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Greg

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.

OUCH! OUCH!

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:

Blogs:

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

MS Excel: a formula for Ordinal Numbers

Today I was surprised to find that Microsoft Excel 2010 still doesn’t have a format option for Ordinal Numbers; dates or numbers such as 1st, 2nd, 3rd, 4th (etc).  I wanted to display dates like this: Sat, Jun 4th. A quick search revealed some functions that people had written, but I wanted to do it in-cell so I whipped up the following formula…

=TEXT(A2,"ddd, mmm d")  &
IF(OR(DAY(A2)=1,DAY(A2)=21,DAY(A2)=31),"st",
IF(OR(DAY(A2)=2,DAY(A2)=22),"nd",
IF(OR(DAY(A2)=3,DAY(A2)=23),"rd","th")))

It seemed like it should have been easier until I realized that 11,12,13 are th’s. The first line of this formula does nearly all of the work…the TEXT function can give Sat, Jun 4. The three lines of IF() are just to display st, nd, rd, or th. This function only works for calendar dates, after 31 it falls apart.

You may find it easier to read if you use carriage returns in lengthy formulas.  Simply press ALT+ENTER while editing in a cell.  Also you can drag the formula box taller to ease the process. For more details on Excel’s TEXT function, look here http://office.microsoft.com/en-us/excel-help/text-function-HP010062580.aspx to see the formatting options and examples.  Expand the headers in the syntax section to see details about numbers, dates and times, currency, strings, etc. that TEXT display.

Let me know if you’ve found another way to do this.

Hey here are some, and they’re not limited to calendar days: http://www.cpearson.com/excel/ordinal.htm


Posted by Greg on June 5th, 2011 :: Filed under MS Excel,Tips

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

Turning off Google Chrome’s ‘Instant’

I like to use Google Chrome for my day-to-day browsing and for basic testing of web-sites.  For more advanced work Chrome can be pretty annoying (but that is a topic for a different post).  In one of it’s recent updates, Chrome has added the feature called Instant.

Oh how I hate it.  If you’re not already familiar, Chrome’s ‘Instant’ is the relatively recent feature that starts searching or navigating as soon as you start typing.  OK, it’s not so bad when searching, but really, getting 10 or 20 404 errors while typing out a URL gets pretty annoying, and it’s even worse if the site tries to redirect on 404.

It turns out that it is very easy to turn off this feature, just go to settings (Click the little wrench icon), then Options.  On the ‘Basics’ screen you can simply uncheck the Enable Instant for faster searching and browsing checkbox.  Of course, you’ll lose ‘instant’ for both urls and for searching.


Posted by Greg on June 1st, 2011 :: Filed under Browser Basics,Google Chrome,Web