Tuesday, June 5, 2012

Physical Therapy, Daily Routine

Here are the exercises that I am currently doing to maintain some strength in my quad/hamstrings and knee; along with flexibility. [Week 1,2,3...]

Warm Up
- Heel Slides (20x, work to 30x)
- Calf Stretch, seated (with strap or band)

- Quad Sets (3-5minutes, flex & hold quad for 5sec intervals)
   -- At PT I do the quad sets with the E-Stim and do 10sec intervals
- Leg Lifts, with bolster under knees (30x)
- Straight Leg Lifts (laying down, right knee bent, 30x)

At Home I also add:
- Abduction Leg Lifts (30x)
   -- Lay on 'good' side and lift 'bad' leg up. Works outside muscles of thigh.
- Adduction Leg Lifts (30x)
   -- Lay on 'bad' side, cross good leg over and across, lift bottom leg up. Works inside muscles of thigh.
- Seated Leg Extensions (30x)
   -- If you can sit on edge of bed/table & if you can bend to 90deg
   -- Sit with legs hanging and knees bent to 90deg, extend leg up and into the straight 0deg position

Final Stretches
- Hamstring Stretch, with strap or band. Lay on back, pull leg (straight) up, toward head. 3x/30sec
- IT Band Stretch, with strap or band. Lay on back, pull leg (straight) up & then across body. Keep foot pulled up toward head. You should feel stretch along outer thigh from knee to butt. 3x/30sec

Keep the rest of your body stretched. You will get sore from crutches (arms, hands, shoulders, back) as well as possibly right leg and hip/glute. Take care of your body - heat and ice work wonders!

**Make sure that you have a pillow or bolster between knees and be very careful of your incision.
**Do not perform if you are in pain or are putting direct pressure on incision.

***Do not worry if you can't do 30x right away. Work up to 10x, then 20x, then 30x... (Most important are the straight leg lifts. Don't worry if you can't do sets of 10 - work to 30 with as many breaks as you need. It's okay to do 2-3, break, do 2-3more. Push to 30 - you can do it!)


Week 2 - Progressing...

I wanted to share some overall comments about how my first 2 weeks post-op have been.

On the day of the surgery - I was surprisingly awake, came home, and did very well. Day 2 was definitely the hardest. I would say that the most difficult days were day 2 - 5. As I was told and read in several places - STAY AHEAD OF THE PAIN. Take the medicine every 4-6 hrs, elevate constantly and ice 4-6x day. I found that for me, until day 6 I had to take the pain meds every 4 hrs. I tried every 6hrs at first but it would take too much time to kick in. Taking them every 4-5 hrs allowed the medicine time to get in my system before the last dose completely wore off. My day 6 I started to take 1 pill instead of 2 and move to every 6 hrs. By Day 8 I was no longer taking meds during the day. I still take them to sleep at night so that I don't move and get some deeper sleep. Also - make sure you're elevating when you sleep!! I was also given medicine for nausea along with a stool softener. If you take the nausea meds (even if you're not nauseous) it will intensify the pain meds and also help you sleep. I made sure I did that at night in particular. Do take the stool softener too with a lot of water. You're whole body is not used to being shocked by pain meds or anesthesia. It can affect your whole body for several days. I noticed that it hindered some of my digestion and also dried out my skin and face. This is normal. Plus, showering is difficult so I was not keeping up with my usual regimen of washing my hair as often, washing my face in am and pm, or applying lotion everyday. I could definitely tell the difference after the first week. However, you have to just accept it and allow yourself to rest and take the meds for the first week or so until you're body can adjust and detox.

Some other things you can do to help your body: Drink A LOT OF WATER. I also recommend adding lemon because it naturally helps to cleanse and detoxify your body. Probiotics and digestive enzymes can also help your overall stomach/intestine/digestive health if you take them as directed.  I take a probiotic in am and pm (on empty stomach) and digestive enzyme with each meal. I am also gluten intolerant and dairy sensitive so watching what I eat is imperative, particularly now that I've just been through surgery and am on strong medication!

Make sure that you start moving and stretching ASAP. I'm non weight bearing - but that doesn't mean I can't do leg lifts for strength and work on my flexibility. (I will post my current PT workouts soon). My brace is unlocked so I'm working up to 90deg. I was able to do this by the end of the first week. That is my limit still at week 2.

Once I began the second week, along with physical therapy my energy levels began to improve. Because I was doing PT prior to my surgery and I have a good grasp on what to do and my body limits, I've chosen to do PT twice a week. I can do the rest at home. I know when I begin walking again I will need to go at least 3x/wk to utilize more of the equipment and machines.

I spend a lot of time on the couch (not the most fun, I know). I keep my leg elevated most of the day unless I have an appointment or need to run an errand. The rest of the day revolves around trying to cook my food and plan when I need help during the week.

I think I am progressing well. I have my week 2 follow up tomorrow - my sutures will come out from the arthroscope but not the 2 larger incisions. I'm doing my best to keep my outlook positive and do my exercises each night. I will say that the overcompensation is affecting my right leg/hip. I look forward to when I can begin proper weight transfer again.

6 weeks until I'm weight bearing!!

Items to Make Limited Mobility Easier

It's been quite a few days since I wrote a new post. I've been busy and my energy each day still varies quite a bit. Now I've got some catching up to do!

Some items that I have received lately that help immensely (and I highly recommend!):

1. Shower Chair (with back): This makes taking a shower much less uncomfortable. It fits in the shower properly. I don't have to sit partially on the shower curtain to make sure water isn't spewing out onto the floor. The back supports me and allows me to sit up and not awkwardly lean back, especially when I am washing my hair. A hand held shower head with hose is a MUST. The back on the chair also helps because you can drape the hose on it and keep it closer to you. I can't wait until I can stand up to shower - and more than anything, just let the water run down on me for the entire shower. It gets cold sitting there and only being able to wash small parts of your body at a time. I definitely recommend putting your shower items as low as possible so you can reach them (and don't forget a trash bag to cover your knee!).

2. Wheelchair: If you're home as the space, this has been a lifesaver! I was able to get a script to rent the wheelchair until I am weight bearing again (2mo). The place where it is the most helpful is in the kitchen. For me, I was able to move my bedroom to the main floor for the time being. My wheelchair only can fit between the kitchen, living room, and dining room. Due to the layout of our stairs and where my bedroom is, I can't fit it through that particular hallway. However, I can tolerate using my crutches around my bedroom. In the am, once I'm ready I crutch to the main part of the house, and then I can transfer to my wheelchair to use for the majority of the day. It makes cooking much easier since I am able to sit instead of stand awkwardly on one leg for an extended period of time which causes me pain in the foot of my injured leg and the hip of my good leg. It did take some getting used to in terms of maneuvering. You have to be strategic how you move and how to place things to cook. But, once you get a few major items arranged in the kitchen to where you can reach them - you are able to cook for yourself. (This is imperative for me because I live alone!) I won't lie - cooking is much more time consuming this way. My stove is in an awkward location so I do a lot of turning and rotating to cut/chop food and then transfer and stir things on the stove. I do my best and try to make fairly simple dishes. One of the most important goals for me is to still eat healthy and make sure I have my veggies.

3. CrutchBuddies!: I recently ordered a set of crutch covers, grips, and a pouch from Crutchbuddies.com These have been another lifesaver! The covers for the part of the crutch that goes under your arms is so soft and cushioned. It also has a fleece covering so it is soft against the skin. This has really helped calm the irritation and chaffing I was getting. The hand grips are also very soft and comfy. Lastly, I got a pouch as well. It is a great way to be able to carry my phone, keys and other small items that I take around the house and into and out of my bedroom. I got mine in leopard print! Gotta be stylish!!

4. Lap Tray (for wheelchair): If you get a wheelchair - I recommend getting some type of lap tray/table as well as possibly as pouch or bag. The tray for me is helpful because I can carry drinks and food that is hot much more easily from room to room. My set up doesn't allow me to eat in the kitchen so I have to take my meals to the living room so I can sit comfortable with my leg elevated. If I have a plate that isn't hot, I just set in on my lap - but that's not always the case so the tray is very helpful. And now I can bring hot tea to the couch and enjoy it at night! The pouch is nice here too - just as it is with the crutches.

5. Temp Handicap Parking Tag: Luckily, I can still drive because my surgery was on my left leg. As I've mentioned, I live alone so I don't have anyone to drive me to regular doc and physical therapy appointments. (Yes, I do have to recruit people to take me grocery shopping because I can't carry things into the house). I spoke with my doc about a temp parking tag so that while I am non weight bearing I can park closer when I am at the store, etc. Being on crutches is exhausting in itself, and even more so when you're non weight bearing. If you're able to get this - it's a great help and also a good way not to over strain yourself while you're in the most important phase of recovery.

Do you have any at home items or layouts that have helped assist you when you're in the recovery phase??

Wednesday, May 30, 2012

Week 1 - Follow Up & Take a Look at the Incision!

At my Week 1 Follow up I got to see my incisions for the first time. The surgeon also reviewed all the scope pictures, xrays, etc with me. There are 2 larger incisions and 3 small incisions from the arthroscope. 

If you're unfamiliar with this surgery, or haven't read some of my other posts. I had MPFL Reconstruction and Microfracture. MPFL (medial patello-femoral ligament) Reconstruction consists of attaching a new ligament from the femur into the patella for lateral stability. Microfracture is an "articular cartilage repair surgical technique that works by creating tiny fractures in the underlying bone. This causes new cartilage to develop from a so-called super-clot." (Wiki) Essentially this creates a form of padding because you cannot replace/add or regrow actual cartilage. I had this done on the lateral femoral condyle portion of my femur. I had severe cartilage damage in that location from when the patella would dislocate and upon snapping back in place it would hit and scrap the outside of my femur. I also have a lot of cartilage damage on the underside of my patella but there is really nothing they can do (along with some small fracturing). I will have to be conscious of my knees in the future because I am a candidate for early arthritis. 

Below are the pictures of my knee 1 week post surgery along with the brace I will be in for the next (at least) 3 months.

Original Ace Bandage with Knee Still Wrapped Beneath from Surgery

With Brace

Top View, Left Knee. 2 Large Incisions with 3 Smaller Scope Incisions

Side View, Left Knee (from Inside of Knee), Better Shot of Two Incisions

Side View, Left Knee (from Outside of Knee), sorry for the upside down photo!

Friday, May 25, 2012

How to enable my home for recovery...

One of my biggest challenges in living in a very large home all by myself. Luckily, my boyfriend is here for the first 8 days post surgery, but after that I'm on my own for the remaining 7 weeks. We have been working diligently to find ways to mobilize the house for me.

Firstly, we moved my bedroom up to the main floor of the home. I was previously sleeping in a bedroom on the basement level (of a 3 story home) but stairs are my worst enemy at this time. I can get up them with crutches as long as I take my time and watch my balance. However, I cannot get down them without sitting down and doing the 'boom boom' like you did when you were 5. It is virtually impossible to not bear weight on your leg and use crutches to get down the stairs in a way that resembles walking.

The bedroom on the main floor level is great because I also have the bathroom attached to my room. The living room, kitchen, and laundry room are also all on this level. The only time I need to use the stairs is to get outside to go to my car (which is half a flight to the garage level). It's the best that we can do - and it is still much better than an entire flight of stairs up and  down everyday just to eat then sleep and shower.

Carrying things is definitely difficult. Some of my set ups include:
- Having a satchel type bag that I can wear across my body to carry things room to room
- Stool or ottoman in every general area (vanity for makeup and hair, bathroom sink to wash face, kitchen to cook...etc)
- Make space in hallways and walk ways as wide and uncluttered as possible
- Have a daily 'command center'
  -- For me this includes an area setup on the reclining couch where I have my laptop and accessories, phone, meds, small end table for water bottle and snacks, remote, and pillows within reach for elevation. I recently bought a small basket/bin to hold all of these items on the couch with me.
- Develop a routine for your ice so you can easily wrap your leg
- Still looking into getting some type of cart to push or pull more items than can fit only in a big on my shoulder...

I'm still working on how to utilize the kitchen. I can't stand long on only one leg for very long...

At my one week follow up I plan on asking for the following items:
- Shower chair (necessary!)
- Handicap (temp) driving pass
- Seated Scooter or Wheelchair for in the home - this will help me move around and also sit to do longer tasks like cook

Hopefully Wednesday will shed a lot of light on how to maneuver better along with providing further assistive devices.

Three days, the Ups and Downs

By now it's Friday evening and well - that last few days have been interesting. As I expected, the day after surgery was the most difficult and painful (as described in my last post). Thursday and today both were slightly better. More energy overall - especially in the mornings. At least when I do fall asleep I get very deep sleep. The pain has not changed tremendously. I still take the pain medication every 4-5 hours. Taking the nausea medication (whether I'm nauseous or not) definitely helps make me feel less shaking overall. Particularly later in the day when I feel like my blood sugar has dropped or I'm ready to eat another meal.

I'm starting to be able to feel some tingling where the incision must be. Normally I feel it when I'm moving into drastically different positions such as swinging my leg down and off the bed, or half picking up and assisting my leg up onto the bed or couch. My brace is unlocked in both flexion and extension. I'm doing my best to stretch as much as possible along with keeping my foot and ankle moving.

Today I went to physical therapy. There isn't a lot we can do without being weight bearing but we did go back to the basics. Heel slides, calf stretches and variations of straight leg lifts. I can also cleared to continue my range of motion work. Tomorrow I will start hanging my legs off the bed or chair to work toward 90deg.

I'm hoping that by the end of this weekend my energy and pain levels will even out more. I also hope that I will be able to back off the meds so that I can start taking 1 instead of 2 and try to move from every 4hrs to every 6hrs.

Wednesday, May 23, 2012

Day 1 - Post Op

As expected, today was definitely more difficult and painful than yesterday was. After coming home from the surgery yesterday afternoon I was sore, but it was tolerable and I stayed awake the entire afternoon and evening. I took my pain meds every six hours as prescribed. I was due for another dose at 1am - I knew I wouldn't make it through the whole night without them. I tried going to bed around 11pm...but set an alarm for my meds. By midnight I was already uncomfortable in bed and took my Lortab an hour early so that it would have time to kick in.

I did get some sleep, but woke up at 3am in a lot of stiff and pressure type pain. I had to wake up my boyfriend so he could get me wrapped up in ice. That alleviated some of the issue. I stayed awake for a good hour before I was able to doze off again. I made it until almost 730am when I needed another dose. Elevating the leg really does help. And for as much as it hurts to be standing and having the pressure and weight of my leg/bandage/brace it is necessary to change positions as much as tolerated so the leg doesn't lock. I've been doing my best to keep my foot and ankle moving to keep up the blood flow and prevent additional swelling or potential blood clots.

Once I ate breakfast and got back up to the couch I was a little better. I did doze off more often today. I'm much more tired and sore. I can feel more pain in the area of the incision and have been taking the meds closer to every 4 hours. I also started to feel some of the nausea. It's hard because you need to eat with the meds - but you also don't want very much either. I also have noticed I'm a lot more shaky and irritable (the lack of sleep probably isn't helping either!).

Tonight we attempted a shower...it was so difficult because I can't get my leg wet. Good thing I just got a nice hand held shower head and that I have some good core strength! My boyfriend had to help me a lot. I did my best to leave my bad leg out of the tub and sit on the edges. Then trying to do my hair without washing tons of water out and all over the floor was quite a challenge. The whole ordeal exhausted me. Hence why I am currently back in bed awaiting some dinner with my leg wrapped back up in ice.

Hopefully I will sleep through more of tonight and tomorrow will be better....

The doctor who called to check on me earlier today said that if I take the pain meds - followed by the nausea medication (even if I'm not nauseous) 2 hours later - the combination should enhance the pain medication and also put me to sleep. I'm going to try that before bed because I have yet to get any kind of deep sleep since 2 days before the operation.