This image is captured from my health insurance provider’s website.  Frankly I think it speaks for itself.  What are these discounts?  What do these services really cost?

I can’t claim to know how to fix it, but I am pretty sure this system is broken.

There is no doubt that the process is somewhat easier for physiological reasons, but i also give a great deal of credit to my physical therapy. Before i go in to detail about the PT i’ve been doing this time, let me address my previous PT experience.

Towards the end of my PT after my last surgery I started to get the feeling I was being taken advantage of. Surely they gave me good exercises and lots of oversight, but they also were billing my insurance for hours and hours of time in the Russian Stimulation machine that seemed to do nothing. When my insurance benefit ran out my treatments changed somewhat and the billing changed dramatically. It was truly remarkable what they could get the insurance company to pay for. In the end I was mostly a convenient way for them to access the fertile billing grounds of my insurance.

After having began practicing yoga since my last surgery I looked for a PT that did some Yoga Therapy as part of a rehabilitation effort. I found such a person in Carri Kaplan at Bend To Mend.

Carri’s approach to my rehabilitation has been to identify some of the things going on with my body that have made me susceptible to ACL injuries and attempt to address those while rebuilding my strength and range of motion.

Perhaps the best suggestion that Carri’s given me was to stop wearing my big hinged brace after about 4 weeks. She showed me how the brace was causing me to walk, sit and stand in unnatural postures. As such it was causing me a a lot of cramping and encouraging very poor alignment in my lower body.

Every meeting we’ve had has resulted in some kind of a revelation in addition to a great deal of helpful advice and encouragement as i heal.

While I don’t doubt that a more traditional PT experience has it’s benefits I’ve found that this more wholistic approach has done me wonders. More importantly, I’m hoping that by learning more about how my body works and some bad habits I have I will be more prepared to protect myself from future knee injuries.

Thank you Carri!

1. Tidy up for convenience and safety

There’s going to be a time after your surgery where you’re trying to get to the bathroom in the middle of the night on crutches and under the influence of some pretty powerful drugs. But even in less trying conditions we need to make sure that our home is going to be a safe place for us in our new condition.

When you’re crutching your way to the bathroom in the middle of the night the last thing you need is to set your crutch tip down on a rouge sock or piece of paper.  Take the time before your surgery while you’re still fairly mobile to clean up and organize.  Concentrate on walkways in particular, but also on the areas where you’ll be performing delicate maneuvers: near the bed, in the kitchen and the bathroom.

Cleaning gets a whole lot harder when you’re in crutches and feeling lethargic from the drugs.

2. Prepare your nesting area

In the hours and days immediately after you get home from surgery you’ll be spending a lot of time sitting still in one place.  Whether you’re strapped in to a CPM machine, icing the joint  or just resting this nesting area will be your daytime home.

Take the time now to get this space ready for your return.  In my case I concentrated on our couch which is in the main living area of our home near the TV,  between the kitchen and the bathroom. It’s in this space that I’ll use the CPM, work on my laptop, watch TV and talk to visitors.  My focus was on creating a flexible and comfortable space that caters to these concious activities, i figure if i’m going to sleep I may as well crutch over to the bed.

Here’s what I did:

• Buy an ottoman. This might seem like overkill, but 24 hours after coming home this is one thing i’m really appreciating.  It allows me to maintain a near normal posture while keeping my leg comfortably supported. It also allows me to share the couch with my lovely girlfriend/caretaker.  The one I bought is fairly small and the same level as our couch, it cost less than $100 and will be useful long after i’m recovered from surgery.
• Place a good side table in the area. While you’re recovering you’ll have lots of small items collecting around, my table is currently holding:
  • The keyboard/remote control for the computer attached to our television
  • A glass and a pitcher of water
  • My phone – gateway to the outside world!
  • Miscellaneous items: It’s nice to have a place to set things down that keeps them off the floor.  This keeps you safe getting up and down.
• CPM Setup – The company that provided my CPM machine specified that it should not be used on the couch, so as to avoid a nasty situation with the machine falling off.  So i prepared my nesting space to let me move the CMP machine into a position where i’m sitting on the floor leaning my back on the couch.  I have a yoga mat handy which i can fold over several times to create a cushioned non-stick surface.  This is crucial on my cement floor.  A few pillows behind my back and one beneath the ankle of my non-surgical foot make me very comfortable even when i’m in the machine for hours at a time.
• A small trash receptical.  This helps you keep your nest clean and tidy, good for mental health

3. Healthy, Convenient Food

Your body has gone through a lot when you get home from surgery and in my experience, it’s not uncommon to have a healthy appetite.  My focus is on healthy foods that are tidy and convenient to eat. They should have as little left over as possible to prevent my nest from becoming a compost bin. Here are some things i prepared in advance:

• Lots of chopped celery and carrots.  These are great healthy/tidy snacks and can be combined with some peanut butter or even cheese to make them a bit more substantial.  I chop mine well in advance and store them in water in the fridge, this way they’ll keep for at least a week.
• Fruit.  Apples and pears in particular are healthy and nicely self contained.  Washed in advance they’re very convenient and when paired with a small garbage recepticle in yoru nesting space they clean up very easily.
• My lovely girlfriend/caretaker prepared a delicious vegetable intensive lasagne.  This dish is filling, not very calorically dense  and stores nicely so i can pluck some out of the fridge later on.  This could also be made in advance.
• Water.  I’m always trying to stay hydrated, but even more so after surgery. Good hydration has all kinds of benefits and is particularly helpful in combination with lots of high fiber foods in combatting some of the digestive downsides of the narcotic pain killers.

4. Sleep area

Between the stresses of surgery and the effects of the pain killers you’ll be wanting to sleep a lot after surgery.  To make your bed as safe, comfortable and convenient as possible i recommend these three things:

1. Have extra pillows on hand to support and pad your knee while you’re sleeping.
2. To limit the number of times you have to get in and out  put a table or chair directly next to the bed.  Mine contains:
   • A dimmer switch for a lamp near the bed – now i can turn off the lights after i’m in bed and turn them on before i get out.
   • My meds so i can re-dose the pain pills during the night without getting up
   • Water for the pills and for general hydration
   • Phone + charger.  I use the timer function on my phone to wake me when it’s time to take pain drugs in the night.
3. Make it as safe and easy to get in and out of bed
   • Keep the access to your bed wide and clear, nothing you can trip or slip on
   • Have a pre-determined place for you crutches while you’re in bed
   • Have a plan to keep this area clean, don’t let dirty clothes or dishes start becoming obstacles.

5. Entertainment

While you’re laid up you’ll need something to keep your brain engaged. I find that having a couple of good books, a handful of good movies and a TV series i’m interested in give me plenty to do. Additionally i have my laptop which allows me to work a little … and of course to blog.

What are some things you did or wish you did to prepare for you recovery?

My surgery was this morning and it went quite smoothly. My anesthesia was a bit different this time from what i’ve had previously and it’s made for a markedly improved day of surgery experience.

I’ll do a timeline post later on to help those who are doing this for the first time know what to expect, but the purpose of this post is to simply note that I had the operation, it went well and i’m feeling good.

A quick note on the anesthesia:   This go around I got a nerve block in my left leg in addition to the more traditional general and localized anesthetics. In surgery it doesn’t really matter as I was out cold like i always have been. However, come back in the recovery room was a much better experience due to the reduced use of a general anesthetic. By the time I was ready to be discharged my head was quite clear and i felt generally great.

Additionally a large portion of the left leg is still numbed, meaning i’m not experiencing even the slightest ache 6 hours post-op.

Now the hardest part begins. However, my last experience re-habing from an ACL repair ended up having a broader positive impact on my life. I’m hoping this go around will continue that trend and further enable me to engage my body.

And now, back to Mad Men Season3

Stepping out of the shower it struck me that it would be the last normal shower i have for a few weeks.

Here we go again!

After the requisite paperwork you will be taken to a changing area where you’ll be asked to remove any garments with metal on them and to put on a hospital robe. Most facilities will provide secure lockers for you to place your belongings in during the exam.

The exam room itself is laid out much like a recording studio. There is a large room containing all the MRI equipment and a smaller room separated by large windows that holds the controls.

A tech will lead you in to the room and get you situated in the machine. You lie on a sliding table that slides in to what looks like a giant metal donut. At this point they will likely offer you either headphones to listen to the radio or earplugs.

The MRI machine is very loud. You’ll definitely want the earplugs or headphones to drown it out.

Once you’re situated in the machine the tech will run a series of exams, taking between about 30 seconds and about 5 minutes. These exams should total about 30 minutes.

In my case my doctor had the pictures a couple of hours after my exam. He called me and cofirmed that i had indeed torn my acl. Additionally theres some tearing in my miniscus and some bruising on the bone, but nothing too out of the ordinary.

If it’s the first time you’ve damaged the anterior cruciate ligament you’ll probably end up either at the emergency room or your primary physician’s office. Once they suspect a ligament injury in your in your knee the doctors will probably suggest that you schedule an appointment with an orthopedic surgeon to get an official diagnosis.

Those of us who who’ve done this before (acl revision patients) will probably call our orthopedic surgeon directly to get the knee looked at.

I fell squarely in to this second category. After a restless night worrying about my knee I woke up feeling quite confident that I’d torn my ACL again, as such i wanted to get right in to see my surgeon.

When you get to your surgeon’s office you’ll have to fill out the requisite paper work and wait until someone leads you to an exam room. Here they’ll ask you to put on a pair of those horrible paper shorts, unless you thought ahead to bring some athletic shorts. The doctor needs good access to your knee for the exam.

After asking you some questions about your history and the circumstances of your accident the doctor will likely have you lie back on the exam table while they move your leg in all directions and observe the joint. They may do the same to your ‘good’ knee to compare the two.

In my case this part the exam was very quick. Within moments the doctor was able to confim my suspicions, but he then spent a few minutes thoroughly examining my knee.

After this exam the doctor may ask to have some pictures taken of the joint. In my exams that’s usually meant they took 3-4 x-rays to cover all angles of the knee. It is my understanding that these pictures don’t really show the ligament but serve more to give the doctor an idea of the condition of the bone.

The width of the tunnels through which the ACL passes are of particular importance to a revision patient. Apparently the tunnels grow in width with each surgery and at some point it is necessary to graft some additional bone into those tunnels to make the knee stable.

My doctor says that my tunnels have increased in size but that i can get away with another allograft (cadaver tendon) if we go up a size from my previous one.

After examining the x-rays with you the doctor will more than likely suggest an MRI to confirm the diagnosis. And that will be the topic of my next post!

When i was able to get an appointment with the surgeon who’d performed my previous acl reconstruction it took seconds for him to confirm my suspicions. Today I had an MRI and heard back from the doctor. The pictures make it official, my ACL is torn again and it needs to be fixed.

The most frustrating part to me is that i had done a lot to make sure this wouldn’t happen again. I’ve lost 25 lbs to reduce pressure on my joints, regularly practicing yoga to maintain my flexibility and riding my bicycle frequently to keep my muscles strong. The night i injured myself i had chosen not to enter a bike race where i feared i could injure myself but instead worked the relative safety of the finish line. Apparently all that was not enough and this freak accident was all it took for me to re-injure.

This blog is a silver lining. By chronicling my experiences here i hope to help some others through the process of acl surgery. Being my third time through this I’m starting to get the hang of things and i’m hoping my recovery this time will be the best yet.

http://well.blogs.nytimes.com/2010/09/29/phys-ed-are-bad-knees-in-our-genes/?scp=1&sq=acl&st=cse

Its about female twins, but the data has implications for everyone. Basically, if you are like me and have really flexible knees, it could have contributed to your ACL tear (or in my case, both my ACL tears). If you are like Henry, with a mother and father who tore their ACLs, then it is just another thing you inherited from your parents. My parents never tore their ACLs, though my aunt did (and she opted, instead of surgery, to never do any strenuous activity ever again! – Really!).
But, like most genetic traits, flexible joints is likely pleiotropic say the authors of the study, meaning that lots of genes contribute to that trait, not just one or two. Regardless, next time you see your parents, you could let them know what they did to you Or in my case, fear for my children