August 16, 2007

MY &&$%#*&ING TORN ACL EXPERIENCE

For cathartic purposes, I have decided to reduce to writing the events giving rise to my torn ACL and the experiences and emotions endured during the weeks following the injury and prior to my reconstructive ACL surgery on March 6, 2002, and in the weeks and months following the surgery.

THE ACCIDENT

The morning of Monday, February 4, 2002 was just like any other sunny crisp morning in Vail, Colorado. It was the last day of a 5 day ski trip and I was rearing to get my last bunch of runs in before making the 2 hour drive to Denver to catch a flight back to Washington. It was my first day on a brand new pair of skis that I had bought the evening before. The morning was spent taking in a wide variety of runs from cruising to challenging. After a quick lunch break, we determined that we had time for about 4 more runs before having to take off. The first two of those runs were perfect. I was skiing great, I felt great and I was looking for one more challenging run before calling it a trip. I decided to take a fun run down under Vail’s chair #11 . . . a narrow bumpy run with a rock structure about halfway down that has two options: ski around or ski over. Having lived in Vail for a year back in my early 20s and having skied since I was 5, I already knew in my mind that I would be skiing off and over the rocks as I had done 100 times before. I stopped about 20 feet above the rocks and sent my two less-game friends around the side so that they could see me jump off. Once they were in place, I started down. I took about 4 quick turns before hitting the top lip of the rock face and then started to drop down. To my horror, I looked down and noticed that some rocks were protruding from the snow just above where I would normally land. As I was on my brand new skis and didn’t want to mess them up, I kicked myself farther out from the lip to avoid the rocks, but in doing so, ended up landing on a more shallow and sideways-tilted incline. The result was an extremely hard landing that twisted my right knee. I felt a pop and then a sudden sharp pain and then rolled over onto the ground. For a few minutes the pain was intense and I couldn’t move. Some people from the chair above were calling down to see if I needed the ski patrol and a stretcher. Initially, I thought I would. After a few more minutes, the pain began to subside and I was able to stand on my other leg and stretch out the injured leg. Summoning both strength and a healthy dose of foolish pride, I decided to try to ski down to the chair and was able to do so by skiing mainly on my good leg. I took the chair up and then took a long run down the front side of the mountain to the Village, again totally favoring my healthy leg and putting very little weight on the injured leg. Upon reaching the bottom, I was able to walk to the car, but definitely felt that something was wrong with the knee. It felt like a rope was tightly tied around the knee and my movement was slightly restricted. Unfortunately, we had a flight to catch so I didn’t want to stick around to have it checked out.

The two hour drive to the airport wasn’t too bad. I think the action of putting foot to accelerator was actually helpful in keeping the knee loose and stretched out. The plane ride was another story. Though I slept most of the way after taking a potent potion of advil and dramamine, I could feel the knee tightening up. By the time we landed in DC it was so tight and swollen that I had trouble walking. By the time I woke up the next day, it was really sore and I realized that I should see a doctor immediately. At this point, I knew nothing of knee injuries, nor did I even have a clue about the anatomy of the knee. Anyway, I was able to get a doctor to see me and he told me that although I seemed to be bending the knee ok, I should have an MRI to determine whether there is any ligament or cartilage damage. I quickly scheduled an MRI for the following day and kept my hopes up that there was nothing seriously wrong. I could not bear to have a serious injury as I had another ski trip to Vail planned for the following month, I had 8 games left in my winter hockey season, golf season was approaching and I am an avid mountain biker.

So I arrived for the MRI on Wednesday evening and the technician stuck me in this long tube that makes a lot of funny clink and ping noises. Fortunately, I’m not claustrophobic, so I didn’t mind it too much. After about 30 minutes, the technician told me that I was through and I asked him to send the pictures to my doctor. I didn’t ask him what he saw as, frankly, I didn’t want to hear the news (good or bad) from an MRI technician.

On Friday morning I revisited my doctor. The leg was already feeling better so I was optimistic that I had dodged another in a long line of dodged sports injury bullets. The doctor looked at the MRI pictures, shook his head and told me that he had good news and bad news. The bad news was that I had completely torn my anterior cruciate ligament (ACL) . . . the good news is that there was no trauma to any of my other ligaments or to the meniscus cartilage. I couldn’t believe it. He then showed me an illustration of the knee and explained what purpose the ACL serves. He explained that most people can rehab the surrounding muscles and tendons and carry on with life without ever fixing the ACL. I explained to him that I was an athletic fanatic and participated in my selected sports with an aggressive gusto. He said that I should get myself into physical therapy for a few weeks and then come back and see him to determine what we should do. Without another word, he was out the door and I was left feeling helpless, slightly depressed, a bit pissed off and full of many unanswered questions.

I limped back to my office in a daze. By late afternoon, I had devoured every website that I could find that dealt with knee injuries and ACL tears. I learned what the surgery entails, who is a candidate for the surgery and, most importantly, how long the rehab process takes. By late afternoon, the full reality of my situation came crashing down and I became really depressed. I couldn’t fathom that the next 7 months of my life would be spent working through pain and hardship just to get my knee back to the shape it was in 10 seconds before I took that fateful jump off the rocks. I also started to get even more pissed at my doctor as everything that I read about ACLs and athletes suggested that surgery is the only option to safely return me to the level of athletics for which I am accustomed. With that, I decided to get another opinion.

My friend at work (Steve) went to college with a local orthopedic surgeon, Ray Thal, who happens to be the team doctor for the Washington Redskins. Steve told me that I should go see Ray, that he understands athletes, that he’s incredibly smart and that he would walk me through the process. I was able to get in to see Dr. Thal on the following Monday and he spent a half hour with me explaining the injury, explaining my options, explaining the specifics of the reconstructive surgery and explaining the rehab process. By the end of our meeting, I had decided to go forward with the surgery and I felt comfortable having Dr. Thal perform the surgery. I still needed to do 2-3 weeks of physical therapy to get the range of motion back in my knee, so we set the surgery date for March 6, 2002. He explained the various grafts that I could use to reconstruct the ACL (Patella, hamstring, cadaver) and he convinced me that the hamstring graft would be the best option for my situation. Of course the whole concept of having an otherwise healthy tendon removed from my hamstring to be used to connect my femur and tibia sounded absurd to me, but I trusted that this was the best way to go.

My depression continued for about a week. Fortunately, that week coincided with the first week of the Salt Lake City Winter Olympics, so I had a nice diversion every night that would keep me from thinking about the activities that I was missing. I began physical therapy that Thursday and went through an assortment of stretching, bending and lifting exercises. At first, I could only bend my knee to about 114 degrees and was still noticeably limping. In the days that followed, I religiously stuck to the exercise regimen and by the end of the next week, I was no longer limping and my knee bend had improved to 130 degrees, only 10 degrees less than my healthy left leg. My therapist told me that if I stuck with my post-op rehab with the same attention as my pre-op rehab, that the recovery would go smoothly.

With a week and a half to go before surgery, I was ready and I just wanted to get it over with. I even tried to get the surgery pushed forward a week, but Dr. Thal was unavailable until my scheduled date. I therefore simply spent that week and a half getting my affairs at work in order and continuing to strengthen my knee through exercise. I was constantly asked by friends and co-workers whether I was nervous for the surgery and I constantly replied with honesty that I wasn’t nervous. I knew it was going to suck, I knew I’d be in pain and I knew that my life would be a physical hell for a few weeks. However, I also knew that I had no choice but to suck it up and move forward. For the past 15 years I had suffered dozens of minor injuries (broken collarbone, broken foot, torn rotator cuff) and had simply dealt with the pain and, in many cases, continued to play through the pain. Although I’m not a professional athlete, it had always been a point of pride for me (albeit very FOOLISH pride) that I could force myself to play through injuries and sickness. I was hoping that this mentality would carry me through the ACL surgery and I was certainly approaching the surgery as simply an obstacle that I would overcome. If anything, I was more worried about how my wife, Lisa, was going to deal with our three daughters without me being able to lend a helping hand during the weeks following the surgery. I wasn’t going to be able to carry or feed the baby or bathe and dress the other kids. I figured that the least I could do following the surgery is to do my best to not be too much of a burden for Lisa.

SURGERY DAY ARRIVES - March 6, 2002

There are a lot of instructions to be followed in the 24 hours before surgery. I had already stopped taking Advil and other aspirins 6 days before as ibuprofen and aspirin apparently have a blood-thinning effect that is detrimental to surgery. I was also told that I couldn’t eat anything after midnight the night before the surgery. Although my anxiety level was increasing throughout the day before the surgery, I surprisingly slept pretty well the night before. I awoke around 7 and went straight to the shower to shave my leg from mid calf to mid thigh with my electric razor. It was pretty weird to see the resulting white hairless leg. At least on the operating table they would have no trouble discerning which knee needed the surgery. I had a slight headache, so I washed down a couple Tylenol with a gulp of water, but otherwise, I wasn’t allowed to eat anything. After kissing the kids goodbye, we left for the hospital at about 8:30am.

We made a quick stop to pick up my mom and then arrived at the hospital at about 9:15. We were directed to the registration area and I was asked to provide my insurance card and a picture ID. After making a quick trip to the bathroom (my third of the morning) we were sent down to the pre-op waiting area where we were met by Claude, the resident physical therapist. Claude gave me the rundown on how I was going to feel after the surgery, how I was supposed to ice the knee over the next few days and what stretching exercises I should be doing to start working on range of motion following the surgery. After a bit more waiting, I was finally called back to the changing room at about 10:45. In the changing room, I was asked to completely disrobe and put all of my clothes into a locker. They gave me a hospital gown and a pair of socks and then sent me on to the pre-op “holding room.” In the holding room, I was asked a bunch of medical history questions (for the 4th, 5th and 6th times) and then hooked up to an IV. We hung out in the holding room for about 45 minutes, during which time we met the anesthesiologist, the anesthesiologist’s assistant, Dr. Thal and Dr. Thal’s assistant. I was definitely feeling that I was well covered in terms of the number of people involved. All remaining questions were answered and Dr. Thal assured me that my feelings of “cognitive dissonance” were normal. At 11:45, Lisa took her leave of me as the operating room was apparently close to being ready.

Finally, at around noon, they were ready for me. Two nurses came to each side of my bed and said it was “Happy Hour.” I asked what they meant and they said that they were going to give me something to make me happy. I said that unless they were giving me a tall glass of vodka and a blow job, I wasn’t sure that anything could make me happy at that moment. It was also a little different than I expected. I thought that they were going to wheel me into the OR, explain all of the procedures and instruments to me, strap me down, and then put me under. Instead, things were getting fuzzy by the time they were wheeling me out of the holding room and by the time I reached the OR, I was already out.

My next recollection is awakening out of an incredible fog. “Brent, Brent . . . can you hear me . . . are you awake?” I was slightly aware of a throbbing right leg and slightly aware of my surroundings, but it took a while to come to the realization that the surgery was over. That was about my only realization for the next two hours. Apparently, I was able to speak when spoken to and move my limbs when asked, but I really don’t have much memory of the 2 hours following surgery. At some point they moved me from a bed to a chair and then they brought Lisa and my mom to see me. No matter how much I tried, I could not get my eyes open and I could not get myself to move. I kept hearing the nurse say that there was no hurry . . . so I didn’t hurry. I felt pretty nauseous when I opened my eyes, so I thought I was better off leaving them shut. For whatever reason, I made a point to keep twirling my foot around as much as possible as somewhere in the deep recesses of my drug-addled mind, I thought that my physical therapy should start immediately.

Finally, at about 4:15pm, Lisa decided that enough was enough and it was time to get the hell out of there. Her feeling was that if it were left up to me, we wouldn’t leave for hours. I reluctantly agreed to make the move, but felt that I needed to throw up before we left as I was incredibly nauseous and was pretty sure that I would throw up in the car if I didn’t do so in the hospital. My mom gave me a bag, but I couldn’t get anything out. Finally, I hearkened back to my fraternity days and simply stuck my finger down my throat. Bingo, the floodgates opened and I was able to heave out whatever was left in my stomach. It must have been pretty gross to anyone watching, but frankly, I was in no position to give a shit and I sure felt a lot better. When I was done with my vile exercise, they moved me to a wheelchair and rolled me out front where Lisa had pulled up the car. Very carefully, I was eased into the back seat and promptly went back to sleep. We arrived home at about 5:30 and I didn’t waste any time getting myself up to the bedroom and getting in bed. Lisa was amazed at how easily I negotiated the stairs. I barely remember it. I slept until about 8pm and then awoke feeling mildly hungry. Since I was still pretty queasy, I didn’t venture much beyond jello and crackers and my first (or maybe second) dose of percoset. For the next two hours, I stayed awake listening to a Washington Capitals hockey game on TV, but was not really able to open my eyes without feeling nauseous. I recall feeling satisfaction that the Caps won . . . a bright spot in an otherwise miserable day.

That first night was awful. The percoset made me sick as a dog and the pain in my leg was pretty intense. I simply could not get comfortable and I don’t think I got more than 20 minutes of sleep at a time at any point in the night. My biggest challenge came at about 1am when I thought I had to go to the bathroom. I was able to hoist myself up, grab the crutches and amble my way into the bathroom. Feeling pretty proud of myself, I stood in front of the toilet, waiting to go. I waited . . . and waited and waited and waited. Nothing. Frustrated, I got back in bed. I waited about an hour and then got up to try it again. This time, after 10 minutes of waiting, I finally started to go . . . and go . . . and go . . . and go. I guess they gave a lot of water to me in that IV! So the bladder was empty, but I still couldn’t sleep. I went through an identical toilet exercise at 5am and 6am and finally got up for good at around 8am. I was actually pretty surprised by how much weight I could put on the repaired leg. Though I couldn’t walk on it, I could definitely stand on it. It also didn’t hurt as badly this morning as I expected. I therefore decided to go off the percoset as I simply couldn’t deal with the queasiness anymore.

LET THE REHAB BEGIN March 7-8, 2002

Well, only 179 days left until I can resume my normal athletic activities!!! But who’s counting. Thursday the monotony began. Ice bags, medication, television, phone calls, constipation, painful exercises, general discomfort. At least I was off the percoset. Dr.Thal switched me to Vicodin and while the Vicodin didn’t seem to be the strongest pain reliever, it didn’t give me any queasiness or lightheadedness. In fact, my appetite came back strong and I generally felt pretty good all day. I tried to stay off my feet as much as possible and also tried to always keep my leg propped up on pillows. When I would move the leg, I would occasionally get a really weird oozing sensation as if fluids and/or air were being released from my leg, but Dr. Thal assured me that this was normal. I began the series of exercises that Claude had explained to me at the hospital, but I found that my flexibility was pretty limited. I was able to do the ankle pumps, but my first few leg lifts were extremely difficult. I also really couldn’t bend my knee more than a few degrees. Regardless, I attempted them several times through the day and by nightfall, I was actually able to do 20 leg lifts in a row.

Thursday night was no picnic. The pain came back with great intensity at around 9:30pm and there was nothing I could do to shake it. I tried to go to sleep at around 10, but it was nearly impossible as I simply could not find a comfortable position. I had a 3 position rotation, with each position lasting about 5 minutes. This went on until about 1:15am, when I finally fell asleep for about an hour and a half. Unfortunately, I was up again at 3 and really didn’t sleep again the rest of the night. To make matters worse, I developed a pretty intense headache at around 6am and immediately starting supplementing my Vicodin intake with two Tylenol. The headache finally subsided around 9am and I moved myself back to the couch. I did my exercises again and noticed some pretty good improvement on both the leg lifts and the bending of the leg. I still wasn’t too comfortable walking around on the crutches and I really felt a surge of pressure every time I stood up. At about 3pm, it was time to finally unravel the bandages and take a look at what was inside. My fear was that it would be a disgusting oozing mess that would make me sick. On the contrary, it was actually quite clean and I couldn’t believe how small the incisions appeared on my leg. There was no clotted dried blood and no mess. It was quite heartening. Now that the bandage was off, the ice treatments also became more worthwhile as the chill could more easily invade the skin surface. The knee was still pretty swollen, but it didn’t look like a grapefruit or anything similarly repugnant. I still couldn’t get over the effect that the medication was having on my body. For one, I hadn’t slept for more than 3-4 of the last 48 hours. More frightening was the fact that I hadn’t sat on the toilet in almost 3 days. I was wondering if I would have to mix a laxative into my medications at some point. One thing I was going to change from the night before is that I wasn’t going to sleep until I was thoroughly exhausted. This was accomplished by sticking the DVD Pearl Harbor into the player and watching the whole damn 3 and ½ hour movie. At 12:45 am, I finally got in bed and, hallellujah, I FELL ASLEEP!! Although I was still up several times during the night, I was able to fall back asleep each time and it seemed as if the bad pain had gone for good. Another good sign was that I was able to walk to the bathroom during the night without my crutches.

THE THIRD DAY March 9, 2002.

Saturday morning I awoke feeling pretty good. I knew that I still faced a few more days confined to the couch, but I was starting to see the light at the end of the tunnel. For one, the exercises had become pretty easy. Bending the leg was still tough, but the leg lifts were a breeze and my mobility was much improved. I no longer had to lift my bad leg off the pillows with my arms every time I got up. I also didn’t have to grab my crutches every time I wanted something. I was getting used to the schedule of icing, medication, and exercise. I also took my first shower since the surgery. That was an experience as I had to set up a folding chair in the shower and then gingerly position myself on the chair so that I wouldn’t slip off. It was slightly tough maneuvering, but I felt a helluva lot better once I was shaved and clean. Then it was back to the couch to continue the monotony.

DAYS FOUR AND FIVE March 10-11, 2002

Two more days on the couch, not much change in the routine. The pain is still pretty intense, I’m still not sleeping well and my appetite hasn’t gotten back to normal. Sunday morning I took a couple Senekot pills (herbal laxative) as I still hadn’t gone to the bathroom since the surgery. Those things worked pretty quickly and by noon, I made the first of about 6 trips to the bathroom. It was actually quite comical. I couldn’t quite put my leg on the floor when I sat on the can, so I had to bring two stuffed pillows into the bathroom so that I could extend my right leg on the cushions while I did my business. What an ordeal. So now I really felt like a baby on a schedule: During every two hour period I spent 30 minutes icing, 10 minutes eating something, 15 minutes on the can and 10 minutes exercising. The rest of the time was spent reading and watching tv.

DAY 6 March 12, 2002 – First Follow-up Doctor’s Appointment

Tuesday morning I jumped out of bed as I was excited to get out of the house for the first time since surgery. I was heading to Dr. Thal for my first follow-up appointment. We made the 45 minute drive out to Reston without incident and I was able to stumble into the office. He looked at the knee, removed the stitches, gave me a couple x-rays and told me that everything looked great. He showed me the pictures from the surgery and I was pretty amazed by the inside of my knee. I told him that I was still in a lot of pain and not sleeping well, so he prescribed Vioxx, an anti-inflammatory, and Ambien for sleep. He also told me that I could start physical therapy and that I could take the brace off when walking around the house. Anxious to get moving, I had already made my first 5 PT appointments before we got home. That night, I took the Vioxx pill and then took the Ambien as I got in bed. Dr. Thal told me that it would have an immediate effect and he wasn’t kidding. Unfortunately, it wasn’t the effect that I was hoping for. Instead of falling fast asleep, I spent two hours hallucinating. Now, this would have been great 15 years ago when I was in college, but now, I JUST WANTED TO SLEEP!!! Oh well, at least I was used to the insomnia.

DAY 7 March 13, 2002 – ONE WEEK ANNIVERSARY

To celebrate the one week anniversary of the surgery, I went to my first physical therapy session. I had decided to stick with Kristin, my therapist during the weeks prior to surgery because (1) I liked her, and (2) she had gone through the whole torn ACL process herself about 4 years earlier. The first session was pretty painful. She had me go through a bunch of leg lift exercises, which weren’t too bad, but then we switched to the knee bending exercises. The first measurement was positive as we established that I could straighten my leg to 0 degrees. The second measurement was for flexibility, and this wasn’t too great – 50 degrees. She put me through a bunch of contortions and I was able to painfully push myself to about 80 degrees by the end of the session. I was definitely glad to get to 80, but it hurt like holy hell to get there. That night, I gave the Ambien one more shot to fall asleep, but it didn’t work as I again spent a few hours in la la land. By 3am, I was back on the couch with an icebag on my leg and at some point I finally fell asleep again.

DAYS EIGHT AND NINE March 14-15, 2002

The drudgery continues. At least today I had the first round of the NCAA tournament to keep me amused. I also had a series of new exercises to work on. Thinking that pain was good, I really pushed myself in my stretching. Basically, I would bend myself to the point of gasping pain and then take it one step further. What a mistake this was and the payback turned out to be hell. I fell asleep on the couch around midnight and then awoke at about 2am in extreme pain. I literally spent the next 4 hours writhing around on the couch and whimpering in agony. I couldn’t believe it. This was the worst night since the surgery and it was over a week later. By morning, I couldn’t take it anymore and called the doctor to see if there was anything he could do for me. Dr. Thal was unavailable, so I spoke with his partner, Dr. Miller. Dr. Miller said that I probably overdid the exercises and that at this early stage, I should only push myself to the point of discomfort, not to the point of pain and certainly not beyond the point of pain. I told him that it would have been nice to know this three days ago! He told me to take it easier and that I could double my Vioxx dosage if I wanted. Shit, I was wondering if I could triple it!

Friday morning I paid my second visit to Kristin. I told her about my conversation with the Doctor and about the miserable night that I had endured. She agreed that I pushed too hard and she decided to spend most of the PT session doing hand massage and then electric therapy massage. After the session, everything felt a lot better. Time for more college hoops . . . and icing and icing and icing.

DAYS TEN THROUGH TWELVE March 16-18, 2002

Things continued pretty uneventfully. Each day the pain slightly diminished and each night I was able to gain a little more sleep. Even though I was still having problems bending the leg, I could feel it getting stronger and I was able to support more and more weight. My bodily functions had finally reached complete normality (appetite, digestion, etc.). I continued the exercises, but did not push it. I watched a lot of basketball, continued to read the paper in full and was totally absorbed in Nelson DeMille’s new novel, Up Country. I still did not venture too far from the couch as the pain was still quite bothersome. On Monday morning (the 18th) I even called the doctor again to ask whether it was normal to still be so uncomfortable. His answer was no and that he wanted to see me again on Tuesday morning.

DAY THIRTEEN March 19, 2002 Follow-up Doctor’s Appointment #2

On Tuesday morning, Lisa drove me back to see Dr. Thal. He inspected the knee again and gave me more x-rays and told me that everything still looked great. He couldn’t explain why I was still in so much discomfort, other than the fact that I had major surgery two weeks before that involved holes being drilled in my bones and tendons being removed from my leg. He asked me whether I had a high pain threshold (which sounded a lot to me like “are you a big pussy”) and I assured him, with Lisa’s corroboration, that I normally have quite a high threshold. He assured me that it would continue to get better and that this recovery is a marathon, not a sprint. He also told me that by the weekend he wanted me out of the brace and off the crutches. With that, I went home and spent the rest of the day on the couch.

DAY FOURTEEN March 20, 2002 Two Week Anniversary

Two Weeks since the surgery and I am still pretty ornery. Today, however, I ventured forth into the world. After an hour of PT in the morning (flexibility up to 87 degrees), I walked the three blocks to my office. To ensure the appropriate receipt of sympathy, I put on the brace and used 1 crutch. Everyone at work was very nice and they were all glad to see me back. I walked to lunch with a group of co-workers and by the time I got back to the office, I was absolutely exhausted and ready to go home. Lisa picked me up around 3pm and it was back to the couch for the rest of the day.

WEEK 3 March 20-26, 2002

I made a lot of progress during the third week following surgery. I spent a half-day at work on Thursday the 21st and then went out to dinner for an office function. Thursday was also the first day that I was able to drive again. Though it was a bit uncomfortable, I made it through ok. Basically, I used my right foot for accelerating and my left foot for braking. It wasn’t much different than driving a stick-shift. I just had to always give myself a bit more room with the cars in front of me. Friday through Sunday I took it pretty easy and remained mostly confined to my trusty couch. At therapy Friday, I increased the amount of exercises I was doing and was able to get my flexibility up to 100 degrees. For the most part, I was able to sleep 4-6 hours a night and was more or less able to fall back asleep after awakening in the middle of the night. The pain continued to diminish each day and I was finally accepting of the fact that my strides over the next 5 months were going to be infinitesimal.

On Monday, I returned to work full time and was able to achieve 104 degrees flexibility at PT. Additionally, I was able to perform a step-up/step-down exercise and also was able to make about a ¾ rotation on the exercise bike. I can’t wait until I can make that full rotation and really begin riding the bike in earnest. Hopefully next week. Regardless, life is finally returning to normal. I can now help with the kids, enjoy sex with my wife, drive my car and help myself when I need something. I am now completely out of the brace and off the crutches and am actually quite mobile considering the circumstances and timing. I probably was on my feet too much on Monday and I really pushed hard at PT. The result was a bit of discomfort Monday night, but it wasn’t anything I couldn’t live with. I’m still icing the knee about 3-5 times a day and am not able to sit in a chair for too long a stretch at a time. The bruise on the underside of my knee is almost completely gone and the scars on the top of the knee are nearly indistinguishable. Certain stretches still hurt a lot and, if I bend too much, I will often get a muscle cracking or popping sensation (which I am told is completely normal). My goals for week 4 include (1) full rotation on the exercise bike, (2) 115 – 120 degrees flexion, (3) normalized walking gait, and (4) one full night of uninterrupted sleep.

WEEK 4 March 27-April 3, 2002

Holy shit, I achieved two of my Week 4 goals on the first day of Week 4. As Wednesday was the 3 week anniversary of the surgery, I really was hoping for some kind of breakthrough at PT and I got it. Starting on the exercise bike, I was doing my usual 5 minutes of back and forth and I found that I was getting closer and closer to a full reverse rotation as the end of the 5 minutes neared. Up to now, I was basically just going back and forth in ½ and ¾ rotations, being completely unable to get over the top. With about 15 seconds left in the period, I figured what the hell and let momentum carry the leg as far as it would go. Lo and behold, it made it completely over the top and down . . .and then I did it again and again and again. I was so excited to make these full rotations that I just kept doing them for another minute or two. After the bike, I went through the normal progression of exercises until it came time to do the measurement. I knew that I would beat the 104 degrees from Monday, but I wasn’t sure by how much. Natalie (Kristin was out today) first had me bend as much as I could without assistance and I reached 107 degrees. Yeehaaa! Then, with a little help she got me to 115 degrees. It hurt like hell, but damn it felt great! For the first time since the surgery, I felt that I had made some significant measurable progress. Despite the added soreness from working harder, I felt incredibly motivated to tackle the road ahead. Friday’s PT session brought more improvement. Two minutes into the bike exercise, I was able to repeat the full reverse pedal rotation that I had achieved on Wednesday. Three minutes into the exercise, I was able to complete a forward rotation and was able to forward pedal for the remainder of the 5-minute session. After going through the normal exercises, I was then able to bend my knee unassisted to 112 degrees and to 120 degrees with assistance. I also walked backwards on the treadmill at 10% incline/1.5mph for 5 minutes and performed my quad exercises with a 2 pound weight around my right ankle. I worked out on my own on Saturday, including a forced 15 minutes on the exercise bike. I probably overdid it as my knee was pretty sore the rest of the day. Monday, it was back at PT. I went up to 3 pounds on my quad exercises and did my first right leg presses at 40 pounds. Flexibility slightly improved to 122 degrees and the bike just keeps getting easier and easier.

WEEK 5 April 4 – April 10, 2002

I am finally sleeping well as the pain is now down to about a 1 on a 1-10 scale. Each day at PT, I would increase the weight on the quad lifts by a pound or two so that by the end of Week 5, I was lifting 7½ pounds. I also increased my weight on the leg presses to 60 pounds. On Tuesday the 9th, I had my 5 week follow-up appointment with Dr. Thal. He said that everything looked great except for my flexibility. He said that I need to push harder on the bending exercises. I thought I had been pushing pretty hard, so I wasn’t happy to hear that. Guess who was even less happy to hear that? My therapist, Kristin. She must have taken it personally because at the next therapy session on Wednesday the 10th, she pushed my leg so hard that I was screaming in pain . . . and then she held it for 15 seconds . . . 6 straight times. Total agony. But I hit 130 degrees. I also asked Dr. Thal whether I could play golf by mid-June. His answer remained the same – not until after July 4. Shit.

WEEK 6 April 11 – April 17, 2002

Took my first trip since the surgery. Two flight legs to Austin, Texas, a tour of a factory, and walking all around the restaurants and bars of Austin . . . and no pain. As far as everyday activities, I am back to normal. This week, my quads lifts went up to 10 pounds, my leg press went to 70 pounds and 120 pounds with both legs, and I also started hamstring curls on one and both legs at 20 pounds and 50 pounds, respectively. At PT, Kristin is on a flexibility mission and on Monday, through blood curdling screams and the assistance of another therapist (to hold me down), she got me to 135 degrees. Of course everyone in the place is now scared of her! I can pretty much do the bike for 15-20 minutes and the stair-master for 10 minutes and get a full work-out. I am, in fact, reducing the PT sessions to 2 a week and will work out at the gym on the other days. I’m rarely icing any more and I haven’t had the need for any Advil or other pain relievers. Now it’s just the long slow haul to return to normal strength and flexibility.

WEEKS 7 THRU 11 - April 18, 2002 – May 22, 2002

I knew that I couldn’t keep this up on a weekly, much less daily, basis. Rehab and recovery is such a long slow process with barely discernible improvements that it is hard to keep describing the same thing over and over again. So I increased my leg press weight by 5 pounds each time. So my flexibility slightly improved today. It gets old. Sufficeth to say, I just hit my 11 week anniversary since the surgery and I guess that everything is going well. I finally got my flexibility to the full 140 degrees a couple weeks ago. I am doing a full assortment of weight training and cardio training. Against doctors orders, I went and hit a few pitching wedges and 8-irons last week on the driving range. This past Sunday I even hiked the Billy Goat trail down in Great Falls (4.5 miles) followed by cutting the lawn. So I basically have full use of the leg for a wide range of activities, none of which are high impact. I’ve jogged on the beach and I’ve ridden my bike around the neighborhood. The biggest change in rehab occurred a couple weeks ago when they had me start a bunch of lateral movement exercises (side to side, running figure eights, foot to foot side-shuffling.) Continued fun stuff. I am basically down to 1 day a week for PT, mostly because I just don’t get a good enough workout at therapy. I see Dr. Thal again in 2 weeks for my 3-month check-up and I’m hoping that he at least lets me play golf. As for measurements, I’m doing 200 pounds and 140 pounds on the leg press, 80 pounds and 40 pounds on the leg extension and 70 pounds and 40 pounds on the hamstring curls. I can also pretty much go as long as I want on the exercise bike and stairmaster. Since I can’t play golf anyway, I’ve also started an upper body stretching and weight regimen. Hopefully, by the end of this process, I’ll be in the strongest shape of my life. We’ll see.

WEEK 12-14 May 23 – June 11, 2002

This will probably be my last submission for awhile as I am running out of meaningful things to write about. Over Memorial Day weekend (May 25-28), we took a trip out to Phoenix for my brother’s wife’s sister’s wedding. While there, I worked out, took a yoga class, hiked up and down Camelback Mountain (basically a straight-up and straight-down rock climb) and went on a very fast-paced 5 mile hike. While Camelback Mountain wasn’t the smartest endeavor (one slip and I was screwed), I made it through fairly unscathed and the knee held up fine. When I say “fairly unscathed,” it was because my knee was pretty sore for about 10 days following the trip and I actually had to cut back on some of my lateral exercises. On June 6, I had my 3-month appointment with Dr. Thal and he said that everything looked great and that I would be really happy with the knee when all was said and done. I told him that I couldn’t wait until July 4 to play golf and was able to get him (begrudgingly) to allow me to play sooner as long as I promised to swing easily and take it easy. That’s all I needed to hear. I was on the driving range the next evening and played my first 18 holes a few days later. Considering that I hadn’t played in 8 months and that I could only swing at about 75% capacity, I was pretty proud to open the season with a 77. Dr. Thal also told me that I could be finished with Physical Therapy as the knee was sufficiently healed to continue the rehab on my own. This worked out well as my new insurance doesn’t cover continued PT.

So anyway, I am over halfway there and all has gone well. There have been bumps and anxious moments along the way but, all in all, I am definitely glad that I chose surgery and couldn’t be more pleased with Dr. Thal. As an aside, a guy I know had ACL surgery about two weeks before me with a surgeon from the first office that I visited after the injury. He had a cadaver graft. His therapy was progressing well until he started having some sharp pains at around the 8 week mark. Long story short, his graft didn’t take and he needs to go back for re-surgery. I don’t know whether it was a case of bad luck or surgeon error, but I am sure glad that I chose to go with Dr. Thal.

I am constantly asked whether I’ll be going skiing again or participating in other high risk endeavors and I constantly return such questions with a look of pure disdain like it is the dumbest question in the world. Of course I’m going to do all those things again. I can’t wait to ski again. Why the hell would I have subjected myself to this hellish process if it wasn’t to resume all of my normal activities? I will no doubt think twice before jumping off another cliff, but I have no intentions of slowing down or otherwise changing my aggressive skiing style. In fact, I can’t wait to do so. If Dr. Thal told me that I could ski tomorrow, I would ski tomorrow. That’s not to say that I won’t be nervous when I take my first run . . . how could I not be? However, I assume that by December (the date of my next trip), I’ll be fully healed and rearing to go.

SEPTEMBER 3, 2002

I’m BACK!!! I had my six month appointment with Dr. Thal on August 30 and he told me that the knee had healed great and that I could resume all activities. I asked whether I should wear a brace and he said that there is no tangible evidence out there that suggests that a brace helps prevent re-injury. Anyway, I gave the knee the first full test yesterday with an hour of mountain biking and the knee felt great. There was even a point where I slipped off the bike and landed on my right foot and the knee supported the weight without a problem. Dr. Thal told me that I should ease back into sports and I plan to do so with hockey and skiing. I will try to skate for the first time in a couple weeks, so we’ll see how that goes. As for the last 3 months, I didn’t kill myself with rehab, but still stuck with it fairly consistently. I rode the exercise bike at least twice a week and I chose some pretty hard manual programs on the bike. I also did various weightlifting exercises from hamstring curls to leg extensions to leg presses. Finally, in the last month, I started working out on the treadmill to improve lateral movements. Basically, I put the tread at a 15 degree incline and then worked 30 second shifts doing side shuffles on each side, with each shift getting faster and faster. I will probably continue doing these in the upcoming months.

After biking last night, I now am 100% sure that I made the right decision with surgery. I know that I was pretty sure after 3 months, but I still had some small doubts. After biking last night and having no strength, endurance or cardio problems, I have no doubt that surgery was the only way to go. I can’t imagine that I’ll have a hard time with hockey. My ski trip in December is with the family and I’ll only push as hard as the leg will allow. My guess is that I’ll only do cruisers and small bumps and I’ll save the big ones for spring.

FEBRUARY 1, 2003

I haven’t had my one year appointment with Dr. Thal, but I am reasonably certain that I am completely healed. It has now been 1 year since the accident and I have ZERO limitations with the knee. Hockey season started slowly and the first few times on skates were pretty rough. However, by late November, I was skating without worry and by mid-January, I pretty much saw a return of whatever speed and strength I once possessed. I have had no problems on the mountain bike and I continue to ride 1-3 times a week. The big test for me was in December when I was back on skis for the first time. I was pretty nervous in the weeks leading up to the trip as I had no idea what to expect, both mentally or physically. Even worse, my college buddy was coming up to Vail and the only day that he could meet me to ski was my first day. Sheesh . . . talkin’ about jumping right back in! I was pretty hesitant the first few runs, but my buddy wouldn’t let me take it easy. Long story short, we skied hard that day and my knee was throbbing by the end of the day. I went home that night and iced it for a half hour and then it felt fine the rest of the trip. By the 4th and 5th days, I was skiing the bumps with my old half-reckless abandon and even took a few wipe-outs without incident. Finally, I exorcised my demons by jumping off the cliff that tore my knee a year ago. Only this time, I had the benefit of a landing in a foot of fresh snow AND I took off from slightly lower down. I am now preparing for my next ski trip in 3 weeks and my knee isn’t even a concern. In fact, I barely think about it anymore.

That’s about it. Hopefully this story is closed and hopefully this missive will be of some benefit to some poor soul in the future who has to go through the process. At least the time went fairly quickly in retrospect. Then again, time always does.

2 comments:

Ramesh said...

hi:

I tore my ACL playing racquetball and and did not think twice and wanted the surgery because I want to play till my last day.

Your recap was very helpful..me and my wife read it and i know what i am in for. BTW..Dr. Thal is the doctor.
Ramesh
ramesh at engineer-cec.com

skibrent said...

Ramesh, good luck with the surgery. As you can see from my subsequent biking posts on this blog, the repaired ACL hasn't slowed me down one bit.
Brent
P.S. Just curious, how did you come across this Post?