post #5 Physical Therapy

Physical Therapy Day!!!!

I absolutely love my physical therapist.  I worked with her months before surgery so I've known her for a little while now and she's just amazing.  If a certain exercise hurts too much, she'll find a way to modify it. She doesn't make me push through loads of pain.  It's great. Well it's my first day back and I'm nervous.  I'm nervous just because my pain is all over the place.

Either way, PT day is here- let's give it a go!  I am not able to raise my right leg at all on my own.  I try really hard but it just lays there.  I've been reading a few blogs from other people who have gone through this surgery and someone explained this feeling extremely well so i will quote her:

 "They (PT exercises) seem really easy, but your quads shutdown in amazing speed after a surgery like mine as a protective mechanism for the knee joint. To understand what its like to use your quads about 1 week after MPFL reconstruction, here's a really simple example. Look up, and pick an object across the room from you. Now concentrate really hard on it, see if you can get it to levitate. Didn't get it? Try harder, focus! There, maybe, I think it moved for a millisecond! Its really like that. Once they start moving they start to remember, but take an hour off and they forget again." 

Rachel from Peace Love & Knees wrote that on her blog.  She explained it to a T!  Here's her blog address if you'd like to read her blog also: http://www.peaceloveknees.com/

It really is the most frustrating thing.  JUST MOVE ALREADY, LEG!  It almost feels like dead weight just hanging off the right side of my body.  But my physical therapist taught me a few exercises and by the time my appointment was over i was raising my right leg on my own!  Ok, ok, it wasn't that high, maybe 10 inches off the ground.  But dang it that's better than nothing!  I was so excited.  I had to use a six inch foam roll under my knee to be able to lift it that far, but at least my muscles were firing.  If I lay my leg completely flat and try to raise it up nothing happens.  Ok, i shouldn't say nothing, my leg will shake but that's about all the excitement i have.  I guess having your knee bent and then raising it is a lot easier, so hopefully once i get that one down better, i'll be able to do the straight leg raise.

That is about all we did for PT that day.  She massaged it and tried to move the fluid around in my leg since even with the ted hose, it is still pretty puffy.

The exercises she gave me after my first PT visit.  Sounds easy huh!?

That night i noticed a huge difference in my sleep, though.  I was able to move around in bed a LOT easier. Usually i have to sit completely up in bed and try to move my leg an inch.  Last night i was able to ever so slightly raise it up (i sleep with a pillow under that leg, so it's bent) and move it, so i could lay on a different hip.  YAAA i slept sooooo good that night.

In the morning i was bouncing off the walls with excitement.  Finally I'm seeing progression.  Funny how the tiniest of movements can really make a girl happy.  That morning my mom helped me with my exercises. I'm suppose to do them twice a day.  Boy was it hard to raise my leg again.  Rachel from Peace Love & Knees was right!  If you don't use your quad muscle for an hour and then try to move it again, you're back to square one.  However after a couple tries my quads remembered how to lift my leg and i was able to raise it much faster than i was at PT, but still only able to raise it about ten inches off the ground.  I tried soooo hard at my exercises by the end my leg was shaking.  I kept pushing through the shaking, but as the shaking increased, my raises decreased, so I figured i should rest.

A couple hours later the pain came back- and at full force.  At first it was just a very sharp pain in the inner part of my knee.  I was due for my pain medicine (which I am still taking every four hours...awesome...I was really hoping to be able to cut back at this point).  Sometimes it takes a good hour for the pain medicine to kick in, so even though the pain was becoming more intense, i knew it had only been forty minutes since i took my percocet, so i just tried to take deep breaths in and out.  Almost an hour after the pain had started my leg all of a sudden spasmed.  And spasmed bad.  My leg was almost off the couch it was so tight, and my toes were starting to tingle.  I haven't had this much pain/spasm since my last night at the hospital.  I screamed for my mom and brother to help me.  My brother grabbed my polar cube which ices my knee, and my mom started to massage my leg.  I popped a muscle relaxant and tried to relax though the massage.

(Sometimes this is how i feel. A big crying baby)

After awhile my spasms relaxed and my mom was able to stop massaging my leg.  Gosh i was back to a pain of 12 (the pain scale: 0 being no pain, 10 being the worst you've ever had).  I've had to pop a few more pain pills than I've been having to take the last couple days and I'm still pretty painful.  I skipped my second round of exercises tonight since the inner part of my knee is painful whenever i move. My excitement for the day was squashed.  Another set back i guess.  I'm just frustrated because one minute I'm doing good and i think I'm starting to climb up this hill, next minute I'm sliding back down to the bottom.

I need to look on the bright side and just know things are getting better even though i sometimes feel i take one step forward and one step/one crutch back (HA, get it?  Cuz i'm using crutches to get around!).

Hopefully tomorrow will be a better day.  It's suppose to be 72 degrees tomorrow!  And in Oregon that means gardening day!!  I really hope i feel better so my mom and i can go to the nursery tomorrow and pick up some pretty flowers.

I'm finally caught up on this blog so hopefully i can write this as things are happening, and not try to remember what happened days ago during my pain med haze!

Post #4 A few resources

Here's a few resources that helped me understand my surgery better

• A fast read
• A great short and to the point video
• Several videos about all kinds of knee surgeries. The MPFL (last two at the bottom) are the videos that pertain to me

Post #3 First couple days at home

So I live alone.  My Dad is retired and my Mom works fairly close to home (about a five minute drive away).  So i decided to stay the first week with them.

*I'm trying to catch up on this blog. I'm currently writing this nine days after my surgery date, so I've been at my parents' house for 6 and a 1/2 days now since leaving the hospital.

I have my good hours and my bad.  For the most part i know my pain level is slowly decreasing.  But every now and then I experience a lot of pain.  For instance I have a walker and crutches at home.  My bathroom is about 25 FT from the couch I am chained to (that's a joke, but since being home this couch has been where I spent the majority of my time).  The first couple days all I did was sleep on this couch and hobble to that bathroom.  Exciting, huh?  Anyway, on the way to the bathroom and back I've caught my foot a couple times on the carpet.  Talk about pain.  As soon as i catch my toes i get this sharp shooting pain on the inner part of my leg, where the donor ligament was placed.  Again once i instantly get to a pain level where it takes a bit of time before it slowly fades away.  You probably won't believe me, but i honestly don't cry very much.  I think i have a pretty high pain tolerance.  But let me tell ya, catching my toe on the carpet will send me into a stream of tears.  Maybe my pain tolerance isn't that high.  Maybe I am a big baby.  I just figured with how many times my knees have dislocated, I knew what pain was.  Guess not.  Ha, oh well call me a baby, you may be right! :-)

Lets take a little break from the blog to look at pictures! :-)  I have to change my bandages every day for seven days until i see my doctor for my first post op visit. 

First day at home changing my bandages. How my knee looks with the ted hose and the brace off.

How my knee looks with all the bandages off. I believe this is post op day # 3 or 4.  Here's another angle:

And now back to what i was rambling on about before:

My parents live in a two story house.  The first couple of nights i stayed downstairs and slept on the couch, but by the third night i wanted to try a bed.  The stairs are definitely a challenge.  The first couple nights went fine, but a couple days ago the muscles in my leg kept tightening up as i went up each step and by the time i got to the top i was in extreme pain again.  I had tears just flowing down all over again.  That was a rough night.

Showers are also a challenge but i think we found a pretty good technique.  My mom puts a step stool in the tub and lays a couple of towels down. One for the stool to be on (so it doesn't slip) and one for me to sit on.  We take a hand towel and wrap it around my leg, just above my brace to soak up any drips. We duct tape that towel as tight as i can stand it.  We then placed a garbage bag around my whole leg and duck tape that right above the towel.  This seems to work pretty well.  I've only gotten water in the bag once.  I sit on the side of the tub and my mom swings my leg into the tub as i scoot over to the stool.  A hand held shower head really helps with all of this, too.

The other day my tail bone was hurting.  Found out in the morning i have a pressure sore on it.  Thank goodness it's small and i caught it soon, but just one more sore spot on my body.

Post #2 Day of surgery/Hospital stay

March 20th, 21st, 22nd 2013
Surgery Day/ My two night stay in the hospital

Well it's surgery day. Today I will be having two surgeries on my right knee. The MPFL reconstruction, which is where I have a cadaver ligament placed on the inside of my knee. My own ligament has been stretched from all the numerous dislocations and honestly does not hold my knee cap in place at all anymore. Its basically just hanging out in my body, not doing its job! And the second surgery I am having is the Tibial tubercle fulkerson osteotomy. This is where they will break my shin bone (tibia) and slide it over so that the ligament attached to that bone is straight and not being pulled to one side. Right now my ligament is not straight and it is pulling my patella to the outside, so any slight twisting to my knee causes my patella to pop right out. Stupid knees, everything else in my body is doing it's job.

 The anesthesiologist gave me the option of having a nerve block or not. Heck I didn't know. I've never had a surgery like this before. I figured if my doctor ordered it he had good reason. So I got the nerve block. When i hear nerve block i think: CRAP THIS IS GOING TO HURT GOING IN. Talk about a piece of cake. My nerves slightly "fluttered" a couple times but that was it. The needle was so tiny i didn't even feel it going in.

After the nerve block was placed i was on my way to surgery. My surgery took about three hours and i woke up in the surgery room. They wheeled me into the recovery room and pain was pretty bearable.  Although i was still pretty doped up, a couple fentanyl hits fixed any pain i had. The pain was more related to pressure.  It felt like there was a lot of pressure on my kneecap and every now and then there was a sharp pain in my inner knee (hence where the fentanyl came in).

After sitting in the recovery room for almost three hours (they didn't have a room for me, i only needed to be there for an hour), they wheeled me away to my room.  Funny side story, the person who wheeled me up to my hospital room was someone i had a couple college classes with.  It was nice to catch up, although i was still pretty loopy.

When i got to my room my parents were there to meet me.  I was amazed by how little pain i felt.  Heck if this is all there is to it, I'm kicking myself for not doing it years before (little did i know PAIN was soon to come).  I took a small amount of pain meds every four hours but for the most part due to the block, my thigh and knee were both numb completely.  I could feel my foot and move it, however it felt like my foot was just asleep.  You know that tingling feeling you get after sleeping on your arm or leg wrong?  The anethesiologist warned me that a large part of the nerve block would start to wear off by that night.  When they said "wear off" i assumed they meant as the nerve block wore off my pain would slowly start to increase.  Boy was i wrong.  At 1AM my nerve block started to wear off, and my pain rocketed from a 5 to a 12 on the pain scale.  I've never felt that kind of pain before.  I woke up crying, and once at that pain level it took about two hours to come back down.  I was not expecting that.  I honestly thought my pain would slowly increase from 5 to maybe 8, then 8 to maybe 10; but not from 5 to 12 almost instantly.

The nurse i had that night was not very helpful either, so maybe if i'd had someone better, it would have been more manageable.  Either way that was a bad, bad night.  I finally fell asleep around 5AM and woke up again at 7AM with a lot of pain.  Not nearly as bad as the night befor,e but i would say maybe an 8 on the pain scale.  I asked the CNA to help me to the bedside commode.  I instructed her to lift my leg a certain way and that she could not drop my leg down.  She however did not follow through with instructions well, and by the time i got back into bed i was in severe pain again.  She had dropped my leg twice, and by the second time i lost it; tears just poured from my eyes.  I spent the majority of that morning trying to catch up on my pain.  Anyone who has dealt with extreme pain might know that catching up to and overcoming pain is MUCH harder than maintaining pain.  By afternoon i was doing better, but i decided to stay one more night just to make sure my pain was under control.  And boy am i glad i did...again that evening i found myself going from a pain level of 7 to well over 10...again.  My leg muscles spasmed so bad my leg almost levitated off the bed.  The good thing was that the RN i had that night was amazing!  He explained to me that my pain medicine would not take effect until my muscles stopped spasming.  Understanding this helped- I believed him since my muscles were so tight, my foot/toes were tingling.  After several hours of pain, thankfully we finally started to get the pain back under control.

I don't like taking more medicine than i have to since I tend to get sick with pain medicine.  However after my two experiences with extreme pain i learned that it's better to stay on top of your medicine (at least for the first couple days/first week), than to bravely try and take the bare minimum meds. Once you get to that pain level it takes an hour or two to get back down to a tolerable level.  A hard lesson learned!

Pain was my biggest obstacle in the hospital.  The physical therapist worked with me only a couple hours after surgery.  He bent my knee and i took two steps with the walker.  By the next day i was using crutches and trying the stairs.  It was a very slow walk, but it was a walk, i was so excited!  I'm only allowed to do toe touches/ten pounds of weight on my right leg.  So with crutches i basically just touch the ground with my right foot to gain a slight amount of balance.

Well this is a long post, so i think i'll jot down key points (don't laugh) of this post so people who are reading my blog for insight on their future surgery don't have to read this WHOLE blog, HA!

Key Points:

• Placement of nerve block was a piece of cake, didn't hurt at all
• Directly after surgery = very little pain...or maybe i should say pain was tolerable
• Once nerve block STARTS to wear off pain level will jump to extreme pain (if you do not "stay up" on pain pills- literally- watch the clock!)
• If you do get a nerve block, i suggest taking all the pain medicine you are allowed, even if you are not in much pain, so once it wears off pain will not hit as hard as it hit me
• Physical therapy worked with me just hours after surgery, he bent my knee and i took two steps with a walker
• I ended up staying two nights in the hospital due to pain control, if you stay absolutely current with your pain meds i would expect one night in the hospital might be enough for you

Post #1 What is wrong with my knees?!

Bare with me during this blog.  I am currently 6 days out of a two-procedure surgery: Tibial Tubercle Fulkerson Osteotomy and MPFL reconstruction with a donor ligament on my right knee- and still on quite a lot of pain meds.  And let's not lie, I am not the best at writing.  Hence why I went down the medical path in college.  HAHA!

I wanted to write this blog for several reasons.  1) Before surgery I had a hard time finding information about my surgery,  2) I will be having this surgery again on my other knee, and I may want a reminder of everything I felt,  3) To keep myself busy.  I'm pretty bored sitting on the couch all day, waiting for my body to heal.

Maybe someone else considering this surgery will find my blog helpful, since like i wrote before i found little to nothing about the whole procedure/what to expect.  I'll start out by explaining what my knees do: since sixth grade (I am now 24 years old), my knee caps (the patella) dislocate to the outside of my knee.  They used to dislocate while playing sports and would relocate back into place on their own.  As the years went on, there was little reason as to why they would dislocate.  Sometimes during my attempt to sit in a chair they would dislocate.  By this point rather than relocating on their own, they would get "stuck", and i would have to ask someone to rise my leg to relocate the knee cap back into place (since i could not raise them on my own when dislocated).  Both knees had this issue.  I have done physical therapy several different times and have been to numerous doctors, most referring me to physical therapy which was only a help, but not a fix, to the problem.  Occasionally PT would actually hurt them more.

Along with the dislocating patella, I limp.  Sometimes my knees just plain hurt, even if it has been some time since last dislocating.  I don't know why they hurt, they just do.  Usually when i limp i don't even realize i'm limping, i'm just used to it.  But other people point it out to me. 

Within the last year or two the pain has gotten worst.  With my line of work I'm on my feet for 12 hours, and typically walking around the majority of the twelve hours.  After a week of work i am in a lot of pain.  I can't play sports anymore, and i used to really enjoy playing basketball and tennis.  Hiking is another passion of mine; however even though i still do it, i pay for it later, usually with a great deal of pain afterwards. 

Last June my right knee dislocated to a point much farther than it has even done before, and it was pretty hard to get back into place.  That dislocation landed me on crutches for a week, I've never had to be on crutches after a dislocation.  This was a bad one.  Every doctor has told me, once you dislocate it to a certain point it will always go to that point.  With how bad that dislocation was, along with the increasing pain I've been having, i gave up "living with this" and went on another quest to find a doctor who might have a better solution.

Thanks to a great coworker it didn't take me long to find a doctor.  She suggested someone several people in her family had gone to.  I made an appointment for this doctor, who took one look at me and said "I cant help you".  Awesome!  Not what i wanted to hear.  But he smiled and said he knew a better specialist in his orthopedic clinic who would be a great fit for me.  And he was right, as soon as i met the this doc, he knew exactly what needed to happen- and was so confident, i felt confident.  A couple months later i was on this journey to have a tibial tubercle osteotomy and MPFL replacement...or AKA: saw a nice big wedge out of my shin bone, slide it over and screw it down.  Then add a cadaver ligament to the inside of my knee by drilling three holes in my knee, two all the way through to the other side.  Sounds cool, right?

Here's a picture of the tibial tubercle osteotomy.