Weird legs...

You may or may not remember I've had knee pain in the past.  Well, it seems my leg muscles are all messed up, well not very symetrical at least.  This weekend I wore a little heel when going out.  Oddly, my hamstring and calf on my right leg are sore.  Why only my right leg since I was wearing the same shoes on both feet?  Who knows.  Like I said, my legs are messed up.

My Thoughts on Night Shift

I'm about half way through my current block of night shifts and I'm learning that night shifts are definitely not something I want to do on a long term basis.

For five nights a week, I work just under 14 hours. This leaves me with 10 hours to commute, sleep, shower, and complete any required daily activities. The lack of free time isn't really a concern right now--it's more of the sleeping schedules. Once my shift ends, I mentally shut down. All I can think about is getting a couple hours of sleep. Unfortunately, it's made driving home a little difficult. I've started listening and singing show tunes as I drive home in the morning so I'm more alert. I'm not going to lie--it's been a little scary some mornings.

Along with the sleeping, my meal schedules stink. I feel like my body has mostly adjusted to staying up all night and sleeping during the day, but there are still some moments where I find myself eating to stay awake. Not good.

Exercise has also taken a major back burner. Unfortunately, my knee pain has been pretty bad. I know a large part of it is I've dropped off doing my prescribed knee exercises and tried other work outs. Last week I didn't work out at all though. Now just with nights, but residency in general, I have to make time for work outs and my knee exercises. I know I prescribe physical therapy to my patients, and I know it's beneficial, but it definitely can be annoying when it's needed for such a long term basis. I'm almost at the point where I feel like I'm never going to not have to do my knee exercises.

Now here's the major kicker--I hardly get to see my husband! Joe's started training for a new job and our schedules will not cross paths until Friday night :( So, for those who work nights on a regular basis so people like me don't have to, thank you!

I ran almost a mile today!

I used to call myself a runner, but with my knee pain for so many years, I really haven't been able to run. In fact, I think the last time I went for a true run was about 4 years ago. Since it's been about 8 months since my knee surgery and it's warm out again, I figured I'd give running a try. I'm happy to say I ran almost a mile today. I probably would have ran a full mile if it didn't end with a super hill and I didn't have my wallet and cell phone in my pocket hitting my thighs with each step (I was on the way to the Farmer's Market). I used to hate running distance at tracks, but I might try that next since it's a softer service--at the very least I should find a short trail.

I had a slight twinge in my knee as I was running, but it was definitely tolerable. It now hurts slightly in my left quad (side of bad knee) when I go down the stairs, but other than that I think I'm feeling ok. Today's run was no where near the speed or distance I'd like to achieve again eventually, but it's a start!

Bad Knee Day

I'm not going to lie, I've been slacking on my exercise, especially my knee exercises. I don't know what it was about today, but it was definitely a bad knee day. I got so excited I was able to do the elliptical again without pain that when I did have time to work out, I opted for the elliptical instead of strength training.

While I know I have to go back to doing more strength training, it's frustrating. When I have time to work out, I want to do what I enjoy, not just quad strengthening. It's also very frustrating, because I feel my pain today was at a similar point as pre-surgery. I do think something else is going on. My left calf is truly more developed on the outside and much less developed on the inside. I don't know if it's my gait or my arches, or what. I've been wearing my orthotics all day, so supposedly I should have proper foot alignment.

I don't know. I just know I'm tired of knee pain. I should go back to the physical therapist, but since it's a new year, I have to re-meet my deductible and PT isn't covered until the deductible is met. I don't know if I throw in the towel and try new orthotics made fit by the physical therapist (not a podiatrist) or what. While we haven't touched our deductible this year, I probably should get things taken care of before we have to switch insurances this summer.

Sigh. I'm just stressed with life and I just wish I could wave my magic wand and have the muscle tone I need and no knee pain.

Knee Update

Since it's been a while since the last knee update, I figured I'd catch my imaginary readers up to speed.

I'd love to say that my knee is completely back to normal, but unfortunately that's not the case.

I was a very bad patient the month of December and slacked off on my knee physical therapy exercises--but I was feeling fine. After the holidays and being back in Omaha, I wanted to get back to a normal workout routine. Since I hadn't really been having knee pain, I decided to start Wii's EA active and stopped doing my knee routine. Yes, I still did some exercises here and there, but not the full workout.

Sigh. It seems my knee isn't ready for me to do EA active. I'm not sure if it was the running in place, jumps, or just doing other exercises that caused my knee to start hurting again. It was mostly an ache. It didn't get worse with exercises, but it didn't get better with rest either.

This week I decided I need to leave EA active behind and go back to my knee physical therapy routine. I want to do some more cardio in there too, so I won't make my knee routine my only type of workout.

Good news. Since going back to my knee routine this week and avoid EA active, I haven't really had any pain. As a bonus--I did thirty minutes of the elliptical without pain today! Seven months ago that would have been unheard of. So, yes, I'm making progress, but I'm still a little bummed I don't have a completely normal knee yet. I still take one naprosyn almost daily though. Sometimes it's for pain, but most of the time I think it's for NSAID withdrawal headaches. Yeah. I need to work on that.

Interviewing and my Knee

For the past couple of weeks, unfortunately my knee's been bothering me again. It's getting the dull ache I had before surgery. I haven't tried much cardio since being in Baltimore, so we'll see. Some of the hotels where I'm staying have gyms, so hopefully I'll be able to use them this week. I have been doing my exercises, but it's still frustrating. I've also noticed my knee bothers me with lots of sitting and since I'm in the car driving a lot, that's not helping. Ugh.

Can't Quite Run Yet

So yesterday I took a leap and gave running a try. My goal was 5 minutes. Yeah, I lasted about 1 minute. I still had pain in my knee, but in a different spot. I'm thinking the pain is due to the inflammation left over from the surgery. So, I must continue to be patient and still do biking and walking. That said, I'm not having pain with those activities anymore, so at the very least, surgery has been some benefit.

Elliptical Success!

It's been exactly 11 weeks since my knee surgery and I almost feel completely back to "normal." I still can't squat down to patient's level and stay there for a couple of minutes, but that will come. Otherwise, I'm not having pain, the swelling's gone, I can go up and down steps with out pain, and pretty much everything else.

Over the weekend I used the elliptical for 25 minutes at various inclines, resistances, etc, and then again today. I'm happy to announce the pain I used to get after 5 minutes is not there! Both times I did notice a slight dull ache around 15-17 minutes, but nothing near the sharp pains I used to have. I know I still need to keep up my strengthening exercises and I don't want to irritate the inflammation that's still healing by causing more, so I think I'll limit my elliptical workouts to once a week. I'm getting excited that I might actually be able to run again in the near future, but I don't want to get ahead of myself. For now, I'll still focus on my strengthening while the deep down inflammation of surgery is still healing.

Post Op Appointment 2

Can you tell I'm back on rotations? No cooking, baking, or even blogging this week. Yesterday was my second post-op appointment. It's been just over 5 weeks since my surgery. My ortho doc continues to say I'm doing better than expected, so that's good.

As mentioned, last week was rough. I was the most swollen I'd ever been and limping like crazy. This week, the complete opposite. It was actually a little weird. Monday I expected to come home and be really swollen again, but nope. By today, I'm not even really limping anymore. I still feel a little weak walking down stairs and I can't squat as low as normal yet. I'm making progress!

The doc would like me to build some more quad muscle before I try to start running. I don't want to undo any progress we've made, so I'll hold off a little longer. I admit, I'm starting to get tired of my knee exercises. They're all about strength training and I'm more of a cardio girl. Either way, I'm keeping them up, no fear.

First Day Back

Ahh, it feels good to be back on rotations, seeing patients, and using my brain for clinical knowledge again. That being said, I'm tired as all heck! My knee is a little more swollen than yesterday. OK, actually, it's the most swollen it's been since surgery. I took an ice pack with me and iced during lunch. I'll keep that up. The hardest part is being on my feet so long. Clinic really isn't a desk job, plus we're walking around a lot. I was a bad girl and didn't do my exercises today. I figured 8 hours of standing was enough PT for today. I didn't want to shock my body too much all at once. Anyway, I'll pick back up with my exercises tomorrow. No more baking for awhile. Once I get home from clinic and do my exercises, I'm plopping my butt on the couch and putting my feet up.

Back to School Tomorrow

My two weeks off for recovery has come to an end, and my knee's the most swollen it's ever been, go figure. I'm excited to go back to rotations tomorrow. As much as I loved having the time to try tons of new recipes and surfing the internet, it's time for it to end. Joe is ecstatic I won't be trashing the kitchen as often. I clean up afterward, but no matter what, he feels the need to clean up again after me.

Overall, my recovery's still going well. I pushed myself at physical therapy a little hard this week. That, along with my desire to "just try one more recipe," contributed to my knee swelling. I'm really curious to see how swollen it is by the end of the work day tomorrow. Fortunately I think I'll only be at clinic for about 8 hours, but I'll find out tomorrow. The swelling isn't really painful, just annoying and an indicator that I'm doing too much. What can I say? I'm an overachiever in all senses of the word.

Post-Op Day 12

There's a fine line between rehabilitation and recovery. Recovery involves rest and limited activity, but rehab requires use of affected problem areas. And here lies my problem. If I don't work my legs, I'll lose whatever muscle I've already developed. Even everyday activities help rebuild or maintain my muscles in my left leg. The problem is, when I'm on my feet too much, my knee starts to swell, hence affecting my recovery. I'm trying to find a balance, but it's definitely hard for a girl who can only handle being off for so many days.

That aside--I can now go up and down the stairs alternating feet. I'm still limiting my stair use though for reasons of recovery.

Like clockwork, I wake up from knee pain at 4 am. It's odd because my knee only throbs at this time, not when I'm up doing things. I've tried taking ibuprofen just before I fall asleep, but I still wake up. Naprosyn has a longer half-life, so perhaps I'll try that tonight.

Let's Look Inside My Knee

I really spent way too much time labeling these photos, but alas, it's not like I have anything else to do. I mean, really, do I want to work on a research paper? I know these aren't the best quality. I scanned the color photos the doc printed out for me. So, buckle your seat belts and hop on the magic school bus =)
The band above is the plica. Plica can cause pain, but the doc says this wasn't big enough to be the sole source of my pain.

Although I didn't have any symptoms of torn menisci or collateral ligaments, it's always good to check them out while they're in there.

Here's the fat pad. Everyone has one, supposedly mine is a little inflamed, likely secondary to the tracking misalignment.
I can't remember if he said he removed this or not...

And here are the big bucks. If you look at the picture, you can see my knee cap rubs against the lateral (outside) of track and is a distance from the medial (inside) of the track. The rubbing of bone on bone contributes to the pain. To help the knee cap move in the proper tracking, the doc did a lateral release, which is better described in this post.

Lateral release will not solve all of my problems, but as long as I keep up my exercises, it should help. Only time will tell.

Post-Op Day 8

It's official, I've been doing too much. Today I had my first post-op appointment with the doc. The doctor was impressed at how much progress I've made so far but warns I shouldn't push myself too much or else I'll start regressing. I haven't used a crutch since Sunday and he suggests I start using one again. I don't know if I'll take this piece of advice, but I will start wrapping my knee in the ace bandage again. The past two days I have been doing a lot of baking, cooking, and errand running, so I will ease up on that. It's probably better that way and I've known I've been doing too much.

The stitches came out today. Here's a picture. One to close each of the 3 port holes and 4 on the outside where they performed the lateral release. The nurse removed two of them and then I realized I wanted to be in control of the discomfort, so I removed the rest myself. Yes, I'm a weirdo.

Today is the most swollen I've been since two days post-op...likely due to all of the activity I've been doing. It's hard to determine from the picture above if my knee is swollen, but as one of my attendings said, "God was kind enough to give us two of each so we know what's normal." So let's have a little lesson.
The best way to tell if a joint is swollen is to compare it to the other. While looking at both joints, look for the dimples. As you can see, I've circled my dimples on the good knee, but you can't really see them on my left knee. If there is enough fluid in there, you can press on one side of the knee and feel it on the other side. So...I'm keeping my feet up a lot more than I have been for the next couple of days.

Next post...a tour of my knee.

Post-Op Day 6

I have been completely beat all day.

Yesterday I went shopping with Joe for about 2 hours and today I woke up with a killer back. I don't know if my back pain was due to walking around or the joys of being a woman. I would love to take a hot bath and soak, but I can't until my stitches are out...two more days.

Today I was itching to try some new recipes, but I needed to go to the store to get the ingredients. Between shopping and cooking, I've been on my feet at least 6 hours today. My knee's feeling fine, but I just feel like it's taking more energy than usual to do everyday tasks. I didn't finish my baking, I'll do that tomorrow.

My big accomplishment of today - going up the stairs using both feet. My knee still feels too weak to go down the steps alternating feet, but I'm glad I'm starting to be able to put more weight on it.

Pain wise, honestly my back hurts so much more. My knee pain is the worst when I wake up, but as soon as I get moving around, it starts to feel better. I'm still taking ibuprofen on a regular basis, but I can now go longer in between doses.

Post-Op Day 4

I apologize for the crappy photos, they are coming from my camera phone. Either way, here's my knee today. I think it looks almost exactly the same, perhaps a little less swelling.

I'm no longer using a crutch to walk. I might have a slight limp, but I feel like it's the same with and without a crutch.

I'm back to sleeping in the bed. Joe hasn't rolled over onto the knee, and I feel like the pain is down enough to finally be able to get into a comfortable position. Before I was sleeping on the couch.

I still have to take stairs one step at a time, and I'm trying to limit them completely. I tried alternating feet, but it put way too much pressure on my left knee and caused pain.

I'm being very diligent with my exercises. Day one I could hardly flex my knee, today I'm at over 90 degrees. The first day it hurt too much to do the bike, today I could do 10 minutes. Mind you, I'm not biking near the speed before surgery, but it feels good to be able to do start to do things again. Plus, I'm all about limiting the degree of scar tissue that forms.

I'm not going to lie, my knee can tell when I've been doing too much and I'm glad I don't have to start a rotation tomorrow. That would be too much pain for sure. I'm on the max dose of ibuprofen, and that's enough as long as I take it on a scheduled basis. I didn't like the feeling the hydrocodone gave me.

I'm starting to get antsy just sitting around. I'd love to try some more recipes, but I think that's too much standing for now. Perhaps in the next couple of days. I'm catching up on my reading, but I can only read so much in one day. I've also started cross stitching again.

I have a research paper I need to write by the end of the year. I'd be remiss if I didn't use this time to do some hard core work on it, so that's part of my plan for tomorrow.

Mom left for Baltimore yesterday. I am so glad she came out to visit and help. I definitely underestimated how little I would be able/want to do the first two days after surgery.

Plica Removal

If you can't tell, I'm bored. Here's a little tutorial on my plica removal and why I needed it.

Provided by the Bones Health Channel on eMedTV.com

I think "tightness" is a great way to describe my knee pain, especially after working out.

Provided by the Bones Health Channel on eMedTV.com

However, it seems having a plica was not my only problem, so the doc did a lateral release as well, see previous post.

So what's a lateral release?

Browsing you-tube I found some videos of arthroscopic surgeries. Some are probably better than others, but without the commentary, I have no clue what's going on. These are not my knee. I don't know if they recorded mine or not, I guess I'll find out at my post-op appointment. I also won't know my official diagnosis based on what they saw until my post-op appointment, September 3rd.

Here's an image of the forces on the knee cap. We suspect a large part of my knee pain is due to too much tension from the iliotibial band pulling my knee cap towards the outside of my body. This causes the knee cap to come out of it's natural tracking and cause pain and inflammation from the friction. When stretching and strengthening doesn't work, lateral release is a way to help decrease some of this tension. Some docs completely cut the lateral retinaculum (on the left of image above), but that can make the knee too lose. My doc does more of a "hashing" to give it some more stretch, but not a complete release. Several years ago, surgeons did way too many lateral releases and often the patients didn't have much improvement. Fortunately, my physical therapist says that her patients who have a lateral release done by my doc have almost always had improvement. She believes a large part of it is due his "hashing" technique and that he does it through an open procedure.

The videos below show the lateral release done completely arthroscopically and a full cut, not the small cuts my doc did. Either way, it gives you a better idea of what went on.

Day of Surgery

I'm already starting to get bored, so I figured I'd record my experience the day of my surgery.

The night before the surgery I hardly slept. After working evenings at the ER, my circadian rhythms had me going to bed around 2 am and I needed to wake up by 5 am for the surgery. I couldn't fall asleep any earlier, so I was exhausted that morning.

Pre-op wasn't anything exciting, just peeing in a cup, reviewing health history, etc.

I know I had IV's when I was a kid, but I don't think I've ever had IV antibiotics. We get into the OR room and they start to give me the versed, fentanyl, and antibiotics. I've always heard the nurses warn the patients that it might sting going in. Oh, my, goodness. Yes it does. Fortunately I was out right after that and don't remember anymore.

My surgery only lasted about 35 minutes. When I woke up in recovery, my first thought was, "man, that was some great sleep, finally." Then I open my eyes and realize I don't know the woman who's sitting next to me. Then it dawns on me where I am. It took me five minutes to become coherent and I know I asked her name at least twice. She mentioned my blood pressure and heart rate increased after waking up, but not to worry, it's due the pain. I realize that, but I also wonder if it could be due to blood loss, even though I know it's not a bloody surgery. The nurse looked a little surprised when I asked for my estimated blood loss. I guess that's part of treating someone with medical knowledge. Supposedly my blood loss was zero, but I have a hard time believing I didn't lose anything.

After my heart rate and blood pressure decreased, they wheeled me over to post-op. My post-op nurse was amazing and so patient. She could tell I was still in pain and offered some morphine. It's fairly common for morphine to cause a local rash and itch after being injected. I noticed my arm was extremely itchy just a few minutes after she gave me the morphine. She was spending an large amount of time with me and I wanted to make sure I wasn't taking her away from her other patients. In my half asleep state I ask her if I'm her only patient and if so if she could get me some benadryl and point to my arm. She responds, "you do have quite a rash developing there." I was out before she even finished injecting the benadryl. Mom said it looked like I was catching flies.

As an aside, getting a rash after receiving morphine is common and is not considered an allergic reaction. So if it happens to you, just ask for some anti-histamine and the itching will go away.

Post-Op Day 1

I initially thought I'd post today in the style of a progress note we'd write on rounds, but I figured I'd spare you the medical jargon. Plus, I really don't think you care if I've been able to have a bowel movement or pass gas yet. I've felt a little dizzy and nauseous today. It's hard to say if it's my body reacting to pain or the side effects of my pain meds. They gave me Norco, which has hydrocodone and Tylenol. I'm trying to switch over to ibuprofen. It's what we give our women after c-sections, so I figure it should be enough for me too. So far so good. I just woke up from my evening nap, it's sore, but not a sharp pain or anything.

Today was my first physical therapy session after surgery. They unwrapped the dressing and worked on range of motion. I definitely can't flex my knee as much as before surgery, but the PT says I'm doing well enough for day 1. She tried to put me on the bike to get more blood flowing to my leg. My knee was definitely sore and I started to get dizzy. I have a history of fainting and I didn't want fall off the bike, so we'll try that again tomorrow.

Here's my knee day 1. It's a little swollen, but not too much. I don't really think the blue is bruising, but more of the "yes" marker. The three smaller holes are about 1/2 inch. The longer scar is about 2 inches and that's where they went in to do the lateral release. Something I find funny, both Dad and Joe made the comments, "I wonder how big your scars will be." Me, I personally don't care about scars as long as my knee's starting to feel better.

I'm still walking with a single crutch, but I think I'll be able to get rid of that in the next couple of days. I have the next two weeks off from rotations, so I'm going to go light and not try to force myself. That being said, I'm already tired of living purely on the couch.