ACL Reconstruction Pre-Surgery Rehabilitation

October 16, 2009

Well it took until today to fit in an appointment at North Lake Physical Therapy North Lake Physical Therapy and Rehabilitation where Big Country has gone before for rehab. After a thorough evaluation, their plan includes an exercise bike to get the motion and strength going again. Measuring his thigh they noted that he had already lost two inches in its girth from inactivity. Amazing, but it did reflect two weeks of inactivity. Along with the three times per week therapy sessions, he was given a pass to the Nautilus club where the physical therapist practice operates out of and told to come in on the other off days and do specific work on his own to hasten the conditioning of the knee. It was interesting to hear them talk of the only way that the fluid and blood cane be removed from the knee allowing it to regain its full movement is by the lymph system. Now what exactly is the lymph system? Time for some more research.

October 17, 2009

Did some research on the lymph system today. Did you know it is second in importance to your blood stream? Lymph is the fluid that surrounds your cells. Its job it to take away toxins and wastes and run through your lymph nodes set up along the system and ultimately through the liver. Through exposure to environmental toxins, excessive wastes being handled by the lymph system, and accumulation of “junk” in your body, your lymph system can become overworked and the nodes plugged. As well, your liver may be under strain from filtering all of this garbage. The lymph system is also your body’s carrier system for the immune system as well. A simple Google search turned up loads of information. It was enough information that I decided to visit our local General Nutrition Center and purchase an herbal liver support nutritional supplement containing primarily milk thistle, an herb which has been used for liver cleansing for ages. My thought is to get DS15’s lymph system healthy and free from obstructions so that it can do its job of ridding his knee of the pooled blood and fluids as efficiently as possible. A detox of his liver will make sure that it’s running well too.

October 19, 2009

The physical therapist today asked DS15 which ACL reconstruction he was going to have: patella, hamstring, or cadaver. What? Not being as informed as I should have been at this point in the game, I had just assumed the ligament would be stitched back up…similar to how DH’s was 18 years ago when he tore his Achilles tendon. Back to Google or more accurately, Swagbucks. Yes, there are three methods, and they are reconstructions. You do not repair an ACL. It is replaced from either the middle third of your patella tendon along with bone pieces at either end or a hamstring tendon is removed. Using a frozen cadaver part is sort of a last resort option, so I didn’t research that any further. There doesn’t seem to be a large consensus as to whether the patella or hamstring reconstruction are preferred. DS15 has some patella tendinitis in the same knee, so I’m guessing that might not be the best option for him. More questions for the surgeon when we meet on November 3rd I guess.

October 23, 2009

Physical therapy appointments every day after school are getting old at least on my end as they are taking a huge chunk out of the day. Not really enough time to go home…and a needless use of gas…but I can only go to Fred Meyers so many times a week. Monday, Wednesday, and Friday DS15’s meeting with the therapist and goes through their routine. The other days of the weeks he goes in and uses a stationary bike to work his knee. In one week, it has straightened considerably. It looks like he should be ready when we talk to the surgeon next week. A fellow varsity football player, also a sophomore, injured his knee during the last football game. They are wondering if he damaged any of his ligaments as well.

October 24, 2009

Being a bit of a research junkie, I decided to do a YouTube search for ACL reconstruction. These videos are not for the faint of heart, but I did find a really nice surgery animation site showing a patella reconstruction. Very, very informative. It also looks like some surgery centers use a continuous motion machine for 23 out of the first 24 hours following the surgery to slowly move the new ligament immediately after surgery. That would appear to me that an overnight stay at the hospital would be required. Yes, more questions for that November appointment.


October 28, 2009

DS15 told me that Luke did tear his ACL. They were both at the physical therapists office today riding the stationary bike together. How sad/pathetic/??? is that. There is also a freshman player that tore his ACL and is rehabilitating from his surgery right now. What a common injury for such young kids. A friend stopping by the house today also proceeded to tell me about his ACL tear and of another common friend of ours who had reconstruction surgery as well. One of them used the patella method and the other the hamstring. It seems that taking the ligament from the patella seems to produce a little more pain during recovery but not that much of a difference.

October 30, 2009

Today we meet with the physical therapist for the last time before meeting with the orthopedic surgeon to determine whether DS15’s knee is in shape for the surgery. By now I don’t even notice any hesitation is his gait, and he showed me that he has just about full range of motion. We’ll see what the therapist has to say tonight.

October 31, 2009

Received a clean bill of health and okay to perform surgery on the ACL from the physical therapist yesterday. There is still a need to keep the knee moving on the stationary bike all weekend and Monday before meeting with Dr. Feinblatt on Tuesday after school. DS15 happened to be at the therapist at the same time after school with Luke and found out that his ACL reconstruction surgery is scheduled with Dr. McWeeney on November 10. A great day to have it as the following day is a school holiday. Wouldn’t that be a hoot if the boys could have surgery the same day, recover in the same hospital room, and work their therapy sessions together. I will certainly be asking at Tuesday’s appointment.

November 1, 2009

DS15 remembered to tell me that the therapist had picked up a magazine to show the boys during their appointment on Friday. It was an article showing how the hamstring tendons are harvested in preparation for ACL reconstruction. Of course the article came with an abundance of photographs. Apparently it was a little more graphic than the boys wanted to see!

November 3, 2009

Remembered to call into high school attendance office to excuse DS15 at 1:50 p.m. so that we can make it on time to his appointment with Dr. Feinblatt.

Interesting information from the surgeon. But first things first. Surgery is scheduled for November 11 with an 8 a.m. sharp check in. Normal protocol of no food or drink after midnight. That will be fun for DS15. We talked about the options for the reconstruction: harvesting his own hamstring tendon or using a frozen tendon from a donor cadaver. The latter risk runs a 1 in 1.2 million chance of posing the risk of contracting hepatitis or HIV. Why would anyone use that option? As it turns out, statistics show that there can be a 10-20% loss of hamstring strength in the leg that had the tendon harvested. In a young person they are known to regenerate to some extent but are usually not as strong as the original. Dr. Feinblatt jokingly referred to it as the starfish syndrome. We will obviously do some more research in that department before making the final decision. Other than that, the surgery is done on an outpatient basis, and DS15 will be sent home with an ice-type brace (know there is a technical term for it) that will circulate cooling for the knee to reduce swelling. Dr. Feinblatt will also administer a femoral block in that leg to reduce the associated pain upon coming out of surgery. DS15 will be using crutches until the next post-op appointment and can plan on being medicated up for a few days...hence a surgery on a no-school holiday resulting in missing the two following school days and then having an additional two days from the weekend to recuperate before heading back to school on Monday. No rest for the weary.

November 5, 2009

DH has talked to quite a few people over the last few days and has come to the conclusion that most individuals, including the physical therapist that is currently working with DS15, that athletes who are strong to begin with do not seem to suffer from any hamstring weakness or slowness in speed after the reconstruction. The therapist also commented on how they have been really strengthening the two boys' hamstrings on the affected leg for that very purpose to have them in top shape before the hamstrings are harvested. With that in mind, there seems to be no reason to opt for the cadaver tendon.

November 6, 2009

The pre-op from the hospital called today to give me the low-down on what to expect the day of surgery. There were reminders to bring DS15's photo ID, crutches, and leg brace as well as no food or drink after midnight. She talked about the check-in procedure and where each step of the stay would take place. Anesthesia these days does not include Demerol as it did when I had my wisdom teeth taken out, and apparently you wake from surgery just about the time they withdraw the medication from your IV. Dr. Feinblatt will be giving a femoral block which will keep that leg numb for anywhere from 8-30 hours depending on how fast his body metabolizes the drug. After that she said it is extremely important to give him pain medication the minute he starts to feel pain so that he can keep his 1-10 scale at about a 3. She said he will be able to negotiate stairs but would be best off staying on just one level. As I will still be doing school with the girls upstairs and his room doesn't have a TV, I think I will have him stay in our downstairs bedroom with access to a TV and DVD player and bathroom just a few feet away and plenty of quiet. That way he'll also have someone close to fetch and carry for him in the middle of the night. Due to H1N1 threats, only two visitors are allowed per patient which will put a bit of a kink in our family and with his friends, but we'll just have to trade off and on throughout the day I guess.

ACL Tear and Meniscus Damage Injury and Diagnosis

October 2, 2009

After fighting the flu this week, Big Country was pretty anxious to be able to play in the varsity football game this evening. He had managed to only miss one practice this week and was feeling better by Friday, raring to go. Just before half time, Big Country went in for a tackle. Seeing that the player was already down with a pile on top, he began to swing his leg to jump over the stack of tangled players. As his right leg came up, he was hit by friendly fire...a team mate going in for the same tackle dove towards the pile mistakenly tagging Big Country on the outside of his left knee with a helmet shot. Pop went the knee and Big Country hit the ground...knowing that something was not right.

As we were sitting on the visitor's stands fairly low, I couldn't see past the line of players to actually see the play. I had been attempting to video tape the game from my poor position and was about to the point of bagging it since it was too hard to see over the sidelines. Casually putting away the camera, I wasn't even aware of the delay of game and finally hearing the mention of who #44 was around me. Suddenly I realized they were talking about a downed player...Big Country. Looking up I could see the field taking a knee and then began to get worried. Camo Queen who was watching the game jumped up in a flash to tear down to the tape around the field to see if it indeed was Big Country. I stayed put with H-Bob and maneuvered myself so I could see what was happening on the field.

The trainer for the team had Big Country stretched out flat and was adjusting his leg, obviously accessing the damage. They finally helped him up, and he hobbled over to the sidelines. Great! An obvious injury. As typical he was taped up with ice and had a seat along the edge of the field. Within minutes, the whistle blew for half time, and he slowly walked off the field with the team.

By the time they returned from half time, Big Country was definitely having trouble walking...lagging way behind the team which began to bother me a bit. It didn't look like just a bad bruise or strain. After the game, which by the way had the most exciting finish a high school team could ask for, I spoke at length with the trainer. She had performed several tests on the field immediately after the hit which are valuable in determining if there had been ligament damage...tests that are more difficult to perform later once swelling starts in. She couldn't come to any conclusions that would positively indicate a torn ligament and had hopes that he would be 100% the following day after some significant icing this evening. With instructions to check in with her after school on Monday, we went home.

October 3, 2009

As the weekend progressed, Big Country elevated and iced his knee continually. The swelling was definitely becoming an issue and his greatest complaint was his inability to straighten his leg. The motion just wasn't there. Forcing it in either direction caused pain, and interestingly enough the only pain he even had associated with the injury. Sunday came and went and there was no improvement. This perhaps was not a simple bruise or strain.

October 5, 2009

As the health of Big Country's knees are the lifeblood of his hopes to some day play Division I or II football as well as a body part you don't want to deteriorate early in "old age", I begged for an immediate appointment with our local orthopedic office, Oregon Orthopedic & Sports Medicine Clinic whom we have gotten to know quite well. An appointment for Tuesday was scheduled. We visited with the high school trainer after a long line of athletes streamed into her office for various tapings and injury evaluations. We are fortunate to have an on-site trainer available after school and present at games to be there to assist the coaches in evaluating injuries and coordinating rehabilitation between the coaches and the athletes’ doctors. Melissa of ProActive Orthopedic and Sports Physical Therapy went through another set of evaluation tests and provided us with a more specific speculation...a damaged meniscus (knee cartilage). She was thankful that he had an appointment already scheduled with the doctor as his situation definitely warranted further investigation.

October 6, 2009

Today I hauled Big Country off to visit with Dr. Feinblatt of Oregon Orthopedic & Sports Medicine Clinic to go over the injury to his knee and hopefully find some answers as to why there had been no lessening of his swelling and to see what his consensus was as to the outlook. As expected, he gave a thorough exam of the leg and sent Big Country down the hall for an x-ray. I've learned to bring plenty of reading material with me on appointments like these as you never know exactly how long you'll be there. Today was no exception. With x-rays in hand, Dr. Feinblatt went over them with us and showed where they did not indicate any bone chips or obvious impediments that would affect Big Country's ability to straighten his knee. His conclusion concurred with Melissa's that there was probably damage to the meniscus, and that perhaps a flap of the torn cartilage was flipped up as often occurs keeping the knee from operating properly on a mechanical level. He gave us the option of scheduling surgery or performing an MRI to get a better look at the soft tissue structures before going in. We chose the MRI as that would most conclusive. He hoped that a MRI could be performed that week and asked us to schedule a return appointment in one week. And the big bomb...the surgeon wanted Big Country on crutches...no weight on the knee at all...in the event pressure could further damage the torn meniscus.

So the phone calls began...to the insurance company, to the MRI facility to determine their insurance participation, back to the insurance company, to my husband who was out of town hunting, to the orthopedic office, and on it went. Finally with a bit of persistence, I had a MRI scheduled for the next day.

October 7, 2009

Neither Big Country nor I had any idea what is involved with an MRI and so went to the appointment after school pretty blind. We were just happy to have it performed soon enough so that the scheduled appointment with the surgeon would not have to be postponed. The timing of the appointment was also critical as Big Country didn't want to miss any school realizing how hard it is to make up missed lectures and notes in his AP classes, and we were able to get one late enough in the day and at a time that DH could also attend once he returned to town. After confirming the Big Country had no metal parts in his body, which we got a big laugh out of, they took him off for his scan. Apparently they needed to straighten his knee in order to strap it into place, but not wanting to tell them how difficult it was to straighten it, Big Country gritted his teeth and endured the pain as it was in the brace for the three or five minutes the scan took hoping he wouldn't pass out. He did admit though that he could move it a little bit further after that. Odd I thought. Perhaps they pushed the torn meniscus out of the way. One could only hope.

October 8, 2009

Getting along on crutches at high school with a 50 pound back pack is not fun for Big Country. Now he complains of terribly sore arm pits. But he did get an elevator key pass so that he can negotiate getting to the second level of the school for classes. Fortunately we have a medical supply source locally, so after dropping him off at football practice...yes, injured players still attend all practices...I purchased a set of fleece arm pads for the crutches. They had belonged to DH after his Achilles tendon surgery about 18 years ago and were pretty deteriorated. Fluffy fleece pads on a football player's crutches? Yes, he had to take a lot of guff for that one.

October 9, 2009

Big Country and I are both tired of these crutches now. Somewhere, somehow the deteriorated foam pads slipped off the crutches without his knowledge, so off to the medical supply store again. Fortunately, they had a single package of replacement parts in stock but in two different sizes. Taking a wild gamble, I purchased the set I thought would fit and headed off to doctor up the crutches. The sales associate did have some good advice about the height of the crutches though and arm pain. The height should never touch the underside of the arm and the hand piece should fall about the wrist area. Big Country's were adjusted all wrong. So here's hoping for a better fit and a little more comfort.

October 10, 2009

With the weekend here, it was time for a little research homework and see what all this meniscus damage could mean. It would appear that a meniscus tear can be fixed pretty simply. Once you start talking about it with people, they have either had the surgery performed on themselves or know of someone personally who has. If the damage is to the front, live tissue of the meniscus, however, it needs repair and that repair takes time. Time to heal, time to rehab, and time away from athletics. Big Country was not liking the sound of that option.

October 12, 2009

The big day. The reading of the MRI. It rather felt like you were about to go before a judge and be handed your sentence hoping it would be a light one. Dr. Feinblatt pulled up the MRI on his computer screen, which is a pretty impressive way to look at an MRI if you ask me. He showed us the meniscus and how there appeared to be no damage at all. Perfectly intact. We all exchanged glances and gave a big sigh of relief. Then there came the BUT word. "But it would appear that his ACL is torn." What! How could that be! I would have loved to have had our expressions video taped. I'm sure they would have been a text book example of a "fallen countenance". Dr. Feinblatt went on to show us in detail where the two stumps of the ACL were and that the ligament was no longer attached. He looked at the two exterior ligaments and found that they were perfectly fine. It was hard to find the right questions to ask. He did a pretty good job of filling in the blanks. Surgery was optional. Rehabilitation and time to get back into athletics could be up to nine or even twelve months. Forty percent of ACL surgeries do not result in 100% pre-injury performance. Not a pretty picture. It was pretty obvious to all of us that surgery would be necessary to reconstruct the ligament. It was obvious that Big Country would miss the remainder of the football season and that he would not be playing varsity basketball this winter either. And that there would be a lot of appointments and physical therapy down the road.

Dr. Feinblatt explained that before the surgery would be performed, he would want Big Country to attend physical therapy sessions three times a week for the next three weeks so that the fluid and blood that had accumulated in the knee at the time of injury could be removed. Full motion of the knee was necessary so that it would not be compromised before the surgery. There was some good news....no more crutches. The more movement the better. Would have been nice to know that a lot sooner! He gave Big Country a knee brace to wear for stability and as a sign for others to be aware of his injury. He must realize that high schoolers don't think twice before doing stupid stuff like chucking a backpack towards someone forgetting about their injury and possibly doing further damage. He set a follow up appointment for three weeks, and off we went feeling pretty glum.

Fourth Meal

I don’t think Taco Bell has anything on our family. We’ve been having a Fourth Meal for way too long around here. Perhaps it started with trying to eat as a family after various evening extra curricular activities or it could have been eating too early before said activities and then needing something later on. Regardless…the Fourth Meal habit appears to be here to stay at least while we have 2.5 teenagers eating at home (12-year-olds count as a half, right?)



A semi made from scratch dinner is served most every night. Nutritious, filling, and healthy. It may not go over well with some family members, but it is what we routinely eat. Dishes are cleaned up. Leftovers put away. The over-used dishwasher is loaded to the hilt one more time. A few hours pass, and then those stomachs start to grumble again. Out comes some leftover dessert; perhaps nachos are made or an ice cream shake is whipped up; it could be some stove top popcorn. Whatever ever the snack, it seems that everyone needs something. Plates are pulled from the cupboards. Dishes are filled. Utensils used. And of course more cups are out on the counter. Now multiply all of this by six household members. Regardless of whether they clean up after themselves or not, the fact of the matter is there seems to be a sink full of dishes by the time morning arrives the next day. Sigh. What’s one to do?

Well, short of padlocking the refrigerator…not a good idea since I do want them to eat up those leftovers…I’m thinking of other creative ways to limit the sink full of dishes that await me every morning. There is nothing like unloading a dishwasher and then turning around to fill it again first thing. Growing kids with active lifestyles do need to eat and frequently, so I won’t begrudge them their food, but it’s just the side issue of the residual dishes that result because of their Fourth Meal. So I believe my answer is going to be PAPER…paper cups and paper plates exclusively after dinner. Whether that is a green option or not is beside the point at this time.



So now that my shopping list is going to have some paper goods on it to purchase this coming week, it will be up to staff sergeant mom to enforce the new code. But hopefully the family will see that a happy mom is a happy home. Any other families with Fourth Meal dilemmas out there? How ever do you cope?

Goat's Milk Ricotta Cheese at Home

Do you ever wonder what can be done with goat's milk other than drinking it? Well baking and cheese making ranking pretty high around here as well. The simplest cheese on the face of the planet to make has to be ricotta. In fact I had no idea that I could have been making my own ricotta even from grocery store milk all along. It was one of those revelation moments such as I had when I started preparing my own buttermilk.

Here's how I go about making our own fresh, creamy ricotta cheese. Heat two quarts goat's milk to 180 degrees on the stove top stirring frequently but gently to distribute the heat. As it nears the 180 degree mark, stir in two tablespoons of either apple cider or white vinegar. As you continue to heat the milk, you will notice that the acid in the vinegar will begin to coagulate the milk and the yellowish whey will begin to separate. You may have to raise the temperature up to 200 degrees to achieve separate of curds and whey but do not let it go any further than that. If you have reached 195 degrees and there is no separation, add an additional tablespoon of vinegar and that should do the trick as it continues to climb to the 200 degree mark. Once you see the curds really begin to form, remove from the heat and allow to cool. The curds should float on the whey and form a semi-solid mass. For the creamiest ricotta, allow to cool undisturbed for a half of an hour. You can then gently lift the curds off of the whey with a slotted spoon and place them into a container. You may occasionally need to drain extra whey from your container as you fill it with the warm curds. Refrigerate and use within the week.



That's all there is to it. Once you're comfortable with making your own ricotta, next thing you know you'll be hankering for some semi-soft cheese as well. It's easier than you think and more rewarding as well. Enjoy!

Flu Update

So far, the nasty flu that Camo Queen came down with over the weekend has kept itself to her and her alone even though our high schooler, Big Country, is currently fighting a nasty cold. Yesterday, after over three days running a temperature that varied from 99 to the upper 101's, she woke up fever free. Her first comment when I had woke her in the morning was that now she felt like she could sleep comfortably even though she has been sleeping most of the weekend. When that fever breaks, you just feel relaxed.

She's still battling a cough though it's hard for her to tell whether it is coming from her chest or whether it is caused by dripping nasal passages. No matter what illness befalls her, an attack on her sinuses usually follows. I always blame that on me for having to return to work and not knowing enough to continue nursing her in the evenings. Her immune system never has been what the other three kids are fortunate to have who had the advantage of being nursed for a great length of time.

Afraid to miss any more of her veterinary technician classes at her college a good hour's drive away from home, she armed herself with cough drops and set off to school this morning...not quite prepared for the two tests that she was too ill to study for over the weekend. A phone call back home 45 minutes into her drive to let me know that she was stuck in a massive traffic jam gave me the impression that she's still pretty exhausted. There's a pretty good chance she will be entirely late to her first class in which her test was scheduled first off. It's hard to tell a perfectionist student to stay home and rest when they really do feel much better than they did.

Unfortunately, it usually takes her several weeks to completely combat whatever illness she encounters. And in today's environment we unfortunately do not seem to take the luxury of time that is required to completely heal ourselves before we launch back into life. Perhaps that is why it seems so foreign to us to read historical novels in which patients were confined to bed for weeks convalescing before they were allowed to do much of anything. There's something to be said for getting up and moving, but where to draw the line between staying at home and returning to your normal schedule is difficult at times. One of life's never ending questions I guess.