Day 80: Smashing through the boundaries

Lunacy has found me
Cannot stop the battery
Pounding out aggression
Turns into obsession
Cannot kill the battery
Cannot kill the family
Battery is found in me
Battery

After the weekend off, I went to Highschool Rugby practice and helped coach. I managed to hang in with the youngins during the sprints.

I then went lifting. I decided to try my luck at the squat machine again. I started with 320.

320x10x2.
340x10x2.

Both were rather uneventful. Lift off was a struggle for both. I usually do 0->90 or my leg press but I have the set at maybe 80. So the first 10 degrees are a bit of a struggle. I can definitely say that most of my atrophy has gone. Visually there's no difference (I really need to get my camera into the gym for doing these reps).

Then I decided to do a full 360. Changed the iPod to Battery, my power lifting song (more specifically Battery as performed by the San Francisco Orchestra and Metallica [0]). Got on the machine and did some slow breathing during the intro. Then up. Take off felt like forever and almost felt like I was moving against a stone wall. Everything was going good through rep #7 when my knee locked straight. Reflex took over and I contracted it and dropped all the weights. I finished the set and #8 take off was more difficult than the first.

Then a 'simple' 360x10 on the left leg.

I think I broke some blood vessels in my pecs holding on to the hand grips on the last set. I was dead tired (as if I had just sprinted) and couldn't immediately stand without feeling light headed. Surprising from an anatomical point of view how much O2 had to have been carried and how hard my heart was pumping to get it there just for a simple set of 10 leg presses.
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Gotta love the doctor. I went in for my thumb.
10 minutes - Driving to doctor
10 minutes - Waiting and filling out a form (apparently my allergies may have changed since I had an ACL done at the same place)
10 minutes - Waiting for X-Rays & Doctor
30 seconds - Doctor grabbing my thumb, "Yep, you did something to it, lets schedule an MRI"
10 minutis - Driving back to work.

I should have just scheduled an MRI from the beginning. Although to be fair to the office I saw the sheet of appointments ranging from "Wrist pain" to "Something hurts in hand." I think I was the only one to walk into him and told him what I did.

MRI tomorrow determines if it's a just a cast or surgery and a cast.
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[0]. Battery, as performed by the San Francisco Orchestra and Metallica.

[1]. Hall of the Mountain King, as performed by Apocalyptica. My other 'power' song. Typically I use it more when running to set a quick pace or for trying to punch out reps. I have other stuff on my iPod, but these two seem to get played more than anything else.

Day 74: One Ligament to Another

So at the SIU Carbondale Rugby Tournament I managed to tear another CL, my ulnar collateral ligament (UCL). ACL held up most excellently. According to the team captain I was a tackling machine. Knee felt great through it all, i completely forgot about being only 10 weeks out. Managed to smash the other one into the ground. Currently it's bigger than my right knee.


I don't remember tearing it during the game, but I don't remember tearing it at the social either. Currently my thumb does this awesome trick.


I have an appointment next Monday, but given that I can barely tie my shoes without the joint almost coming out of place (Think of a Mini ACL and the knee) it looks like I'm headed for another 3-6 weeks of a cast/splint and then another 3-6 weeks after that in a soft cast. Good news is I've almost hit my MooP for insurance so this one should be free.


SKIERS THUMB

Day 67: Size doesn't matter.

One of the metrics which I just thought about and wish I had recorded was the circumference of my thy. It's measurable, easily obtainable and it would definitely show a trend towards atrophy, etc.

Even though it's a bit too late to keep record now, I decided to break out the cloth tape measure and see what I was. The doctor was right. My right (surgery) leg was larger.

24.5-24.75 vs 24-24.25. I tried taking the measurement at the same place and apply the same amount of tension. I repeated it a few times until I settled on those measurements.

When I went to Google to determine how I was doing I was suprised at the lack of information. They have chest and bicep sizes for weightlifters, but not leg. I did find this USE AND MISUSE OF THE TAPE-MEASURE AS A MEANS OF ASSESSING MUSCLE STRENGTH AND POWER. Which I believe, I know my right leg isn't up to 100% par with my left. I just wish I measured the entire time so that I'd know what it was doing the whole time. Especially when there was atrophy that people commented on in the early weeks.

While I had the tape measure out curiosity got the best of me... and should I ever need a manzier/bro I'm a 42B.

Day 65: For he to-day that sheds his blood with me shall be my brother

Disclaimer: I am not a doctor, a physical therapist, a trainer or licensed in anyway as a medical professional. More specifically I am not YOUR doctor, physical therapist or trainer. This is just my blog, not advice.

This weekend was Nashbash 27 a massive Rugby tournament in Nashville, TN. I was in Louisville for work and my brother was playing for Purdue and... you can't get away from this sport. And as my dad always said, "You can't play if you don't bring your stuff." I packed the car and went.

Despite some bad Plantar Fasciitis from St Patty's day. And walking around all day at a Truck Show certainly didn't help a single thing.

I watched a few games and made the decision to play. I warmed up by doing some child's pose in yoga. Bending the knees fully, plyometrics, and shuffling. Everything felt solid. For mental assurance I put a wrap on it (you can't wear any hard braces in Rugby).

I went around to a few teams and finally found one that short of subs. Saint Louis Royals showed up with 16. I went in about 10 minutes into the second half and ended up playing around 20-25 minutes. I was put out on the wing where I couldn't do too much. I only touched the ball twice and I don't think made any tackles.

And then we drank and then it rained. And it rained some more and we drank some more. All said the 200 people that were left because the rain was too wet floated 32 kegs in a little over 2 hours. And there was dancing, and slip and slides, and there were zulus and singing. And it was a Rugby Social. Comparable to no sport I've ever played, seen, heard even heard of.

Sunday I got in about the same amount. Except I went in at Flyhalf, many many rookie mistakes from just being out of touch with the position (I haven't played it in over a year and I really don't like it either.) Made a few tackles, made a few runs. Sprinting, turning, running, after about 10 minutes in and being caked with mud I forgot all about my knee. I was still a bit guarded going into tackles and avoiding taking them when possible.

Today I woke up sore, sore everywhere except for my knee. My thy was bruised, my pinkie toe was stepped on, my shoulders ached, my hands were stiff and my quads were tight everything I'd expect from a game of rugby except neither knee bothered me.

I was out of shape. Walking way more than I should have been. I shied away from some tackles I would have taken or made previously, but as I've said before, now it's all mental. Convincing your brain that your knee can handle something after being on crutches for .. well 2 days is hard to do.

Today in the gym with the silence of everyone else lifting I had some extra motivation. On leg press it was:
260x10, 280x10, 300x10, per leg. Now don't go comparing this to yours because the 'gearing' on this one I think is a bit different. But the last set, the set of 300, on my right leg I was taking pauses everyone after 6. The sweat started down my face about 7.

When I stretched between each set (Lat machines are excellent stretching devices. Set the knee pad to the highest setting and hold on to the top (after selecting a weight >= your own)) my quads were the tightest part of my body no longer my knee.

Thanks again St. Louis Royals!

Day 48: Week 12 er how long has it been?

Hit the gym last night:
220x10, 240x10, 260x10,

480x10 (last set on 'old' press)

'New' incline style leg press.

Shuttle + 8x45s so I'm going to call the Shuttle 45 and say 405.

Then 2 more 25s to make 455.

Unlike the other one, you need to almost lock out to lock the bars. Unlike where if you 'fail' you come back to starting. I tested it on an empty one to see if I'd crush my self if I failed out part way through. It wouldn't be comfortable but I wouldn't die (good engineering). The final set wasn't the quickest I've ever done but they got done. I'd say a good set of leg presses is one of the most exhausting lifts ever. Dripping with sweat, trying to catch my breath, I tried to stand up a bit too quickly and had to immediately sit back down.
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Today I had doctor follow up #3. Except I didn't even get the doctor at first. I got some assistant. (Which I would have paid full doctor prices for either way. If I'm paying for the doctor send me the damn doctor.)

He has me lay down:
Him: "Flex, ok, flex the other one." Looks at chart. Which one was it again?
Me: "The right one, the one with the most recent scar"
Him: "Oh, Well I'd almost say that it looks bigger. Lets see about flexion."
Me: Flex both to about 150ish
Him: "Well, that looks excellent. I'd say I'd go ahead and give you a full clearance, you're what 12 weeks or so out?"
Me: (Read the damn chart). "Um, tomorrow is 7 weeks."
Him: "Oh. Well, I really don't know what to do, lets wait for the doctor."

So I get to wait around for another 10. Doctor repeats everything above. I get the spiel on how my knee may feel very strong but the ACL is actually at the weakest point. Because when I got my graft it was full of blood tissue (I didn't even care to remind him again* that this was an allograft). Cleared to 'run'. No sprinting. No cutting or anything that involves cutting (Rugby).

*He's not to bad of a doctor but his perceived memory of who his patients are and his bedside manner suck. I know every single time I've been in there he's asked me who did the knee before me and I know that we've had a 30 minute conversation our first meeting that it was Dr. Shelbourne.

Day 46. Weight limit exceeded

Well after taking Friday->Sunday off for travel. I made it back to the gym. Since I'm on a diet I decided to hit the bike for 70 minutes tonight. iPod + TV Shows = best way to pass time, plus I never have to fight for TV space or watch commercials. (I use rtorrent, pytvshows, & mp4ize if anyone is interested).

A combination of it being 4 days since my last leg lift, I was feeling great, I had a long day at work, and I just wanted to push my limits lead me to start off at 220 lbs. Per leg.

220x10, 240x10, 260x10 then 440x10,480x10,495x12. And that's all the more the machine has. It does look like I'm going to have to move to the sled where I'm going to have to rack all the weights by my lazy self.

I'm definitely gaining some tone back in my right leg. Actually I'm adding tone in both legs. This is definitely leaps and bounds beyond both previous surgeries. Hitting the gym early is the only reason. Even before I had full flexion back I was working on strength. While I've heard one before the other, I think they go hand in hand. I've gotten my best flexion stretches after doing leg press.

Unfortunately my camera, flash and skin don't exactly show this off the best...

Day 42. Week 6.

Last night I pushed the limits of what I could do, with both legs. I ran my last set of leg presses to failure. In much the same manner as before individual legs than both.

180x10
200x10
220x10

400x10
420x10
460x10 (to see if my legs are more than the sum of their parts).

I haven't attempted running yet, but I'm still biking like I used to. Although I would have to say that I've been ready to run for 2 weeks.

Knee feels strong, when I put my hand on it there is just a slight bit more 'noise' than my left. If I've been sitting for a long time the first time I straighten my knee there's a slight pop coming from under the knee cap, sounds/feels about like cracking a knuckle.

If I stand with my knees locked for a while, when I continue walking something medial will 'catch'. Not painful just feels really awkward.

Day 39. Status Quo

More of the same. Stretching and lifting. Tonight I did 60 minutes on the bike on level 10. I didn't get as far as normal because my legs were exhausted and the last few days of my diet have been high in protein and not so much carbs. So RPM was around 60-80 rather than 100+ like Sunday.

Although the long term energy stores weren't there, I had plenty in me for leg press. Which I did like I have been: 3 sets of 10 on each leg then 3 sets of 10 combined.
160x10
180x10
200x10

380x10
400x10
420x10

After which my right leg felt amazing. I was stretching between each set on the combined and I could get both legs equally as far up in flexion. To stretch my PT suggested that I go up against a table and rest my leg on it then sit back rather than grabbing my ankle and pulling. I was doing this but against the arm curl machine (the leather than you rest your arms over). I was getting a nice deep lean into into it. Everything feels great for 5.5 weeks. Atrophy is nil.

1st surgery: I was about at this level. I remember being amazed that I was cleared to run at 5 weeks, however I was pushing myself to make senior track season.
2nd surgery: Recovery, flexibility started great out of the gate but stagnated around this time because well, I had nothing to work for. I was going to take a whole year off Rugby and I was in the middle of school.
3rd: I seem to be combining the best of both.

A tip for everyone:
Atrophy is horrible. I'd have to say that I'd rank atrophy above flexion as the worst thing that could happen to an athlete trying to return. Even if you steadily work on it your flexion will return, it's a slow process as is. But once you lose that muscle, it's gone and it's not going to come back over night. Now obviously one has to precede the other, you're not going to stop that atrophy if you can't bend your leg to 90 degrees.

What is atrophy? It's when you start losing your muscle due to inactivity. Even if you don't actively lift your legs do. Imagine every step as a short rep of your body weight. A football field would be 50 reps per leg of what ever you weigh. Now imagine completely stopping that.

What did atrophy feel like? Guys, grab your favorite lady friend. Ladies you already have two simulation atrophy legs. Yes, I'm serious. That's what it felt like. Subcutaneous fat on the stomach doesn't have the right 'texture'. Grab your thy and 'jiggle it' with your quads loosened. With atrophy you can try as hard as you want to tighten those quads, but it still jiggles a little bit.

Get Flexion Back.
Stop Strength Loss.

Day 38. Double Dutch

Years ago in freshmen wrestling we had to do 500 jumps before we could even begin to warm up.

The first week was painful. Flip rope over. Step over Rope. Flip rope over. Step over Rope. Flip rope over. Repeat to 500.

I steadily improved until 500 was either a 1 or 2 series set of jumps.
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I recently found my jump rope after unpacking in my new house. I used it for my CryoCuff lift, but it was too elastic.

I recently started taking it back to the gym. I've been doing a few hundred a day in the 'activity room' of the gym (before attempting my yoga headstands.)

I've been warming up with typical jumping, but I've been doing at least 50 a day, consecutively, on only my right leg. It feels just as strong and as tight as my left.

A metric that I didn't think of recording was atrophy using a cloth ruler. (And here's to hoping I don't ever get the chance to find out). At 2-3 weeks under full quad tightening I could still pinch off a bit more off of my right leg than my left. Tonight before yoga I did a full quad tightening (by tightening everything I could and then lifting my heel 1/4" off the ground) and I honestly couldn't tell a difference between my left and my right. Meaning all 'atrophied' material must have been reabsorbed into my body or turned back into muscle. I'll have to dig it out later and measure the difference in size to see if it's just tone or if it actually regained everything I lost. Given how well I'm doing on leg press I'm hoping it's the latter.

40 minutes on the bike today.

Day 35: 5 full weeks.

Today was another leg day at the gym. Only 20 minutes on the bike, mainly because I was tired. Which is probably my own fault I came home dead tired from the gym last night and passed out, missing dinner and consequently I only had 1130 Calories for the day. Every night this week I've done 40-45 minutes on the bike or elliptical.

My left leg is definitely stronger, but only because it feels more steady and sure of itself when I lift.

Each leg individually:
160x10.
180x10.
200x10.

Then a group effort:
380x10
400x10
420x10

Much more and I'm going to have to move over to the sled...

Day 33.

Another day at the gym. This week I've been doing 40 minutes on bike or elliptical.

I've been doing legs every other day. I've been doing equal weights with each leg to keep them even, even so my right leg is only slightly behind my left leg. It's just a bit more difficult, but not by much.

140x10
160x10
180x10

Then I decided to do a group effort and see if I could be better than the sum of my parts.
340x10
360x10
380x10

Knee is just a bit stiff. Tonight at Yoga I had near full flexion. Kneeling on it wasn't too difficult nor were any positions.

Day 27. PT Redux

I went in for my 4th and final PT session today. I've been going once a week just to sort of keep tabs on how I'm doing, but now that I've joined a gym it feels like a waste of time. Especially considering each PT visit is $250 ($50 after Insurance) and a the gym is $25 per month. The choice was easy.

I did find out that all leg presses are not created equal. The PT one must have different 'gearing' because I did: 100x10,100x15,115x15,130x15 and they felt much much more difficult than the 130 at the gym. I didn't do legs tonight but I'm going to guess that the 130 was closer to a 150 or 160 at the gym.

Then some leg curls, where I definitely am lacking a bit. I still can't do much and less than 50% of my left knee.

Then on the calf raise shuttle I maxed it out at 7 bands. And then finished up with 10 lb leg extension with the knee bent over something.

Official measurements for the day: 145 right vs 150 left. I also wasn't given any warmup just went into the flexion.

Some Lachman and other tests concluded what will be my last PT session.

I then had a follow up doctors visit at which point he just looked at it and said 'looks fine'. I'm sure that one was in the $300 range. 10 minutes too.

Day 25. Heavy Lifting.

I hit the gym tonight and did my usual aerobic warm-up in front of the TV. Then did some stretches on my knee and found a Yoga mat and went down into child's pose. Rested for a few seconds came back up and went down a few more times.

Since I haven't taken a break from my upper body and it's been since Sunday that I worked on my leg, I decided to do legs today. The last time I did leg press was Sunday, but given that it was a day after rock climbing I think I over did it.

I moved from the incline rack with the loose weights to the other side of the gym to the one with the pin and all the weights already attached. I started out very easy:

Left: 60x10.
Right: 120x10.
Ok. That was too easy.

Left: 80x15
Right: 140x20
Ok. Still too easy. My knee has warmed up very well (I'm working out in sweat pants).

Left: 100x15
Right: 140x30
This can't be right less than a month out and this is too easy.

Left: 120x14.
rest.
Left: 140x20.

I got off of that machine and felt amazing. Grabbed my ankle and did a full flexion - heal of my shoe. Rest of the day I felt great (and still do). Between every set of things I did for the rest of the night I would either go down into Child's pose or just standing hamstring stretch. On the way home I think my left knee may have been aching a bit more due to the weather.

As soon as I got home and showered I got ice on it to keep any swelling down. Unlike last night where I just made contact, tonight I actually got my heel indented my butt. Not quite as far as my left leg, but it's definitely close.

Day 24. Down in a Yoga like position.

2/15:
40 minutes of bike riding while watching Law & Order. No leg workout but I did stretch during my upper body lift. Got my heel to touch my ass for the first time in 3 weeks. 3 weeks to the day much better than the last 2. (To be fair, I wasn't trying the 2nd time)

2/17: 40 minutes of running forwards and backwards in the water with rugby. Then to the gym for 20 minutes of the bike and then leg press and curls and regular upper body. Pushed my knee to a bout the limit. It's stiff and there's a bit of pain below the incision when moving.

2/18: Yoga tonight. Was able to do child pose and pigeon on both knees.
http://www.sissel-online.com/exercise/yoga_pigeon.php




http://www.abc-of-yoga.com/yogapractice/childpose.asp


Bit of numbness when kneeling. Not too much pain. Slight amount of pain when biking, but on the knee isn't caching. I gets close but it just passes.

Day 22. Upper Limit

What better way to promote a quick recovery than rock climbing. I had been invited by some co-workers to go rock climbing and thought I'd give it a shot.

We went to the Upper Limits climbing "gym" in Bloomington, IL. After abysmally failing the belay test (it's been at least 10 years since I last belayed) we go to climb. My knee was feeling pretty good. The only thing I couldn't do is some weird bending of the knee. Other than that it was no different than climbing stairs.

The only time I had climbed in the past was in boy scouts and a few of those portable towers. All were designed to be climbed by anyone. This place was not. I made 2 full silo ascents on 5.7 and 5.8s. I climbed an auto belay 5-6 more times. I attempted to go as high as I could on the 5.9 route but gave up (or fell). I much enjoyed the bouldering 'cave' better. Lots of grips everywhere but it still tested your upper and lower body strength and if you fell it was no more than 4'.

My knee was a bit stiff afterwards but nothing more than usual. Felt great to get out and get a workout.

Day 20. Gym!

Joined a gym on 2/10.
Day 1 leg press and leg curls. No weight on the leg press, but it was the inline type.

Tuesday PT: same as week 2 but bike for 5:00. No more leg workouts at gym until Thursday. (Every other day). Knee continually makes improvements. Still some minor flexibility on flexion almost to equivalent to left leg.

Wednesday went to Yoga. Could not do exercises requiring sitting on the ankles. Everything else the knee held up.

Thursday: leg press, worked up to a 25lb weight (in addition to the weight of the shuttle). Leg curls. Everything feels good, no pain, just no muscle. There is a sitting leg press that I will switch to next time I'm there. I won't have to rack my own weights and it's oriented such that I can do some low weights on it and it goes up to 495 lbs.

M, T, Th: 20 minutes of bike riding. W, 20 minutes of elliptical.

Day 11. PT #2.

Today was my second round of physical therapy. The PTist said that I was doing excellent. 130 degrees without any assistance or towel to pull me along. We started on the weight lifting today. Here's what I did:
3 sets of 20 leg extensions (with my knee oven a 'thing') with 7.5lb weight
3 sets of 20 leg lifts with a 2 lb weight
2 sets of 20 leg curls with ~40 lbs
3 sets of 20 on the 'shuttle' leg press on a medium difficulty.
3 sets of 20 calf raises

I've been given strict instructions not to do leg extensions and to do squats instead (Wall squats). I've also been cleared for elliptical and bike.

Afterwards everything felt great and I was walking probably the best since I walked into surgery. As soon as I went back to my desk and sat down everything stiffened up again.

Speaking of which, yesterday was my first day back at work. I'm at a desk 90% of the time, but getting up and walking I could tell my walk was getting progressively worse. If I went down to a test cell I had to sit down otherwise the swelling / throbbing was just too much. I think 10-15 minutes is my limit for being on my feet. Having my leg below my heart is enough.

Day 9. Homo erectus.

Last night was the Peoria RFC Banquet. I was up for a good portion of the night. I could only be up and mobile for 20 minutes at a time. I made it to the banquet sans crutches and canes. It was held in a bar/reception area. I'd walk around and be social then have to sit down once the swelling and throbbing started. But the whole night my knee was below my heart. By the end of the night I was cheating with my walking (even though I was trying not to) and using a flat foot. Came home and now having a bit of difficulty getting to straight. Lag has shown back up in leg lifts.

Today I went to Rugby training at the YWCA. They have a wonderful oval pool designed for fitness. It's 4' deep the entire round of the pool. They have a current generator, but it was broken. But if you toss 10 rugby players into a pool and have them all walk in one direction it gives plenty of current. The weightlessness was excellent and allowed me to practice walking proper. I even got up to a slight jogging pace in the water. I got my knee forced straight, going both forwards and backwards. I've made up my mind that I will not atrophy like my first surgery, especially since I am going to try and return to sports as soon as possible.

Afterwards I felt like I was walking better and without cheating.

Day 8: Status Quo

Much more of the same. Last two nights I slept with no ice, no compression nor elevation. My body seems to be past the peak to where my body can handle all the swelling on its own. I am still icing for bruising and swelling.

I do seem to have hit a limit with flexion. Not a pain limit but a physical stop. Once I hit a certain degree it just stops. I've moved past using the towels for flexion stretches and I'm now rocking up on the balls of my feet and manipulating my hips to bend my knee even more. But it just seems to 'stop' where it wants to.

Day 6: What say you Doc?

Cryocuff on the skin over night worked great. I woke up with much less swelling and it felt great. Should this happen again I think I'm going to get 10' of clear flexible piping from Lowes and just wrap it directly on the skin tightly and then use a fish tank pump.

First doctor's visit: The blisters are 'tape blisters' and occasionally happen. The bruising also 'just happens'. I also got follow up X-Rays. There's also an extra 'piece' of twisted metal above one of the screws that has me concerned. The Shellbourne method seems the safest for re-tears rather than backing out screws and putting in a larger one each time.

0-110 degrees is without restriction or pain.
0-90 under my own power. Just feels like my knee is full of a viscous fluid (imagine that). Sort of like running under water.

Day 5.

I woke up with with drymouth, even though by time I went to bed (5 am) all the affects seemingly wore off.

My leg is a bit stiff, no cryocuff at night. 0-90 with no effort under its own power.

There's bruising on the shin which doesn't make any sense. This is probably the largest source of pain today. I took the best pictures of the bruising during week 2. My CanonSD550 has a feature where you can 'highlight' a color:


I also did one in Photoshop:


I took the TED off and then passed out in a nap. It was a huge mistake. My knee is extremely swollen and throbbing. It's extremely painful to walk on it now. I feel like I undid 5 days of PT by not doing RICE.... however.

I finally did get around to PT and it felt great. I applied the cryo-cuff directly without the TED and I even flipped it upside down so the bulk of the thermal mass was over where it hurt the most:

and it feels ... amazing. Thankfully I didn't undo all my previous days work.

Rearranged the room (yet again) so that changing the water can happen quickly. I took the hinges off the closet and put the fold out couch 'in' it so that I could sit up against the wall when I was awake and have easy access to my cryocuff. I've been changing it out almost every 30 minutes.




After 3 hours of Cryo-Cuff treatment directly on the skin I stood up and didn't feel an immediate rush of blood to my knee.

I also now have full hyper extension under its own power ...

and around 125-135 (According to photoshop)...

Day 4. Fear & Loathing in Peoria

I woke up extremely stiff. Last night I decided to sleep with out the cryocuff. The TED is quite tight. Stiff movement in walking is getting a bit easier, as is getting to 0 degrees.

First round of PT for the day I could barely get 90, after that the knee loosened up and I was able to get more. 127 according to the measure tool in Photoshop and this photograph:


I'm able to get every other leg lift with no lag, but it's extremely taxing. The quad is starting to respond and I'm even getting the 'ridge' muscle no the top.

I've rearranged the room again.


Stretching is done for the day. I haven't had any Oxycotin in 2 days so I decided to take twice the recommended dosage to see what the hype about... which is absolutely nothing. Dry mouth is about the 'best' side effect. Another one was itching, which explains what was going on the first few days after surgery. I thought it was laying on the floor/not showering. Turns out it was the Oxycotin. The whole 'high' lasted probably an hour and was more or less ... useless. Alcohol's cheaper and legal. I think I'll stick with that for now.

Day 3. PT #1

No pain when I woke up. I can get 5-10 with ease and lifting my leg is quite easy. Walking unassisted feels great also. My extended sleep must have put by body into super repair mode as everything feels relatively great.

I can get 0-45 under my own power. Further if I push it. I no longer have to rely on the crutches trick to stand up.

It's a big day, my first day of PT.

Driving isn't too bad. Occasionally I'll just use my left foot for brake so that I don't have to move my right leg over. It makes for some interesting stops.

First thing I got yelled at for was my walking. Although I'm walking w/o crutches, my form leaves much to be desired. I'm 'clomping' when I walk. Meaning I just keep my leg at 5-10 degrees and drag it along and place it. What I need to be working on is heel-toe, heel-toe.

Official measurement is 85 degrees but I only got one run, no chance to warm up and I didn't get to use a towel. Leg goes completely straight. Dr. Gibbons is not a fan of hyper extension so i shouldn't be pushing it, just getting it straight is the goal.

My leg lifts are ok but not perfect. There is a small lag in between when I lift my leg and when my calf comes off of the ground. Meaning I'm not getting any quad engagement from 0-3 degrees, it's only once the leg is off the ground does my quad kick in and lift the lower leg.

A condition which I've never had before surfaced today when I changed the bandages: blisters. Supposedly what happens is they attach the tape when I'm nice and unswollen. As my knee swells the tape pulls on the surface of the skin and creates blisters. I trimmed the tape back and put some gauze/antiseptic on it.



As I was practicing flexion for the rest of the day I managed to make it pretty far:

Day 2. Progress

The knee was rather stiff when I woke up. I had 4 aspirin and now the pain seems to be down a little. Flexibility is up quite a bit. I'm walking on the leg now with some assistance from the crutches.

While I didn't get any instructions for PT (rather I was just told to come in next Tuesday) I decided to start on my own PT regime loosely following what Dr. Shelbourne had me doing after surgery number 2. While I'm not doing it as often, I am doing it maybe 3-4 times a day. I'm doing towel stretches, leg lifts and quad tightening.

Right now I'm almost up to 90*.


As with almost everything through Week 2. Infinitely better than #1 and slightly worse than #2.
Swelling is under good control:

I did find a good use for my plethora of Cactus cups. They make excellent ice containers. They also last much longer than just cubed ice. I have about 6 in rotation in the freezer so I can get a solid one.



One trick I've found to the CryoCuff to get the longest amount of time out of it: Fill the container with water and attach the Cuff (while it's off your body). Lift up the cooler as high as you can to fill the Cuff completely full. Disconnect and drain out all excess water. Fill the cooler with as much ice as you can and still close the lid. Now drain all the water back into the cooler and put the cuff on. You should have minimal have any 'extra' water now in the container.
(This may not work if you use the Auto Chill)
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Transitioning from laying to standing is the worst. You can feel all the blood rushing to your knee and the pain just goes right up. After about 3-4 minutes when the body adjusts to you standing the pain goes away and everything feels fine.

I'd say that I'm 80% weight bearing. I haven't had any drugs since I woke up, but took more ibuprofens to control swelling.

Day 1. Status Update

My sleep schedule is completely erratic. Due to a number of reasons: I pulled an all nighter the night before the surgery. I'm still a night owl my 'unrestricted' my sleep schedule is 4:00 am - 11 am. Drugs. Lots of Drugs.

I woke up at 3:00 after falling asleep right after my previous day's drugs. I feel completely wide awake. I change out my water and put on some TV. The leg block is still at about 50%. Feeling is returning and I have some movement, but it still is numbed up.

I slept from about 6 am until about 10. Had 4 ibuprofens and 2 Oxycotins at 11 am. The leg block is down to 25%.

I unwrapped the bandages and removed a ton of gauze. Everytime I changed the water out in the CryoCuff I barely felt anything. I figured out why, there was a good 3/4" of insulation between the CryoCuff and my Skin. I removed most of it and put the CryoCuff as close to my skin as possible for maximum cooling.

I have no pain in my quads or in the front of my knee, I'm guessing most probably due to the fact that I didn't have a patellar tendon extracted. Quad tightening is going well. Still not much definition, but I can feel the muscle on the verge of forming.

Walking is about 20% weight bearing I hope to be on the cane by Monday.

5:30pm I had 3 Oxycotins with dinner. They just make me weird sleepy. Just seems to induce narcolepcy. Eyes lose focus of the computer screen and nod off, I've woken up with pages of one letter. However you can tell when they wear off.

Around 10 pm the sides back and inner front of my knee started throbbing. I changed out the CryoCuff water since it had gotten warm and took a few more ibuprofen. (I'm done with the Oxycotins). The block has worn off 100% by now, so I can feel my hand touching my knee, etc. I decided to get some chilling on my knee so I un wrapped it completely and applied a bag of ice to it directly.
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There's still a bit of bleeding:
but for the most part everything is in place.

Swelling isn't too severe. Remember Swelling = Decreased ROM. I'm on my back 23 hours a day and the CryoCuff is on 24.


I have about 40-45 degrees ROM. No weight bearing (all the weight is going through my crutches).

Day 0: Under the Knife

I pulled an all nighter just because of nerves and to help me sleep better afterwards. I took my last shower for a while and ince I didn't feel like having a nurse do a hack job at it I got my prepped. I marked on the opposite leg with a big X and "NO".


This is my 3rd ACL surgery and the 5th time I've gone under. I'm no stranger to the whole process. I showed up in some XL fleece pants from Old Navy (with NO ankle cuff) and a T-shirt/Sweatshirt. My mom had my crutches. They allowed me to bring my old Cryo-Cuff from surgery 2.

Definitely check with your doctor/hospital if they'll allow you to bring your own Cryo-Cuff. You can definitely get them for cheaper on eBay. My parents took care of the insurance for #1 and #2, but I can't imagine that they cost anything less than $200. (Like the $150 pair of crutches that an ER tried to charge me once). I have 2 pair of crutches that I got at Good Will for $6 and the second pair for $3 (they were half off).

I got in around 9:30 for pre-registration. I got in by 10. Then the waiting game. I got into a special big mobile lazy-boy chair. IV in (I can't stand watching needles). Oxygen the whole 9 yards.

One thing that was different was the IV block. Both previous surgeries I was under before the blocks went in. Peoria Center for Health likes to run things like a methodical factory. Right down to the LCD with upto the minute status updates on where I am...

Anyway, I asked for a block. #1 I had a spinal block and they over did it. It felt like I was sitting on Jello until at least midnight. #2 had a leg block that was done proper. This time I got another leg block. The doctor came in with some rather large needles and one of those things that are used to stimulate muscles. Except they were going to be doing it directly. Inserted the needle on the bikini line and probed around using the electric stimulus to determine when they were ON the nerve bundle (think frogs legs in science class). Then injected something. Took 5-10 minutes for effect to take place. Numb (as in completely, not novicane numb) from point of needle insertion to 1/2 of shin bone on the FRONT of the leg only. (Different nerve bundle controls the back/foot). No feeling AND no response to muscle commands. Any extension of the leg is impossible. Any muscle that is under the numb area does not respond to any commands (no matter how hard you send them). It definitely felt weird.

By 11 I had made it into the room and another medieval torture table (just as all the others). Imagine if you will a table slightly larger than hip's width with two 'wings' for your arms and lots of strap downs. I got my self moved over with some assistance (due to my leg not doing anything). Laid back. I got the good gas and was asked to start counting back from 100.

Unlike the previous two surgeries I did notice that I almost had the feeling of being giddy/drunk (I didn't drink back when I had my other 2 so the 'feeling' was probably indescribable). I started from 100 and I think I made it to 95... I asked the nurses to mark down how far I made it. I wanted to know if that's just when my memory stopped. Similar to an alcohol blackout, body keeps on functioning and you say a whole lot of stupid things, but it's completely wiped out. Unfortunately I never got a report back on how far I made it.

I woke up around 2:30 in a completely different room. My leg was (thankfully) still completely numbed up. But I knew it hurt, even if it was all in my head. I seem to do very well with anesthesia because I came down from it with in 15 minutes. I was out of recovery 3 and on the way home by 4.

I'm home and immediately go to my 'recovery room' that I've set up in one of the extra bedrooms in my house. I have a tri-level so to reduce stairs I moved a couch / heater upstairs. I keep forgetting how much I absolutely detest crutches. If you are in fairly good shape I think a good pair of muscular dystrophy crutches would be much better to deal with (and have much less chaffing).

I'm able to move my leg 5-10 degrees. Mainly just by lowering myself on my crutches. It bears some weight (directly down). Flexibility is much improved over FWO but not as much as Shelbourne. I still feel like I'm on Day 1 because I didn't stay over night.

Around 5-6 PM the feeling started to return and it felt more like a novocaine number. It's still to heavy to lift on its own.

Since I pulled an all nighter the night before to help facilitate sleeping now I decided to crash around 7. 2 Oxycotins weren't doing much good so I took a third and drifted off to sleep.

I woke up and started watching movies. I took 2 more Oxycotins at 11 pm and then 3 ibuprofens at midnight. Oxycotins are 5-325mg and for pain control. I'm to take 2 every 4 hours. I'm using the ibuprofens as swelling control (in addition to the CryoCuff.
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Here's the room where I'll be spending the next week:


I've rearranged the room probably 5 times before I got it into the setup that I like, but this is how it started. Note I spent the first 48 hours laying exactly as you see it here.

This is how I have my leg setup, it's resting comfortably on 3 pillows from the couch. They're rather soft and it feels great:


I've set myself up in one of the other bedrooms of my house since I'm a bachelor in a 3 bedroom. Since I didn't get the "Auto Chill" this is the improvised set up I have. The jump rope was a bit too elastic so I switched it out for some twine later on.


In a later post I'll be going over the art of using crutches. Here's what I'm doing to drain the water out. Note there is absolutely no additional pain in my knee. It actually feels kind of nice as I can feel the blood draining out of it.

Damned Dirty Politics

There's politics. There's home owner association politics. There are office politics.

There's Rugby politics.

And then there's Medical politics.

You may think that there's one way to do an ACL repair. How hard could it be? Slice, Dice, Fix, Stitch, Rehab.

As an Engineer I've seen how my teachers taught a subject to how I apply it at work. How the equations were balanced, variables used, even equations used. Some people I know love to use A=pi*d^2/4 rather than A=pi*R^2.

Orthopedic surgeons, from what I've seen, are no different. What school they went to, who their teachers were, and where they completed their residency and I'm sure a wide number of other variables. From surgical procedures to post-op to recovery and rehab. 3 surgeries and I haven't had any two exactly alike.

Cryo-Cuff, Over-night stay or no, block or no block, weight bearing after surgery, locking brace, I could go on...

And as I'm finding out with my last surgery these just aren't different methodologies, these are strongly opinionated convictions. All of it stemming from doctor #2, Dr Shelbourne of the Shelbourne Knee Center. He's heavy into research and his own way of doing things. He seems to be well known in the ACL repair 'business'.

When I went in for my third consult and my first PT session after the third surgery, both know of Dr Shelbourne and of his methods, and both had opinions, and I could tell what sort of opinion it was.

I'm still not sure the point I was trying to make of this post. Other than: Everything you read on this blog may not coincide with what your doctor is going to be telling you. It may be different than what you read on other blogs of similar nature.

Just like with real politics, there is no clear cut right and wrong. Do your own research. You're not going to drop $10k on a brand new car without doing some research. You're not going to redo your kitchen without reading at least two different opinions on how you should do it. Your ACL surgery should be no different, even if it's two doctors at the same practice.

My 3 ACLs

How they happened:

1. September-ish 2000. Left Knee. Soccer. I was playing sweep when there was a break away chip to the top of the PK box. This is a particularly dirty team, the striker realized that I was out running him to the ball so when we were neck and neck he reached under my arm pit and grabbed my shoulder then threw his weight into me and I went down over my knee. I came back and played a few more games but always ended up going out after torquing. I finally went and saw a doctor after a game of dodge ball in gym when I was running full tilt to the 'line' stopped with my left foot and felt the bones go over each other and went down. My knee got to the size of a grape fruit.
2. July 17, 2004. Right Knee. Rugby game at FWRC Three Rivers Rugby tournament in Fort Wayne. Whored in with a team and was playing outside center. Inside center threw a hospital pass high and behind me. I turned and reached for it at the same time I got tackled across the knees. Stopped playing rugby but continued to run. I knew something wasn't right because I could hyper straighten my leg with ease, leading me to suspect the ACL but I waited until school resumed to see a doctor.
3. December 29, 2007. Right Knee. Snow bowl rugby game in Fort Wayne. Just a bunch of people getting together to play in the winter. I kicked the ball on and was sprinting down field to try and make a tackle/score. The fullback got the ball and we were running straight at each other and he cut left so I cut left and pop. Went down and hobbled off the field, stretched it. Slapped my knee brace on it and finished the game. Even scored a try. Went home that night no swelling at all felt the knee hyper extend with no stop. Immediately knew what I did and sat down and performed a modified Lachman test on myself and put in the call to the local orthopaedic shop as soon as I got back to Peoria.

Doctors & Medical Staff:

1. Dr. Cooper. Fort Wayne Orthopaedics. Patellar tendon graft w/screws.
2. Dr. Shelbourne. Shelbourne Knee Clinic. Patellar tendon graft w/buttons.
3. Dr. Gibbons. Midwest Orthopaedic Center. Allograft patellar tendon w/screws.

Surgery:

1. December 27, 2000
2. November 15, 2004
3. January 25, 2008
   

Recovery:

1. Over night in the hospital and sent home with minimal instructions. PT starting on week 2 for 3 times per week. My leg was in an immobile brace for a while. I remember my first PT visit as being extremely painful getting to 45 degrees. Recovery was slow going. I was excited when I was cleared to run at 5 weeks (instead of the usual 6). I was eventually cleared in time to participate in track my senior year. Although I still had major amounts of atrophy. I lasted on crutches for about 3 days before I was sick of them and their chaffing. I switched to a cane and walked with a major limp (keeping my leg straight and walking with no flexion).
   
2. Over night in the hospital. A week in a CPM machine, swelling was down considerably. I didn't have any sports I was pushing to return to so I took it slow. But for the first few weeks I followed the rehab schedule on Shelbourne's website. 0 PT visits. I only came back twice, 1 week post op and 2 or 3 weeks, to get instructions on how I should do PT on my own.
3. Out patient, I was home that night. I was doing stretches on my own before my first PT visit. This blog should carry you through the rest in greater detail than the other two. I didn't have time to Blogger it all as it happened but I have notes that I'll be entering and post dating.