Scar Tissue and 10

Dr. Tex, my surgeon, and Evan, my physical therapist, are both on the same page when it comes to the scar tissue in my knee: the scar tissue needs to go. Under each incision, there were portals where Dr. Tex used his arthroscopic tools to place my new ACL. These portals will turn to scar tissue, and if that tissue isn't softened, it will limit my mobility in the long-term. Dr. Tex told me to massage my incisions to soften the tissue.

Evan has a more rigorous approach. I should have learned by now that for each of my post-op physical therapy appointments, a good five minutes is dedicated to knocking out this scar tissue. Normally, I don't pay close attention to the intention of what he is doing when he works on my knee. I know in general he might be working on my extension or flexion, but I finally figured out the scar tissue thing, and I need to start preparing better for it.

Evan and I started on a conversation last Friday about pain. He brought it up as my right leg squirmed and squeamed as he "massaged" my scar tissue. Here, the term "massage" means use a tool and grate on the incisions. In addition to hurting the muscles, it is a royal bitch on the outer layer of flesh. This is not fun.

"I am a pretty good judge of how much pain someone is in," he said as my right foot approached his forehead in an effort to distract myself from the pain. "I can tell when someone is drug seeking. They come in sitting with a straight face and tell me their pain is a level ten. When I ask them what's going on, instead of telling me about their injury, they tell me of their history of pain meds."

Over the weekend, I was thinking about what a ten level of pain might be. Everyone associates childbirth, third degree burns and kidney stones with level ten pain. I thought of the hospital scene in Gone with the Wind where the solider needs his leg amputated. I was traumatized by this scene when I saw on television when I was a kid. I had to leave the room, but I could still hear him screaming. I know that was the reality of war in that time. On the pain scale, I bet getting a leg removed by hatchet without anesthesia would be a ten on the pain scale. I can think of little that would be worse.

While the my scar tissue "massage" is extremely uncomfortable, I can reasonably tolerate it. Maybe it is a four or five on the pain scale, but it is only for a few minutes, and not worth needing a higher level of drug. Now that I know this is on the agenda every day since my incisions sealed up, I should take a large dose of ibuprofen before I go to PT. I don't need oxycodone, but a little over-the-counter stuff should help a bit.

Staying Home, PNB and Member of the Club, Part 2

Since my injury and the subsequent surgery, I haven't been getting out much. Here are things I've missed recently due to my injury:

• The Washington State Democratic Caucus. Glad I missed this one. Jack stood in line for two hours before he got in the middle school where the caucus was held. My left knee would have been furious. She might have gotten up and left after putting up with that abuse.
• Political Rally with Claire Adele. My daughter wanted to attend a political rally this week with one of the Presidential candidates. I didn't want to go (see "Annoying Knee") and Jack was on call. The rally was on the other side of town on a school night. She could have taken the light rail down there, but I didn't want her trying to take the train back home at 10:00 at night in an unfamiliar neighborhood. The trade off was listening to her mope half the night. She was asleep before the main speaker took the stage. Clare Adele would not have made it inside the venue anyway. I had a friend who got there four hours ahead of time and didn't get in.
• The Cool Jazz Hot Java concert at the Paramount Theatre. Jack and the Boy went. I didn't want to sit still that long.
• Rocket Launches. The Boy is in Rocketry Club, and I've missed all of the launches so far. One of the members of my PT team recommended not hanging out in a muddy field for hours. 

I did make it to my son's band concert this week. Yay! I ran into a bunch of friends. It was good to get out and be social. One friend asked she could come over. Seriously. Asking a borderline shut-in if she'd like company is a no-brainer. Right now, my best friend is my dog, bless his little heart. (No offense to my human friends.) I wonder if I'd get out more if I didn't have a dog. Would I just be so fed up with hanging out alone that I'd get out? Maybe.

Jack and I got out again last night. We went to the Pacific Northwest Ballet. We had been to the dress rehearsal last week. I am not that much of a shut-in, but thank god for ballet otherwise I might not have an excuse to leave the house ever. I wore my brace and crutch as my insurance policy against the crowds. Crowds actually have a dance and rhythm all of their own. You don't notice it until you can't play along with everyone else, and you stand out. My daughter's high school newspaper had an article about this phenomena. They did an experiment where girls walked down the hall and did not change their trajectory. Usually, girls move out of the way of boys passing in the halls. Boys barrel down the halls like they own the place. No one sees the dance until they tried to change it. Wearing a brace and crutch changes the dance. Not being able to move about freely also changes the dance.

Jack and I got there early so we got a glass of wine and sat down. Three women and a guy were sitting next to us, and we could hear their conversation. The three women were friends from a dance class. They looked at me with my brace and crutch. It was hard not to notice. They sort of looked at my like I was some scary thing they wanted to ward away, as if knee injuries were contagious. I heard them talk about their knees aching, arthritis, and not wanting surgery. One of the women said her daughter had surgery, but we never found out what kind. The other women wouldn't let her finish her story. I am sure they didn't want to hear about torn ACLs, bad ankles, or other maladies.

I settled into the show. Before it started, I took off my brace so I could stretch my leg more. I loved "Little mortal jump" by Alejandro Cerrudo. He is a choreographer from Hubbard Street Dance Chicago. My friend Cork used to work at Hubbard Street, and we used to get tickets to their shows. Seeing this reminded me of my old life back in Chicago.

As I was watching last night, I began to take an inventory of steps I could or could not do, based on my current condition, not based on how well I could do them normally.

• Stand on my right leg with my left leg in the air: Sure.
• Walk across the stage: More or less, as long they didn't want me there by any specific time
• Jog: Nope
• Turn: Nope
• Leap: Nope
• Walk in slow motion: Sure.
• Jump off the stage into the orchestra pit: Hell no.

Soon enough, I started watching James Moore and forgot about my inventory. Moore is the best contemporary dancer at PNB. He makes it look so effortless, as if he doesn't have to concentrate or strain as he moves. He is like Baryshnikov where I was too busy watching him and not anyone else on the stage. Other dancers look as if they are trying to remember an upcoming sequence or recall an instruction from the director. Dancing looks as if it just flows out of James, no effort required. You can tell he is working hard, though, because he sweats like a pig, bless his heart. To be clear, James does not resemble a pig in any other way. PNB went to New York in 2013 and The New York Times called Moore "hunky." The official paper of record for the U.S. said James Moore is hot. I cannot argue.

At the intermission, Jack and I headed to the lobby, me without my brace. I was going to brave the crowd with just a crutch. People looked at me and whisper "surgery," "arthritis," and "knee pain," trying to avoid my glance. I was mildly paranoid, thinking I was freaking everyone here out.

When we got to the lobby, I saw I woman with two crutches, a leg brace and a bandage around her knee. She was standing by herself. I went up and said hi.

"You only have one crutch!" she said.

"I tore my ACL," I said.

"Me too!" she said. Another member of the club.

"I am four weeks out of my surgery," I said. I wasn't sure I wanted to tell her. What if she were six weeks out? Would I make her feel bad? There is nothing worse than competitive recovery.

"I had my surgery Tuesday," she said. "I am not supposed to be here."

Wow. She was getting out and about, far more than I was. I was impressed.

"Heal well!" she said. "Heal well!" She tried to give me a fist bump, but I had to hobble close enough to her. She was looking a little bleary and wobbled a bit when I realized she was probably still on the oxycodone. But at least she was out. On second thought, maybe the oxycodone is what helped her get out. Not that I want to go back on the oxy, but maybe I would if it improved my social life.

Ibuprofen

Bike Time: 10 minutes

Distance: Going too slow for bike to measure

After the surgery, I was supposed to take 600 mg of ibuprofen three times a day for the first three weeks after the surgery. Last Friday on schedule, I stopped taking it three times a day. I started biking ten minutes a day on Friday, so I decided to take one ibuprofen before I began my exercising. I didn't know how much ibuprofen helped me until I stopped taking it. Unlike Oxycodone, ibuprofen doesn't have any obvious side effects like drowsiness, a mild buzz or withdrawal. You can drive while talking ibuprofen, unlike oxycodone which is a narcotic. The long-term effects of taking ibuprofen aren't great, though. It can cause stomach problems and decrease healthy inflammation. Plus, you can't drink while taking ibuprofen on a regular basis.

Life has not been good since I limited the ibuprofen. At first, I thought my discomfort was caused by the biking, that I was now having to move in more vigorous and thoughtful ways, ways that would cause me a fair amount of discomfort. Today, I figured out the ibuprofen link when the rest of my body started to ache. My right foot was sore for no apparent reason. My right knee was giving me grief and my shoulders were complaining. I felt like I had just done some serious rock climbing, but in a race instead of at a leisurely pace. I was having a harder time sleeping because little aches would wake me up. All around, it was unpleasant.

Today, I didn't take any ibuprofen at all. I was biking at the YMCA. All of the bikes and cardio equipment are crammed into the same small room. At the university sports center, I found a bike that is off to the side, not close to other riders. I know that bike isn't invisible, but it is not in the center of all of the action. I am kind of hidden. At the Y today, two women were on the elliptical machines behind me while I was biking. I hobbled in with one crutch and then took off the brace and got on the bike. I do not look pretty or happy when I ride the bike. I am slow and cumbersome and my head and shoulders twitch like I am having mild electroshock therapy. As mentioned in a previous post, my form is horrid. 

Midway through my ride, one of the women on the elliptical finished her ride. She came up and said, "Good job! You are really working so hard! It is great you are here. Keep up the good work!" She was so sweet and kind to say that, but man, I must have looked awful. Until I look moderately graceful, I'll need to take ibuprofen before I go work out.

Pain Meds v. Ice

For the past two mornings, I've woken up sore and stiff, hardly able to get to the bathroom.  Last night, I woke around 4:00, and was up for about forty-five minutes with an uncomfortable leg. I figured I'd make it back to sleep eventually, and I did.

Tuesday, I went to my post-op appointment and Claire readjusted my brace so I had greater extension. This really stretched out my leg, and it caused me some grief. I took half a pain pill Tuesday afternoon and I felt better. I managed to go to bed without out pain meds, but I woke up sore.

This morning, it was the same as yesterday. When I was out of bed, my leg ached when I walked. The first thing I wanted to do was take a pain pill, but then I had to decide: did I really need a pain pill to get out of bed in the morning? Could it be something else that was causing my leg to ache that needed to be attended to? Maybe my leg became swollen overnight, and it needed some ice and to be elevated. Maybe the brace was too tight, or maybe it was pressing against the incisions. Maybe I need to make adjustments instead of reaching for a pain pill.

So far, I have and icing and elevating seem to do the trick. I also tried playing a computer game that the Boy was playing on my phone. There have been studies on the narcotic effects of computer games, for better or worse. When the Boy had his sleep study years ago, they had him play video games while they attached a million nodes and wires to his head. He was so engrossed in the game, he didn't notice a thing until they were done and we had to turn the game off. He was not happy when he looked in the mirror.  Likewise, Jack had a patient who was recovering from major surgery. The hospital gave the child an iPad, and she no longer needed pain meds. Carl, my friend the carpenter, said he finished Zelda while he was recovering from his knee surgery.

Carl also said the six months of recovery were the most boring months of his life. I can understand. I could see how the pain meds could cut the edge off the boredom, and give an excuse to sit around and do nothing all day.

In the meantime, it isn't all that bad. When I walk around the house without my crutches, I grab on to every nearby surface. I feel like I am floating around like an astronaut in zero gravity. I wish I were recovering from this in a zero gravity environment, floating with no pressure. Maybe the swelling would be less.

Pain Meds

I had my surgery five days ago, and I had post-op appointment today. Claire and the nurse changed the dressing and cleaned up the knee. I had to lie down. Just as I didn't want to see the images from the surgery, I couldn't watch as they took off the bandage. I didn't want to be a doctor because I don't like blood, pus or sick people. I am squeamish, and I don't like anything that will challenge my gag reflex, especially if it is on my own body. Looking at my post surgery knee falls into this category. Jack recommended I look at it so I could track changes over the upcoming weeks. I still declined.

Jack, of course, looked at my knee with curiosity. If god forbid this ever happens to one of my kids, he will have to take them into their appointments. Jack said my knee looked better than Lindsay Vaughn's after her surgery.

"Where did you see a picture of Lindsay Vaughn's knee?"

"On the internet." Of course. And he looked it up. Weird. I sat up and looked at my knee. It looked like a piece of raw chicken skin -- yellow and lumpy.

"That looks fabulous!" Claire said. "I have two patients today who have beautiful knees who took care of them as they were told."

My knee might look good, but it was sore. I had a hard time getting out of bed because it hurt when I walked. Yesterday, I took 5 mg of oxycodone because it hurt to walk. Then I couldn't walk because I was looped out by the pain meds. I was tired and groggy and I had nothing to say. I was dull in every sense of the word. My friend Laura came over for lunch and I just listened, which is fine, but it is strange not to have any words or ideas to share.  For the first few days, I wondered why anyone would take pain meds for recreational use since the sensation was so odd.

And then, I liked it. I should know better. I have one friend whose son died from an overdose of prescription pain meds, and I have another friend who had a major addiction. She has been in and out of rehab. Once, she couldn't remember when her son's field trip was. I told her it was two weeks ago. She was totally snowed and had vague recollections of her life.

I can see how people get addicted to this stuff. Pain is bad, but fear of pain might be worse. Before the surgery, Jack recommended taking the meds to stay ahead of the pain because once it starts, it is hard to make things feel normal again. Being groggy and tired might be a small price to pay for not feeling bad. It lifts the mood, too. Being sore and stiff and uncomfortable made me grouchy. Being foggy and pleasant is better than being a curmudgeon, I suppose.

Even though I like the pain meds, I am still afraid. The literature my doctor's office gave me said only 15% of people become addicted to pain meds, which is good, except how do I know which group I am in, the 15% who fall for the drug, or the 85% who don't. 

Today, the nurse called and I asked what I should do. Claire changed the range of motion on my brace and my leg now has full extension. As a result, it is sore from this change. The recommended half of a pill. It seemed to do the trick in easing the pain, and gave me some faith that I could wean off the stuff.

Until the soreness and stiffness comes back.

ELMS Puzzles

A few weeks ago, I was reading Architectural Digest in the waiting room of the Sports Medicine clinic and I saw an article about George W. and Laura Bush's home on their ranch in Crawford, Texas. When the author described a table that "usually had an ELMS puzzle" on it, I dropped the magazine and googled ELMS.

ELMS is based in Maine where they hand make wooden jigsaw puzzles. I was smitten. Instead of selling the puzzles, they rent them out for three months. I called up to find out more about it. I talked to one of the women who cuts the puzzles and we talked in the phone for forty-five minutes about their puzzles. I joined and ordered some puzzles for my recovery period. The puzzles come in a green cardboard box with no picture of what the puzzles is supposed to be.

"You are entering advanced puzzling territory," said Jack. "This is serious stuff."

Tower of London

I fell in love with wooden jigsaw puzzles a few years ago when I came across Liberty Puzzles at Card Kingdom in Ballard. Liberty is based out of Boulder, Colorado, and there puzzles are laser cut by a machine.

The joy of all wooden puzzles are the crazy shapes.  Instead of all of the shapes being close to similar like in a cardboard puzzle, each piece in a wooden puzzle is fairly unique. There are dancers and animals and objects that relate to the theme of the puzzle. I often will start one of these puzzles by looking for matching shapes instead of matching colors or themes.

Why do I love these puzzles so much? I am almost addicted. I get in a zen-like flow state, where my subconscious brain will pick a piece before my conscious mind knows what is happening. Jack commented that I am really good at this. I am. I hoping that when I fully recover from my knee injury, I can get a job in the lucrative jigsaw puzzle assemblers market.

Ha. I am not sure what transferable skills match up with solving jigsaw puzzles. Maybe I could become a maker of puzzles myself, or starting my own jigsaw puzzle company.

Today is the third day after my surgery, and my friend Lisa stopped over for lunch. She is a social worker who focuses on abused and neglected children. She reads about mindfulness, and she saw my stash of stuff to keep me busy during the acute phase of recovering from the surgery. I have coloring books, puzzles, quilting projects, Soduko puzzles, books, and the BBC's Pride and Prejudice.

Finding things to keep me busy during my post-surgery days is hard. My leg was too stiff to move comfortably this morning, so I took some oxycodone. After the oxycodone, I was too woozy and dizzy to move. This seems pretty much like lose-lose to me.

But I have my puzzles and quilts to keep me occupied.

Post-Op, Day 2

This is the second full day after my surgery. Today is the day that hurts. Yesterday, I was fine bopping around the house. I could walk without crutches, and I felt fine. I took one pain pill in the morning, and was fine for most of the day.  After dinner, I began to feel a little sore. I think the swelling my knee was starting to increase, which then caused discomfort. Last night, I couldn't sleep too well and got a pain pill in the middle of the night to help me sleep.

What is the point of this? I felt better the day the surgery and the day after the surgery than I feel today. Argh. I hope this is the nadir, because it isn't fun. I am not in pain per se, but my leg prefers to be still instead of moving. I hope this gets better soon, or I might go crazy.

Today was a pretty slow day for the family. Jack and I did a crossword puzzle, and the whole family watched The Martian with Matt Damon. It has been pretty much a sit around and do nothing kind of day.

Fox keeping me company.

Low Expectations & Post-Op

I had my surgery this morning and I survived! Here's a happy disco song with a survival theme, thanks to Gloria Gaynor. I am dancing in my mind. Or you could dance in your kitchen and I could vicariously live through you. Jack thinks I am dancing in my mind thanks to percocet or oxycodone whatever I am on. I also don't understand how Hemingway and Lewis Carrol wrote while medicated.

I am on narcotics while writing, so have low expectations. Speaking of low expectations, I had the worst expectations going into this. I remembered taking care of The Boy after he has his tonsils out. He was vegged out. I remember getting my wisdom teeth out. I remember child birth. Mostly, I remember the day of the injury and how incapacitated I was. My expectations were so low, that they have been greatly exceeded. I suppose that since I thought the worst case was death, being alive is a good thing. (Jack, The Boy and I are listening to disco while Jack reads The Martian by Andy Weir and The Boy is working on a Lego Wall*E.)

I did not want to be there this morning. I was in the pre-op room, and went to the bathroom. Even though I was in the hospital gown, I thought about making a run for it. The pre-op nurse was outside the door waiting for me on the pretext of helping me find my way back to my pod. I think he was checking on runners.

I have been surprised in many ways, and not pleasantly surprised in others.

• Pleasant Surprise: Dr. Tex was very kind and upbeat. He was in a jolly mood, like he was going watch (or play) in the big college football rivalry game and dammit, his team was going to win. I am glad this guy loves to cut. He is probably happier on OR days than on days when he has to meet in the office with middle age women who had skiing accidents.
• Pleasant Surprise: I was awake in the OR for about two minutes before I conked out.
• Mildly Unpleasant Surprise: Before I went into surgery, I was in the waiting room reading People. (Do people read this magazine outside of waiting rooms?) There was an article about Marie Kondo, the tidying queen from Japan. While I am attached to my clutter and I think there are thinks that don't bring us joy that we need, I recall the OR was like walking into the Room of Requirements storage closet in Harry Potter. Granted, I was starting the flow of narcotics. I might have been hallucinating, but the OR could have been tidied up. I could be wrong. Perhaps they could potentially need all of these million of tools close by. They probably need a surgical tool room librarians or a card catalog.
• Pleasant Surprise: I woke up gently, not in an altered state where I was rambling incoherently and thinking I had a dragon tale. It was like waking up from an awesome nap.
• Unpleasant Surprise: I think the team was very generous with the pain meds, which is good, except as soon as I woke up from this awesome nap, I my eyes slammed shut. I could kind of hear people, like I was in a half sleep state. I didn't expect to be so exhausted.
• Neutral Surprise: I could hear what was said during my half sleep state. I had a femoral nerve block while I was in a mild coma and the resident and anesthesiologist guided him through the procedure. They were very polite, not only to me, but to each other. "Move the needle to the left, a little deeper. Perfect. Perfect." Perfect is a great word to hear from a medical professional after surgery. Be nice and civilized to people who appear to be sleeping after surgery. If someone is asleep after surgery, make an assumption that they might be able to  hear you and remember what you say. Don't assume they will act on what you say, but don't be a jerk, i.e., "How soon do you think she will lose weight after this surgery?"
• Unpleasant Surprise: The narcotics make me nauseated. They gave me several of these rhino/hippo/elephant condom shaped things as a barf bag. I was not hungry or thirsty after the surgery. The good news is that it will be easy for me to lose the 10-15 pounds I gained since the accident if I can only manage to eat three bites of a croissant for lunch and a few tablespoons of rice for dinner.

• EXTREMELY Pleasant Surprise: I walked up awful 23 steps to my house using crutches and Jack standing behind me. I had a lot of practice after the accident, and watched a YouTube video. Up with the good, and use two crutches under the arm for support. All of my prehab paid off! I could bear weight on the bad leg and could hobble up the steps. It was raining and I was worried that I'd have to haul my drugged up, sleepy ass up those step,s the bane on my existence. Instead, I kicked it.* As Clare Adele would say, "Go me!"

I posted this picture of these horrible steps before, but here they are again. Imagine them wet and you have to crawl up them on your butt.  I hear you swearing.

• Unpleasant Surprise: They gave Jack pictures of my surgery. He keeps trying to show me. I don't want to see them. Do you? I thought not. Clare Adele is deathly afraid of vomit but looked at them the first time Jack asked to show them to her. The Boy is like me. "Do you want to see them?" No. I prefer seeing my body parts from the outside, thank you.
• Pleasant Surprise: Before I left the hospital, they gave me a nosegay/air freshener called "Quease | Ease" to wear on my shirt. It had a lavender and mint and chamomile scent and it is supposed to ease nausea. It also doubles as a deodorant since I can't bathe or shower for several days until they take the sutures out. I also have this awesome "Dry Shampoo" from my hairdresser. (I used it on the campaign trail when I didn't have time to wash my hair.) The good news? I don't care if I need a shower or not.

* While I am excited about this accomplishment, I never want to test how strong I am like this again. Just saying. And I'll probably have to go down the steps on my butt next time I leave the house.