Tomorrow will be one week since my surgery. I have a PT session and I do have some questions-mainly I just want to review and have everything written down. It seems very important that I am absolutely certain how to do things and what the limits are so that I do not damage the new cartilage.
I have been told that I can put up to 20 lbs on my right leg. Also, that I can do as high of a degree of ROM on the CPM machine as I am able-and I am able to do unlimited-120 and beyond. Even though the doctor and the physical therapist approved this, I just want to review it again, because this protocol is not the same as the more limited one I had expected and I want to be absolutely sure I am not doing anything to damage the graft! The computers have not been working at the office, so the therapist has written things down and some things she just said verbally without writing them down and I did not take notes. The first day, my husband came with me and he did take notes and one thing was that I should "not go from bent to straight" which we think meant when I was ambulating, but I am not positive! So, I have been keeping my leg straight most of the time. They had said I should put on my brace in locked position and then can unlock it, which means it can bend. I want to review all of it though. I am doing amazingly well thus far, with the pain managed well with the medication that I am taking about every 5 hours still. I have lots of energy and am reading, writing, watching movies, letting my family wait on me, and taking crutch tours of the house several times a day. When friends visit, I am able to sit in the family room with my leg propped up on coffee table and socialize easily. It may be a neurotic, overly anxious thing, but I almost feel like it is too easy and hope that the ease does not mean that the graft did not take! I guess everyone with this type of surgery (ACI, denovo, etc) will wonder how the graft looks and I can't have a xray/mri for quite a while I guess....
Monday, August 19, 2013
July 1, 2013. 1 week post op
Tomorrow will be one week since my surgery. I have a PT session and I do have some questions-mainly I just want to review and have everything written down. It seems very important that I am absolutely certain how to do things and what the limits are so that I do not damage the new cartilage.
I have been told that I can put up to 20 lbs on my right leg. Also, that I can do as high of a degree of ROM on the CPM machine as I am able-and I am able to do unlimited-120 and beyond. Even though the doctor and the physical therapist approved this, I just want to review it again, because this protocol is not the same as the more limited one I had expected and I want to be absolutely sure I am not doing anything to damage the graft! The computers have not been working at the office, so the therapist has written things down and some things she just said verbally without writing them down and I did not take notes. The first day, my husband came with me and he did take notes and one thing was that I should "not go from bent to straight" which we think meant when I was ambulating, but I am not positive! So, I have been keeping my leg straight most of the time. They had said I should put on my brace in locked position and then can unlock it, which means it can bend. I want to review all of it though. I am doing amazingly well thus far, with the pain managed well with the medication that I am taking about every 5 hours still. I have lots of energy and am reading, writing, watching movies, letting my family wait on me, and taking crutch tours of the house several times a day. When friends visit, I am able to sit in the family room with my leg propped up on coffee table and socialize easily. It may be a neurotic, overly anxious thing, but I almost feel like it is too easy and hope that the ease does not mean that the graft did not take! I guess everyone with this type of surgery (ACI, denovo, etc) will wonder how the graft looks and I can't have a xray/mri for quite a while I guess....
I have been told that I can put up to 20 lbs on my right leg. Also, that I can do as high of a degree of ROM on the CPM machine as I am able-and I am able to do unlimited-120 and beyond. Even though the doctor and the physical therapist approved this, I just want to review it again, because this protocol is not the same as the more limited one I had expected and I want to be absolutely sure I am not doing anything to damage the graft! The computers have not been working at the office, so the therapist has written things down and some things she just said verbally without writing them down and I did not take notes. The first day, my husband came with me and he did take notes and one thing was that I should "not go from bent to straight" which we think meant when I was ambulating, but I am not positive! So, I have been keeping my leg straight most of the time. They had said I should put on my brace in locked position and then can unlock it, which means it can bend. I want to review all of it though. I am doing amazingly well thus far, with the pain managed well with the medication that I am taking about every 5 hours still. I have lots of energy and am reading, writing, watching movies, letting my family wait on me, and taking crutch tours of the house several times a day. When friends visit, I am able to sit in the family room with my leg propped up on coffee table and socialize easily. It may be a neurotic, overly anxious thing, but I almost feel like it is too easy and hope that the ease does not mean that the graft did not take! I guess everyone with this type of surgery (ACI, denovo, etc) will wonder how the graft looks and I can't have a xray/mri for quite a while I guess....
Sunday, August 18, 2013
June 28-48 hours post op
48 hours, plus: I am now writing three days in a row-which I won't keep up-but i have to comment on the minimal amount of pain i have had so far. I have had the femoral nerve block medicine still going-I carry it in a little pouch that goes on my shoulder or my neck like a necklace. I reduced the speed of release for the medicine as of this morning, just to keep it going as long as possible. It looks to be getting pretty low now and I am starting to feel more in my leg. I was numb for about 36 hours and really this afternoon, more than 48 hours after surgery, is when I have started to feel some pain. I guess because of the medicine and numbness, I have been able to achieve very good degree of knee movement. I use the constant passive machine CPM about 4 hours each day-actually more, because I am trying to take advantage of this time with so little pain where I can hopefully prevent scar tissue and encourage blood circulation in the knee/leg, which is good for the graft. The degree of knee movement is at 110 degrees!!!! When I had the arthroscopy in March, to harvest the cartilage, I could barely bend at first and absolutely could not engage my quads. Today, I was able to lift the leg using the quadriceps (ie not compensating by using hip muscles) and we added straight leg lifts to my PT exercises, along with hamstring stretch, calf stretch, heel prop (prop it on a thick foam so that the leg straightens-not so comfortable, but therapeutic)., and ankle pumps (moving foot around, "drawing letters" in the air with toes).
I am walking on the crutches a few times a day around the house and to the car when I have to. I have only gone out of the house to go to PT this morning and yesterday morning. My husband keeps reminding me that I have to get up and move some so that I don't develop blood clots and to keep circulation going. Today, I was fitted and given my immobilizer brace that I will be wearing for 6 weeks to 3 months. So far, it is not uncomfortable. I have heard from other people I know and read on this site that the brace can be painful if it pushes into tender areas.
I know there may be some challenges ahead with rehab, but the lack of pain and the quick initial progress has been great!
I am walking on the crutches a few times a day around the house and to the car when I have to. I have only gone out of the house to go to PT this morning and yesterday morning. My husband keeps reminding me that I have to get up and move some so that I don't develop blood clots and to keep circulation going. Today, I was fitted and given my immobilizer brace that I will be wearing for 6 weeks to 3 months. So far, it is not uncomfortable. I have heard from other people I know and read on this site that the brace can be painful if it pushes into tender areas.
I know there may be some challenges ahead with rehab, but the lack of pain and the quick initial progress has been great!
June 26-preparations I'm glad I made
I may already have listed the things that i purchased prior to surgery that are helpful, but if not, I would like to share my suggestions. I got many of the ideas from other peoples' posts. I bought most, if not all the stuff on Amazon. Most are really reasonably priced-the shoes are expensive!
1. Raised toilet seat[ftp] - Drive Medical Premium Seat Riser with Removable Arms for Standard Toilets, purchased on Amazon. Very good-comfortable, good height, and stable because it is screwed in. Has arm rails.$34.70
2. Shower seat-white plastic seat, can't find the brand-Amazon purchase.
3. Merrell shoes-I got a few to use for the duration of rehab (and rehab for my next knee eventually) My favorite is: Merrell Women's Circuit Mary Jane Breeze Shoe ($136) and also I like another pair :Ahnu Women's Gracie Flat.-$110, purchased on Amazon too!
4. a hospital style table on wheels, which I absolutely love, even before the surgery I have been using it bedside or in a chair. The brand I got is very stable, lifts and lowers easily, is large enough for computer and books, place for cups. The brand is: Medline Overbed Table, Composite Top-$65.
5. I rented the "Game Ready" ice machine-my doctor works with a certain company who met me before both knee surgeries at the surgery suite prior to my operation to review how to use it. It cost $300 to use for both surgeries. I have submitted the receipt to see if insurance will help with cost. This is an amazing invention!
6. I put a chair (actually the rocking chair I bought for nursing my kids when they were babies) with an ottoman in my room to make it easy to get to a place to sit comfortably.
**July 29-I am adding a couple more thoughts here about planning for surgery. In retrospect, I am very glad that I accepted offers of help from family, friends, and neighbors. Several people brought meals, a couple friends drove me around, and some people brought treats, and I have had visitors that came to chat and refill my ice machine, make me a snack, and keep me company. I had hesitated at times when people offered to help, not wanting to put anyone out or burden anyone, and I highly recommend to accept all offers! People want to help and it makes a big difference. It was really nice for me and my family to have the meals that people brought over. It's very very helpful and also nice to know people care. Even if you only have one or two offers of help-it can make a positive difference.
Also, I have enjoyed my time reading and watching movies I got from Netflix -stuff I don't do enough of normally. But, I found having a visitor stop by each day or a few times a week- to be a mood booster, and kep me from feeling isolated. Some people offered to visit-ESP my closest friends-but I also asked friends who live in my town to come over for an hour or so, if I was needing some company.
1. Raised toilet seat[ftp] - Drive Medical Premium Seat Riser with Removable Arms for Standard Toilets, purchased on Amazon. Very good-comfortable, good height, and stable because it is screwed in. Has arm rails.$34.70
2. Shower seat-white plastic seat, can't find the brand-Amazon purchase.
3. Merrell shoes-I got a few to use for the duration of rehab (and rehab for my next knee eventually) My favorite is: Merrell Women's Circuit Mary Jane Breeze Shoe ($136) and also I like another pair :Ahnu Women's Gracie Flat.-$110, purchased on Amazon too!
4. a hospital style table on wheels, which I absolutely love, even before the surgery I have been using it bedside or in a chair. The brand I got is very stable, lifts and lowers easily, is large enough for computer and books, place for cups. The brand is: Medline Overbed Table, Composite Top-$65.
5. I rented the "Game Ready" ice machine-my doctor works with a certain company who met me before both knee surgeries at the surgery suite prior to my operation to review how to use it. It cost $300 to use for both surgeries. I have submitted the receipt to see if insurance will help with cost. This is an amazing invention!
6. I put a chair (actually the rocking chair I bought for nursing my kids when they were babies) with an ottoman in my room to make it easy to get to a place to sit comfortably.
**July 29-I am adding a couple more thoughts here about planning for surgery. In retrospect, I am very glad that I accepted offers of help from family, friends, and neighbors. Several people brought meals, a couple friends drove me around, and some people brought treats, and I have had visitors that came to chat and refill my ice machine, make me a snack, and keep me company. I had hesitated at times when people offered to help, not wanting to put anyone out or burden anyone, and I highly recommend to accept all offers! People want to help and it makes a big difference. It was really nice for me and my family to have the meals that people brought over. It's very very helpful and also nice to know people care. Even if you only have one or two offers of help-it can make a positive difference.
Also, I have enjoyed my time reading and watching movies I got from Netflix -stuff I don't do enough of normally. But, I found having a visitor stop by each day or a few times a week- to be a mood booster, and kep me from feeling isolated. Some people offered to visit-ESP my closest friends-but I also asked friends who live in my town to come over for an hour or so, if I was needing some company.
June 26-first PT session
I went to PT for the first time today (day after surgery). I saw the fellow who works with the doctor and will see Dr. Gillogly day after tomorrow. I still am numb and not in pain. I am trying to take advantage of this time with no pain to get used to the crutches. Also, in PT today, I bent my knee at 90', which may not happen once the pain develops. I just now am using the CPM machine-"constant passive motion"for the first time and I am going to try to get it up to 90' today. Again, once pain meds wear off, this will likely be uncomfortable, but right now I can do it easily. Its good to bend it to prevent against scar tissue build up and also develop flexibility that will help my progress. I took some Percocet today because I have a bit of feeling coming back and very slight pain. i have read the knee geek/guru diaries and posts related to the ACI and the Fulkerson, as well as other knee surgeries, and everyone says stay ahead of the pain. I had just read a post by someone who had the same surgery (on the website: "knee geeks") about her post op experience and sounds like once she started to regain sensation, the pain came on quite quickly (and her nurses were not on the ball and she suffered for that). I am at home and in control, so I am starting the pain meds now!!!!
I thought I would have more limitations, but today the PT said I should be driving before 6 weeks, which is sooner than I had expected. Also, I can touch my foot down on the ground when I am standing, to help with balance., which the physical therapist said with other areas of the knee for ACI, the protocol is to not bear any weight in the beginning.
There is one small stair in front of our entry door and this morning and yesterday I was so scared to lost my balance on it, that I had my husband pick me up and over the threshold (so romantic)! But at PT today, the therapist said I can put right foot (the one that had the operation) down as I do a stair or something harder, as long as I put all my strength into the crutches and not put much weight down on that foot.
I thought I would have more limitations, but today the PT said I should be driving before 6 weeks, which is sooner than I had expected. Also, I can touch my foot down on the ground when I am standing, to help with balance., which the physical therapist said with other areas of the knee for ACI, the protocol is to not bear any weight in the beginning.
There is one small stair in front of our entry door and this morning and yesterday I was so scared to lost my balance on it, that I had my husband pick me up and over the threshold (so romantic)! But at PT today, the therapist said I can put right foot (the one that had the operation) down as I do a stair or something harder, as long as I put all my strength into the crutches and not put much weight down on that foot.
June 26-ACI surgery-1day post op
I had my ACI AND Fulkerson surgeries yesterday morning. The doctor was Scott Gillogly in Atlanta. The location was in his "surgery suite" next door to his office. I had two nerve blocks, femoral and sciatic, so 24 hours later my leg is numb (although I can move it- to swing it over to get out of bed, etc. (I am using my thigh muscles though, not the quads, which are hard to engage because of the block). Today when I go to the office to meet with PT and the doctor/nurse/and or fellow, they will refill the little ball with the block medicine and so I should have relief for another 24 hours. I think that will be the femoral block only. I will also see my phuysical therapist (PT is also located at the office which is especially good for ACI patients because the therapist are well trained for the ACI protocol working with this doctor.
So I've been feeling well all day yesterday and woke up this morning well too. Dr Gillogly said to lay on my stomach as much as possible so that gravity helps the patch to adhere. I have my "cuff" for icing and squeeze,although I can't feel it! Also a soft brace to help me keep knee straight. I will soon get the more "serious brace-perhaps today that I have seen the ACI patients wear in PT.
Feeling very excited to be finally "moving forward"
So I've been feeling well all day yesterday and woke up this morning well too. Dr Gillogly said to lay on my stomach as much as possible so that gravity helps the patch to adhere. I have my "cuff" for icing and squeeze,although I can't feel it! Also a soft brace to help me keep knee straight. I will soon get the more "serious brace-perhaps today that I have seen the ACI patients wear in PT.
Feeling very excited to be finally "moving forward"
Insurance issues
May 21, 2013-after a disappointing and frustrating 2 months, where my insurance issued multiple denials and stonewalled any communication, I did get an approval for the lab -ie growing cells at Carticel. We knew someone at the insurance company and that person helped us to talk to administrators. Based on the fact that I already had the first surgery, they approved it. I need the left knee done too-so I hope that we will be able to approve that when I am ready. My husband's office may change insurance companies (he has a say in it because he is a partner in the business)-which might be helpful....My understanding is that this insurance has approved ACI patella surgery through Carticcel and including through my doctor's office. The problem is how difficult they make it to communicate after a denial.
I am cautiously excited to move forward and I have surgery date for June 18. My doctor is not in network and had been approved for both surgeries in network (United Healthcare had approved that easily and quickly-which made it even more surprising when things became difficult with them)because he is the only doctor in my area with experience with ACI surgery (and the PT's who work in the office are trained in rehab for ACI as well). So now it has to be reap proved and I hope that does not have any complications that will change the date again. I hope to be posting in a few weeks about ACI rehab and not about insurance. (:
I am cautiously excited to move forward and I have surgery date for June 18. My doctor is not in network and had been approved for both surgeries in network (United Healthcare had approved that easily and quickly-which made it even more surprising when things became difficult with them)because he is the only doctor in my area with experience with ACI surgery (and the PT's who work in the office are trained in rehab for ACI as well). So now it has to be reap proved and I hope that does not have any complications that will change the date again. I hope to be posting in a few weeks about ACI rehab and not about insurance. (:
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