7 weeks post op ACI and Fulkerson- Last week, I had a 6 week appointment with the doctor. He said I am ahead of schedule for my recovery in terms of swelling and muscle strength. He gave the physical therapist (who met with us) the go ahead to start walking without crutches.
Right after the 6 week mark, I went on a vacation for 3 nights to Key Largo where I spent the day at the pool while my family went diving. I got a wheelchair at the airports and that was helpful. I would not have gone on the trip if I had to walk through the Atlanta airport. First of all, we did not have to wait (stand) in the security lines, I was not up to walking far distances, particularly at the huge airport in Atlanta, and I avoided being in crowds of people where I could possibly get bumped or knocked over. I highly recommend the wheelchair option. I had just started walking without the crutch at home a couple days before I went away, but I used the crutch on the vacation when we were not in our hotel room. I went in the pool and swam around using my arms. My doctor had said I could flutter kick, but I must keep my legs straight. No "breast stroke" style kicking. I found kicking more difficult than I had anticipated- my leg was stiff. So, I held onto the side of the pool and kicked gently. I was not careful enough on the beach and one evening I stepped into a hole in the sand with my newly operated leg which was scary and briefly painful. Luckily, I was using the crutch and that prevented my falling to the ground. My knee hurt slightly, but felt better quickly-for which I was thankful .
At 7 weeks post-op, I would say it is not ideal to go on vacation. I am glad we went because I wanted to have a family experience (and not stay home alone!), but if I had had control over time, I would have waited a few more weeks.
There are lots of new PT exercises at 7 weeks for me. In addition to what I have been doing (quad stuff, leg lifts, a series of hip exercises "Pilates", and stretches for calf, hamstring, and quad) they added the following:
1. Ankle Weights for the hip exercises, 2. leg press machine, 3.balance board-2 legs and then 1 leg, sitting down and then back to standing, 4. plank and 5. side plank. The standing and sitting are hard for me-partly because my "other" knee hurts when doing this. I asked to use a platform to sit on so I am higher up and don't have as far to go.
I also went to the gym today and rode the bike for 30 minutes, somewhat vigorously with a bit of a higher level of resistance. Then I swam laps for 25 minutes mostly using only my arms. I tried kicking, but it was somewhat painful in the knee and I am afraid to take any chances. I feel glad to be doing exercise, but tired because I have been so sedentary!
My knee has improved alot the last couple days-less swollen and more flexible. Still, I like to use the crutch when going places where I may walk far (my quads or my knee does gettired/slightly sore at times) or where there will be alot of people. The crutch serves as a sign for others to be careful around me. Another way to signal "caution" to other is to wear a brace or a compression stocking (they have mesh black ones at PT), but my doctor has said not to wear the brace anymore. One thing that has surprised me is that even when I am using a crutch or wear the brace, how people will not slow down near me or will "cut me off" -like at the grocery store or other crowded places. It is unnerving. I have started going to the grocery store without a crutch, but I don't shop for as long as I may have in the past.
I feel best after I do the exercises that work the quad. When I first wake up, sometimes my thigh muscle gives out and I almost fall, so I keep the crutch by the bed for when I wake up. The swelling has decreased alot, although not back to normal yet. Sometimes it feels a bit warm and I usually ice it when I exercise. The scar has started to mature and is not too bad. There is no noticeable difference in my leg muscles-ie, the operated does not look atrophied. Because the improvement in my strength, swelling and pain have been rapid recently, I think my stamina and strength will continue to improve in the next few weeks.
Yesterday, I went for my 10 day appointment. The nurse took out my sutures-which hurt a bit-but not badly! Sylvia, who is Dr. Gillogly's assistant, seems to be a pro at removing them. Dr. Gillogly has fellows working for him. Dr. Shue has been his fellow since I have been going to that office and for both surgeries. She assisted on both surgeries, although he said that fellows do not do the ACI's, only him. She probably did some of my osteotomy this last time though. She is finishing her fellowship and will work for Kaiser here in Atlanta, where they are starting an Orho program (or an enhanced one-something is new about it) and she seems excellent. I was sorry to say goodbye to her because she always comes by during PT and seems very smart and is also warm and friendly.
They confirmed that it is fine for me to do the high degree of range of motion on the CPM machine-no risks for to the patella graft. They explained why, but I don't clearly remember the details-it related to where the graft is.They recommended I continue on the CPM for 4 hours a day. I already have max ROM, but it is good for scar tissue and also, there is a belief (per Dr. Gillogly and I also read this) that the cells learn from the CPM movement, where the cells should settle to accommodate bending and normal movement of the knee. This is a theory that I don't think they know the exact reason for. I can use the brace at home, but don't always have to. I do not have to sleep in it, although I can if I toss and turn alot. The movement I must avoid is going from a bent to a straight knee. For example, if I am sitting with my leg dangling and then straighten my leg. I must use my other leg to straighten it, but coming under the leg and using it as a support. The brace can be uncomfortable and so I will use it less, although I am nervous about inadvertently twisting or unbending, so I won't stop using it completely at home.
The protocol for me has been surprisingly different from the Cartilcel/Genzyme packet I received, from protocols online such as the Brigham and Women's rehab (http://www.brighamandwomens.org/Patients_Visitors/pcs/rehabilitationservices/Physical%20Therapy%20Standards%20of%20Care%20and%20Protocols/Knee-Autologous%20chondrocyte%20implantation.pdf), and from the link that Vickster shared here, as well as the protocol described by Grace. This could very well be because the patella ACI is one of the newer ones (of a new surgery!) but also perhaps Dr. Gillogly is using more aggressive rehab that he has found works well. He has been doing alot (relatively) of the patella ACI's. So the higher range of motion, not sleeping in the brace, weight bearing soon after surgery, etc. Because I have been doing so well in terms of pain and range of motion (sorry I keep repeating this), I may be able to drive next week. I would use my left (good) leg for brakes, to protect the graft on the right.
The hardest thing about this surgery for me, in light of the fact that my recovery has been very easy so far-minimal pain, good range of motion-is waiting to see if the "graft" worked. I was discussing my hopes for the 2nd knee and Dr. Gillogly said that I have to make certain that this surgery worked for me. He is in general very encouraging and positive-but that is a fact. I had an xray yesterday and saw the screws from the osteotomy and everything looks great, but the xray does not show the cartilage. Dr. G said there is a type of MRI that shows the cartilage clearly from a procedure like this one, but it is not widely available and insurance won't cover it. So, most of the diagnosis of the success of an ACI is from the patient's functioning: ie a poor outcome would be if the patient has difficulty walking later in the process, etc.
I do have confidence in Dr. Gillogly. He is a respected surgeon and also has a very nice manner - easy to talk to and does not seem in a rush from the first time I met him. I personally do not mind that he has fellows helping him. To me that shows that he is dedicated to teaching and if I were at Emory here in Atlanta or at another teaching hospital, fellows would be involved too. This also means that he has to keep up to date on the latest research and techniques since he is teaching new practitioners.
The last thing I will add is despite a low level of pain, I still do take pain medicine throughout the day-mainly for exercise, particularly for the CPM machine, and also to sleep. Last night, I tried to go to sleep without meds and ended up taking them. I may be able to move to just Alleve, but at present I am taking one one 325 mg Hydrocodone and one Alleve(which is supposed to last 12 hours). I don't worry about overusing meds for any reason except that I have a sensitive stomach and have already had a bleeding ulcer-and both the prescription and non prescription meds can cause stomach issues! Also, in my first or second post op post, i said that I wished I had practiced with the crutches. I think my problem the first couple days was more weakness from having had surgery. After those first days and since, using the crutches has been a breeze. I do not have any steps though in my house which helps.
They confirmed that it is fine for me to do the high degree of range of motion on the CPM machine-no risks for to the patella graft. They explained why, but I don't clearly remember the details-it related to where the graft is.They recommended I continue on the CPM for 4 hours a day. I already have max ROM, but it is good for scar tissue and also, there is a belief (per Dr. Gillogly and I also read this) that the cells learn from the CPM movement, where the cells should settle to accommodate bending and normal movement of the knee. This is a theory that I don't think they know the exact reason for. I can use the brace at home, but don't always have to. I do not have to sleep in it, although I can if I toss and turn alot. The movement I must avoid is going from a bent to a straight knee. For example, if I am sitting with my leg dangling and then straighten my leg. I must use my other leg to straighten it, but coming under the leg and using it as a support. The brace can be uncomfortable and so I will use it less, although I am nervous about inadvertently twisting or unbending, so I won't stop using it completely at home.
The protocol for me has been surprisingly different from the Cartilcel/Genzyme packet I received, from protocols online such as the Brigham and Women's rehab (http://www.brighamandwomens.org/Patients_Visitors/pcs/rehabilitationservices/Physical%20Therapy%20Standards%20of%20Care%20and%20Protocols/Knee-Autologous%20chondrocyte%20implantation.pdf), and from the link that Vickster shared here, as well as the protocol described by Grace. This could very well be because the patella ACI is one of the newer ones (of a new surgery!) but also perhaps Dr. Gillogly is using more aggressive rehab that he has found works well. He has been doing alot (relatively) of the patella ACI's. So the higher range of motion, not sleeping in the brace, weight bearing soon after surgery, etc. Because I have been doing so well in terms of pain and range of motion (sorry I keep repeating this), I may be able to drive next week. I would use my left (good) leg for brakes, to protect the graft on the right.
The hardest thing about this surgery for me, in light of the fact that my recovery has been very easy so far-minimal pain, good range of motion-is waiting to see if the "graft" worked. I was discussing my hopes for the 2nd knee and Dr. Gillogly said that I have to make certain that this surgery worked for me. He is in general very encouraging and positive-but that is a fact. I had an xray yesterday and saw the screws from the osteotomy and everything looks great, but the xray does not show the cartilage. Dr. G said there is a type of MRI that shows the cartilage clearly from a procedure like this one, but it is not widely available and insurance won't cover it. So, most of the diagnosis of the success of an ACI is from the patient's functioning: ie a poor outcome would be if the patient has difficulty walking later in the process, etc.
I do have confidence in Dr. Gillogly. He is a respected surgeon and also has a very nice manner - easy to talk to and does not seem in a rush from the first time I met him. I personally do not mind that he has fellows helping him. To me that shows that he is dedicated to teaching and if I were at Emory here in Atlanta or at another teaching hospital, fellows would be involved too. This also means that he has to keep up to date on the latest research and techniques since he is teaching new practitioners.
The last thing I will add is despite a low level of pain, I still do take pain medicine throughout the day-mainly for exercise, particularly for the CPM machine, and also to sleep. Last night, I tried to go to sleep without meds and ended up taking them. I may be able to move to just Alleve, but at present I am taking one one 325 mg Hydrocodone and one Alleve(which is supposed to last 12 hours). I don't worry about overusing meds for any reason except that I have a sensitive stomach and have already had a bleeding ulcer-and both the prescription and non prescription meds can cause stomach issues! Also, in my first or second post op post, i said that I wished I had practiced with the crutches. I think my problem the first couple days was more weakness from having had surgery. After those first days and since, using the crutches has been a breeze. I do not have any steps though in my house which helps.
