Day 13: My Doctor!!!

I had another appointment yesterday and it was with my doctor! Yay! It was great to see him.
He said that everything went great with surgery. The loose body was too big to remove during the arthroscopy procedure, so he had to take it out later... I'm guessing through the lateral release incision.
He told me to start putting weight on it as long as the leg was straight and gave me permission to shower!!! So I went to my parents' house last night because they have a walk-in shower. They put a patio chair in the shower for me and one outside the shower to rest my foot on.
It felt wonderful!
I'm going back tonight for another one. :)
My doctor also told me to start therapy, so we scheduled the first one for later in the afternoon. I'm so happy to have started therapy. This is a big step towards recovery and getting out of this stinking chair! My therapist worked on quad muscle strength and started bending. Very, very slight bending. And at the end he even had me walking on it! I was in the locked brace though, so that I didn't accidentally bend it and I also had my crutches just in case.
Now I have to get the nerves to work on these exercises from home.

Day 12: Lovenox

Since my surgery I have been using a blood thinner called Lovenox. I picked up the prescription the week before my surgery and instead of receiving a little bottle of pills I received 3 boxes of needles!

28 pre-packaged, pre-filled needles.

It was at that moment that I became goofy. The way I usually get when I'm shocked and have no idea how to react except to smile, laugh and keep repeating the thing that I'm shocked about.

Micah has been giving me the injections, but when he is not home I have to do it myself.

Not fun.

It must be administered into the abdomen, so first you clean the area with rubbing alcohol.

Then you pinch an area of skin so that way you are injecting into fat and not into an organ or something. After pushing the mediction through you pull the needle out quickly and immediately stop pinching.

These needles are really cool because after you are done you continue to push and a guard pops up.

Boom. Safety.

Isn't that cool?

The Tibial Tubercle Osteotomy

I found a 3D video of one of the major procedures that I had done.

Tibial Tubercle Osteotomy

If you open this link you will see a blue outlined box in the middle/right portion.
Notice that in the top right it says "Main Menu." Click on that just I know that you are starting at the right spot.

A list should appear directly under the Main Menu button.  Scroll down that list and click on "Orthopedics."

A new list should appear and from that you should click on "Knee"

Then a long list of Procedures should appear to the right. Scroll down and click on "Tibial Tubercle Osteotomy."

After is loads you will need to click on the "play" button and then the "see the animation" button.

Day 9: Pain Review

Every day I am asked about how my pain is and I always say that it's not any better.

Today I was thinking about my pain levels at that hospital. They ask you to rate your pain on a 1 to 10 scale.

Before leaving the hospital 1 week ago I was rating my pain at a 7. Right now I am due for meds in 10 minutes and I would say that my pain is a 6, so at my very worst I'm still better then I was a week ago.

About an hour after I take my meds I'm at a 3. As long as I'm laying down.

My foot is still swollen around the heel and ankle area, but the toes seem to be a normal size now.

The top of the foot is still tingly and gets worse as my medication wears off.

The bottom of my foot feels really weird. Like there is something wrapped tight around my foot, creating pressure on the bottom. And the knobby part on the sides of my ankle have a strong bruised feeling

There is a soreness slightly above my knee and towards the outside. I think this might be from the lateral release procedure. See a 3D video of this procedure here.

In this video the first couple steps are about the arthroscopy which I also had done. The lateral release begins at step 5.  This pain ranges from a 0 to 4.

Every now and then the incisions will sting sharply and I definitely notice it more when I am walking crutching around. It feels like gravity is pulling down on the brace which is fairly tight causing it to pull on the stitches.

At least that's what I imagine is happening based on what it feels like. The pain is short-lived, but I would rate it at about a 6.

I also get some sharp pains around the knee whenever I go to the bathroom. Let me explain... The toilet faces the bathtub, so I have to put my foot up on the edge of the tub and then sit down.

Turning my foot one way or the other can help. It seems to have something to do with pressure being put on the brace from the edge of the tub. This pain can be really bad sometimes. Rating: 4 to 8

My shin is also sore almost constantly, but that is quite mild. Like a 3.

On top of all of that I've developed some hip and back pain that are sometimes more annoying then the knee!

I'm looking forward to tonight as we continue our tradition of reading How the Grinch Stole Christmas and The Night Before Christmas.

Day 7

I've had a lot of horrible pain in my foot the last couple days.

It will just randomly hurt for an hour or so and usually just once a day. I tried adjusting all my pillows and towels and sweatshirts that I'm using to keep my leg propped up, but nothing seemed to work.

My husband got the idea to put my herbal neck wrap in the freezer and then wrap that around my foot.

That felt amazing!

But the pain would come right back.

I finally realized that the end of the brace was pushing hard into my calf

right above my ankle whenever I had my leg propped up. After enough time

it cut off circulation and caused me great pain. So know I unhook the brace every time I lay down.

It's kind of a annoying to take on and off every time I get up and lay down,

but it definitely feels much better.

I'm not comfortable enough yet to get the brace out from under my leg. So it just sits there. Unstrapped. Under my leg. It would probably feel even better if I could get it out of there,

but my knee feels far too unstable to try to lift it without the brace on.

I have my meds down to 2 tablets every 3 hours and 20 minutes,

but I realized today that I will run out of them by Monday morning.

Two days before my doctor appointment!

I'm not sure what to do because even if I quickly work my way to 4 hours that will only gain me half a day.

I'm just hoping that I can call and get them to write a new script and go pick it up.

My favorite multi-vitamins that I had been taking pre-surgery contain herbs that interact with my medications.

So I just started taking a drug-store version of One-A-Day.

I'm still taking additional C, D and Fish Oil.

They've got to be good for something, right?

Obviously our body needs vitamins. Certain vitamins help certain things.

We know that K is good for the eyes. C is good for almost everything. So I'm pretty sure

that somehing has to be good for healing my leg.  I just don't know what.

Days 5 & 6

I realized Monday night that my oxycodone would run out on Tuesday morning.

PANIC!!!

It didn't have any refills either. Apparently they don't give you any refills for narcotics.

Thinking that they would switch me to Vicodin I started to change my dosages of the oxycodone. I had been taking 2 tablets every 2 hours and still felt a lot of pain. Over the night-time hours I changed 2 tablets every 3 hours and then in the morning 1 tablet every 2 hours.

This was not working at all. I was back to the 1am pain from the hospital.

When we arrived at the orthopedic's office I was too proud to use one of the wheel chairs that were available at the front door. The longer I'm in an upright position with the blood running down to my foot the more it hurts. And not just me knee. My foot too. 

Tip #1: loose the pride, save yourself some pain.

Usually I wait in the waiting room for a minute or two at the most, but of course the time that I'm in excruciating pain it takes forever! Micah helped me get comfortable...

My doctor was on vacation, so I was seeing another doctor. He didn't tell me much at all because he didn't do the surgery.  He just said that the incisions looked good. Actually, I thought it seemed like he was acting kind of defensive. He looked at my knee for a few seconds and then tried to explain that this type of surgery looks bad and he wanted to make sure that my doctor had explained all that too me.

I told him that I was still in a lot of pain and he prescribed more oxycodone for me and again seemed defensive, asking if my doctor explained that this would be very painful.

I also told him that my hip was really hurting from holding my foot off the ground when I'm up on my crutches. He said that I have to deal with that and just try not to get up if I don't need to. "Don't go to the grocery store if you don't need to."  Are you kidding me?! I was starting to wonder if this guy dealt with knee surgeries at all.  Possibly only arm surgeries.

He and the nurses started to give me a few basic instructions that were different from what my doctor had told me. So, I straight-up told them "That's not what my doctor told me." So they kind of retracted what they had said, telling me to obey my doctors orders.  I was getting really frustrated. At least they took the ace bandage off and put a much smaller one on just at the knee.

We took a picture of it while the bandage was off, but for the sake of your stomachs I'm not going to post it.

The problem was they only tightened the brace strap just above my knee. The other straps were fairly loose because they had been adjusted to fit around the thick bandage that was on before.

So when I stood up the whole thing was weighing down on the top of my knee.

I was in so much more pain then when I had arrived.

I asked for a wheel chair.

Micah and I tried to tighten them before getting into the car, but the one at my ankle wouldn't tighten enough. I have really small ankles I guess.

When we got home I went right back to 2 tablets every 2 hours.

I'm trying to eat healthy and take vitamins. I want to do everything I can to make a difference.

For some reason I'm not supposed to be taking multi-vitamins, so I'm taking C, D and Fish Oil.

One of the medications is making me extremely thirsty. I'm drinking almost a gallon of water every day!

Over night I changed to 2 tablets every 3 hours. That allows me to get better sleep too.

As long as I'm not in really bad pain. I've been continuing that into today (Wednesday) and doing alright.

I just have to be careful about when I get up in relation to when I took the medication. I'd rather get up about an hour after I take the meds when they are working at full force.

Micah is home today too, so he is able to get everything for me. Tomorrow I might need to take them more often since he won't be home.  I'll have to get my own food, water, vitamins etc.

It's amazing how easily you loose track of time sitting in a chair 24/7.

I can't believe that Christmas is in 4 days!!!!

Day 4: History Continued

Continuing from yesterday... I have the final event to review.  It happened in February.  The 19th I believe. Micah was in York applying for a police officer job opening and Elliot and I were home by ourselves.  It was a Saturday morning and in no hurry to be anywhere. It was the time of year when I start to think, "Hey, if I work out 5 minutes a day I could look great by summer time."  Yeah... I tell myself that pretty much every year. And I do work out for 5 minutes. Everyday. For about a week. And then a month later I do the same thing. So, on this particular day I put Elliot in his swing and went to the basement to work out hardcore and become lean and toned. For 5 minutes. I decided to work out my legs and I specifically remember doing mostly squats.  Then I went upstairs feeling great about myself and ate a nice healthy breakfast of baked oatmeal with Elliot.

After breakfast I took Elliot to the bathroom to wash his hands. In our bathroom you have to turn completely around to your right to get the hand towel that is hanging on the wall behind you. So, after washing his hands I made the turn to my right to reach for my towel.  With my right foot planted.

And then it happened.

I was on the floor screaming in pain, trying to reach down to hold my knee,

but at the same time not actually wanting to touch it.

Something was different this time.

It felt way worse then any of my other experiences.

I was concerned that if I actually felt my knee I would find that it was still dislocated and would have to physically pull it back into place.  Still yelling pathetically,

"ow!, ow!, ow!, ow!"

over and over again I realized that poor Elliot was also screaming.

I was pretty sure that I had protected him when we fell.  I don't think his head hit the floor.

About that time Winchester came in and started barking at us and somehow I found the situation hilarious, though I couldn't find myself capable of laughing.  Just something about 1 adult, 1 baby and 1 dog all "yelling" in unison and all for different reasons... I, because I was in pain. Elliot, because he was scared to death, and Winchester, because heck, if they're doing it, why can't I?

I managed to crawl past Winchester into the hall and opened the basement door.  I yelled at him over and over again to go downstairs. He was way to curious about this situation to want to do that, but he obeyed after a minute or two.

~INNOCENT~

Than I crawled into Elliot's room, still holding onto him with one arm, and tried to read him books through my sobs to calm him down.  He was so scared and upset.  After a few minutes he stopped crying and I crawled over to his crib and pushed him up over the side and then grabbed his hands to let him slowly drop into the crib.

I crawled to my bedroom to get the phone and called my parents to come. After that I called my family doctor and explained what had happened and how it felt so different this time, almost like I had chipped a bone. She told me to go to the E.R. right away.
The pain I felt that day was definitely different. It landed me in a knee immobilizer for 4 weeks, during which time I lost all muscle in my quads.  The orthopedic specialist I went to told me that most people don't recover from this type of injury.  It's sort of the "last straw." He explained that the muscles surrounding the knee were fairly week when I injured it and that allowed the knee cap to dislocate further then the other times that it had happened.  If only I had been more serious about staying in shape, this may have never happened.

I went through 7 weeks of physical therapy and felt like I was making a lot of progress. I was sent home with a routine that I could continue until my muscles were back to, or even better then, what they were before.  This was in May. And it was right around this time that a small bone spur of some sort formed on the right side of the knee. At my last P.T. appointment I asked what it was and he didn't really know. He said that it was probably something that my body created in order to protect my knee from this type of injury. He was slightly mesmerized by it and basically said that it seemed to be no big deal.

I now know that that little "spur" is actually called a plica.  A natural part of the knee that became aggravated because of the injury. Within a month after finishing P.T. it became so uncomfortable that I stopped all at-home therapy exercises. It didn't take long for me to realize that I would never be active again as long as that thing was there. And even if we removed it there would always be the possibility of injuring it again. Every day is a risk that it will happen again. To either knee. By the fall months I was consumed by the thought of it dislocating.  Every step down.  Every turn. Every walk with my son in my arms. Every time I passed by the dog.

So here we are. It was a difficult choice because I knew that I was basically choosing to put myself through all of that pain all over again. Little did I know that the pain would be worse.

Day 3: Recovery and History

This morning I felt a little better. For the most part the pain hasn't changed, it's just my overall health.  Feeling like I can handle the pain more. The anesthesia is completely gone now, no more morphine... I just feel like I'm back to my normal self. Except with a broken leg. The incisions are starting to sting every now and then and the back pain is ever present.
Micah dropped Elliot off with a friend at church this morning, but before that Elliot decided he wanted to be like Mommy...

Micah slept all day in preparation for his night shift tonight. He got ready for work as fast as he could, so he could clean the house some.  He's the best!

The oxycodone makes me extremely drowsy, so I spend a lot of time just dozing off, but not sleeping really well. My dreams are so crazy and vivid! I'm also fairly light headed when I get up and I really only get up to go to the bathroom and fill my water bottle. I decided that I should have someone with me in the evening when I was going to be up for a longer period of time to brush my teeth, wash my face, etc.  So I asked my parents to stop in while Micah was at work.  They picked Elliot up from my friend's house and brought him along, so that I could see him.  They also fed the dog and let him out while they were here.

I needed to give myself the blood thinner shot and neither of my parents seemed interested in helping with that.  Micah made it look so easy.  Like he was injecting it into butter.  It was quite a riot when I tried to do this.  It felt like I was injecting it into a rock!  I started acting like a ditzy girl. Then on the third try it finally went in, but it definitely burned more then when Micah does it.

I was thinking about all the previous times that I had dislocated my knees and decided I would recite them here. I believe the very first time was when I was in youth group. I was very active as a teenager.  Probably annoyingly active now that I think about it. I was hanging out with some girls as we waited for youth group to get started. I think I picked one of the girls up and then tried to throw her in the grass when it happened. I don't remember which knee, but I remember knowing that this must be what happens to my mom all the time. It hurt and felt quite tender for a few days, but then it was gone and I forgot about it.

The second time was when I was playing basketball. I'm almost positive that it was my right knee that time. I was running and then stopped, planted my feet and turned to my right to pass the ball when it happened.  Suddenly I was on the ground writhing in pain, unable to speak, but no one knew what had happened.  I was on crutches for a few days after that event, but just like before I recovered quickly and forgot about it.

The third time I was playing soccer. I don't recall exactly how it happened, but I believe I was just dribbling the ball and turned my foot in to change the direction of the ball when it happened. On the ground, no speaking, indescribable pain, within a couple days I'm recovered and back to normal.

The fourth time I was wrestling with Micah. Somehow it happened and he felt horrible about it, but I was back to normal within a week.

The fifth time was in the summer of 2010.  I was walking back from my garden with a bunch of vegetables when our golden retriever started jumping up at me trying to get some food. I did a typical plant and pivot and boom, I was on the ground, screaming in the middle of the yard, while the dog ate up my vegetables and then started chewing on my ponytail as I tried to crawl back to the house. I was back to normal within a couple days after that one.

I'll leave you in suspense about the really bad one that happened in February until tomorrow.

(Cue the suspenseful show-ending music for Lost)

Day 2: Coming Home

After experiencing the knee pain overnight because of the block wearing off I really did not feel ready to go home, but the nurse came and removed the morphine, so that we could test how well I could handle the pain with just the oxycodone. After an hour they called for someone to bring a wheel chair to take me to our car. The ride home was horrible. Every bump sent a new wave of pain through my knee and shin.

At home I settled into a big reclining chair, propped my foot up and slept most of the afternoon. Up to this point I had only been eating crackers and pretzels and a few cooked vegetables from the hospital dinner last night, so after my nap I decided that my body really needed vitamins. I ate a banana and loaded up on a multi-vitamin, fish oil, and a double dose of vitamin C. Within about an hour I was feeling so much better. My appetite still wasn't great, but I needed to eat something every time I took the oxycodone, so I became more selective about what I was eating. I'm not sure how each vitamin helps, but I do know that the vitamin C will help the incisions to heal. My goal is to take 4,000 Mg each day, but spread out throughout the day.

My parents dropped off Elliot with us that evening. He did not want to leave my lap and I was loving every minute of it. Never does he cuddle with me unless he is hurt or sick. He laid in my arms for about 45 minutes before we put him to bed.

He loves this book.

"Little Boy"

His Aunt Pam got it for him and he

loves the dog that is in it.

I attempted to sleep in my own bed that night, but that didn't work out at all. It was incredibly painful, so I moved back to my chair. I stay in the same exact position all day long and all night long. It was during this night that my back started hurting. From this chair I have been texting, emailing, blogging, eating, reading books and watching Andy Griffith.

Micah gave me the blood thinner injection that night. Surprisingly it was completely painless when he did it. It stung and then burned for a while when the nurses would do it. I love my husband! He will do it again for me tomorrow morning, but then tomorrow night I will have to do it because he'll be at work. Not looking forward to that!

Day 1: The Surgery

I was finally contacted late Thursday afternoon about the time of surgery. It was scheduled for 10:40, but I had to be there at 8:40. I was asked to purchase an antiseptic soap called hibiclense and wash thoroughly with it, so against everything I believe in I purchased this ridiculously expensive, over-sized bottle of liquid soap at full price. And without a coupon. I almost fainted. I got up early to shower with that stuff and make a big pan of baked oatmeal. Why do I torture myself like that. I love baked oatmeal, especially the smell of it baking and yet I wasn't able to eat any of it. Nothing to eat or drink since midnight.

We arrived at the hospital a couple minutes late and they checked me in, asked me to change into the dreaded hospital gown and pee in a cup to make sure a wasn't pregnant. Then an annoying, yet slightly humorous routine started. A lady entered the room to check my medical history, but first she asked me to state my full name and birth date. Then another lady entered the room to wash my leg with the exact same stuff I spent a fortune on, but first asked me to state my full name and birth date. Then a man entered the room to go over my anesthesia with me, but first asked me... Yep, you guessed it. And still one more lady and one more man.
Such a tedious thing just begged to be interrupted by some excitement. So surgery was started about an hour early! They wheeled me down to the anesthesia room and gave me a relaxant and a femoral block, which basically numbed my whole right leg. That's the last I remember, but apparently they wheeled me back to see Micah one last time before surgery and we conversed... apparently. And I asked him to take my picture.

Then around 1:00 I woke up in recovery. Very drowsy. I stayed there for a about 10 minutes, but I can't recall anything that was said or done during that time except that I overheard a nurse complaining about how one of her co-workers who always makes a delicious white chocolate peppermint stuff was on vacation. I yelled out "peppermint bark!" She came over and I told her how to make it :) At least I think I did. Hopefully she's not trying to cook it on a grill or something. Two men wheeled me to my room and on the way they asked me how I injured my knee. I decided to tell them that it happened in an MMA fight with my husband. I think they believed me.

They gave me a morphine drip which I controlled, using as often as I wanted, but no more then once every 8 minutes. This made me very nauseas. My leg was still numb, but there was a strong ache in the lower half of my shin. I hate medications, so I put off taking the oxycodone until around 6:00. That helped, but it takes an hour to kick in and that first hour makes you super drowsy. Then at 9:00 they started me on a blood thinner injection into my abdomen.

Micah and I tried to sleep. At 1:30am I awoke to incredible pain, now in my knee. The block must have worn off. The nurse gave me more oxycodone which wouldn't kick in for nearly an hour, so with the help of the drowsy side effect and cried myself to sleep.

T Minus 1 Day

Still waiting on a call informing me of the time of surgery. I'm not allowed to eat anything after midnight tonight, so I'm hoping for a morning surgery.  Thankfully I'm allowed to drink until 2 hours prior.

Continuing the list of procedures...

Procedure #5 Distal Patella Realignment (code #27418)
AKA Elmslie-Trillat Procedure
AKA Distal Osteotomy
This procedure starts by making a long silce from just below the knee cap down about 2 or 3 inches so that they can access the a part of the shin bone known as the Tibial Tubercle.  It is located on the front of your leg at the top of the shin bone, just below the knee.

In this image you can see the tibia tubercle located just above the 'a' in the word Tibia.  You can also see the patellar tendon is attached to this part.  The idea is to slice off the tibia tubercle with the tendon still attached to it and move it slight towards the inside (left side of my right knee) and then screw it in place. Currently my patellar tendon is pulling my knee cap towards the outside.  This procedure will realign that tendon so that it is straight.  It will also help tilt my knee cap down into a more natural position.

And the last procedure is to remove a some floating particle that showed up on the x-rays.  Looks like a par of bone that chipped off during one of my injuries.

Keep in mind that I'm learning all this as I go along and I'm sure that 75% of what I've described isn't accurate, but this is how I understand it. My doctor said that my knee is... (yes, he even paused to consider what words to use) "anatomically wrong." Fantastic. Oh well, we all gotta deal with something, right?

T Minus 2 Days

So I've decided to write a blog.  I really don't have time for this, but I have 2 big reasons to.

Reason #1 - I was searching for a blog that would walk me through a personal account of the surgery that I'm about to go through.  I couldn't find such a blog.  And that frustrates me.  So for all of those people facing a similar surgery I decided to write one of my own.

Reason #2 - I'm sure there are friends and family who would like to know what is going on, so I considered sending out a mass email to you all, but then I got to thinking that that could become quite annoying for someone who isn't really interested in details. A blog feels a lot less invasive to me.  Follow at your own pace kind of thing.

I'll start off by attempting to describe each procedure of the surgery.

Procedure #1: Arthroscopy
This phase of surgery involves two small cuts on either side of the patellar tendon (just below the knee cap). A camera will be inserted so they can check on the inside of the knee... presumably the cartilage.

Procedure #2: Scoping the Plica
On the outside of my knee is a hard object that I always described as a bone spur. Or calcium deposit. It formed about 4 months after my injury in February and this annoying object is the number one reason I returned to my doctor to talk about surgery.  It has grown and become extremely uncomfortable when putting weight on that leg while bending.  Apparently it is a normal part of the knee that has changed in some way or another.  I don't understand this part of knee very much at this point, but I hope to learn more. Anyways, they plan on "scoping" this plica down, so that it is once again unnoticeable. I'll talk more about this object at a later time.

Procedure #3: Lateral Release (Code #29873)
This is one I really don't want to think about and therefore don't know much about because I don't want to research it. Basically something on the outside of my knee is tighter then it should be and is pulling my knee to the outside.  The idea is to cut away part of this thing to release some of the tension.  I just keep picturing a rubber band or something like that being pulled taught and then cutting into it.  It seems like it would just want to keep tearing... ok we're done talking about that.

Procedure #4: Medial Patella Femoral Ligament Reconstruction (Code 27420)
This is where they add a tendon.  We've decided to use cadaver tissue because mine are unusually stretchy which would defeat the purpose of this procedure.  Otherwise we could use a part of my hamstring. First they will drill a hole into the knobby end part of my femur on the inside of my knee.  By "inside" I mean the left side of my right knee. They would also drill a very small hole straight through my knee cap from left to right. Starting with the hole in my femur they will insert an end of the new tendon (or old if you think about... really old) and insert the other end of the tendon into my knee cap, stringing it all the way through to the other side and attaching it on the outside (right side) of my knee.  Double ouch.

I'll talk about procedure #5 tomorrow.  This took much longer to write then expected as I was quite distracted by the season finale of Psych.

If your knees are working properly... be thankful. :)