Monday, December 28, 2009

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.

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