11. 6 weeks post -op , surgeon review

Well, I made it!! I made it to 6 weeks post-op MPFL and TTO.... HOORAAYY!!
I think i thought that 6 weeks was going to be the magic time to be back to pretty much normal. I would ditch the crutches, id be walking freely and driving kids to and from school like normal oohh and back to work.

                                              Week 1                                           Week 6

                                               The scar goes really purple when it is cold!

Don't get me wrong I am super excited as each day is a day closer to being back to my pre-operative functioning. BUT....
My expectations at this post op appointment where pretty simple, I like to have goals...
*Can I have the brace off...YES...woohoo i can finally have a full shower and not just wash the leg on its own with a washer, no more garbage bags...sweet
* Can I start physio...YES...great...this come with a two tone excitement as I had heard most people have a love / hate relationship with their physio- pain to get the gain but thats OK i want it to be better and i am more than happy to work for it.
* Can i come off crutches...NO...BOO! reason being i have to 'wake up' my quads as they have been wasting for 6 weeks due to inactivity. That is for my physio to help me with, lucky him. If i come off them too early i risk falling, instability and disappointment...patience
* Can i drive....Drs question ' can you guarantee your leg is going to respond quickly to brake hard and have fluid movement to and from accelerator to the brake pedal?' Unlucky for me although i have an automatic car my affected leg is my driving leg. Now he did say once you are confident off crutches generally you will be OK to drive. He suggested as we live rurally to drive up and down dirt road before i do any great trips. I would hate to cause an accident so i understand, it just doesn't make it any easier getting on with life..patience... I have been down our 2 car road to pick the kids up off the bus but i had to use two feet two pedal method was kinda funny!
*Can i go back to work...this was more a question surrounding do i have to go back to work haha! If I had a desk job I would be happy to go back. I am an emergency nurse and we are due to relocate into a bigger building so we are going from 15 bed department to 52 bed department. I'm not sure who is reading this but for people who have ever attended an emergency department there isn't many jobs that require us to be sitting, we have to walk quickly with purpose and poise haha!. Wearing a pedometer you can walk 10,000 steps in the first 4 hours and we do up to 12 hour shifts. We have to park and walk 2 blocks to the hospital up hill which was great exercise pre-op. As this is not workcover I want my knee to be where i feel comfortable before i go back and if that means more sick leave than so be it. My Dr suggested triage and although one of my favourite jobs in the department i dont think triaging with crutches is going to be OK. Dr wants to see me again in 6 weeks which will put me at 3month mark so I asked for a medical certificate until then and he abliged.

The Dr removed my brace and gave it a stretch sitting my heel on his knee and asked me to relax it into a straight position. Interesting I had thought with the brace on I was extending the leg into a straight position. OUCH! clearly not. Dr explained my last 30 deg has been blocked by the brace and it was now up to me to gain this back, lucky me. He then proceeded to bend my knee back under the the chair...ouch ouch ouch! so tight it feels like an elastic band is going to go PING. 'I am very happy with that! was his response to that movement so I guess if he is happy then I am too.
I still feel like the knee is very swollen ans feels warm to touch compared to the other knee, surgeon said to carry on! That i will...
I don't know exactly why but that first night sleeping without the brace was excruciatingly painful! I was quite excited to be without it as I thought i would have a great night sleep as i wouldn't have to chase the support pillow that i put between my leg all night (I toss and turn a bit) and i wouldnt have the weight of the brace to manouvre under sheets, blankets and doonas. I woke crying, actually not just crying sobbing! I couldn't even vaguely move my leg without wincing and trying not to squeal. I couldn't get comfortable. I had already taken panadol osteo and nurofen and wasn't due for more, so i asked my husband to get me an endone, i hadnt used narcotics since week one. I did have to laugh my husband who by all account has been very helpful brought 1 tissue for a crying woman, well better than none. Sleep didnt come easily but it did come and i woke feeling fine, so just a bad night. The leg feels like jelly kind of like the lower half of my leg isnt being controlled and its doing its own thing.
So off to make a physio appointment and get this knee moving!
Liss x


(15/8/2016)

10. pain/no pain/pain, trying to reduce crutches unsucessfully and the rubber band knee feeling at week 5

It is interesting the pain process that i have had. In my mind I assumed i would have acute surgical pain and then be back to  normal sore knee. I don't think anything could have prepared me for the initial post op pain but after that first 2 weeks the pain was really easily managed and each day within that two weeks you could tell each day you needed less.
As the wound healed it remained feeling sensitive if touched and i still remain with some numbness to the right hand side of the wound below my knee.
Weeks 3 and 4 the pain had reduced considerably and I think following my post op visit i still remained cautious about doing anything extra things so i was relatively pain free for these 2 weeks bar a bit of panadol. In these 2 weeks i also heard a clicking sound like when you stand and you've been stiff and something cracks. It didn't happen all the time but it could be heard by others.
Week 5 however i think i overdid it, and after i got home after a day out to watch a school singing concert my leg was aching and had big diverts where the brace was on all day. Sitting awkwardly in a chair with a partial bend in your leg that doesnt reach the floor...mmm not my best choice but i had kids to watch sing and beautifully they did. I had walked 2 days before on crutches to our main road which is 500mtrs down and back approx, the longest i have done since surgery.

 

The 2 big diverts where the brace sits on lower leg after a full day up on my leg...oops

The pain that has really hit this week (week 5) though, is like there is 2 rubber bands one below my patella and the other on my inner patella ready to go ping!!! They feel so tight you can feel the stretch and pull with each small movement. It feels like when you bring your knee passively into a bend position that it would spring it self straight back into a straight position if it was allowed! So i have had to go back onto regular panadol and i started naprosyn as i was having trouble tolerating the celebrex.
I remain dubious about steps and have been avoiding them when i go out as i feel like i am going to be a victim of the ground if i do. At home i am managing quite well as we have a railing which i hold onto and use the crutch under my other arm.
I became frustrated with the crutches and not being able to do simple tasks like get the butter out of the fridge to make the kids sandwiches and being able to put washing away in the cupboards, so i tried to go back to using one crutch whilst at home.
I think the key here is i made the decision myself and i should have respected that i was to be on crutches for 6 weeks. I would do ok for a while and could do what needed to be done and then all of a sudden in the middle of the kitchen i would have the oddest sensation of unsteadiness and the frozen i can't move my legs for fear of toppling over. This happened a few times and I realised i was not ready to be rid of my crutches just yet and that this process was going to take time. So i employed the kids unpaid of course and i now have helpers to get lunch ready, empty the dishwasher and set the table and i think this has been a great lesson for a 6 and 8 year old to recognise all the little things that a mum does that go kind of unnoticed because they are always done for them. I am very proud of this pair!
Week 5 also saw my first 'real bend' and i don't know if it was coincidence but it happened about 48hours after i started on naprosyn the new anti inflammatory for me. Sitting on a chair with a straight leg i could bring my leg into about 45deg and passively bring it in to sit and nearly a 90deg, although only for a short time but still my first bend really in 5 weeks!! A little progress, i took a photo, i dont really know how the numbers work on the brace but thought i would show you what it says.I can now fully straighten my leg, where this has been needing a small pillow underneath the knee to keep it up a little to be comfortable.

Brace a bit low in this pic ...(they are troublesome to keep in the right spot!) but i have bend!!

Maybe i could drive??
Maybe i should start some single leg raises??
Maybe i should just be patient!!
Maybe i should enjoy the fact i haven't had to go the grocery shop for 6 whole weeks, cause it aint going to last forever ...hahaha

Liss xx

9. Mishap with the cat,Tears and Stairs issues...week 3.5 not my week!

Well i should have known it wasn't all going to be roses and its amazing how one simple mishap can seemingly put you off track.
We have 2 outdoor cats , 1 is 15 years old, he scooted in the house at feed time and darted across in front of me. As i only had one of the crutches in my hand i over balanced, i felt myself bending at the hips and going down, my knee did a funny slooosh, i corrected but not quite enough. Both my hands went to the ground, my knee did another sloooosh feeling. So i was hands down, bum up with my daughter in the background saying 'mum what should i do?'. I didn't know i was stuck neither up nor down, couldn't get up, didn't want to go down on my knee/knees and i didn't know if it was hurt, it didn't feel hurt, so i slowly put my head up, pulled my core in and used my good hand to work my way up my leg holding on the crutch with the other. Few... i was up and all seemed OK, and that story became the first thing my daughter told everyone, mum fell over the cat. Never tripped over the cat before but suddenly things that werent obstacles before are now, lesson learnt.
3 days after this i noticed i was having trouble at the top of our stair case, we have 7 up to a platform then another 7 to the top and exiting/entering the one step out of the house. Over the weeks since surgery i have had this happen maybe 3 or four times mainly when going downwards with a feeling of 'give way' when i lift my good leg to bring it down.
Not thinking much of it, i carried on, realising i was struggling more and more until i just couldn't do it. my knee felt like it was just going to give way, so when the main weight was on the operated knee it would kind of push itself all the way back and then feel like it was going to keep me up. Unfortunately this meant when i got that feeling in my knee which i didnt want as it felt really awful, my good leg would start to shake and my arms would go to jelly. I was doing all my jobs upstairs of a morning so i didnt have to go back up and i was waiting for my husband to get home from late shift at work to help me up the steps to get to bed. Some days I could get up one or 2 steps and have no trouble going down, then others i could go up 4 and then struggled to go down, the pattern didnt make sense.
I started to think it was all in my head, it seemed really ridiculous that i had been doing stairs without any great issue the only difference the cat mishap. I had no issue walking on flat ground but unfortunately life gives you steps. So i thought i should contact the Dr. He wasn't concerned about the mishap, he said that is why he put the brace on so as the knee would only go from 20ext-90flex it wouldn't allow it to go any further than  he wanted. The stair issue he explained is a loss of quad strength because of the splint and that it is not an uncommon scenario. I felt much better that it wasn't in my head but i did feel i had lost a lot of confidence and i so didn't want to hurt the knee as i dont want to have to go through this all again...some kind of weird self preservation maybe.
Unfortunately i waited one night just a little long for my husband to come home, i wanted a shower which was upstairs, i got stuck 3 stairs from the top, couldn't go up couldn't go down, grasping onto the railing like i was going to fall to my death, ridiculous i know! I did those last 3 steps by dragging myself in the most awkward position, i don't know how i didn't hurt myself. I had just reached the bathroom door and my husband arrived home and was so excited i made it up the steps, my response wasn't nice, it wasn't his fault, I got myself into the shower and cried and cried, and repeated the why did i do this question. I am suprised i lasted this long, with all the things you cant do, that you could do before it is very frustrating to not be able to do what needs to be done! Tears dried up i needed to move forward as there is no way back, i am alot further ahead than i was in week 1.

This tided me over the weekend and i was struggling still into the beginning of the 4th week, I know i wasn't to start physio but i messaged my physio to ask his advice, He wanted to see me.
I got worried then i didnt want the physio to speak to my Dr as he had made it clear no physio, and like i said i like to follow the rules. I went to the physio for crutches support only ! I promise...
I'm really glad i went he took me up and down the step with canadian crutches then got me to use the normal underarm crutches and suprisingly the underarm crutches made a huge difference he did agree that you lose quad strength quickly but also thought it was mainly a confidence issue. The other part of my physio visit involved rearranging my splint, it didnt look right and had been slipping down heaps over the last week. Apparently this is common as the swelling recedes the braces need to be adjusted and whilst i tightened the straps there was more to it. When that brace was put back on my leg it was like an instant comfort, it felt way more secure and seemed to fit around the knee much better.
I stopped taking the celebrex again i just didnt seem to be able to stomach it, so am in the process of arranging the naprosyn to try it and see if that will help.

Enjoying a little sunshine on day 20

Wound Day 22

Liss x

8. first post -op visit

A little over 2 weeks and i'm off to see my surgeon for my first post-op visit. Back in the car for a 2 hour trip north to the hospital, i thought i might do a little shopping while we were up there.
Amazing how much longer things take to do when you are on crutches so by the time mum and I stopped in for some lunch along the way it was time to head to the surgery for review.
I got the all clear....well the all clear to do more but within limits! Meaning my Dr is very happy with my progress and i can do 'thing' as i wish but i will need to gauge things on how my knee is travelling so if its hurting stop. Yay!!! im happy with that. I mentioned all of the concerns i had spoken to the nurse about a few days before and an agreement that i needed to be patient with my recovery was made.
The Dr removed the brace and gave a straighten, a pull, push here and there and seemed happy with his handiwork. I was more guarded than i thought when this brace came off i didn't think i had much pain but i didnt want him touching it or moving it, i grasped the chair and was ready to jump. A bit of fiddling and the brace was back on....i have become friends with this brace and i have come to rely on it to keep me safe. my legs felt like jelly when i left the surgery!
No physio yet either the Dr explained that he was wanting all that had been done within the knee to heal properly before i started causing extra strain to it, made sense.
As i was leaving the Dr did comment once more on the amount of swelling and he thought perhaps i should try and go back on the celebrex as nurofen wasn't strong enough, so i will revisit it but i didnt like it. Dr mentioned another type of anti- inflammatory Naprosyn if i couldn't tolerate celebrex so we will see how i go.
So i was good to go, carry on, and see him again in 4 weeks, appointment booked!
The dressings could remain off now, the looks from my kids when they saw the scars was priceless...ewww i think was the main word.

Still alot of bruising day 18

scar is healing...

I have been using one crutch at times within the house so i can try and get some chores done, just simple things like sweeping the floor, putting clothes away, amazing how you can still stand at the ironing board and iron but i couldn't get the clothes up the stairs to put them away. So i am still asking for a lot of help.
Movement wise i still have very limited range of motion, when i sit, my leg still is out straight in front of me and walking it is like a straight leg lift up to the next position.
Showering i am managing well on my own but i still find i am having one when i know there is someone about, just in case.
I sent a letter to the bus driver to get him to let the kids off the bus without me. The kids are dropped to the end of our street, we are on a quiet dirt road about 400mtrs from main road. So with a lecture about bus safety i waited at our mailbox and waited for them to get off the bus, they did fine, I don't think you give the kids the credit that is due sometimes.
Football training my dad has picked Harry up and taken him to that 2 afternoons a week, and i think this has been a great bonding exercise for them as well.
So all my pre-op concerns were no longer concerns, it was all working out OK.
ohh the shopping after my post-op visit... didn't happen, i was exhausted!! maybe next visit...

Feeling so confident them Bam the 3 post-op week mishap and tears, it was bound to happen!

Liss x

7. Week 2 concern , boredom and kids on school holidays

Lucky my first week post -op coincided with 2 weeks of school holidays and my mum took the kids for the first week. No school lunches to make, no uniforms to be ironed or afternoon sport to be ferried to, however, you dont realise how much 'ducking about' you do with kids on school holidays, going to the skate park, movies or a trip to the beach to go fishing, when you cant drive or mobilise properly it makes it very 'boring' at home for kids for a week.
The bruising on my leg continued to shine and then decline, the pain had reduced considerably also but the swelling remains. I remained taking regular panadol anyway just to keep myself covered.
I developed a pain in my thigh which i woke with on day 10, it felt like a corked muscle as if i had strained it. I only noticed it when i did certain things so it didn't concern me greatly. I still had a lot of swelling in my foot and knee and was unable to feel a pulse, my foot was pink and warm so i wasn't concerned. I decided to ring and speak to the Drs nurse and told her of the above issues and was given reassurance that i had had extensive surgery and need to rest, ice, elevate and be patient with the healing process. I had an appt next week to see the Dr, so I continued on with my lounge chair gilmore girls back to back episodes and annoying people with my requests for coffee refills.
The intermittent thigh muscle pain lasted about 5 days.

Day 14                           Day 7

back of my knee           

Day 14                              Day 7

Inner side of my knee

At day 13 i was needing a little out of the house time so my mum took me in for a drive to the local coffee shop, I managed to manouvre into the car, crutches in tow. I was ready for real coffee.
Wearing the brace and crutches is a good indicator for people to steer clear and people are very helpful at offering to help. I managed to get up the curb guttering, i managed to fit my non bending leg under the table and OMG I enjoyed that coffee. It may have only been an hour out of the house but it was devine. I felt really proud i had accomplished an outing with no dramas.
As it was school holidays, I thought it would be a good idea to go to the movies, I was very uncomfortable in that chair after about 15 minutes and no position seemed right. It was a long 1 1/2 movie.
Both outings have given me a newfound appreciation for people who are permanently disabled. I have always taken for granted that i have been able to access anywhere i needed to go without assistance, I have never needed to look for disabled access to shops or buildings. It is always a longer way round for the disabled and there isn't always easy appropriate access. Whilst on crutches you are always thinking about the best and easiest way for you to get about.
In hindsight the movie wasn't the best idea but my kids had a ball and i owed them one for being so great this week at home not whinging about not being able to get out of the house themselves. Sometimes your mental health needs, need to be met also.

Back for my first post -op visit next week this should be interesting.
Liss xx

6. My first week post surgery

Being home is the best feeling but it also brings along with it the feeling like you should be doing something. I don't know but those cobwebs that have been there for months suddenly are necessary to be removed or the world will crash.
I was given instruction by the hospital physio i was to have minimal activation of my quads for the first 2 weeks after surgery. What exactly does that mean how does one tell the quads to not activate...ohhh right that means only doing the activities that are absolutely necessary for 2 weeks. So it was explained as movement from the bed to lounge to toilet privilidges only. OMG this is going to be a long 2 weeks.
As it turns out when you take a regime of pain medication there is very little you want to do apart from go from bed to lounge to toilet, As someone who is only used to panadol going to taking targin, endone, celebrex, gabapentin, aspirin and regular panadol knocked me for 6. I didn't like the way it made me feel, I felt sick, I couldn't string a sentence together, I couldn't read a book as I couldn't concentrate. I still had pain but only on movement, so sitting on the lounge with my leg up I was great and then I was asleep... again. I weaned myself pretty quickly (i think) off these and at day 6 I was only taking regular panadol and nurofen with an endone to go to bed. I felt so much better.

What did suprise me this week was the size and distribution of bruises over my leg. Now when i say leg i had knee surgery so i expected a bruised knee. As i had the brace I had taken little notice of the rest of the leg but there was massive swelling over the whole front of the knee and massive bruising mainly over the inner knee. There was also a bruise on my foot, ankle, a bruise on my inner calf and the back of my knee coupled with a large swollen foot.

Behind my knee

Swollen ankle with a touch of bruise...

I did a dressing change to the wounds at day 10, just to make sure they all looked OK and they did.
Showering was going great i was using the plastic chair in the shower if i needed to wash my hair- very important! My husband was very clever at the stickytape wrap on the top of the garbage bag over my leg and brace to keep it dry. You do realise though you lose alot of dignity when you need someone to help you get ready to shower, you have to be willing to let your saggy bits and post baby pouches to hang free without embarrassment. I did quickly realise a slip mat was needed, no near miss but when you shower after children there is soap everywhere left behind. I do like to follow the rules and i was told to leave the brace on at all times, I took it off to wipe my leg over with soap and washer as i couldn't leave 1 leg unwashed for 6 weeks. I didn't do this in the shower though and i maintained one hand grasped contact to the vanity at all times, i promise.
I didn't sleep well in the first week mainly because when you wanted to go on your side you had to physically lift the leg and position the pillow in between your legs. The pillow for comfort and pressure care as the brace put alot of pressure on the underleg. I also gained a sore lumbar back i think just the awkwardness of crutches and different sleeping positions, I did a bit of bed hopping to see if there was a more comfy bed in the house but the back pain settled after a couple of days.
Stairs havent been an issue i have been using one hand on the railing and one crutch with other arm.
I have little to no bend in my knee and i'm unable to straighten so does requires a pillow for support underneath at all times. It is early days and I'm hoping as the swelling recedes the movement will improve.

Wounds at day 10

Week 2 is better than week one but this is a slow process and the bruises get darker!

Liss xx

5. Discharged from hospital and heading home.

The big outer dressing was removed, the drain removed- that felt weird like a stingy pulling sensation but over quickly, the physio visited and applied a ROM brace.
A shower sitting on a chair with my leg in a plastic bag, i was feeling not to bad, still not right but determined to prove i could go home, except i couldn't eat and had had little to drink. I got myself dressed feeling pretty proud made my way with a tall four wheel walker frame to sit myself out in the chair.
As i still had that numbness feeling down my leg i didn't realise i was bleeding. I looked down and there was blood at my toes. Why is it you can never reach your nurse button when you need it! i made my way over to the bed dragged my new pj bottoms off that now had blood all over them and found the culprit, the drain site was oozing alot...pressure applied, nurse bell called, leg up ahhh the old clexane trick, blood thinners are great. Not only over my pj bottoms but also over the very expensive looking freshly applied ROM brace, ooh no. The nurses tried to clean it but the physios deemed it to be an infection control issue so would replace it in the morning.
In the morning! Dr and I agree best to stay another night to be sure to be sure, i guess being 2 hours from this hospital it is a good idea to be fairly confident prior to discharge.
My beautiful sister and husband visited and I remember this visit somewhat better than their first but i still say sorry as my eyes didn't want to stay open.
As we live on the farm my husband headed home to the kids and animals and would return to pick me up tomorrow...yay...i hope!
The physio returned and took me for a walk for the first time with canadian crutches, the ones that have a support just below your elbows.
The Stair Challenge...3 stairs up 3 stairs down and repeat ....as the physio chatted away about children and work i didn't realise, i had passed.... up and down yay yay yay!! with no issues.
I have a 2 story house, bedrooms and bathroom upstairs, 1 toilet downstairs, a step into the back of the house and a few steps to the front. So i needed to be able to do steps!
I must say when the dressing came off  i was suprised to see such a great incision site. When the Dr visited he said it had been very extensive and he had some pictures to show me at my post op visit. I don't mind the scar, that will fade but it actually gave me a better understanding as to why i had so much pain. I had watched plenty of MPFL and TTO videos on utube and I shouldn't have been suprised the amount of work that was done in that old knee of mine, it wasn't going to be happy for a while.
As i settle in for another night i am pleased to say it was a much more pleasant experience than the night before and as the sun rose that morning i did feel confident about going home. I was up showered, nibbling on breakfast, a big bag of discharge medications and waiting for my husband to pick me up.
The 2 hours trip home in the car was pretty uneventful and i made my way into the house with ease, i was doing OK. I settled in to start watching some videos my sister had kindly sent home and netflix was set up.
Relying on other people is hard when you are so independent, how do you carry your cup of coffee over to the lounge room when you are on crutches?? Its the simple things that you take for granted.
Learning to ask without being annoying, there has to be a way. Watching everything going on around you and not being able to help is difficult.
Where was that bag of discharge medication i was needing them, sleep came easily that first night at home. I slept on the lounge and with pillows between my legs i could prop myself up onto my side and rest my back into the back of the lounge. It isnt restful sleep as when you roll from side to your back and vice versa you have to wake and physically lift the leg, which seems to be a dead weight.
I have asked my husband to attach one of the shower heads that are on cord that you can hold onto and asked him to bring in a plastic chair for me to sit on, looking forward to my first shower at home in the morning, just have to get up the steps!

My first look at my knee without the bandages on.

Finally enjoying a cuppa before my husband picked me up to take me home :-)