Fix My Knee

Yesterday was a scary day, just in time for Hallowe'en. I will write more about that, and reveal my most excellent costume, this weekend.

Until then... Boo!

I received the first statement from my insurance company, from Hot Italian Guy (the anesthesiologist): $2040.00. (It's all covered by insurance, I just thought the amount was interesting.)

Vital stats:

Flexion: 105°
Extension: Almost 0°, needs some work
Bike: Full rotations w/seat at 10, even sped things up a bit
Crutching: Lots (whew!)
Car services: 0

I can't believe it's been 26 days since surgery. Time flies when you're on crutches! (Speaking of which, on Saturday when we went out for breakfast - successfully! - we ran into another guy on crutches. He'd been on since APRIL - femur reconstruction. He was good on those bad boys - taking stairs two at a time.)

Today David stayed home and came to PT with me, then we went out for lunch and ran some errands. Yesterday when I bought a scone, the bakery guy asked me if I wanted a bag with handles. I told him no thanks, but I could use a manservant to schlep my stuff. To which he replied, yeah, couldn't we all. I agreed and said I'd wanted one before the crutches. Well, today I had one! Yay D!

So. Blockage. We crutched from our place to PT (six short blocks), then to the 2nd St. Cafe (two long blocks plus two short blocks), then to Rite Aid (three short blocks), then to D'Ag's (one short block), then home (two long blocks). Total distance about a mile. Whee! I was beat when we got home, and sweating by the time I made it up the stairs. Took a brace-free nap this afternoon which was simply divine.

If I didn't already have the best Hallowe'en costume in the works, I could go as a porn flick: Everything is tight, or stiff, or has something strapped on.

Ba-dum bum.

Nope, not the band... The angle! Had a good weekend in terms of at-home exercises, and a great session this morning with Svetlana. The two other people at the clinic when I was there were also ACL repairs. Laura is at her six month anniversary, which was very inspiring. She injured her ACL skiing in Jackson Hole in March, and had the surgery there (ACL and meniscal repair, plus she fractured a bone - ouch). She told me she was walking with a slight limp two months after surgery, and she looks great now.

My leg raises (the quad sets) were strong today. Svetlana told me I should leave the brace locked at 0° until I can weight bear, but that it's OK to set it at an angle when I'm sitting. That will make work a heck of a lot easier. I see Dr. Nestor again on November 12, and he'll hopefully approve weight-bearing - at which point PT will get a lot more interesting. Today after PT I opted to crutch home instead of calling a car service - it's raining a little but very pleasant outside, and crutching around is a good way to use up the excess energy I have these days.

Four more days 'til Hallowe'en! David & I came up with the absolute best costumes on the weekend, I'll post pictures at the end of the week. And, I decorated my crutches with rubber bats, spiders, and skeletons. Very festive indeed.

New physical therapist today! Boris! I've met Boris before, seen him around the clinic, but never worked with him.

I should note that my PT has progressed to the point where I often spend the first 30-40 minutes doing my own thing at the clinic - about 20 minutes on the bike, then I sit on the table for a few minutes to do the regular bend, then the leg press (still 50lbs). So, that's how I started today. Big news on the bike: I did a complete rotation! Woo hoo! One step closer to adding some cardio to my "workout." There was cheating involved, though: I set the seat one notch further back, so the maximum bend wasn't quite as far as it would have been at the previous setting. Still. (The cheating was sanction by Boris, he told me to do it just to get the rotation.) I went around a few times, forwards and backwards, particularly slowly when I approached and hit maximum flexion with my right leg.

When I reached the end of my own routine, Boris came over for the manipulation part. I started with heel slides and actually hit 90° (that was a little surprising since it was without help, I guess I'd loosened up a little with the previous exercises). After a few of those I flipped over onto my stomach and Boris pushed my heel up until my knee was at about 95°. He also explained that this exercise would be more difficult because my hip was straight, which meant that my quad would tighten up more quickly.

I asked him a few questions about timing. He said I'm on-track for being three weeks post-op (yay!). I asked him how long it would take me to walk after I'm allowed to weight-bear, and he said a few weeks, depending on how much strength is in my ankle and hip. He also stressed that I have to have complete extension - like, when I'm extending my leg, the back of my knee needs to touch the table. If there's even a degree or two of flexion, I'll limp. Good to know.

Tomorrow morning D & I are going to try that trip to Dizzy's again... Wish us luck!

Just before surgery, I Googled "ACL repair" and came up with a bunch of sites on the topic. Some were published and maintained by hospitals or schools, with diagrams and technical details about the surgery. Others were personal accounts - written by people who'd had one or both knee operated on, with prep lists and ideas of what to expect before, during, and after the surgery. These personal sites freaked me out. I started my blog for a couple of reasons, not the least of which was to find the more optimistic side of this procedure.

And, even though it hasn't been the funnest thing I've ever done, a lot of funny moments have resulted. Like David taunting me with my crutches just a few days after surgery, then standing on his right leg and jumping up and down and saying, "Wish you could do this, eh?" That cracked me up. And when Mom was here, her leaning *across* my legs (that were propped up on the coffee table) to pick something up on the other side of me. (I caught her before she really leaned, and we had a good laugh about the incident.)

I've said it before and I'll say it again: Stuff is funny. Listing my religion as "chocolate" on the patient information form was funny. The woman beside me in pre-op was funny. She was having double-knee replacement surgery (OK, not so funny). One of her pre-op questions was which knee was worse. The nurse explained to her that whichever knee she felt was worse would be replaced first during the surgery, in case anything went wrong and they had to stop: At least she'd have the worst knee done, and she could come back for the second one. Well. This woman could. Not. Decide. She hemmed and hawed and went on and on about the right knee being more painful but the left knee being more stiff or vice versa and back and forth, for probably 10 minutes, until the nurse gave up and told her the doctor was going to ask her the same question, so she should decide. Then another nurse came in to talk to her, or maybe it was the surgeon's fellow, and asked her again which knee was worse. Same debate. It continued for another good ten minutes, while David & I listened on and rolled our eyes wholeheartedly. When the first nurse came in to ask my pre-op questions the first thing I said to her was, "Right knee, please." We all cracked up. When the double-knee woman's surgeon finally came in to talk to her (they still hadn't resolved the "which knee" conundrum) and asked her that fateful question, I heard her husband say, "We can't go through this again." I don't know what they decided, maybe they flipped a coin.

Waiting five hours for the opthamologist after surgery is kinda funny in hindsight (no pun intended). Crying while hooked up to oxygen and getting snot all over the tubes is funny in a pathetic sort of way.

When I could finally haul my own leg onto the bucket to go to the bathroom, the Huggies commercial song "I'm a Big Girl Now" popped into my head. That was freaking hilarious.

It's funny that I'm incredibly proud that I can put on my own sock and shoe.

Even The Brace is now funny. When I wear pants over it I look like the Michelin Man - dudes, that's funny. Yesterday, trying to sit at my desk with a too-short ethernet cable and my leg up on another chair was pretty damn funny.

One thing that's not so funny is daytime TV. Shut up, Dr. Phil.

I'm tired of the "ACL Repair" game. Can we stop now?

Signed,
Gillian "Ready to Walk Already" Gutenberg

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Yesterday it was 18 days since surgery. I had my third shower in over two weeks, and went to work for a few hours. It was really great. My coworkers rock, and were very accomodating and understanding about my limited mobility. I flipped over a recycling bin to rest my leg on under my desk and was OK like that.

Today is Day 19. I had PT this morning at 9am with Svetlana. I started with about 30 minutes on the bike - still back and forth, but I came incredibly close to a full rotation. Interestingly, today going backwards was easier than going forwards. The opposite has been true the past two times. She measured me at 90° on the bike, and I probably pushed a few degrees past that. After the bike I do a standing hamstring stretch, with my right leg propped up on a stool. That feels great. Next, to the bench for the regular flexion.

I mentioned to Svetlana this morning that my flexion is blocked at home by my leg hitting the desk I sit on. She said she'd show me another position I could use to increase flexibility. She had me lie on my stomach, and she pushed my foot toward my butt to bend my knee. It hurt, a lot. It's really interesting that 90° isn't just 90° - it's relatively easy for me to get there on the bike, but when it comes to heel slides, for example, I only make it to about 75° before it hurts. Anyway, Svetlana means business, and while I was on my stomach she continued to push my foot forward until I was at 95°. Woo hoo!

But. Not so fast with the celebration. Next came the quad sets. While lying on my back, with my left knee bent so my foot is flat on the table, Svetlana instructed me to tightly flex my quadricep, pull my kneecap up, push my heel forward to get my leg *really* straight, then raise my leg. When lowering my leg, I need to concentrate on keeping my knee as straight as possible. She watched me do this a few times, and noted that I'm probably losing 10° every time I raise my leg - that is, my knee bends slightly on the raise. This is not good. She said I should be doing this exercise at least 10-15 times, three times per day, and that being able to raise my leg keeping it completely straight is one of the indicators that I am ready to have flexion in the brace.

I did a set of 12 of these raises, and my quad was burning at the end. It requires intense concentration, because it's really easy to relax a little bit and let my knee bend slightly. I tried it a couple of times with my left leg just to see which muscles I use, and I was surprised at how easy it was with a leg that already works!

After the quad sets, I did the usual set of side lifts, then moved on to the leg press (three sets of 10 at 50lbs). Then I did a few calf and hamstring stretches with a strap, then ice (I love ice). I'm planning to do at least three more sessions at home today, and on Friday I'll be working to get a full rotation on the bike.

Svetlana was my physical therapist again this morning. I started with 20 minutes on the bike. The first time she measured my flexion, I was already at 90°. Wahoo! She told me I can safely go for another 15°. David came with me, and was probably underwhelmed at the intensity with which I "rode" the bike. I only move my left leg forward until my right leg is at about 90°, then I move it back until I hit the same angle.

After the bike, I moved to the table and did the usual flexion exercise. Then Svetlana suggested I try the leg press. While she went to check my chart to see whether I'm ready for that, David & I exchanged the same panicked looks that Mom & I had exchanged when she'd suggested I get on the bike. But I've never done that before!

Deep breath. Svetlana adjusted the seat on the leg press so that when I sat down, my resting position would be at approx. 90°. She set the weight to 40lbs, and had me sit with both feet on the same pedal. She instructed me to push primarily with my left leg, then resist on the ecentric with my right leg. It went surprisingly well!

I talked to Svetlana today about setting my brace to have some degree of flexion during the day. She said four weeks is the usual timeline for that, which means my leg has to be locked straight until the end of next week. I'd been planning to wait until I could bend to return to work to sit comfortably at my desk, but now I'm planning to return at least a couple days a week and just prop my leg up on another chair when I'm at my desk. Should be OK.

I also asked her about how long I needed to sleep wearing the brace, and she said it really varies depending on the surgeon. I get the impression that Dr. Nestor is pretty conservative, which I respect, so that means it's probably going to be a few more weeks. Unfortunately, sleeping is becoming increasingly difficult. My back is really stiff. I wake up a lot, and don't have the luxury of turning over and going back to sleep.

The weekend went smoothly. My mobility is way up, I made lunch (veggie burgers in the toaster oven) on Saturday, and even baked brownies (from a mix) on Sunday. I miss cooking a lot.

Mom left Saturday morning. Her help was invaluable, and our kitchen has never been so clean! Thanks Mom. So much.

Saturday morning I took my first shower! In two weeks! Dr. Nestor said a shower would be OK, he just didn't want the incisions (still covered with steri-strips) to be soaked. Logistically the shower went something like this: I used one crutch and the sink to suspend myself long enough to hop into the tub with my good leg, then swung my right leg in as well. I stood with my left side toward the shower, which left my back against the wall for support. David stood outside the shower with his arm available for me to grab onto for balance. It was the best shower ever. Getting out of the tub was a little more challenging - I had to sit on the edge and swing my legs over, then stand up.

Saturday both D & I crashed. We were exhausted. He'd had a busy week at work, and I'd made it to 90° the day before. No small feat, that. I did a few rounds of exercises on Saturday, and again on Sunday. Sunday I tried something new, which resulted in a breakthrough of sorts: While sitting on the desk for the flexion exercise, I did shoulder presses and bicep curls using a body bar that D brought home on Friday. That totally distracted me from the pain in my knee, and I was able to bend it further (on my own) than I had previously. We're estimating I got to 90° here on Sunday, which rocks. I'm sitting on a desk for these exercises and we measure by how close my calf gets to the bottom of the drawer on the front of the desk. I hit the drawer for the first time on Sunday, and even held it for a few seconds (without screaming hysterically).

Lena was off this afternoon so my physical therapist was Svetlana, the woman who had come to our apartment for the initial visit.

She asked me what I usually start with, and I told her the flexion exercise. She asked if I'd been on the bike yet. Nope, no bike. That's fine, she said, your surgery was two weeks ago? You can go on the bike. What did your surgeon say? she asked. I told her: He said my flexion isn't good enough. OK, she said, it was at 76 last time right? (I was impressed at this point that she'd read my chart.) She pointed to the bike and told me to see how far you I could get.

I was freaked out. I think Mom was freaked out too. I protested: "But I've never done the bike before..." Svetlana was all business. "It's fine," she said, and instructed me to use my left leg to push the pedals forward and then backward as far as I could.

It rocked. I was so much more comfortable (the bike is the kind with the seat back), and felt so much more in control. She measured the angle of my knee when I'd pushed it to the limit. 80°! Score! After 5-10 minutes on the bike, she had me move to the table. Time for the manual pushing. She told me she was going to get me to 90°. Today. Right now. I freaked. Then breathed. She had me put both hands on the right side of my body, and instructed me to keep my right hip down. Then she pushed. Oh dear God it hurt. I think I squeaked, and tried to breathe. She held the stretch for a count of seven, then released it. Then she did it a couple more times. Finally, she held the goneometer at 90° and pushed my knee to meet it.

That's right, I hit 90° today. Doesn't mean it's going to get back there all by itself, but at least now I know how it feels (it hurts) and that nothing breaks when it gets there.

I did some more new stuff during the session, including heel slides. Then the usual quad and side raises, then ice.

I probably accomplished more in that 45 minute session than in any of the previous (longer) sessions. Thanks Svetlana.

Google comes through again. Here's The Brace, in all her glory. Eventually I'll have a picture of me all decked out in this baby, but for now you'll have to enjoy it on this fine model.

Speaking of models, I have become obsessed with knees in fashion photography. In the October Marie Clare, which I bought as part of the first-injury stockpile, there's a particularly leggy model in a short, short minidress with no tights. I covet her knees. I think they are incredibly beautiful. Ditto when I see people walking outside with shorts (or even tights) on. Mom, I think your knees are gorgeous. Take good care of them.

Yesterday at PT, as I was forcing the flexion of my leg for the upteenth time and had tears streaming down my face, another girl comment to me, "Isn't it weird to be crying about pain you're inflicting on yourself?"

Since visiting Dr. Nestor yesterday, we've increased the intensity of the flexion exercises drastically. "Ow, OK, that hurts," doesn't cut it anymore as a surrender. Now we push the bend and hold the leg until I really cannot stand it - usually this means I'm sobbing and gasping for breath. Now, I say "we," but even though my mom is there, I'm doing this all myself. I'm now able to hoist myself up on the desk (which we've covered with my yoga mat and a sheet), keeping my right leg straight, and hook my left foot under my right ankle for support. Once I've scooted back until the backs of my knees are just ahead of the edge of the desk, I start lowering my left foot. Once my foot is all the way down - that is, it's far enough that gravity won't pull it any further - I move my left foot to the front of my right leg and start pushing it further. This is the hard part. The first few degrees are OK, but then it starts to hurt. My quad continues to involuntarily tense up, and despite my best efforts to relax it often feels like there's a fist, or a baseball, just above my knee.

It's impossible for me to know the angle I've made it to, so I rely on Mom guesstimating that it's further than last time. After I've held it for, well, as long as I can possibly stand it (remember I'm pushing my leg myself, with my other leg), I release my left leg and let my right leg dangle. Then I hook my left leg back behind my right and gradually raise it back up until it's nearly straight.

Moving up through a particular range of motion there makes my knee ache to the point that my teeth hurt. The best way I could describe it to Mom was that it's like wacking your funnybone, only the ache doesn't go away in a minute or two. It's there and kind of moving around throughout the movement.

We've done two sets of exercises today. Bending my knee has become my mission. Between sets I rest, eat something, and psyche myself up for the next set. Self-inflicted pain, indeed.

This morning I had the first appointment with Dr. Nestor since surgery. I brought the whole entourage (D & Shirley). (To fit three of us in the car, Mom sat in the backseat with my leg across her lap.)

First the nurse, Mindy, removed the ace bandage and the dressing. Then Dr. Nestor came in and removed the sutures. The larger of the two felt kind of neat coming out as it pulled through my skin. He checked my extension (how straight I could get my leg) and said it was good. Then he said, "OK, let's see what you've got," and instructed me to loop my left leg behind my right leg and lower it down, to see how the degree of flexion.

His comments: "Bottom of the class. D-. You're going to be sent to the principal's office." He pulled out his goniometer, the same plastic device that Lena uses to measure the angle of my knee. "50 degrees. That's not good enough." I saw David and my mom exchange looks. "You need to work on this five to 10 times a day. This is your job. You need to be spending hours every day working to get this flexion."

His point was abundantly clear.

Aside from that, I was instructed to continue to wear the brace, and that in a couple of weeks the physical therapist could set it to have a 90° flexion (which will allow me to sit at my desk). I'm also allowed to shower now - whee! I will see Dr. Nestor again in four weeks.

We left the office feeling somewhat defeated. We'd been doing exercises at home, twice a day, but obviously hadn't been pushing hard enough. I was scared. Dr. Nestor had pushed on my leg when I'd had it bent at his office and when I'd nearly screamed in pain, he'd said, "Breathe through the pain."

Right.

We went from his office to my office, just to say hi - it was so, so great to see everyone. Mom & I stayed there for about an hour, then we stopped at Old Navy to look for brace-compatible clothing. Mission accomplished - we picked up a couple pairs of belted twill pants, and some long-sleeved t-shirts. (I learned when I broke my foot in university that sweaters do not fare particularly well with crutch use.)

We returned home around 2pm, ate lunch, then did the first set of flexion exercises. I was so scared. I think Mom was scared too, but she rocks more than anything and stuck it out. It hurt a lot. I cried a lot. We pushed it hard, and held it down. When I brought my right leg back up, supported of course by my left leg, my whole knee ached. It's unbelievably difficult to relax my quad during these exercises. I've started trying different approaches, and I'm finding that massaging it with my thumbs while I'm trying to push my right leg down (with my left leg) is the most effective. After that set I was exhausted (that seems to happen a lot lately!) and we both slept for about an hour. I left the brace off for that time and it was deliciously wonderful.

When we woke up we did the flexion exercise again - a little shorter this time, because we had PT at 6:15 tonight.

At PT, Lena asked how the visit to the doctor had gone, and I told her. She had me start with the flexion exercise (of course), and the first time she measured I was only at 67°. Urf. So, I tried harder. Again and again. The next time she measured it was 75°, and the last time I made it to 76°. Nobody could have told me it would be this hard to bend my knee. I can hardly believe that only a month ago I could do a pigeon pose. The rest of my exercises went well - I don't have any difficulty working my quads (with leg lifts and side leg lifts). My next appointment is Friday at 3pm. I am determined to get to 80° during that session, and will work to be at 90° for Monday.

My cousin sent a great ACL site tonight, with diagrams of rehab exercises. Note that I have not been instructed to do the Heel Slides pictured here - my equivalent exercise (the "flexion exercise") has me sitting on the edge of a table with my right leg straight and my left foot hooked behind my right heel, supporting it. To bend my knee I lower my left leg and my right leg follows passively.

Number of times a day I could raise my right leg the day after surgery: 0
Number of times I could raise it 10 days after surgery: 90
Circumference of my right knee, in centimeters, five days after surgery: 42
Circumference of my left knee: 37
Number of painkillers I took 10 days after surgery: 3
Number of painkillers I took one day after surgery: 12
Number of Percoset I have been prescribed since surgery: 80
Number remaining: 7
Number of stairs between my apartment and the sidewalk: 67
Degrees of flexion in my knee the day after surgery: 0
Degrees of flexion in my knee 10 days after surgery: 75

The weather here over the past week or so has been simply fabulous - ranging from the mid 60s to the low 70s and very sunny. Since we didn't have any PT or other knee-related outings scheduled for today, I suggested that Mom & I take a breakfast trip to Dizzy's.

We headed out around 10:15. Made it down the stairs sans problème, then began the journey of three short blocks followed by one long block. Total distance about 1/4 mile.

We made it to the corner of 7th St. That's it. One block and change. It was much warmer out than I'd anticipated, and I fatigued very quickly. Shirley helped me hoist my leg onto a ledge so I could rest for a minute, and then we headed back. I was dreading going back up the stairs at home! When I got to the first landing my back was drenched in sweat and I felt slightly faint, so Mom went upstairs and got me an apple. (Gimme fuel, gimme fire...) That helped. A lot. I still needed to rest on the other landings but made it up in one piece and now I'm chillin'. Shirley's going to toast up a waffle and hook me up with some yogurt, and I'm going to get whatever work done I can today.

I wonder if Dizzy's delivers...

For the record: Shirley = Mom. (I also call her Memphis' Grammy, but that is frowned upon.)

I had physical therapy at 9:15 this morning. David came along to check out the facilities. Mom walked to the clinic because I take up the whole back seat of the car. We're going to have to figure out something for Wednesday morning, when both of them are planning to come to the doctor with me.

We explained to Lena the whole swollen-foot saga this morning, and she was pretty unfazed by it. We like Lena, even if she did wrap my leg too tightly. This morning we started with the flexion exercises, and again she measured the angle. I clocked in at a rather disappointing 75° - not as much improvement as I'd expected to see. She also explained how the angle is measured - by drawing a line from the ankle bone to the knee for one arm of the angle, and from the knee to a particular bone that's sort of at the thigh, below the hip. Looking just at my knee, it really appears that I'm at 90°. I'm noticing that I can get a lot further now before the initial discomfort begins. This morning Lena was really emphatic about relaxing my quad. It tenses involuntarily, as a protection I'm sure, and I'm not quite sure how to relax it.

Everything else went well at PT, but for whatever reason coming back up the stairs to our apartment really tuckered me out today. By the time I was at our landing I was exhausted, and barely made it to the couch. Mom says I turn white when I hit the wall like that. I managed to eke out some work from home today, and while I'm not sure exactly how much I contributed, I did feel like I was getting caught up, and it was nice to have interaction with other people. Around 2pm I faded - I went to lay down and slept solidly for almost 2 hours.

My knee is a little achy tonight. We did a set of exercises without incident. Hoping to get to 90° before PT on Wednesday.

Today is the first time I've had that thought since surgery. Yay!

I'm almost caught up, so let's just finish up last night.

Yesterday when I woke up my foot was still swollen. Rats. I stayed in bed most of the day, with my foot elevated and packages of frozen peas wrapped around it. It was still puffy into the evening. Around 8pm Mom made dinner and we started watching "The Others." At a critical plot moment near the end of the movie, I realized my foot was freezing. I alerted Shirley and she whisked me into the bedroom where she completely unwrapped the ace bandage. Fortunately my leg looked fine - the swelling there had completely subsided (except right around my knee) - only my foot was still huge. She massaged it gently and re-wrapped the bandage much more loosely. I managed to make it through the rest of the flick, then fell asleep almost immediately.

This morning my foot had almost returned to normal. It was warm and happy. There is still a little puffiness around my heel, but it's about a million times better. Yay Shirley! We'd really wanted to trust that the PT knew exactly how tightly to wrap the bandage, but clearly it was too tight for me. The set of exercises this morning was the best I've done yet - D estimated my leg was bent to about 80°, and I did a complete set of everything else. Now football's on, Mom's making Thanksgiving dinner (today is Canadian Thanksgiving, dontcha know), and I'm pretty darn content.

On Thursday, my right foot was swollen. I called my mom in to have a look at it, and she found a big dimple beside my heel that she thought was quite hilarious. She was giggling and carrying on about the cute dimple on my foot, and called David in to look at it. D looked at my foot and said, "Should we be worried about this?"

It was pretty swollen. Shirley guessed it was because I'd had it down quite a bit on Wednesday, with going out to PT. I'd also been able to sit on the couch for longer, and when I'm on the couch my leg is straight out on the coffee table and thus below my heart. (It should be noted here that I'd previously argued that having my foot on the coffee table counted as "elevated," whereas Shirley said it needed to be higher than my heart.) Mom was calm about the whole thing and just said we'd keep it up and ask Lena about it when we went to PT on Friday.

Friday morning I had my first visitors! A couple of girls from work made the trek to Brooklyn and brought cupcakes from Cupcake Cafe and chocolate bread from Balthazar. It was really, really good to see people. After they left my mom & I got me washed up, and at 1:30 we headed out to the clinic for another round of PT.

Lena said it wasn't great that my foot was swollen and I lost the elevation argument: My foot needed to be above my heart whenever possible. We went through the usual exercise regime, and she iced both my knee and my foot before I left.

I napped (with my foot on a pillow) when we got home, and Shirley went to the grocery store to fetch bags of peas to ice my swollen appendage. Later that night Andrew came over (whee! another visitor!) and we all ate pizza and ice cream - me with my foot propped up on two big couch pillows on the coffee table.

When I went to bed, I suddenly had this feeling that something was jutting into my leg just above my knee. I thought perhaps The Brace was on a little bit crooked, but what it really felt like was a marble or a knuckle pushing into my leg. I called my mom in to have a look, and we undid The Brace completely, but nothing - I could still feel it. So she unwrapped the ace bandage enough to see my skin, and there really was nothing there - but the sensation was about where one of the small arthroscopy insicisons was, so that's all it was. Some healing going on I suppose, and bruising.

I managed to fall asleep, and fortunately I haven't felt it since.

I Googled "Anterior Crucient Ligament" and found that I'd been misprouncing and misspelling it this whole time - it's really the Anterior Cruciate Ligament. I also found a nifty page that answers basic questions about ACL injuries and repair.

For the record: I had a partial tear (not a complete rupture, which given my activity level probably would have needed surgery before now). The tissue that was used to repair the ACL was taken from my own patella.

In addition to the ACL repair, I had my meniscus repaired. Another page on the same site describes the meniscus and its functions. This part of the surgery means that I won't be able to weight bear for 6 weeks (normally the ACL repair rehabilitation allows for weight-bearing almost immediately).

I was just doing some online shopping, and I'm trying to imagine what will fit over The Brace, or how it will look under an A-line Gap skirt. This sucks.

Look at that! It's Saturday, October 11. One week of crutches down, five to go. It seems like surgery was a year ago. While I can see I've made progress, there is clearly a long way to go.

Back to post-op. I had been instructed in the hospital to start my exercises the day after surgery. Quite diligently, on Saturday afternoon, David & I attempted the first round. It was not a roaring success. The first exercise was to lie down, with my left (good) leg bent at a 90° angle (so my foot was flat on the bed), with my other leg straight (of course), and lift my right leg up to the height of my left knee. Cake, right? Nope. I could not budge that leg. It took all my strength and energy just to flex my quadricep, and despite every ounce of willpower I couldn't lift the leg. It was exhausting and frustrating. We tried a few times throughout the day but on Saturday it just wasn't happening. It was to the point where I had to do raises with my left leg just to remember which muscles I should be using! Sunday, joy of joys, I was able to raise my leg a few times. That was exhilirating. By Monday I could do a set of 10.

On Monday I called my doctor's office to get a list of physical therapists in my area. Fortunately there is one just a few blocks away. I called them to set up an appointment for Tuesday. Still dreading the stairs, I inquired about having a therapist come here for the first visit. The service was available, but would not be covered by my insurance. I opted to spend the $130. (During this phone call I noticed one interesting side effect of the painkillers: When I read my Oxford ID number to the PT clinic, I kept mixing up the order of the numbers. It was akin to having a reading disorder.)

On Tuesday (Day 4) at 3:30pm Svetlana came over. My doctor's office had faxed the rehab script to the PT clinic, and she went over the booklet I'd been given at the hospital. We did the prescribed exercises, and she gave me a few extras, including side leg lifts. It was so, so nice to lie on my side after having been on my back for four days. My hip was already getting tight, and the exercises felt really good. The last exercise (with the brace off) had me sitting on the edge of the bed while she held my right leg. The idea was that she'd lower my heel gradually to practice bending my knee. Oh my God. That was entirely frustrating - we could only go about 25° before the pain was unbearable. So we stopped, and I was left with strict instructions to continue that stretch several times a day until I could increase the range of motion.

I have a new ligament. It is tight, and I need to stretch it out gradually to get the range of motion. The risk is that if I wait too long to stretch it and increase the range of motion, it will heal and be much more difficult to stretch at all.

My mom arrived Tuesday night. Prior to surgery she'd told me to let her know if I needed/wanted her to come. I said I would, as I still wasn't sure what I'd be able to do on my own. When we had arrived home from the hospital on Friday night, I'd called her and tearfully admitted that I wanted her here. The brace alone had given me some idea of how little I'd be able to do myself, and how much I'd be leaning on David, and I wanted to make sure he didn't wear out. She had immediately agreed, and found a train ticket (flying was prohibitively expensive). By the time she arrived on Tuesday I was looking pretty scary, I hadn't bathed for 4 days, and while I had splashed water on my face and made liberal use of facial wipes, you can really only get so clean without soapy water. (Dr. Nestor had given David strict orders after the surgery that I was not to shower until he saw me the following week, as any water would increase the risk of infection.)

So. Shirley arrived and temporarily relieved David of his orderly duties. He went to work on Wednesday, happy to rejoin the land of the walking. Mom & I halfheartedly went through my exercises in the morning, then she washed my hair. That undertaking involved me lying on plastic sheets with my head hanging off the bed, while she shampooed my hair over a bucket of water. It was actually quite efficient. Then she gave me me a sponge-bath of sorts, and I was wonderfully clean.

Wednesday afternoon was my first outing since surgery. I had an appointment for physical therapy (at the clinic, this time) at 4:30pm. Shirley helped me get dressed in David's sweat pants and a tank top, and let me get a head-start on the stairs before she called the car service (I know, to go five lousy blocks). (Coincidentally the driver was the same one who'd driven me to the hospital on Friday.)

Svetlana was away, so I had Lena as my therapist. I loved her, and so did my mom. She pushed a little harder this time with the exercises, especially with the flexion. I think we made it to about 45°. She also removed the ACE bandage for the first time, and measured my knee. On average it was 4-5cm bigger than the left knee. It kind of looked like a knobby horse's knee. The stitches from the arthroscopy were visible, but the incision from the patella graft was covered with steri-strips (which I had been instructed not to touch before seeing Dr. Nestor).

Lena gently massaged the skin around the incisions to increase the circulation. It felt great. She told us to make sure massaging always pushed up the leg, so that it wouldn't end up in my foot and would have a chance to reciruculate in the lymphatic system. After the massage she left me with electronic stimulation things attached to my knee, and a big ice pack.

We were at the clinic for about 90 minutes. After that, and climbing back up the stairs, I was exhausted and fell asleep almost immediately.

The first night after surgery I woke up every 2 hours and took a percoset. This was recommended by the doctors, who made it clear that I was not to be heroic and suffer through the pain. Good advice! David actually woke up with me the first couple of nights to give me the pills. Despite the drugs, it hurt. By Saturday, the day after surgery, I was slightly more comfortable.

We had logistic issues to work out. One was getting my leg out of bed. I didn't have the strength to move it, nor did I even know how to get the leverage to do so. David figured out a way to gently move my leg while I pivoted my hips to get it out of bed, while I stood with my good leg (God bless my good leg!), and he lowered the straight leg down. He holds my calf with one hand, and my thigh with the other, from the opposite side. It's a bit awkward, but gives him the best leverage.

Then, of course, the bathroom. I don't know how I did it the Friday night after surgery, but the adrenaline wasn't flowing as much after a dozen or so percosets, so we had to figure something else out. The solution ended up being an overturned bucket that I could rest my heel on while sitting on the toilet. At first I couldn't even raise my leg enough to place it on the bucket, so D had to do that too. (As if the Ben & Jerry's wasn't enough, he had to put my leg onto a bucket so I could pee. Wow, right?) My slightly bruised dignity aside, we managed. That morning, D went out again to buy fresh challah bread, and came home and served me breakfast of French toast with strawberries and bacon, in bed. It was fabulous to say the least. (He also warned me not to get used to it, that tomorrow morning I'd be served yogurt and a frozen waffle.)

I slept most of Saturday. At one point we tried to move me to the sofa, and that worked briefly, but I got uncomfortable really fast and had to move back into bed. I really don't remember much about the first couple of days except that people phoned, many bouquets of flowers were delivered, and I cried a lot.

The car ride home from the hospital was less than enjoyable, but we made it. Then I had to face, for the first time, the stairs.

We live in a fourth floor walk up. It's five, really, if you count the stoop. Yikes. I honestly don't know how I made it up those stairs, but I did. David's mom was there, and David stood behind me in case I toppled over, and I made it. As I was going up the first flight (outside) our downstairs neighbour Juan came home. That lucky devil has the ground floor apartment. He asked what had happened and I squeaked out "ACL" then turned around so I wouldn't burst into tears (again).

So. Up the stairs. Willpower is a crazy thing. I found myself feeling fortunate that I'd had crutches before, when I broke my left foot in university. I felt pretty comfortable balancing on them, although that was a little different because back then I could bend my leg. This time? Not so much.

I beelined for the bedroom, making a quick stop on the way in the bathroom. Another feat I have no idea how I managed. Try it. Sit on the toilet with one leg straight out in front of you. Great. Now get into that position without bending your leg. See? Not so easy. Anyway. Made it into bed, sent David out for drugs, and tried not to think about my knee.

It hurt. A lot. I had the Cryo/Cuff on it to keep it cool, and that did help, but it was surprisingly painful. I think I'd commented earlier (at the hospital) to David that as the anesthesia was wearing off, it wasn't as painful as I thought it would be. Well, now it was worse. We're talking 8-9 on a scale of 10, with 10 being the worst pain you can imagine.

Let's not dwell. David came back loaded down with prescription drugs, yummy chocolate-cranberry bread, and he even brought over my close friends Ben & Jerry. Have I mentioned David rocks? It's worth mentioning again and again - David rocks.

I was in and out for the first half hour or so. I vaguely remember my Italian guy being there at first, and then another guy checking things. There were nurses around, and other people recovering from various other surgeries. And... my eye. My right eye hurt. I couldn't open it. It burned, and felt like there was sand in it. It was watering like crazy. My legs were still asleep, which was kind of interesting, but MY EYE HURT! I tried to talk but that was weird; I couldn't quite do it. Somehow I got the attention of the guy who was monitoring me (Danny), and told him my eye hurt, and that if that was normal it was OK, but I just wanted to know if it was normal. He gave me a piece of gauze to wipe the tears, and told me he'd call my anesthesiologist. Yay, Italian guy!

An hour passed. No Italian guy. Nobody, in fact. So then I started feeling sorry for myself. It was around 1:30 (I could see the clock), and nobody was paying attention to me, and my eye hurt, and my legs were waking up (I could wiggle my toes), and I was scared. So I started crying. Well, I still had the oxygen tubes in my nose, so that made crying gross, because the oxygen tubes got all snotty. One of the nurses noticed that I was a wreck, and I heard her say, "That girl is in a lot of pain, between her eye and her leg. I'm going to give her some morphine." Yay! Morphine! Danny offered me a sandwich (tuna or turkey) so I could have a Percoset as well. I ate the turkey sandwich, drank some apple juice, and gratefully accepted the drugs.

Around 2:30 the nurse who had given me the morphine came over and told me her name was Betty (I was very excited to have my own Nurse Betty), and asked if anyone had come with me. I told her my boyfriend was in the waiting room, and she went to get David, who came in a few minutes later. He looked hilarious - he had to wear a yellow hospital thing over his clothes. I was so, so happy to see him. He kissed me and it was seriously the best thing ever. I asked him to tell them about my eye again, because it still hurt like a bitch and was watering a lot. He talked to someone, maybe Betty, and told me he could see someone was on the phone "opening up a can of whoop ass" about an opthamologist. The next little while was hazy - I mostly kept my eyes closed to keep them from watering. At one point Nurse Betty tried putting some artificial tears in, but that didn't help much, so they kept trying to get the eye doc.

At 4pm the physical therapist came over. She showed David the book with the exercises (since I still couldn't see properly). He asked her for a better pair of crutches - we still had the crappy wooden ones from two weeks ago at the ER that we'd had to drill holes in to get to the right height. She hooked us up with a fancy metal pair.

Finally I was relocated to another area to wait for the opthamologist. After another half hour or so of waiting, I told David I just wanted to go home. It had been 4 1/2 hours since I'd first mentioned my eye, and I thought it probably wasn't a big deal if nobody had come to check it out, so I thought we should get moving with the other stuff. We'd been in the hospital for 11 hours and we were both exhausted. So he found the physical therapist, who had to show me how to use the crutches before I could get dressed. We practised using them on a little set of stairs they had at the hospital, and I was OK'd by her. Then we had to get someone else to come and fit me with the Cryo/Cuff. The Cryo/Cuff is a fancy way to keep my knee cold - it really also deserves its own entry or at least description.

David helped me get dressed (it was not trivial), and then, after 5 hours of waiting, Dr. Seiff the opthamolgist showed up! Joy! He was worth the wait. He was completely sweet, and apologized profusely for the wait. He put a drop in my eye, and I could see! He told me he'd just numbed it, and he thought I probably had a small scratch on my eye. Then he did this cool thing where he put yellow dye in my eye, and shone a blue light on it. The yellow dye pooled in the scratch, and the blue light made the scratch show up green. David looked through the blue lens and sure enough, he could see the scratch. All of this made me really happy. Dr. Seiff told me I couldn't have the numbing stuff because it isn't good for your eyes, but he prescribed an antibiotic drop as a precaution and told me it would heal within a day.

My question, then, was how did my eye get scratched during an operation on my knee? There are a couple of possible explanations. When you're under anesthesia, your blink reflex doesn't work. So I might have rubbed my eyes when I woke up, and scratched it then. Or, my eyes might have been taped shut during surgery (they do this sometimes so that the eyes don't dry out), and were possibly irritated when the tape was removed. At any rate, I could see again!

The nurses gave us a prescription for vicodin and percoset, and I asked for another percoset before we left because I didn't know how soon we'd be able to get the Rx filled. We called a car service and waited about half an hour, and by 6:30 I was in the car and on the FDR back to Brooklyn.

On Friday, October 3 we had to be at the hospital by 6am. I had been instructed not to eat or drink past midnight the night before surgery, and to shower before coming to the hospital. I was also to wear loose clothing, and to leave all my jewelry at home. We woke up at 4:30am. I showered and dressed in David's sweats and a tank top and sweat shirt. We called our favourite car service (Arecibo, for those of you in the Park Slope area), and within 5 minutes there was a car at the door. It was a quick ride to the Hospital for Special Surgery, since there was no traffic that early. We were checked in and in the waiting area by 5:40am.

Shortly after 6 we were summoned into the pre-op area. I had to put on the fancy hospital gown, and fill out a patient information form. It was early, we were giddy, and the form included such giggle-inducing questions as, "Why are you here today?" We answered the question, "Do you have someone available for emotional support?" with David, my boyfriend, and Memphis, my cat. For religion I wrote "chocolate." It was probably the best part of the day. The woman on the other side of the curtain from me was having double knee replacement surgery, and at one point her husband commented that we seemed to be having an inordinate amount of fun.

[The woman on the other side of the curtain deserves her own entry at a later date.]

I had lots of pre-surgery visitors who generally asked the same questions. The first nurse who came in went over the patient info form, confirmed that I was having my right knee operated on, and asked various questions about my health in general. She also informed me that she'd worked hard all week, and since it was Friday, it was Mean Day, so she was going to be mean to me. She was awesome. Really great bedside. We laughed a lot (which was no mean feat, as I was on the verge of tears that entire morning). The surgeon's fellow came in and autographed my right knee (his initials are JM). He told me he'd be holding the clamps for Dr. Nestor during the surgery. I told him not to slip, and to make sure no Junior Mints ended up in my knee. He seemed to find that really funny. Another nurse came in and asked some questions about my current mobility - at the time, I could bend my knee completely, but not get it straight.

Then the anesthesiologist came in. He was hot. Like, really hot. And Italian. Last time I had surgery the anesthesiologist was hot, too. What's up with that? We went over anesthesia options: general, epidural, or spinal. At HSS they do spinal 99% of the time. He said I'd still be asleep, even before I had the needle to anesthesize my legs, and that the main difference between spinal and general would be that I'd wake up before my legs. I opted for the spinal, and confirmed that it'd be OK for me to leave in my belly ring (it would, but it would have to be covered for the surgery).

Dr. Nestor visited before the surgery too. We had a few questions for him. He explained again how the procedure would go, and told David he'd come out to the waiting room after the surgery to tell him how it went. The first nurse (the pseudo-mean one) came back and inserted the IV. She taped up my belly ring, and then realized that we needed to do a pregnancy test. So we did that, waited about 10 minutes for the results (negative), then I kissed D goodbye and my nice Scottish nurse wheeled me into the OR.

Once in the operating room, another nurse and the anesthesiologist lifted me onto the operating table. He said to the nurse, "I'm going to need you to sit her up," and I said, "It's OK, I can sit up myself." Ha ha. Then he started swapping stuff in the IV, and said, "This takes effect pretty quickly. Some people are surprised at how quickly it works."

Um, yeah.

Then I woke up.

I was still in the OR when I opened my eyes. It felt like I was breaking through a curtain, and I remember having some kind of dream about Taco Bell. The Scottish nurse said, "There she is! Everything went very well. He was able to repair your meniscus." I was wheeled into the recovery room. I remember seeing the clock: 12pm.

I'm back in bed, laptop and cat at my side, for more quality time with The Brace. I just heard David tell his Dad on the phone, "There probably will be some atrophy, but that's what the physical therapy should help." Ack. Freaking out again.

Back to October 1 at my doctor's office. After discussing the options, we both agreed that the ACL repair was the way to go. Without fixing it I'd be at higher risk for future injuries, and I'm a pretty active girl. I'd done research on the ACL repair surgery and had some idea of what it would entail, and the prospect was not so appealing. The doctor and his staff were incredibly understanding. The surgery was immediately scheduled for that Friday - yes, October 3, two days from when I was receiving this news. I panicked, then paid my co-pay, weepily called David to tell him the news, then hobbled off for the pre-surgery bloodwork.

From the doctor's office (at the Hospital for Special Surgery) I called work to let them know I wouldn't be in that day. I was a mess. Every time I thought about the upcoming weeks and months I would burst into tears. When I left the dr.'s I met David at his office. We decided to buy a new bed to replace his ailing 10-year-old mattress. Within about 20 minutes at Sleepy's we'd ordered a new king-sized pillowtop for delivery that evening. We picked up a set of sheets and I went home to wait for the bed to be delivered.

Thursday, October 2 (day -1)

I went to work. The day went slowly, and I tried to wrap things up as I knew I wouldn't be in at all the following week. My co-workers were incredibly understanding. One had had the ACL repair surgery a few years ago and had already told me it would "suck," and given me some details and what to expect. Someone from the hospital called me at 3pm to pre-register me for surgery, and at 5pm someone else called to tell me I was to be there first thing Friday morning, at 6am. I left work then to run last-minute errands, which included buying a wireless router, getting a pedicure, and purchasing a freezer-full of meals for D & I for the week.

[Incidentally, while running the aforementioned errands, I learned some things. One, that the people who shop at Best Buy are nicer and more helpful than the people who work there. Two, that hopping into a Chinese nail place on crutches and asking for a pedicure confuses the hell out of them. And three, that the people who work at Whole Foods are nicer and more helpful than the people who shop there.]

Tune in tomorrow for Day 0! Find out how your eye - yes, your eye - can get screwed up when you have surgery on your knee. Also explore why the anesthesiology profession seems to attract so many attractive people.

It has been 6 days since my ACL and meniscus repair surgery. I finally have a laptop with a fancy wireless internet connection (thanks to David & Garth), and if you didn't know any better and you saw me lying here in this mammoth king-sized bed with the FOP at my side that I've turned into quite the lady of leisure.

But there is, of course, lurking beneath the fluffy goose-down duvet... The Brace.

The Brace and I are spending a lot of time together. We didn't really get along at first... She's stubborn, and doesn't always go with me the way I try to go. I'm stubborn too, so there was conflict. Lately, though, we're working things out. I can haul her out of bed, and raise her up. It takes some persuading but she usually ends up where I need her to be.

How did The Brace and I end up in such close quarters?

Several years ago, in 1996, I was on an Ultimate Frisbee team in Ottawa. I'm not much for team sports, and until very recently (ah the irony) I hated running, passionately, but Ultimate is a fun game and a great way to meet people. Plus you get to drink beer! On the field, after the game! That's my kind of sport. I actually remember my Ultimate career-ending moment, when a pivot turn wrenched my right knee. It swelled up and my aunt, with whom I was living at the time, insisted that I see a doctor the next day. X-rays came back negative, and I was able to walk and not seriously debilitated, so I underwent a brief regime of physical therapy and resumed regular activities.

Some other stuff involving my left foot and my left knee happened in the interim, but they're not so relevant right now.

In January 2000 I was planning a move from California to New York. A few weeks before the move I was babysitting for friends, and knelt on their parquet floor. Something happened that wasn't very nice. I started experiencing sharp pains in my right knee. It was worse when I carried heavy objects on that side, and sometimes it was OK. As soon as I arrived in NY in March 2000, I made an appointment with an orthopedic surgeon. He ordered an MRI of my knee, and found torn meniscus, as well as irritation behind the kneecap. He also informed me that the MRI showed a torn anterior cruciate ligament (ACL), which was not causing this particular pain but was, he explained, responsible for the general instability I sometimes had in my knee. The ACL is a stabilizing ligament. It keeps your knee from moving laterally (side-to-side). When it's torn or otherwise weakened, you can have the sensation of your knee "giving out." That was my experience - it happened occasionally when I was doing something like jumping jacks (ah yes, lateral movements), but didn't affect me much in my daily activities.

The recommended surgical option was to have arthroscopy to repair the meniscus and *hopefully* relieve some of the kneecap irritation. I scheduled the surgery, my mom flew down to help out, and it went incredibly well - I was back at work within a couple of days, and the pain had been completely alleviated. Back to regularly scheduled programming - I resumed working out, strengthened my quads and hamstrings, and while I still experienced the occasional instability, everything was kosher.

Until now. On September 22, 2003, David & I went to Prospect Park to meet some people we'd met on craigslist to play touch football. We were barely warming up, just tossing the ball around, when I stepped on a branch. My right knee twisted and "gave out," as it is apt to do. Usually I walk a little and it feels better right away, but not this time. I couldn't put any weight on it, and I couldn't straighten it out. David suggested we go to the hospital, which I brushed off as silly, but then realized I really couldn't walk. One of the people we were with had a car, so I hopped to the street and he gave us a lift the few blocks to the hospital.

We found a wheelchair (I know, it's pathetically hilarious) and D wheeled me into the ER. I wasn't upset or worried, it just felt like something was out of place and maybe it'd take a little while but that it would adjust. I filled out all the forms and waited for about 2 hours to see a doctor. He bent it and asked me a few questions, then ordered a set of x-rays to make sure there wasn't a bone chip. The x-rays came back negative, and he sent me home with a brace to keep my leg straight-ish, painkillers, crutches, and an order to see my orthopedic surgeon.

Within a couple of days I saw Dr. Nestor once again. He examined me and discussed possible diagnoses, which he would be able to confirm after an MRI. If there was a meniscal tear, he might be able to repair it with arthroscopy. If it was a severe tear, or on the outside of the meniscus, he'd recommend having the ACL repair to increase stability in the knee. Of course there was the possibility that there was no tear, and it was simply a bad sprain that I'd work through.

No such luck.

On October 1 I went in for the results of the MRI. I learned that I had a bucket handle tear of the meniscus. It was pretty messed up. The good doctor listed my options and discussed them with me. He answered all my questions, and we decided that I would have the ACL repair and he would try to repair the meniscus. Because of the extent of the tear there existed the possibility that he would have to remove the meniscus entirely. That freaked me out. Dr. Nestor explained that I wouldn't notice its absence for the next 20-30 years, but that not having meniscus would put me at a higher risk for osteoarthritis, and I'd probably need knee replacement at some point. Whee!

Stay tuned... frequent updates over the next few days.