Meniscus Surgery- another kind of Race Report
I usually write up a race report after a big important race. I write them not so much to share with others (although I usually do) but more so that I have them for myself. So that in 5, 10, 20 years I can read them and remind myself the things I learned from the experience. About 5 days into the whole knee surgery thing, I decided it would be a good idea for me to write up a “race report” for much the same reasons. Then about a week later I found out my cousin was about to have the same surgery and he asked me to share my experience. Sooooooo, I thought perhaps I'd go ahead and copy/paste my journal into the EN Forum so that if one of you some day has to go through a similar surgery, you'll have some idea of what to expect. Of course everyone's injury and recovery is unique, but maybe my lessons learned will help you avoid a few of the same mistakes.
The Injury:
For a more detailed review, go read my IMMT 2013 race report (http://members.endurancenation.us/Forums/tabid/57/aft/13209/Default.aspx#167913) But in summary, I suffered a torn meniscus in the early summer and opted to push the surgery off until after racing the Ironman and well into late fall when days would be short and cold. It was a medial meniscus tear, posterior body, in what they call the “white zone”. The surgery was a partial medial menisectomy where they contoured and smoothed the edge of the tear with a shaver. The surgery was scheduled 11/12/2013, immediately following the OBX Marathon so that I could enjoy volunteering at the race before surgery.
Pre-Op:
I scheduled surgery for 7:30am to help minimize the aggravation of post-op procedures (which really were not too bad). No eating or drinking after midnight the day before, no shaving for 2 days pre-surgery, and I was given special antiobiotic cloths to scrub the surgery area 3 minutes at a time the night before surgery and the morning of surgery. I slept fairly well the night before surgery- probably better than most nights before Ironman.
Tuesday 11/12/2013-Surgery Day:
We had to check into the OBX hospital through the Emergency entrance at 6:30am since the normal admissions area isn’t open that early. We had no problems checking in and by the time we were ready to head to the waiting room my pre-op nurse was already there waiting for us. Joe was able to join me in the pre-op area and stay with me the whole time up until they rolled me into the OR, which was very comforting. The first thing they asked me to do was pee in a cup! Whooops, I had already taken care of that business at home! I wish they had let me know ahead of time that would be part of the process. I managed to squeeze out 3 or 4 drops, just enough for them to run the pregnancy test (hmmmm, I probably could have just confirmed that for them without the test)!
Next up was disrobing into the ever famous surgical gown. But this was like no other hospital gown I’d ever seen. There were all sorts of extra holes, connector thingies, and flaps. All of these things had a function including this one port that connected to a hose that blew nice warm air into the gown to keep me warm with a control I could use to adjust the heat! Ahhhhh, can I take this home? While the pre-op nurse asked me lots of medical history questions, the entire surgery team fluttered in and out to introduce themselves to me and start setting up the dreaded IV drip through my hand (always painful for me) and marking an X on the leg that was to be cut. The surgeon came in, added his own initials to the marked leg, and that was it, time to roll into surgery.
I couldn’t see too much of the surgery room from my vantage point, but the lights looked pretty much like those you see on TV shows. Once in the OR the surgery team moved me from the comfy bed like gurney onto the flat hard operating table and placed the gas mask over my nose. I could feel the anesthesia meds enter the IV in my hand and move up my arm when the nurse said “you will start to feel sleepy now” to which I thought “I’m not sleepy, why aren’t I sleepy? Shouldn’t I be getting sl……….” I had a few dreams (although I can’t remember what they were) and then I was starting to wake up and thought “ug, there’s something stuck in my throat” just as the nurse anesthetist removed the intubation tube (I think that’s what it’s called). They rolled me out to the recovery area (which was the same as the pre-op area) and I started to come back to full alertness pretty quickly. The pre-op nurse was there again to take care of me and got me some juice to drink. Apparently the surgeon visited Joe during this period but I’m not exactly sure when that happened. As I woke up they finished up documenting my file and the surgeon came in to let me know that everything went according to plan. “The MRI didn’t lie” and the tear presented exactly as expected. They did some other exploratory stuff (while they were in there) and he found the knee in good shape, but noted my knee tracks parallel and that is something I should work on during recovery. Eventually the pre-op nurse went to get Joe and then reviewed the post-op instructions with us both. I managed to get dressed again fairly easily and moved into the wheelchair for my chariot ride to the car. I was able to easily boost myself into the Montero (thanks to being in otherwise good health and fitness) and we drove immediately to the drug store to fill the pain medication prescriptions.
Back home, Joe made me banana pancakes for breakfast while I rested, iced my knee, and watched a lot of TV. I had expected to feel groggy and maybe nauseous, but instead felt alert and completely comfortable. I texted my boss that things were going well and I expected to return to work on Thursday as planned. Throughout the day Joe baked an apple pie (which turned out fantastic) and kept track of the times and amounts of medication I took while I tried to keep it to the minimum doses (I was worried about taking too much). Joe also made sure I drank lots of water and kept to the ordered icing routing (20 minutes every 2-3 hours). We ordered pizza for dinner and I rode with Joe to Slice to pick up the pie just to get out of the house.
I used a pillow to prop my leg at night while sleeping but had a very difficult night of sleep. In fact, I simply didn’t sleep at all. At midnight I was supposed to take another pain pill but I opted to try sleeping (or not sleeping) through it instead. By morning I was in a lot of pain and eagerly took the 6:00am pill.
Wednesday, 1 Day post Surgery:
I spent the majority of this day in discomfort and some pain. I was still trying not to take too many pain meds, so I had reduced the amounts down to half a pill every 3 hours (instead of 1-2 every 6 hours). My entire leg was swollen, the bandages felt too tight, and my toes looked like sausages. I was also feeling a bit frustrated that I wasn’t able to put any weight on my leg yet, but still insisted on attempting to walk with the crutches around the house to get some movement going. I sent a text to my boss to let him know that things had gotten worse and I did not feel returning to work the next day would happen. I had obviously under estimated this whole thing. By the time I was ready to go to bed, I was also completely ready to give into the pain meds. I took a full pill before putting my head on the pillow and made sure I had a half pill to take again at midnight, 3am, and 6am. And this time, I took them. I slept much better that night.
Thursday, 2 Days Post Surgery:
I was able to get around quite a bit better but still unable to put any weight on my right leg. I was also finally caught up on the pain meds and the ½ pill every 3 hour routine seemed to work well (although admittedly I was looking forward to them at the end of each 3 hour period). I was able to log onto my work computer, catch up on emails, and take care of delegating some work to my designated back-up, but otherwise didn’t quite feel up to really putting in a full work effort. Thankfully I work for a very understanding and supportive employer and have great teammates who are there to back me up. Unfortunately, I was also constipated and had not had a bowel movement since the day before surgery. Joe picked up Senecot-C as directed by the pharmacist and I took the prescribed dose before bed (along with my pain meds).
Friday, 3 Days Post Surgery:
Finally I get to remove the bandages and take a shower!!! YAY! Joe worked during the morning so I waited for him to return before I attempted any of these next steps. In the mean time I once again checked my work emails and delegated anything new to my backup. Another day off seemed appropriate. I was able to have a small bowel movement but nothing that seemed adequate considering how long it had been. I started tapering off the pain meds (taking Tyelenol instead of the RX every other interval) in hopes this would also help with the constipation side effect. When Joe got home he brought a plastic deck chair up to put into the shower. Thankfully we had recently remodeled our guest bathroom with a curb-less shower that is big enough for a chair. I was able to get in and out of the shower mostly on my own safely. Ahhhhh, shampooing my hair felt amazing! With the bandages removed we could see just how swollen my leg was, pretty incredible. But the incisions themselves were all quite small. The steri-strip had fallen off one of the incisions so I covered that one with a bandaid and left the other two alone for now.
Next up was a visit to the Physical Therapist. The PT visit was probably the highlight of my week. It was the first time I felt like I was doing something proactive for myself besides sitting around taking drugs. She also made me feel a lot more comfortable with where I was in the recovery process, gave me some goals to focus on, and showed me how to use the crutches to get up and down stairs (this was particularly helpful). Apparently the swelling of the knee completely kills the quads ability to fire or have “competent movement” so step one was training the quad to fire again. I went home with an electo-stimulation machine and a set of exercises for the weekend feeling really pleased with everything. Once home, we had dinner and I crashed pretty early. I guess the PT visit took more out of me than I realized.
Saturday, 4 Days Post Surgery:
I was excited to spend the day working on my PT exercises and watching the Ironman Hawaii broadcast on TV. But I also was happy to have a visit from a friend (Terry) who took me shopping for a few hours. Joe’s Birthday was Sunday and I needed to buy him a card and small present. It was nice to give Joe a break from caring for me (he spent the afternoon on a motorcycle ride) and spending time with a good friend who has had her own fair share of knee surgeries. By this point I was also able to reduce the pain meds to taking only Tylenol during the day, but still took ½ of a pain pill before going to bed at night. Nonetheless, I still had not had a significant bowel movement, so I took another dose of Senecot-S before bed.
Sunday, 5 Days Post Surgery:
I woke up feeling pretty good and decided to try getting around the house on just one crutch. It took a little work and trust at first, but it seemed to go well and I really appreciated finally being able to have a hand free to carry things! I made use of my new skill by making coffee and carrying my own cup back to the couch. Joe took me to church where the bell choir set up a stool for me so that I could play with the choir. It was nice to get out and see some people, but I also admit it felt a little funny. I didn’t really like being the cripple kid. At least I know it’s temporary. Joe and I drove on the beach after church and then hung out back at home again for more PT work. The swelling in my leg had gone down quite a bit, but the bruising was now showing through quite clearly. I was bruised from my quad down to and including my shin. Bright pretty yellow/green colors that make us wonder why we never saw the purple phase! By late afternoon I was also finally able to have a significant BM. The saying “I’m so happy I could shit” should really be “I shit so now I’m happy”. Took ½ paid med pill before bedtime.
Monday, 6 Days Post Surgery:
Back to a full day of work! Luckily for me things had not gotten too far behind so it was a nice easy re-entry to the workforce. I set up my workspace so I could sit at the desk and either prop my leg up or not, and moved it between both positions frequently. Swelling continued to improve but there was still noticeable swelling especially around the incisions. My quad felt much stronger and I was able to start bearing more weight, using the crutch solely for balance as a back-up when walking forward. However any side-to-side or turning movements still felt shaky and I was certainly not ready for any extended one leg balances on that leg (still sitting down to put on socks and such). Also not yet ready to use that leg for going up or down steps just yet. Bowel movements also finally returned to normal. Took ½ paid med pill before bedtime but no other meds during the day.
Tuesday, 1 week Post Surgery:
Was able to walk without the crutches but still used them to get up and down the stairs. Had an early Physical Therapy appointment which showed range of motion and quad competency had improved. Was given a new set of exercises to continue rebuilding leg strength and my knee was taped with Kenesio Tape to help with reducing the swelling. Took 1 over the counter pain pill (Naproxin) before bedtime and slept reasonably well.
Wednesday, 1 week, 1 day Post Surgery:
I took my 1st shower standing up since the surgery. Completely independent from the crutches but only able to go up and down stairs using the left leg.
Thursday, 1 week 2 days Post Surgery:
Early AM PT appointment where I was given the OK to start using the stationary bike- no resistance, just spinning for max of 30 minutes at a time. Felt great to be on the bike again even if it wasn’t to break a sweat. I was able to start going up and down stairs using both legs. The PT also gave me reassurance that I had enough quad control again to safely start driving. Overall feeling much more confident with the knee although it is still stiff and does have pangs of pain every now and then.
Friday, 1 week 3 days Post Surgery
The happiest 15 minutes on a trainer ever.
Saturday, 1 week 4 days Post Surgery:
Walking around more comfortably, however the knee continues to feel stiff after sitting for longer periods. Continue to take only one Naproxin before bedtime. Had been sleeping well until this night when I rolled over and out of habit pulled my knee up to avoid kicking the cat (Leia) off the bed. I pulled the knee up faster and farther than it’s been able to bend thus far and it hurt like crap. I sat up strait in bed with a shout of pain. Poor Joe was shocked awake and his first reaction was “oh no, what did I do?” I managed to ease my leg strait again and scooted back down in bed alongside Leia who had slept through the whole thing.
Sunday, 1 week 5 days Post Surgery:
With most of the swelling gone, the pain/discomfort started to feel more specific to the incision areas and less generalized to the whole knee. This time at church I didn’t have to hobble with the crutches, but I couldn’t kneel during service either. Just the thought of kneeling on the bad knee makes me cringe at this point.
Monday, 1 week 6 days Post Surgery:
Shaved my legs standing up in the shower! Woohoo! I had my post-op appointment today with the Ortho and it was all good news from the doc. He gave me pictures that he took during the surgery from inside my knee (pretty wild) and walked me through each picture to explain what I was looking at. It’s a good thing he took the time to explain them because otherwise they just looked like the bathroom tile in our new guest bath to me. There's still a lot of meniscus left for good cushion going forward, there is no arthritis, and the ligaments (including ACL) all look good. My kneecap tracks to the outside a bit (said that was fairly normal for runners, especially women) but that it wasn't causing any problems yet. He suggested I discuss it with my PT so she can help me build a strength routine to help mitigate issues in the future. He also said at this point while the knee might hurt me, there's nothing I could do to hurt it and that I could return to exercising as pain/fitness permit. But I'm going to work closely with my PT on any return to running thoughts to be sure I have all the muscles functioning properly before I put any stress on them. I intentionally have NOT signed up for any races in 2014 yet so that I don't have an artificial date on the calendar that I have to be ready by. It feels good to just take my time with all of this. So all is good!
Tuesday, 2 weeks Post Surgery:
Another successful PT appointment today. She's really loading on the work now! I've easily got 1 hour of just PT work to do every day and that should keep me plenty busy. I plan to hit the pool tomorrow morning and got the OK from the PT to push off the wall. Next week I'm going to ask her if I can start riding with some resistance and maybe even outside.
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