ACL Update Month 5

It's really hard to believe it's been just over five months since I tore my ACL.  In some respects, it seems like a million years ago; in others, it seems like it just happened. I know the hardest part is behind me now, and I'm just perfecting my walk now so that I don't have such an awful limp. But it's still painful, it's still awkward, and I still get a lot of ridiculous comments from people--mostly those who don't even know me. I'll start there.
I don't know why people think it's okay to ask the following types of questions:
"What happened to you?"
"So, did you hurt yourself or...?"
"Don't you think you'd be better off in a wheelchair?"
I have been asked all three of these questions since I started walking with my cane. All by adults--not the sweet little cherubs I work with everyday. (Although they will often ask if I hurt my leg. And I expect them to. Children are curious.) What if I had been born this way? What if I had an incurable disease? What if there had been a horrible accident that took the lives of my family? Is that any of their business? As a matter-of-fact, why is it anyone's business why I "walk this way" any how? It's not! So... if you see someone with mobility issues, perhaps the best thing to say is just, "Hello," or "May I hold the door for you?" and leave it at that. I'm not in the business of rehashing the entire story to total strangers, and a simple, "I tore my ACL," is never sufficient. Most people don't even know what that is. So it's really better if people I don't know don't ask.
Now, I've met a lot of great people the last month or so because I have a new job. And when one of those people, someone I work with, someone I see everyday, asks what happened, or how I'm doing, or the often, "Now how did you do that again?" I absolutely don't mind.  Most of them know I tore my ACL last year before school ended because people talk, and that's fine. I certainly don't mind if they have follow up questions. But that's totally different than someone I don't know who I'm never going to see again asking, "What happened to you?" I got in a fight with your mama. You should see her!
Okay--rant over. Here's what I can do now that I couldn't do last time I updated this blog: I can go up and down flights of stairs with assistance from a spotter, a.k.a. my husband. I just found this out tonight. We removed the ramp from our front door a few weeks ago and I can go in and out of the house with minor issues. I have been using my cane if I need any help at all, and that's mostly at work because our halls are so long. I also use it first thing in the morning when my knee is pretty stiff. I can get in and out of the shower and the bathtub now. Basically, the only things that are still problematic are walking long distances (like a quarter of a mile would be far for me right now) and standing for too long.  This is because I'm still not distributing my weight evenly and it starts to hurt my left leg, my "uninvolved" leg, as it is known.
My extension hasn't gotten much better, despite my best efforts, but my bending is basically normal. My strength is also pretty good, though my quad is still a little weak. I think this is part of what is causing my limp, that and the bend in my knee. I saw my doctor last week and he is concerned about my limp. He took new X-rays and said the placement looks good, but he wants to know why I am limping. I have to see him again in six to eight weeks. He also said I will most likely have arthritis where my meniscus is missing. It already hurts there more than anywhere else, so I'm pretty sure there's no getting around that.

I'm bringing the cane back into style.

As for pain, it hurts in my shin a lot while I am walking and/or going up and down steps. My quad hurts sometimes, but most of my pain comes from the inside bottom part of my knee--where they removed a big chunk of my meniscus.  I'm not sure if that's why or if it is just a coincidence. If it rains, it hurts more than usual. It's not pleasant, but it is tolerable.
The last thing I wanted to address is just a quick explanation of what an ACL is and what it does. A sweet friend asked me one day if I tore the ACL in my knee or my foot, and it made me realize that some people probably don't know much about the ACL. I certainly didn't until this happened to me. With a popular football player and at least one Olympian recently tearing their ACLs, more people may know, but I really think the more people know, the more likely they are not to injure there ACLs in freak accidents like mine. The ACL is a ligament that runs through the middle of your knee. It goes from the upper-outside of your knee to the lower inside of your knee. There's another ligament that goes the opposite way, but it isn't as important. The ACL's job is to stabilize your knee and keep your bones working together.  It's a lot easier to tear your ACL than you might think, and they almost always tear completely when they tear. You can tear it just a little bit, but they don't mend well on their own because not a lot of blood gets to the area, so you will likely have to have it surgically repaired even if it's not a complete tear. I jumped off of bleachers onto uneven ground. I wasn't playing a sport or doing anything where my knee should have pivoted or twisted, which is often what causes a tear. It doesn't necessarily happen because of vigorous activity or anything too athletic.  When it did happen, I just assumed that my kneecap had popped out of place, because I had seen that happen to someone before.  I had no idea that there was something inside of my knee that could tear and cause such a huge problem for me for so long.  So, please, educate yourself about your knees--your ankles, your hips, whatever body parts you'd like to keep working. And be careful. I'm that mom who is always saying "be careful" about this and "be careful" about that. I guess I needed someone to shout to me to be careful!

ACL Reconstruction Post-Op Days 8-10

Day 8 was pretty uneventful--it was basically a repeat of day 6 and 7. Things got a little better in the pain department, but I was still around a 3 or a 4 most of the time, with tiny spikes to 7.  Day 9, however, was a game changer.  Day 9 was the day I took control back over the situation and was reminded that I am the only one who can "fix" me.
I went to the physical therapist for the first time on Friday, which was Day 9. It was an early appointment and I took my medicine about an hour before it was scheduled to start so that if they decided to torture me, at least I'd have something to take the edge off. This is the first time since the accident that,when they've called my name at an appointment,  I've gone back on my own--Brian stayed in the waiting room. It was a little unsettling, but I knew this was something I had to do by myself.
I really liked the therapist right off the bat. He was very easy to talk to, seemed genuinely concerned about my injury, and definitely gave me the impression that we were going to get me all fixed up in no time. But after I finished telling him what had happened, and he'd asked me about my goals, etc., he said something that really resonated with me. He said, "I can't fix you--only you can fix you." I've known this all along, I guess. But hearing him say it really reminded me that whether or not I ever walk again is really up to me. I can go through the motions, or I can choose to ignore them altogether, and either way I end up in a wheelchair for several more weeks, months, years. Or I can give this everything I've got and get back to normal as quickly as humanly possible. Of course, I need guidance from the therapists, but at the end of the day, the results are all up to me.
I was there for about an hour.  We did measurements and I found out that my leg will currently extend 31 degrees. My left leg, the good one, extends to -5. He explained that I will need to get my right leg even with my left so that I can walk without a limp, etc. He also told me how far it was bending, but I don't remember what he said. I am definitely more concerned with extension at this point.
He showed me six different exercises that I will have to do several times a day. They are all designed to stretch out the ligaments and muscles in my leg and get it to extend and bend the way that it is supposed to. The worst one, by far, is the slow stretch, where I extend my leg as far as I can and then leave it that way for up to fifteen minutes at a time.   So, for me at this point, this would be taking it out 31 degrees, and keeping it stretched as long as I can.  He said I could start out at two minutes, but I needed to build up to 15.  This is one of those slow burn, no pain no gain type of exercises. Sounds simple enough, but it is pretty painful. He told me if it hurt above a four to stop, and if it really starts hurting I suppose I will, but a sustained pain at a four that you know you can relieve by changing position is almost as bad as a sharp seven that goes away pretty quickly.
I really liked my therapist, and I felt like he had a great plan in place. Unfortunately, at the end of the session he told me he wasn't going to be working at that location anymore. That was kind of disappointing, but I'm sure they have other therapists that are just as good and that will help me make quick progress.

My daily exercises!

I go back on Tuesday, which will be post-op Day 13. By then, my goal is to have my extension to 20 degrees. That seems like a big jump to me, but I'm ready for the challenge.
My next stop on Day 9 was back at the ortho's office.  There's a nurse there who is very nice and she always stops to speak to me even when I'm not her patient. I was really happy that she was the one to remove the tape from my wounds!  I thought a man would probably just come in and pull it all off, but of course she didn't. (Most of the other nurses in the office are men, including the guy who insisted I fully straighten my leg last time, even though I can't.)  She cleaned it off with alcohol and the tape all came off pretty well. It actually looks a lot better, although it's still a bit misshapen and there will likely be some scarring.
My doctor checked it, forced me to fully extend it, even when I told him the PT said I couldn't, and checked how far I could bend it. Then, he showed me some pictures from the surgery. Apparently, I had completely severed my ACL from my femur. There was just a scraggly little stump left, like the roots of a weed holding on for dear life. He showed me pictures of my new ACL, too.  It looked very sturdy and fully capable of doing its job!
For some reason, I think the doc was under the impression he had already given me a brace with an adjustable locking mechanism. I explained that I haven't had one. He asked a similar question at the hospital, so I think he that we had done this already. Well, I got one yesterday and got it fitted. They locked it in at 20 degrees. I was confused and explained that my extension was only 31 and they said okay. I don't know if these two things are related--I thought they would be--but when they put it on, it wasn't uncomfortable (I mean, not anymore than any brace would be) so I guess it doesn't matter that I'm at a 31 and it's at a 20.  I like it--it reminds me a bit of Luke Skywalker's arm for some reason.  I hope I don't have to wear it for long, but I appreciate the fact that it has a lot of support for my knee, which should be helpful once I can start walking again. Speaking of, he told me to wait until next Wednesday, two weeks from the operation, before I start putting any weight at all on it and then to start off with 20 to 30 pounds tops. We are going to have to get that number up pretty quickly for me to be walking on it anytime soon....
Today is Day 10, and I started my exercise full throttle today. Sure, I went through as many as I could yesterday afternoon, but I didn't really have some of the props I needed, and I didn't have time in the day to do all of the reps.  Today, I have all day, and I'm almost done with them, though there are some I'm planning on going back and re-visiting.
As anticipated, that slow stretch has been a killer. The first time, I couldn't hold it for more than two minutes. I have now worked my way up to 10 minutes, but I don't think I can do 15 yet. I have to have at least an hour in with this stretch each day, which doesn't sound like a lot, but I can't tell you how many times I haven't been able to fit an hour long workout into my day (or have thought I couldn't anyway) which tells me it's a bigger chunk of time than it sounds.  Still, it's the most important thing I can do to help myself get better, so I'll definitely get that hour in each day. For now, I don't have a lot of other things to do anyway....
I do think I am making progress. Even right now, my leg is pretty straight. I usually keep it as bent as possible, but I'm just naturally keeping it straight with one pillow under it right now, and I think that tells me it isn't as insistent that it has to be bent as it has been in the past.
I will go to PT twice a week for the next two months, and then we will see where we are. They said the first two months are the most critical to my recovery.  The doctor still thinks it is possible that I could be walking (assisted) in another two weeks. I hope that I can walk by the beginning of July when I go back to see him.
So... that's where I'm at on my journey right now. It's been two months and two days since the incident. My pain is getting better each day, my leg is starting to cooperate a little more, and I really feel like I have more control over this than I have in a long time.
If you have questions, or something you would like to share, please feel free to leave a comment!

Zombie Knee

I went back to see my original ortho today to go over the results of my second MRI. If you missed the drama of that rant, you can find my post here. I was definitely going to get a second opinion and even had an appointment scheduled for next Wednesday. It is no longer necessary--because I'm getting a Zombie knee.
The doctor looked at my new MRI and realized that when I re-injured myself my meniscus folded up and is now stuck inside of my knee, preventing the joint from functioning. Suspicion of this is what caused him to order the second MRI in the first place, so I'm glad he did, even though it wasn't a lot of fun. He said this is why I can't bear weight and why I can't straighten my leg. Of course, I suspected this all along. (I have done my research.) So I wasn't really surprised. He said the only thing we can do is go in and take it out.  He's basically just going to cut off the inside front half of my meniscus.
And if you cut off a meniscus, you may as well replace an ACL (I'm a kindergarten teacher at heart, remember? If you give a mouse a cookie....)
So he is going to go ahead and replace my ACL with a new one. Okay, not a new one, and old one. One from someone else who isn't using it anymore.
A cadaver.
I am an organ donor, and I think it's a great thing to donate your body to science. Somewhere, there is an ACL in safe keeping with my name on it that someone so graciously donated once they passed on. The thought is a little creepy, but their sacrifice is greatly appreciated. Still, I can't help but think of it as a Zombie body part. Back from the dead. (Since I am also an organ donor. I wonder if a third person will get to use this tendon....)

What's in your knee? In your knee? Zombie. Zombie. Zombie--ee-ee-ee!

The reason the surgeon can't take my own hamstring or some other tendon as is often done in these sorts of operations is because my tendons and ligaments are too stretchy. He was shocked that my left knee automatically hyper-extends whenever I straighten it.  So using my own tendon or ligament wouldn't be the best idea.
I will be scheduling my surgery tomorrow. He said it would be next week at the earliest. He is calling in his partner for this one; apparently, he thinks my knee may be as cantankerous as I am. He said it will probably take two hours. I should be walking within three weeks of the surgery though. That's the part I am the most excited about--I don't care about the pain and the discomfort--I want to walk again.
It will probably take a good 3-4 months before I feel normal and a year before he will completely release me. I will still have to do physical therapy, as well, but not until after the surgery.
I'm really excited to get on with this and get it over with. I know it's going to be a lot of pain, but if that's what it takes so I can function again, I'm all for it.
This has been the craziest year ever. From the tornado in December, to having Duke's face bashed in by a horse, to losing Barkley, and then this ridiculousness with my knee, I'm leery of asking what could possibly happen next. Hopefully, it is only good news from now on!
Thanks to everyone who is keeping us in your prayers! We need it. We have two and a half weeks of school left. I'm not sure if I'll be there for all of it, but my girls likely will be, which means Brian's crazy schedule will continue. It's hard having to do everything that you always do and everything your spouse usually does.  He's done an amazing job of taking care of us, and I'm very lucky that he puts up with me. Something tells me the worst part is probably yet to come....
(PS Since everyone seems to be offended by everything these days, please understand that I know that the tendon will not actually be from a zombie, make me a zombie, or that I am insinuating that the person who donated it is now a zombie. It's a "laugh so you don't cry" situation. I applaud organ donors everywhere and their loved ones who support their decisions to donate.)

MRI Take Two

The only way you don't know that I recently tore my ACL and meniscus is if you've never met me before and stumbled upon this blog post blindly.  This is because everyone who has ever met me in my entire life has had to listen to me whine and complain for the last six weeks.  (Note to self: check "unfriending" data on Facebook.) It's not because I am generally a "woe-is-me" type of person (I don't think) it's because having a torn ACL really, really stinks. I can't walk, I can't drive, I can't do much of anything. But... I can complain, apparently.
So, today's post ain't gonna be any different....
I went back to see my ortho a few days ago. Before the appointment, my husband (who is just as sick of this situation as I am) and I decided I was either walking out of there on my own power somehow or we were scheduling surgery.
Neither of those two things happened.
My doctor was shocked when I told him I hadn't been doing physical therapy for the last four weeks--because he never told me to do it!  He says he put it in my notes to have his people call the PT people, who were supposed to call me. None of those things happened. And so he determined that I couldn't have surgery yet because my leg was still too swollen and immobilized.  He didn't know why it wasn't bearing weight better or why it won't straighten, so he sent me back to get another MRI to see if my second injury about five weeks ago caused further damage to my meniscus which may now be blocking the ligaments and keeping my knee from bending. This injury happened after the first MRI.
I was so upset when he told me four more weeks that I almost lost it. I wanted to cry and punch him in the face at the same time.  I mean, it's one thing to say, "You're knee's not ready yet," but something else entirely to say, "Oops... we never called PT." The fact of the matter is, if he had told me I needed to do PT, I would have called them myself. But I'm almost positive that he said let's re-evaluate in four weeks, and if I needed PT later (like after surgery?) we could do it then, but he didn't know if he was going to order it or not because it's so expensive (guess I looked like a bum that day).
Of course I didn't punch him or cry, but I did take my toys and go home. Which translates to mean I immediately went home and started looking for another doctor.  I know this wasn't done intentionally, and there's a good possibility that he could have said no surgery, continue PT anyway, I just don't know how I feel about having someone cut me open after he's already shown himself a bit forgetful and/or unorganized.
So today I went in for my second MRI.  That probably needed to be done anyway.  I went back to the same place I went the first time, Preferred Imaging.  The first time everyone was unbelievably nice and attentive.  I felt like they went out of their way to make sure I was comfortable. Today was not quite the same.  The receptionist was nice enough but not particularly friendly. And the MRI technician was nothing like the last one.  Apparently, the guy right before me was very uncooperative, which put the technician in a sour mood from the beginning.  As he was walking the other guy out, I heard him explaining that he moved too much and that the image was not going to work. He would need to reschedule. The patient seemed pretty insistent that he didn't think that was necessary and he would just take in the blurry image, and the discussion went on for a while. So by the time it was my turn, the tech was about out of patience.  He was doing his best not to take it out on me, but I know how my knee works, and I knew we were in for a bumpy ride.
The tech pulled my wheelchair to a halt about twenty feet from the MRI machine because of the metal and told me I'd have to walk the rest of the way. (Um, sir, if I could walk, I wouldn't be here.) I explained that I couldn't do that, so he had to go find the MRI safe wheelchair. The transfer was anything but graceful, but eventually I was able to wheel myself into where the machine is kept, it's narrow white tubeyness all set up for my session of misery.

There it sat, like a portal to Hell, beckoning me....

Because, if you've never had an MRI before, here's the deal--you can't move. At all.  If you do, it blurs the image. It's kind of like in the olden days when people went to get their pictures made and they had those rods up their backs to keep them from moving and ruining everything.  So he asked me to put my leg in this little positioner that was designed to isolate it, but my leg had to be fairly straight, so you can see how this might be problematic for a person who cannot fully straighten her leg.
I warned him ahead of time that my leg likes to spasm, and that there is nothing I can do about it. He kind of sighed and instructed me to do my best not to move.  Have you ever tried to stay perfectly still for thirty minutes? Not a twitch, not a spasm, nothing? It's really hard. And seeing how upset the tech was with the last guy, well, that just made it even worse for me, because I am a rule follower, and I really didn't want to mess it up and have to come back, and get yelled at for moving too much.
I am lucky that it is my knee that is injured because they don't have to put my whole body in the tube.  It stopped around my waist, so no claustrophobia. I got to listen to the radio, which was also helpful, because those machines are really loud. They sound a lot like a jackhammer.  They vary in loudness and intensity; sometimes it's a constant hum, other times it's pulsating. It's never pleasant.
And so about two minutes in, I realized my leg, which was hurting due to the straightness and the position I needed to hold, was starting to tighten up. Tightening muscles equals movement.  And then the twitching began.  It started in my thigh, and I tried to keep it there, but soon enough it moved to my calf, and then, inevitably to my knee.  Now, this happened last time, too, but the sweet tech lady whom I now love even more came over the speaker and asked if it was involuntary, and when I told her yes, she said not to worry about it, and I was doing great.  This guy said nothing. I knew he was probably swearing and cursing my name. I continued to do my best to keep from moving, but my leg was uncooperative, and it was especially agitated by the jackhammering, pulsating noises the machine made every once in a while.  I knew any minute he was going to yell at me to please hold still, but he actually didn't say anything at all for about 25 minutes.  I know how much time had passed not because there was any sort of clock or timer but because he told me it would take about 25 minutes and because of the average length of songs.... So he finally says, "Are you doing alright?"
I hesitantly said, "Yes, but I know it's spasming. Is it okay?"
There was a long pause during which I mentally envision myself going out and telling my husband and two cherubs who are patiently waiting in the lobby that we have to come back again because Mommy is an MRI failure before he finally says, "It's okay. Just do your best. Some of the scans are bad, but some of them are okay."
Now, I have no idea what this means--I don't know how many scans he is doing, how many have to be good, if a bad scan means extra years in purgatory, or what, but I am at least a bit relieved to hear that some of it is working... to some degree.  He told me it would probably be another seven minutes, and that it is taking longer because I CAN'T STAY STILL!
I suddenly know how those impulsive five-year-olds with ADHD must feel when teachers such as myself tell them to stop jiggling their legs. I apologize, my little friends. Never again.
I don't think it was seven more minutes. I think it was seven more hours. But eventually, he comes back through my headphones and says, "This is the last scan. It will take about two minutes."
And then I started counting. Slowly. To 120. As I concentrated on not moving. By the way, when you are trying not to move, the worst thing you can do is try not to move.  And I counted past 120. And on. And on. Maybe I was counting too fast. Maybe my wiggly leg is prolonging the torture. By now, my leg is burning and screaming at me. It wants to bend so, so badly.  Finally, somewhere between 300 and 400, he says, "Okay. I'm coming to get you out."
Hallelujah!
Once I was out, however, it was almost impossible to stand up and get off of that table. My leg refused to go back to its favorite bent position. It was so stiff and painful. It was all I could do to lift it out of the positioner. I thought Brian might have to come back and help me up. But I made my way off the table, into the chair, transferred to my own chair, and finally out into the waiting room, where the five minute wait for a CD of the experience turned into a fifteen minute wait, and my leg was furious and screaming at me the whole time.
When I finally got home, I immediately took my "good medicine" (it's only hydrocodone, which is nothing to a lot of people, but it puts me to sleep almost immediately) and took a two hour nap.
It's been about seven hours since MRI #2 was completed, and my knee is still angry. I think it might take a few days for it to stop screaming at me.  But hopefully this MRI will give the doctors what they need to decide whether or not my inability to bear weight and straighten my knee is mental or muscular.  I don't know if it's because I haven't been moving it enough or if it really is incapable of being straightened and/or holding me up. I hope to know soon so we can get on with it already.
If and when my knee is strong enough for surgery, it will ultimately be up to me to determine whether or not I want the surgery.  It used to be a given that if you tore your ACL, you were having surgery, especially if it was torn in two, like mine is. It cannot repair itself. Now days, however, unless you're an elite athlete, you may be just fine without getting it surgically prepared. It won't ever heal, but you should be able to do day-to-day activities with no problems. Your ACL stabilizes your knee and keeps your bones from moving too far away from each other. I can't walk, but I have practiced taking steps, and the sensation is very strange. It's hard to explain, but I feel like the bones are moving, like my knee is fuzzy or asleep in the middle, and most unsettling of all, I feel like it could just fold up at any second. I honestly think that, if it is truly my decision, I want to have it repaired. Not because I know without it I'll never fulfill my dreams of becoming a professional soccer player, but because I am so afraid of it sliding out of place again. I can't ever tear it again if I leave it the way it is now, but other things can re-tear, like my meniscus and the other tendons and ligaments, and I'd like to avoid that at all costs. I know the surgery is very painful and the recovery is long and pretty awful.  I just don't know if I can walk around on a bum knee that feels like Jello for the rest of my life. I do realize that, no matter which way I go, I will have to be extremely careful for the rest of my days not to injure it again.

I know several people who have had ACL reconstructive surgery.  If you're one of them, what do you think?  Would you do it again?