take it if I don’t wake up needing it.  Even though I still woke up many times during the night (as the previous two) I didn’t think I’d need the pain pills so I didn’t take them.

Posted by Greg on June 30th, 2011 :: Filed under ACL Files

Day 1 (Wednesday, Apr 27th)

In my mind I cannot separate Wednesday from Tuesday except that I eat leftover pizza instead of fresh.  An emergency has come up at work that could really use my attention but I am incapable of concentrating enough to address it.  (Maybe it started on Tuesday?)  I fade in and out.


Around 7 PM Gramma calls to tell us she’s bringing Z home.  I doze off but am torn awake by a horrendous muscle spasm in my hamstring, this right as Z and Gramma are coming up the stairs.  I was shocked at how hard and strong the pain was even with muscle relaxant and pain meds.  Had a hard time greeting them, still hurts. Night passes just like Tuesday…wake, drink, go to bathroom, drink, doze, and wake etc.

Posted by Greg on June 29th, 2011 :: Filed under ACL Files

Day 0 (Tuesday, Apr 26th)

I’m wiped out.  Between pain meds and post-surgery I can barely stay conscious for a half-hour at a time.  Kammy is wiped from lack of sleep and taking care of me.  We call in gramma support to help with Z.  I ask the same questions over and over again (so I’m told…I barely remember any of this).  We order pizza, apparently I’m starved!  Eventually I move from sleep/wake cycle on the couch to sleep/wake cycle on the bed.  I’m horribly dehydrated.  All I can recall is wake, drink water, go to bathroom, drink, lie down, look at clock, doze for 1 to 45 minutes and repeat…

Posted by Greg on June 29th, 2011 :: Filed under ACL Files

Surgery Day (Tuesday April 26th)

It is surgery day.  Kammy and I awaken at 5 AM.  I’m filled with nervousness tempered with impatience and even a bit of happiness.  It is actually time to move forward!

Kammy makes coffee (none for me) and we stumble around the house, gathering what we need: Crutches, my knee brace, insurance card, camera (yep photo geek), one credit card.  I leave any jewelry behind including my wedding ring.  We get in the car and make the 20 minute drive to Tria uneventfully.

We go right up to the third floor and its just 6 AM, right on time.   There are two couples ahead of us, one already waiting, and one with the receptionist.  After a few minutes it’s our turn so we walk up, hand over the credit card (to cover copay and the pain meds they’ll send me home with) have a quick chat with the receptionist and then take our pile of paperwork to the waiting area.  By now both of the other couples have moved along so we have the room to ourselves.

Before we really even get seated a nurse comes out and calls my name.  Nervousness wells up in me…here we go.  She leads us back to the pre-op room; it’s a three walled room off a wide corridor.  She hands me a gown, grippy slippers, and a bag to put my clothes in and gives directions.  She closes the curtain that makes the 4th wall of the room and leaves while I change.  As soon as I’m lying down on the bed two nurses come in and get to work.  First there’s an EKG with some easy-on, easy-off electrodes, then they stick some heavier-duty electrodes to my chest and arms (those are gonna hurt when they come off…).  Two more staff come in and get to work.  One introduces herself as the anesthesiologist and starts discussing with me whether I prefer General or a Spinal + a sedative that will ‘make me sleep’.  She points out that with the General I will have to go on a breather and that this surgery is done about 80% of the time with spinal plus sedative.  I feel good going with the latter to avoid some of the complications and annoyances that General anesthesia causes some people (nausea, sore throat, etc.).

While this conversation is going on the IV nurse comes in and gets to work.  I tell her that I have ‘squirmy’ veins that a lot of people have trouble with (I immediately wonder if I jinxed her by saying that.)  Suffice it to say that two nurses and several pokes later the IV is in and my nervousness is giving way to some pretty strong anxiety.  They apologize profusely for having to try so many times (It is pretty typical for me so while I don’t like it it’s not a shock) and I say not to worry.  Then one of the four staff in the room says “What do you think…does he deserve a 2+2?”  One immediately replies YES!  I can’t say for sure but I think it means they gave me a bit stronger dose of Fentanyl than they might have otherwise.  Within under a minute all anxiety/nervousness was gone.  This was very good because now the anesthesiologist was getting ready to give me a Femoral Block. As she’d explained a few minutes earlier, the Femoral Block is a shot they give very high on the groin area (big needle) which goes a long way to helping with the post-surgery pain I’d otherwise be feeling.  It also meant absolutely no weight-bearing on that leg until full feeling was restored.

Then my surgeon came in and talked with us for a few minutes.  First order of business:  Verify who I am, what’s being done and where.  They were all very diligent about asking me my full name, my date of birth, what was I here for, and which knee.  Both the anesthesiologist and the Surgeon wrote on my leg to REALLY make sure everyone was in agreement about what was being operated on, and what was being done.  Then he went on to reiterate much of what we’d discussed during the two consultations: risks, concerns, and outcomes.  After a few minutes discussion he said he’d see me in the Operating room and left.

A nurse put an oxygen mask on me and said that if I started feeling sleepy I should just go to sleep.  They wheeled toward the operating room…the next thing I remember was being shuffled from the gurney to an operating table and lying down, tried to look around…now sit up for the spinal…

The next thing I recall is that I’m waking up.  More specifically I am trying to wake up, sort of like I’m a marshmallow in a bag of marshmallows trying to get to the top…but not trying too hard…I can see my nicely bandaged leg…I’m in a new room I haven’t been in before, more like an ‘area’ where a nurse could keep an eye on several post-op people like myself I presume.  Someone talks to me (the Surgeon… a nurse?) and I agree that I’m ready to go back to my pre-op room…then I’m in the pre-op room and Kammy is there…we talk a bit…a nurse asks me how I feel….OK…no, a bit of pain starting in my leg.  Someone hands me my first Percocet, pain subsides quickly?  Now I’m getting dressed (well Kammy is dressing me)…here’s a wheelchair…I’m getting in it…I’m getting in the car…we’re half way home and I’m uncomfortable…now I’m at the steps.  They seem impossible.

We live in a 110 year old Victorian house in Minneapolis.  There are 5 steps to the porch, one more step over the threshold, four steps to the landing then 12 steps with a 90 degree turn for the last 5 steps.

I ask Kammy to walk behind me and steady me as I crutch up.  It takes forever.

Posted by Greg on June 21st, 2011 :: Filed under ACL Files

Surgery here I come…

Check in with Surgeon (Mon, Apr 4th)

On April 4th we went back to talk with the surgeon again.  He said that my progress was looking good enough to schedule surgery!  I’d have to wait for 3 more weeks though, which he said I’d need to get the swelling down more and to regain more strength.  After that, we talked about which sort of graft I would get.  I asked a lot of questions about the relative advantages of the three types; what pain I could expect, what concerns and what outcomes I could look forward to.  Between us we decided that the hamstring autograft was the right choice for me.   Then Kammy and I went out to the desk and scheduled over a dozen appointments for me: Rehab 2x weekly for a month, Surgery day plus 2 day, 1 week and 6 week follow up with the Surgeon.  I also called my GP to schedule a required pre-surgery physical.

That was it…in 3 weeks I’d be having my first ever surgery.

Rest of Prehab

The rest of my prehab went pretty much according to schedule.  By surgery day I could walk up and down stairs without using the handrail, swelling was still there a bit but you could clearly see my kneecap, range of motion was very good (nearly full extension and 90+percent of flexion).

Pre-Op Physical

The pre-op physical was mostly a non-event.  It was more of a survey/questionnaire than anything else.  Basically, my Doctor looked for anything that could complicate the surgery.  He asked about family history with anesthesia, checked blood pressure, discussed meds I was to avoid during this week preceding surgery; no aspirin, ibuprofen etc. that could thin my blood.  I hadn’t been in to my regular doctor since before the injury so it was also a chance to catch up with him…we joked about me out skiing with a bunch of young guys though I never think of it that way until someone brings it up.  Basically he gave me the two-thumbs-up to go have surgery.

Surgery eve (Mon, Apr. 25th

On surgery-eve Kammy and I went to see Jonathon Coulton with Paul & Storm.  If you’ve never heard of/seen them, check them out!  They’re comedian/musicians and sure put on an entertaining show.  It was nice to be doing something to keep my mind off of the fact that I had surgery in the AM and couldn’t eat or drink anything.  Starting at bedtime even water was off limits.  We got to bed later than I’d have preferred, there’ll only be 4 or 5 hours of sleep before surgery wake up call. Still, I’m nervous and find it hard to sleep.

Posted by Greg on June 15th, 2011 :: Filed under ACL Files

Prehab Week 3 and Graft Research

Prehab Week 3

During this week I kept improving my efforts, working toward the goals.  My physical therapist added Step-Downs to the mix.  They were my new least-favorite; painful!  I started out with a pretty small step, about 2 high”.  My leg felt so uncomfortable that I tried stepping down with my uninjured knee and then modeling the movements as close as possible with the injured one.  I found it really helped to put my hands on my hips to help feel that I was doing it symmetrically.

Researching and Choosing a graft type

Also, during this week, I started to do more research about my three choices for graft.  In the day after my first meeting with the surgeon I’d decided that the allograft (dead guy tissue) was the better choice for me.  But, as I talked everyone’s ear off about my upcoming surgery I started to rethink my decision.  It turned out that (unknowingly) I knew quite a few ACL reconstruction recipients.  Their stories were all interesting to me.  From there I turned to the internet.  I read a lot of people’s stories of their accidents and reconstructions, read surgeon reports about this vs. that.  I learned that there are a lot of opinions in the orthopedic world about the 3 choices.  What started to emerge, though, was that allograft was not considered to be nearly as strong as autograft.  Between the patellar autograft and hamstring autograft the prognosis was very similar as far as I could tell except for this statistic: one study showed a high incidence of significant knee pain when kneeling 5 years after their surgery with patellar autograft.  (I can’t seem to find the study that gave percentages…)

As a result of conversations with friends who’d had the surgery, reading stories of ACL reconstruction on people’s blogs, and other internet research I changed my decision; I’d go with a hamstring autograft instead of an allograft as long as the surgeon agreed with my decision.

Here are some blogs and articles that I used to come to my decisions:

The procedure:


Nicely illustrated Hamstring Tendon Autograft ACL Reconstruction:

Posted by Greg on June 14th, 2011 :: Filed under ACL Files

Prehab Week 2 (March 18-24)

On March 18th my physical therapist modified my PT as follows:

  • Heel slides (20)
  • Toes to nose (1:00)
  • Modified straight leg (30)
  • Active-assisted knee bend (20)
  • Squats (30)
  • Step-ups (20)

The numbers in parenthesis are quantity or time goals.  The Modified straight leg is an exercise where you sit on floor with leg out straight and a rolled-up towel under the knee.  Goal is to lift heel off the floor.  It is the next step in the progression that starts with quad-sets.  The squats are assisted; grab on to a door handle or other waist-height support, then squat down and return, working to a 90 degree bend in legs.  After I reach the goal of 30 I’m to begin pausing at the low point (watch the 90 degree bend in knee), working up to a 5 second pause.  For the Step-ups I started with a 2” step (of books/magazines) and every time I reached the goal of 20 I increased the height of the step.  Ultimate goal is to be able to step up a normal step again.  All of these are to be done 3x daily.  I did PT first thing in the AM, again at lunch (at work), and just before bed.  Sometimes I’d skip one of them on a weekend day just to get a break or because of schedule.

PT is peculiar.  There are times when it feels like literally no progress is being made, or worse, that you’re going backwards.  Odd pains, pops, aches, tiredness creeps in.  I started having problems with my calf cramping up from the exercises.  My muscles felt sore and tired out.  Then one day I’d realize that something that had been quite difficult the day before would ease up, or I’d suddenly realize that I’d jumped ahead quite a bit in range-of-motion.  The trick, of course, is to keep doing it when it feels discouraging.

So, keep doing it!

Posted by Greg on June 7th, 2011 :: Filed under ACL Files

Meet the Surgeon (Mon, Mar 14th)

On Monday March 14th Kammy took me to meet the Surgeon who would operate on my knee.  I’d heard some people comment that orthopedic surgeons tend to have horrible bedside manner so I was curious to see what mine would be like.  The Surgeon was interesting, and completely willing to discuss whatever I brought up.  Nice, and more importantly not horrible by any definition.  He talked over the MRI and X-Rays with us, discussed once again the fact that my ACL is disrupted, and that it would take about 5 or 6 weeks for my leg to heal up and swelling to go down enough for surgery.  The plan would be that I’d continue physical therapy and RICE, come back in 3 weeks and at that point we’d set a date for surgery.

There was something else too: As he was explaining the surgical process he told us that there are 3 choices for where the tissue comes from to create the new ACL.  Two come from my own body and one comes from ‘dead guy tissue’ as he put it.  The two choices from my tissue are either patellar tendon or hamstring tendon.  If it’s dead-guy it’s patellar tendon.

the gamble

it's always a gamble

I like to find a professional I can trust and then follow his advice.  So, I asked the doctor which he’d recommend.  He was hesitant to suggest one over the other…said it was truly my decision.  So I asked what some of the advantages of each are.  He explained that with ‘dead guy’ tissue there is a 10% chance of rejection and 8 month recovery.  With my own tissue, a 5% chance of rejection and 6 month recovery.  He also pointed out that I’d be able to get back to normal life more quickly with ‘dead guy’ graft; days instead of up to a month before I was up and about.  He didn’t make any mention of zombies at all…

Next I tried a different tactic; I asked him which he’d choose if it were his own ACL being reconstructed, but I was in for a surprise…he told me he’d elect not to have the surgery at all! I have to say that threw me for a loop for a minute.  Then he went on to explain.  He’s sedentary, he goes to the gym (because he knows he should), he goes to work, and he sits on the couch.  He continued by saying that he even knew a few active people who elected to forgo the surgery; that by exercising and being careful they could do lots of things without an ACL.  Downhill skiing, playing soccer, etc. didn’t really count among the ‘lots of things’ however.  Then he did say that for ‘guys my age’ he’d, if forced, suggest ‘dead guy’ tissue just because we have a life to get back to.  He also said that if for some reason the tissue didn’t take that the surgery could be re-performed…there would just be a time set-back.  Also, he mentioned that even if I chose to use my own tissue that there would be donor tissue standing by in case of any mishap.

Then we talked about the really amazing part.  ACL stands for anterior cruciate ligament, yet all of the choices for tissue grafts are tendons.  It turns out that ligaments cannot be grafted, but tendons, when grafted into places where ligaments belong, gradually get converted to ligaments by our bodies over the course of several months.  Is that not the coolest thing ever?  (Well, OK, there are definitely cooler things, but that is amazing!)

With that he sent me of to continue my PT and consider my options…

Posted by Greg on June 5th, 2011 :: Filed under ACL Files

Prehab: March 7th

After it was determined that I didn’t have any bone-fragments floating around in my knee, it was time to get it working again.  It is really scary how quickly I lost range of motion and muscle strength while I was immobilized and non-weight bearing.  Certainly, some of the loss of range of motion was due to the ongoing swelling, but a lot of it was just ‘use it or lose it’…and I’d lost it.

snowy rain

snowy-rain is fun for kids but not for crutches...

At my doctor’s appointment earlier in the day the doctor said to start physical therapy immediately; I found that there was an opening later the same day and took it.  Also, I’d been given a flexible brace to wear instead of the leg immobilizer.  It was one of the neoprene types with two metal hinges to keep my leg flexing in only the correct direction.  It felt good to get out of the full-leg immobilizer, but my leg did not feel sturdy at all.  As I’d find out over the next several days, tightening it enough to provide support meant that it gave me bruises…a tradeoff for sure.

In the early afternoon Kammy drove me back to Tria to meet my physical therapist.  Right off the bat he wanted to get some baselines: He asked about level of pain (low) and then had a look at my leg.  He had me get out of the leg brace and checked my range of motion.  My hyper-extension could only go to about 5 degrees (-5, or same as the other leg is the target).  Flexing my knee barely got it to 90 degrees (135 or so is the target).

Next, he had me try a few things to get a feel for where I was strength-wise.  He had me do ‘quadsets’ where I just had my leg extended in front of me (with a small towel rolled under the knee) and tried to tense my quads and push down into the towel.  It was difficult to get a nice quick firing of my quad at all, let alone push down.  He said I should work up to 15 of these.  He also had me do leg-raises.  Lying flat on my back, I bent my unaffected leg about 90 degrees, then tense my quads and raise my affected leg about 45 degrees.  I could do this one OK, but tired quickly.  I should work my way up to 30 of those.  He also had me start on something called passive extension.  This one sounded easy; lying on my back I just put a rolled towel under my heel and relax, letting gravity straighten my leg as much as possible.

It was pure hell!  (OK I exaggerate, but it really did hurt!).  I should work up to being able to lie there for 5 minutes on this one.  Next he wanted me to do ‘heel-slides’.  For these I wrap a towel around the arch of my foot with my affected leg extended, and then pull the towel to help my leg bend as much as possible.  I’d do 20 of these, trying to get more flex as the days went by.  Another flexing exercise had me sitting in a chair or on a kitchen counter, table or other sturdy object.  I’d use my good leg to flex my bad one as far as I could, with 20 repetitions too.

He sent me off with instructions to do these exercises 3 times a day, and work my way up to the recommended reps or time for each.  The first night I managed the following of each:

  • Quad-Set: 10
  • Heel-Slide: 10
  • Toes to nose: 30 sec
  • Leg Raise: 15
  • Passive extension: 3 minutes
  • Chair assisted ROM: 10

By Sunday May 13th I’d reached the goal for each.  Passive extension was the most painful of all, but of course that one involved pushing my knee in the direction of the hyper-extension (it was at least partially psychological).  Most of the others hurt at times but gave the same feeling that a good stretch gives…some pain during the process, but the body feels much better afterward.

Posted by Greg on June 1st, 2011 :: Filed under ACL Files