Weeks 10 and 11

Range of Motion/Swelling/Pain:  My range of motion was about 120 degrees.  I could almost sit Indian-style which is my "go-to" sitting position on the couch.  Swelling was probably average.  My knee looked huge when I looked straight down on it when standing but I was told that's due to atrophy and not fluid in the knee.  Pain at the time was minimal and fleeting.

Walking/Brace:  At week 10, I took the brace off myself.  I just couldn't take it anymore.  Ultimately, it was fine and there were no issues with it.  I actually went to the PGA Championship with my brace on! Luckily, I was given really kind treatment and due to my limitation I got premiere seating (could hear Tiger Woods talking to the caddies).  I guess knee surgery can be turned into Lemonade :)

Physical Therapy:  At physical therapy the main benefit was the access to equipment such as the electrical stimulation and Graston, as well as, getting recommendations from my physical therapist for different exercises that I could do.  I could tell that we transitioned from a primarily physician/therapist based form of care to a more autonomous therapy program.  In other words, it was starting to be more "on me" and less on the care of a third party physician/therapist.

Typical Workouts:  I returned to the gym at Week 10.  I was at a point where I could do enough things that it made sense to go back.  From a mental aspect, it felt great to get back to my normal routine.  Who would have thought that I would miss going to the gym at 6:00 a.m.?!  Here are a few examples of workouts that I could do:

Workout 1

• 15 minutes bike & 10 minutes elliptical
• Hip abduction:  15x2 - 115 pounds
• Hip adduction:  15x2 - 115 pounds
• Sitting hamstring curls:  15x2 - 70 pounds
• Leg Press (sitting):  15x2 - 35 pounds
• Bridge - glutes (on your back, legs straight out and on top of a bosu ball)
• Bridge raise with 17.5 on hips:  60 seconds x 2
• Bridge raise with 17.5's in arms for chest press:  60 seconds x 2
• Sit ups with legs on the bosu with 17.5 lifting straight up:  60 seconds x2
• SLDL/Upward row:  60 seconds x 2 - 20's in each hand
• Memory Foam Pad - alternating standing on it single leg; Movement for stability work
• Bicep curls:  15's, 60 seconds x 2
• Tricep overhead:  15's, 60 seconds x 2

Workout 2

• 10 minutes bike & 15 minutes elliptical
• Hip abduction:  15x2 - 115 pounds
• Hip adduction:  15x2 - 115 pounds
• Sitting hamstring curls:  15x2 - 70 pounds
• Loop Bands
• Ankle - side:  60 seconds x 2
• Ankle - back:  60 seconds x 2
• Feet - sidewalks:  60 seconds x 2
• Calf Raises - single:  60 seconds x 2
• SLDS:  20's, 60 seconds x 2 
• Aerobic Step:  step up, one riser, 60 seconds x 2

Post-Operative Appointment:  I had my third post-operative appointment.  Overall, my doctor was pleased with my progress and assured me that any issues I was having were completely normal and nothing to be concerned about.  He also assured me that what I thought was swelling was really more attributable to quadricep atrophy.  My doctor is a pretty firm believer in using your insurance benefits to the fullest extent which essentially meant that he wanted me to keep going to physical therapy for as long as my insurance carrier will pay for it.  So, I continued to keep going twice a week but considered scaling it back in the next 4-6 weeks depending on the progress.  I didn't mind going to physical therapy but sometimes it was just not convenient from a time/scheduling perspective.

This is my knee!  The picture shows my right patella looking at it from the right side of my leg.  The defect was ultimately larger than I thought so I can see why I was having so much pain!

General Observations:  Getting out of the knee brace was by far the most monumental achievement both in terms of physical and mental health.  It felt so good to just freely walk without having to worry about limping and lugging the brace around. Simple things like wearing regular clothes and going to Starbucks suddenly became a mental boost that I'll never forget.  Even going to Court again (I'm a lawyer) felt so great (even if I lost).  I was like "Buddy the Elf" from the movie - everything felt amazing.  I had an appreciation for ALL of the small things - a real master class in gratitude.  Going forward, this was the most encouraged and happy I felt since surgery started.  I finally had the ability to resume some normal life tasks, both personally and professionally.  Who knew going to the grocery store would feel like such a perk :)

Weeks 8 and 9

Range of Motion:  My range of motion got over 100 degrees.  It's pretty tight at the top but not necessarily painful.  I could sit at my desk basically all day without much discomfort.

Physical Therapy:  At week 8, we got to start doing much more than just muscle stimulation.  Additionally, we began a walking program on the Alter-G.  Basically this machine creates a vacuum around your legs and lifts you up so you are putting only a percentage of body weight on your legs.  You have to put these shorts on that have a hoop-thing that zips you in.  (This doesn't make sense until you see it).  The big advantage is that you can choose what percentage of body weight you want to exercise with; i.e. you can begin walking with only a percentage of your body weight.  We started at approximately 50% of my weight and walked at a very slow pace of 1.1.  It wasn't painful but it was awkward.  I just hadn't walked in two months so it was somewhat challenging but I never felt like my leg was going to buckle from under me. 

These are the shorts that you wear (over your clothes).  Around your waist is the part that zips into the Alter G.

From the waist down you are enclosed within the Alter G.  

In addition to the Alter G we began some biking during Week 9.  We also started doing some actual exercises but none that involved any knee bend.  We did variations of standing on my right leg on top of a piece of memory foam and doing various motions to disrupt my balance such as tossing a ball.  We continued with the Graston tool and also did electrical stimulation.

Pain and Swelling:  My pain was pretty rare and if it was present it was typically a brief moment of pain and did not last long.  I still had a decent amount of swelling and the atrophy is pretty visible still.

Overall Thoughts:  Weeks 8 and 9 were probably some of my toughest mentally.  At this point, I really felt like it was getting hard to just "weather the storm."  My entire summer was spent basically indoors and it got lonely and isolated at times.  I was increasingly more irritable and felt like I had a short fuse.  However, I never felt any sort of regret or second guessed my decision to go forward with surgery.

Weeks 6 and 7

Weeks 6 and 7 were generally the same.

Physical Therapy:  Unfortunately, we were greatly restricted on what we could do.  Because my defect was on the patella, I could not do any active movement with the joint loaded in a flexed position.  So basically all I could do at PT was the following:

• Range of Motion:  My physical therapist would actively work on my range of motion.  He would have me sit on the edge of the table with my legs handing off the side and work it back so that I was going beyond 90 degrees.  This was very stiff at first and painful at times but over time it relaxes.
• Graston Tool:  Graston is a form of manual therapy known as soft-tissue instrument-assisted mobilization. It is one of a number of manual therapy approaches that uses instruments with a specialized form of massage/scraping the skin gently.  Basically, my physical therapist would use some coco-butter so the tool would glide easy over my quadricep and then use one of the metal tools for soft-tissue massage.

• Electrical Stimulation:  Conductive pads are placed at locations on the quadricep and electrical stimulation is sent through the pads directly onto the muscle.  It does not hurt and at most is uncomfortable or just weird.  My physical therapist usually asks me to contract my quad when the stimulation is present.  

Range of Motion:  This has basically been the biggest goal of this initial phase of rehabilitation.  When I first started working on range of motion with out my CPM it was profoundly uncomfortable and at times painful.  But, like most things, the more you do it, the easier it gets.  I was particularly motivated to get 90 degrees comfortable as soon as possible so that sitting in a chair would be comfortable.  Having my leg in the brace and sitting on the edge of my chair has just been really uncomfortable and made my back get really, really sore.

Pain and Swelling:  Pain is not present all the time but it's not totally gone yet.  I would still get a fair amount of tenderness on the patella, sometimes to the point that it was tender to the touch.  Swelling has been the most troubling aspect of it for me.  When I look straight down, my right knee just looks huge from that vantage point.  I still ice every day but it seems like I still have a fair amount present.  This is one issue that if it's not resolved by my next appointment that I hope he will consider treating. Perhaps by draining the knee.

Sleeping:  Sleeping has gotten much better.  Now that I have a little more range of motion, I can bend my right leg, which just allows me to get comfortable and switch sides without as much effort.

Social Life/Mental Aspect:  My social life has been nonexistent.  It's just so hard getting in and out of cars and frankly, this process just makes things not as enjoyable.  I hate that people stare and that it draws attention.  Additionally, while it is nice that people ask me to do things, often times people don't think about it from my vantage point; i.e. how easy would this activity be in a brace and on crutches.  Lastly, you will learn quite quickly who your real friends are and who you can really count on.  I just remind myself that it's only a few more weeks before I'll have much more autonomy back and can start to transition back into my regular lifestyle (somewhat).

Weeks 4 and 5

Again, I got sidetracked so I have to combine these posts!  Managing work and rehab is difficult.

Returning to the Office:  Starting at week four post-op, I had to return to the office.  This is the biggest challenge so far.  It is both stressful and frustrating.  Getting in and out of a cab is frustrating.  I have to "back in" and sit parallel across the back seat with my leg out straight across the seats.  If there are potholes or bumps along the way, the jarring hurts my knee.  Once I get to the office, by far, the hardest challenge is sitting in my chair.  I have to sit in the chair with my brace on and locked which means I have to sit on the edge of the chair.  By the end of the day my knee has been swollen and tender and my back hurts from sitting awkwardly in the chair.  

After my third day back to work, when I got home my knee felt like a softball.  You couldn't really even see my patella in my knee.  My leg just looked like a cylinder. 

Starting Physical Therapy:  Because of the nature of my defect being on the patella, I am limited in any active range of motion exercises that load the joint.  Which basically means that I am limited to quad sets and leg lifts with my leg straight.  Range of motion work is all un-loaded.  Basically at my visits we do the following:

• Scar mobilization

• Graston tool on my quadricep right above the patella (in areas that are not tender)

• Assisted range of motion stretching

• Electro-stim (10 minutes) quad sets when the stim is on

• Ice

Pain:  My pain has been generally pretty good.  I do not have a feel for specific things that trigger pain yet.  Sometimes it's just random small things when I get that patella/femoral pain right across the front of my knee cap - like getting out of a cab or even sitting at my desk too long.  

Sleeping:  I cannot explain why but since I had surgery, I have slept on my couch.  In the beginning it was because my mom stayed with me and I figured she should sleep in my bed because I wasn't going to sleep comfortably no matter where I was.  But, it just kinda stuck.  Sleeping with the brace on is annoying.  It has caused bruises to my non-surgical leg in the knee area from knocking into it.  (And I bruise like a peach!)  I have started loosening the straps at night but I'm still keeping it locked. Since I sleep on my back, I'm usually able to get somewhat comfortable.  I do sleep on my side at times so that's been hard.  At my follow-up visit, discussed below, my doctor said I could start sleeping with it off which was the BEST NEWS!

Exercise:  I can still do the exercises that I listed in my last post.  I have been feeling lazy about it though recently.  The same routine gets boring.  I can't wait until I can go back to the gym.  Even though I won't be doing what I was prior to, getting back to my usual routine will feel so good.  I never thought I would miss getting up at 5:00 a.m. to go workout!

Post-op visit with the doctor:  At my first post-operative appointment with my doctor, it was much more limited in terms of what was addressed.  It was only three days after surgery and he was primarily concerned with making sure there was no infection, my pain was managed and swelling was under control.  We did not really get into much substance and at that early stage, you really couldn't. I was eager for my second visit because I knew it would be more substantive.  In general, he was pleased with my progress.  I am ambulating with one crutch and my incision is healed.  He also made me feel assured that the pain I am having is normal.  I am having some pain over the patella when trying to do leg lifts and he assured me that it is to be expected.  I am now able to start "treating" the incision with Vitamin E oil and other scar remedies.  Dr. Guelich is also just a supportive person to talk to and it generally feels good to talk to people who REALLY understand what I am going through.  At the conclusion, he gave the "OK" to go forward with a standard rehabilitation protocol which is mostly focused on getting my passive range of motion going.  He wants me to start working on allowing my leg to hang at 90-120 degrees - basically allowing my leg to hang over the side of my bed and then passively pushing it further back with the other leg.  I tried it at the doctor's office and it was pretty uncomfortable at first to the point that I was essentially squirming.  All things considered, the visit was positive and I left feeling optimistic. 

Weeks 2 and 3

I combined weeks 2 and 3 because they generally felt the same as I was working from home.  And, frankly I fell behind :)

Returning to Work:  In terms of time off, I took off one full week of work and then worked from home for two weeks.  Starting to work was pretty difficult in terms of balance.  At first, I found myself realizing it was 5:00 p.m. and I had not even gotten into the CPM yet.  I was also just tired and not ready for the stress that comes along with being an attorney; i.e. I did not have the energy to argue with people.  Luckily, I had one work project that involved a lot of document review so I could essentially just balance my computer on my left leg (non surgical) and put my right leg in the CPM.  While it is not ideal, it worked.  Returning to work, even at home, made it crystal clear that recovery was certainly going to be a challenge.  It really gave new light to the saying, “there aren’t enough hours in the day.”  Between how much I was sleeping, in addition to trying to work at least 8 hours a day, sitting in the CPM for at least 4 hours and finding 1 hour to do exercises, it was a lot.  

CPM/Range of Motion:  This was probably the best aspect of my recovery.  I had no problem getting to 120 degrees in approximately 10 days.  While it was definitely tight at the top, I could get there relatively easy.  For each session, I would start lower and work my way up.  As it got easier, my general routine was to set it at 80 to start and then make my way up to 120. 

Icing:  I haven't been as diligent as I should be about icing.  I usually place an ice pack on my knee when I'm in the CPM.  I have not been using the ice machine as much.  

Pain:  The pain has been manageable.  It's frustrating that even the smallest movements can cause pain.  In particular, when I tried to move my leg to the floor, the area on top of my patella was very, very sore.  In fact, even engaging the quad in that area was very uncomfortable.  It feels like each time you need to do something, whether it be getting off the couch, going to the bathroom, etc., you feel like you have to mentally prepare for it.  Pre-surgery you do so many things in a mindless way which really changes after surgery.  

Sleeping:  The phrase "it is what it is" has never rung truer.  Sleeping with a leg brace on sucks, plain and simple.  If you sleep exclusively one way, having the brace on may pose a real problem.  I sleep on my back so I can generally get somewhat comfortable.  However, I do sleep on my side periodically throughout the night and that is generally unavailable.  If you are a stomach sleeper, the brace may pose a real issue.  

Exercises: I started an “exercise routine.”  Those quotes are necessary and if I was verbally explaining this to you, I would use air quotes.  For the most part I used resistance bands as my equipment.  I would have liked to have some weights but I did not want to spend the money on them since it was a limited amount of time that I would need them.  Generally, the entire "workout" would take an hour.  Aside from the physical aspects of doing this, it mentally felt good to feel like I was making forward progress.  

Legs

Loop band 

side life - 3x10 

back lift - 3x10

around the foot/side to side - 3x30

SLDL single 3x10 - resistance band

Quad lifts from the floor - 3x10

Quad lift and hold: 8x15 seconds 

**Heel slides:  I initially tried a few times to do some heel slides while sitting on the floor but I got paranoid about damaging the graft.  I tried 2x10 and got to 15 degrees.  It was a joke. 

Arms

Resistance band - Series x2, each exercise for 60 seconds

Bicep curls 

Overhead shoulder press, single sides

Triceps overhead 

Pull up shoulders 

Lat pull singles 

Front and side raise shoulders, single side

Core

I varied how long I did ab work.  At a minimum I always did 5 minutes.  

Each exercise for one minute 

Resistance Band:  Wood Chopper/cross body pull

Resistance Band:  Obliques standing/lower side to side 

Straight leg sit ups 

Legs up - climb the rope

Russian Twist (sometimes legs down)

Single leg lifts

Double leg lifts

Other Thoughts:  Overall, I would say that things went OK.  Candidly, this procedure makes everything in your life more difficult.  I had to give myself "pep talks" for ordinary life tasks.  For example, showering is really difficult and to some extent scary given the potential for slipping.  I'm not proud of how long I would go in between showers.  You have to sometimes really gear up mentally for really basic tasks.  

Week 1

The following is a general day-by-day summary of my first few days following surgery.  I have tried to cover the main issues/topics that may be of concern to people.  If you have questions, please feel free to leave a comment and I will do my best to respond.  

Day 1: 6.6.18

Sleep: I woke up every hour predominately because of the discomfort of sleeping with my legs elevated on a couch cushion. When I woke up at 5:00 a.m. the blood rushed in my leg after de-elevating but pain subsided shortly and I was able to comfortably fall back asleep.  After taking meds at 5:00 a.m., I slept about 3 hours in a row without waking up.  

Pain: I had no desire to endure pain.  I took 2 norco (10-325) every 6 hours.  I figured that in the early stages there really was not any harm in being extremely precautionary about pain prevention.  I took the anti-nausea pills and stool softener as well.  

Appetite: Fine.  Probably too good :)  

ADLs: I generally felt good waking up, washing my face, brushing my teeth, etc. It helps that I can had limited weight bearing as opposed to completely non-weight bearing. It gave me just the right amount of autonomy; however, my mom is taking care of a lot in terms of getting me water, food, etc.  She has been a real trooper and I am really thankful that she made the trip to help me out.  For those wondering, if you were in my position and could be weight bearing post surgery and would not have live-in assistance, you could do this on your own.  The day after surgery, I could have attended to my own needs.  It would have been pretty damn difficult but it was doable.  Basically, when the brace is locked, you just move around with a peg-leg.  If you are non-weightbearing (like for femoral defects) that likely changes the dynamic and I would imagine that it is much, much, much more difficult.  Lastly, even on day 1, the boredom was highly foreseeable but I was pumped to wake up and watch the French Open on the Tennis Channel.  One of the few times in my life that I'm able to wake up on a week day and watch European tournaments in the morning. I'll take it. 

CPM: My CPM regimen was to start at 30 degrees and to increase 5 degrees each day as tolerated.  I was instructed to sit in it for at least 4 hours each day. 

• First session:  (2 hours) - I was sore in the beginning and took two pain pills at the start. I started at 15 degrees; moved to 18; then 20, 25. The last 45 minutes I was at 30 degrees.  I had a burning sensation in my knee after I was finished. 

• Second session: (3 hours) - Gradual increase up to 30 degrees.  I spent 1.5 hours at 30 degrees. 

• In general, it feels like I’m going to tear the stitches when it gets to the top of the flexion.  At the top, it makes me squirm a little bit as the degrees increase with flexion.

Physical complaints:

• Starting to get muscle spasms in my quad 

• Woke up with a really tight calf 

Day 2: 6.7.18

Sleep: I slept 🛏 better and longer, about 9.5 hours total.  I did wake up periodically and one time with spasms but overall I felt pretty good.  

Pain:  I tried just taking one pill in the middle of the night.  It was maybe a little soon for that.  When I woke up with spasms I was in pain so I'm going to continue taking 2 every 6 hours.  I figure there is no trophy for enduring pain and I have nothing to do but recover so I would prefer to do it pain free. 

Appetite: My appetite is fine but I feel extremely dehydrated from the anesthesia.  I feel like I cannot drink enough water which is fine but when you are immobile, getting up to use the restroom is challenging.

Icing:  I stopped using the ice machine today. I can not feel the cooling through my bandages so for now I am just elevating my leg.  

CPM:

• Started at 20 and went up to 25 and 35. I tried 40, which was a little sore at the top.

• Sitting in the CPM makes my back sore/uncomfortable; my gluteus are sore too from sitting so much.

• I did 5 hours total in the CPM.

Physical complaints:  I feel dirty but I did wash my hair for the first time and it felt great.  

Day 3: 6.8.18 

Sleep: Sleeping is going pretty well overall. Sleeping with my leg elevated is uncomfortable but it is part of recovery 

Pain:  I did not take any pills before bed, but I took one at 2:00 am. Overall, the pain is tolerable. I am planning to try and just take it towards the end of the day, which will help prepare for work days when I cannot take anything in the morning 🗂as I will be working.

Appetite: No problems except wanting to eat🍽 when I am bored.   

Icing: I am using the ice machine again now that I can feel it although I do not believe it gets as cold as I would like it to.

CPM: I made it up to 40 degrees.  I started at 25 and progressed upwards for a daily total of 4 hours.  My complaints are the same as Day 2.

Physical Complaints: In general I feel pretty good. As good as I can be all things considered. Mentally, thinking about starting work from home stresses me out but I have to start on Tuesday. 

Post-Op Appt:

• Today was my first post-operative appointment and things went well. Swelling, mobility, pain, etc are all within normal ranges or better. 

• Bandage and steri-strips were changed 

• Clarified that the following are all normal: Popping in my knee, Spasms in the quadricep, light pressure in the joint on the patella.

• It’s normal to feel some pain in the joint. Some bending in the knee is fine so long as it’s not a loaded movement. 

Plan:

• Generally , it was suggested that I try some light stretching and quad sets. Nothing intense, just some preliminary work before I start PT. 

• I might try and develop a routine of stretching, upper body work and quad sets/lifts 

Day 4: 6.9.18

Today was the first day without my Mom or any assistance.

Sleep: I slept 9.5 hours and got up once around 2:00 am. My discomfort is primarily attributable to the brace and not being able to sleep on my side. 

Pain: I have not taken any pain pills  since yesterday around 6:00 pm before my CPM session. Trying to only take them, if at all, in the evenings. I am going to attempt to not take any tomorrow unless I am in pretty bad pain. 

Appetite: I'm trying not to eat because I am bored.  I have been drinking a lot of coffee because I have been so tired.  I had some friends come over and we had chinese food and ice cream.  This has got to stop.

Icing: This has gotten much better now that I can feel it.  I take the ace bandage off and use two gel packs with the cryo-cuff around them.  I try to do 30 minute sessions with some elevation.

ADLs: I’m doing well moving around my apartment. I live in a small one bedroom apartment in the Gold Coast so there isn’t too much space to cover. Overall, I’m able to get up when needed and get a cup of coffee, make food, etc. I have needed help to take out the trash, do laundry, etc. 

CPM: I got to 45 degrees comfortable and sat in it for 4 hours. I feel really encouraged with my progress thus far with the CPM. I feel confident that by two weeks after surgery I might be near 90 degrees. 

Day 5: 6.10.18

Sleep: I slept in my bed for the first time.  It was generally OK but I miss being able to sleep on my side and freely move my leg.

Pain: I took some pills for comfort in the CPM and I made great progress. I’m going to try being pill free now and see how it goes. 

Appetite: Too good. I ordered pizza but it was worth it . I’ve gotta be more strict. People keep bringing me comfort food which is nice but I have to reign it in. 

Icing: Same as the day before. 

CPM: This is what I’m most proud of. I think I got roughly 4 hours in but I got up to 70 and it was pretty comfortable. I think I’m able to make larger strides than just 5 degrees per day so I may challenge myself to try larger increments, so long as the pain is tolerable. When I start I like to build it up; i.e. start lower and then make my way up. I also need to figure out a way to keep my foot against the back platform.

ADLs: I had a friend come stay with me which is nice. She’s a nurse so she’s fascinated by the procedure. She encouraged me to try higher degrees in the CPM which kinda nudged me to try for more. Once she leaves in a few days I’m totally on my own. I should be fine but I’m a little apprehensive  

Day 8: 6.13.18

Sleep: The brace is so annoying. I’ve tried sleeping on my side with the bad leg up with a pillow in between. It was ok but not how I want to sleep.

Pain: I'm not taking any pills and I'm trying to stay off them until I start formal PT.  I am still sore sometimes after the CPM.

CPM: I got up to 90 today! It’s tight when I get to the top but generally not too painful.  

Icing: I’ve started doing ice cups which is essentially ice directly to the knee. It’s faster and colder quicker. 

ADLs: I started working yesterday at home. Finding balance is really really hard. I found myself at 5:00 p.m. today realizing I had not sat in the CPM at all. Likewise, I did not ice either. I slept in late since I’ve generally just been tired. I have to get myself on a better and more productive schedule. Otherwise, I’ll set myself back both physically and professionally.

Week 1 Observations 

I am so much better off than I ever expected. Both the pain and physical limitations are completely tolerable. With that being said, now that I have to start working again I’ve realized how much this recovery truly entails. I need to start doing some rehabilitation on my own and trying to fit that in with work, the CPM and icing feels impossible.  Literally, it does not feel like there are enough hours in the day.  I’ve started to wonder if I should have put off the procedure until I was eligible for FMLA leave so I could take off six full weeks to dedicate towards rehabilitation and recovery.  However, this procedure was never going to be easy and there will never be a "convenient" time to do it so to some extent, diving right in was not a bad idea. You will always find a way to make it all work. You don’t have a choice. 

Day of Surgery

I arrived at the hospital, Presence St. Joseph, at 8:00 a.m.  Upon arriving I was almost immediately busy filling out paperwork, meeting with my surgeon and the anesthesiologists and getting "hooked up" to various machines.  Collectively, it was a welcomed distraction so I did not get myself worked up about what was ahead.


I was originally informed that I would have a 23-hour admission and basically stay over night for observation.  However, when I arrived my surgeon explained that I could go home that afternoon so long as I felt OK and assured me that I would not have to leave if I was not feeling well. I sent a few text messages to my good friend who was able to come pick me up that afternoon. 

Prior to entering the operating room, I was given some sedatives to relax and at least one administration of fentanyl.  They also gave me a femoral nerve block and it did not work.  They tried again a second time, like right before I entered the operating room, but I do not know if it ultimately ever worked.  I told the anesthesiologist that it did not work because "I have nerves of steel."  That joke was likely a product of the fentanyl they gave me.  

I believe I entered the operating room around 10:00 a.m. (ish) and the procedure lasted approximately 90 minutes.  When I woke up, I was in a recovery room and boy, oh boy, was I woozy.  I'm not sure if woozy is a technical term but it is accurate.  I quickly got my bearings and realized where I was, what had happened, etc.  I have never been anesthetized that deeply before as my prior arthroscopy was much shorter.  While I felt like I was a belligerent fool, multiple nurses commented on how communicative and articulate I was under the circumstances which was comical to me because I felt anything but that. 

After getting acclimated to my surroundings and feeling like I could communicate, the nurses were really helpful in getting me everything I needed.  I am a cherry coke zero addict so I packed one with me and began eating graham crackers.  Around 2:00 p.m., I decided that I would target my discharge for 3:30 p.m.  As such, we began the discharge process and I received discharge instructions, pain medications, got changed, etc.  They force you to urinate before you leave too.  

I was wheel-chaired to the front entrance and my friend drove me home.  I really did not have too much pain until about 8-9 p.m.  Ultimately, I was glad that I went home.  My friend stayed with me until my mom arrived around 5:30 p.m.  That evening my mom and I just caught up and watched a movie.  Another friend of mine had Cold Stone ice cream delivered to my door!  Fortunately, I do not have adverse reactions to anesthesia and did not feel nauseous but I did not have much of an appetite.  I did have a small dinner and the ice cream because my general philosophy is that calories do not count on surgery day.  

That first night, sleep was a little rough.  I woke up about once per hour as I was just uncomfortable.  I had my leg elevated on a couch cushion but removed the cushion around 5:00 a.m. when I took some pain pills.  While I was exhausted, sleep was just not that easy.  My knee was quite tender and even the smallest movements caused pain and discomfort.  

In general, I was pleasantly surprised with how I felt.  I had pictured myself being in profound agony but I was predominately just really uncomfortable with manageable pain so long as I took pain pills every 4-6 hours.  I knew what I had signed up for so all things considered I was pleased without the procedure went and my general physical condition.  

Preparing for MACI Surgery

There are a number of things to consider and plan for when having MACI surgery, of which have varying degrees of importance.  Some are more for comfort while others are vitally necessary.  I hope the following are helpful!

1.  HELP!  My Mom came to stay with me for four nights.  In general, she provides a source of comfort because she is the best in the Mom game.  But she also helped with rudimentary tasks such as getting me food and going to the grocery store.  It was also nice to have someone around "just in case."  I was relatively "OK" when I left the hospital but everyone is different and I would recommend erring on the side of safe versus sorry.  For example, one blogger mentioned waking up in the middle of the night to use the restroom and noting feeling profoundly dizzy from the medications.

2.  Toilet Riser/Stool:  I purchased a five-inch riser seat for my bathroom.  Your leg will be locked in a brace for many weeks and sitting down may be difficult.  I ultimately have not needed to use the riser seat because the set up of my bathroom is such that I can simply lower myself down by essentially doing a tricep dip because my sink is right nearby.   Others may not have a similar set up or the upper body mobility.

One blogger had this set-up in her bathroom.  My sink was right next to the toilet so I could push myself up without needing an armrest.  

3.  Shower Chair:  You will need a seat for the shower.  This is a MUST.  Standing in the shower will be nearly impossible and if you do not have a walk in shower, things can be tricky.  For safety reasons, you should absolutely have one.  Basically, I get in the shower with my brace on and then take it off and start the water.  

This is the chair that I purchased.  The main thing I needed was the two arm rests to help lift and lower myself into the chair.

4.  Entertainment:  YOU WILL GET BORED.  I bought an iPad before surgery so that I will have access to books, magazines and videos essentially at all times.  I also have two smart TVs.  If you can get your friends' and family members' log-ins for streaming (legally of course), do it.  Get recommendations for shows, movies, books, etc.  

5.  Physical Activity:  Get yourself in good shape before surgery.   If you need to lose some weight, lose it.  If you need to work on strength and conditioning, do it.  MACI surgery will take a toll on your body and months of inactivity following the surgery will lead to atrophy.  Additionally, one of your main goals in PT following surgery will be regaining quadricep strength in your surgical leg.  The stronger it is going into surgery, the quicker it will "bounce back" after surgery.  

6.  Balance/Yoga:  You will be on crutches for many weeks. During this time it is essential not to fall or stumble on your bad leg since the graft is very fragile.  Having good balance is of the utmost importance.  It highly unlikely that you will never stumble or trip while on crutches so having the ability to balance will really help with this.  If you have never been on crutches make sure to practice beforehand.  However, if you are at the point of doing MACI surgery, you have problem been on crutches before.  

OK, you do not have to become a full blown Yogi, but you get the point.  Work on balance however you see fit. 

7.  Return to Work:  I may make this the subject of an independent post because of how much it affected my life.  I am an attorney and I work a lot of hours.  However, I will be taking one week off of work followed by two weeks of working from home.  My employer purchased a computer for me so that I can work from home remotely.  After discontinuing pain medications, work to some extent gave me something to do but at the same time was an added pressure on making sure I sat in my CPM, did my exercises and iced.  

This is me at the office; i.e. sitting on my couch in the CPM and reviewing records on a lap top.   

8.  Driving:  I live in Chicago and do not drive.  Obviously, after taking pain medications you cannot drive but I have heard that people are comfortable to drive around the 3-4 week mark.  My graft was on my right leg (driving leg) so it could be longer in that case.  

9.  Pain medication:  Take at the first on set of pain.  Don't wait until it gets really bad.  It is much harder to get rid of pain when it is very uncomfortable because the pain meds take awhile to work.  So far, my experience has been different than most others.  I have read blogs where the patient was taking pain medication for months.  I took it for 4 days around the clock and then only took it in the evening for two additional days.  I have taken it sporadically since then.  Pain is a highly subjective thing so experiences will differ depending on the patient, location of the graft, co-morbid conditions in the knee, etc.  

10.  Have a social network:  Invite friends/family over.  Although you may feel bad and think you look terrible (I didn't shower much in the beginning) don't turn down social visits.  They definitely will lift your spirits.  My mom stayed with me for a few days after surgery and then a friend came to visit from Michigan.  I also have friends in my neighborhood that stop by.  Again, my experience has been "good" so far and I was able to go out to dinner (two blocks from my apartment) ten days after surgery.  The following night I even went bourbon tasting with a friend.  Yes, I was off the drugs at that point. 

11.  Wheelchair:  See if your insurance will cover a rental.  Some people find it handy and it can assist with your ability to get out depending on your recovery.  Thus far, I have not been in a situation where I would need one. 

12.  Stairs:  If you have stairs in your house I recommend moving to one floor.  Stairs are doable on crutches but if you can avoid them, it's better.  It's not worth risking a fall and damaging the graft.  I honestly could not fathom going up and down stairs on a daily basis.  

13.  Considerations for Women:  I got my legs fully waxed before surgery and fully stocked up on dry shampoo.  Frankly, even when you can shower, it is a big task and feels exhausting.  At the same time you do not want to feel utterly disgusting.  Small things can help you feel more comfortable even when you are not and for me, not having hairy legs was a small comfort.  Additionally, following surgery I was instructed not to take NSAIDs as there is a concern that they may interfere with graft adhesion.  This meant that I could not take ibuprofen for menstrual cramps and that has been an issue for me.  I caved one night and took some but the following three days I just took the norco I had been prescribed.  This helped with the cramps and lasted through the night so I could sleep.  

14.  Prepare your home:  I essentially prepared for surgery as if there was a zombie apocalypse upon me.  Stock up and every day items such as toilet paper, kleenex, etc.  Stock up on non-perishable foods too.  Ensuring that I had everything I would need resolved some stress I had going into surgery.  While I felt like I spent a ton of money, the good news is that you are really buying things that you will end up using so you really are not wasting money.  

15.  Your Doctor:  Make sure you are comfortable with your doctor.  This really goes without saying but it is of the utmost importance.  MACI, and its predecessors like ACI, are relatively new-ish procedures in the United States given that they did not receive FDA approval until a few years ago.  As such, there are not a ton of doctors that perform this surgery; i.e. not every orthopedic surgeon will perform this particular procedure.  Additionally, I believe you should personally feel comfortable with your doctor because the road to recovery is a long one and you want to be working with someone that you trust, can communicate with, who answers your questions and you generally like being around.  To be blunt - you're going to be physically compromised for some time and if your doctor is a jerk it is just going to make those visits all the more frustrating.  My doctor is Dr. David Guelich with Chicago Orthopaedics and Sports Medicine.  There are not enough wonderful things that I could say about him.  He is profoundly intelligent and talented and on an interpersonal level he always makes me feel comfortable.  Unlike some physicians, he embraces my questions and takes the time to make sure I can make informed decisions.  I never felt pressured to go forward with surgery and he has always tried his best to give me options.  And, while it may not make a difference to some, he is just a nice person to be around and does not exude the superiority (and narcissism) that other physicians do.