Day 6

First day of physical therapy. I was only able to flex my knee to 38 degrees at the start of the session. By the end I could flex it to 45.

Things are generally fine. Hooray. My mom is going back home to Idaho tomorrow. Awww. It's been pretty great to have her here even though she beat me at Scrabble 3 games to 2. I won the last game with 290 points to her 258.

My mom and I have been playing Scrabble for as long as I can remember. But probably since 6th grade. It took me a long time to become as good a player as she is. So for a lot of years I was playing catch up -- increasing my vocabulary and developing strategy skills. Then for a few years we were evenly matched. And then she had a series of "mini strokes." That slowed her down a lot at first but she's built back up and now we're at par again.

Life is certainly an interesting journey.


OH, and here's a pic of the hideous bruise that's developed on my leg. It's not pretty.

CPM

I'm using this thing called a continuous passive motion (CPM) machine. It very slowly flexes and extends my leg. The starting setting is 30 degrees. I'm supposed to increase the degree of flexion a little each day. I'm at 40 degrees now. It's uncomfortable when I increase the setting.

The grey thing over my knee is the cuff that is connected to a cooler full of ice water. The cooler is called The Iceman (see above). The Iceman has a pump in it (like an aquarium) that continually circulates cold water around my knee.

If you look closely at the first photo you can see two white tubes on my leg. Those are the in and out tubes that connect to the hose to the cooler. I think the tubes look like the milking machine attachments at dairy farms. See below.

Day 3

I think I've pulled a muscle in my groin as a direct result of dragging my leaden leg around like dead weight. For some reason the painkillers don't really help that injury. Odd.

In our apartment we have an upstairs & a downstairs. Kitchen is up and our only bath is down. The bedrooms are down as well. I've been going up and down stairs each day at least two times, but today I will limit that. I think that's what caused the groin muscle pain.

Hopefully I'll be able to go out this weekend to take my mom to someplace she's never been. She must be getting bored here in our apartment. The cherry trees are in bloom at the botanical garden. I'm going to call them to see if they have any wheelchairs. Ideally, I'd take her up to Harlem for some soul food.

Day 2

This is my second day of recovery from ACL reconstruction surgery. I slept so much better last. Thank God. It's been almost 7 hours from my last painkiller. That's much better than most of yesterday when I would start counting down the minutes to my next dose.

At this moment I am laying in bed with a ice-water cuff circulating cold water around my knee and a CPM (continuous passive motion) flexing and straightening my leg. The motion is supposed to feel good. It does not.

My mom is here and taking good care of me and Brett. She's been my nurse, waiting on me hand and foot (knee and foot?). She's cooked dinner two nights in a row. And to keep herself busy she's been out exploring the neighborhood. Each time she goes out she brings me a little treat. Cute!

Yesterday I received a beautiful edible bouquet of flowers made out of fruit. Tres delicious. And fruit is exactly what I need at a time like this. Thanks, Ellen!

Surgery Report

I did it and it wasn't so bad. I watched most of the surgery on a monitor but forgot some of it because of the IV sedation.

The first picture was taken in the waiting room where I spoke with my doctor and the aneshesiologist. The second is about an hour after my surgery. I was laying there waiting for the spinal block to wear off. And the last picture is me on my way home!























The first night was rough. Got no sleep due to pain. Then in the morning I overwhelmed with nausea because I had taken a double dosage of my painkiller.

Tomorrow

OK, this is it. I have to be at the hospital at 8:45 am tomorrow. I wish I could say that I'm ready. I guess I am. What's left to do? I took my toenail polish off (I'm not supposed to wear any make-up or nail plish). I did my rehab exercises one last time for good luck. I made Brett a nice hot meal. Now I'm watching episode 5, season 4, of Six Feet Under with my mom.

Speaking of which, I never realized how much SEX is in this series until I watched an episode with my mom. Ugh.

Getting fitted for my post-surgical brace

It's a beast!

(The brace, not the guy.)

It was delivered right to my house along with a CPM (continuous passive motion) machine.

I'll be wearing the brace locked in full-extension for a couple of weeks (or until I see my surgeon after the surgery.)

Apparently you have to force your knee straight or scar tissue could develop and keep you from ever straightening your leg again!

I'm probably spreading a lot of mis-information here. Don't take my word on anything I say. It's all hearsay and filtered through sheer terror.

Dr. A's Incompetent Staff and the MRIs

So, one more thing about Dr. A's abominable staff. Dr. A ordered an MRI. When I went to the radiologists to get the MRI, I filled out a form requesting that they send Dr. B the films as well so each doctor would have the same information.

Dr. B's office only got a report of the MRI reading and not the films. Dr B's staff called me one day a few weeks ago to see if I could get the films. HA! "Not too likely!" I say and tell them about the debacle one post below about just trying to confirm an appointment. Dr. B's staff member says, "do you mind if I try to conference them in?" I agree.

Dr. A's assistant Olivia picks up and says she's glad to hear from me so we can schedule the follow-up appointment. I say, "no need." I'm not coming back and I want you to send my MRI films to Dr. B's office. Olivia can't understand the problem. I explain the frustration I have with them. She says, "But I was out of the office." Lady, I don't give a damn. I'm dealing with a serious (though common, I know) surgery. I'm frightened, and I don't want to deal with two offices for my doctor that cannot communicate. She says she has to talk to Dr. A and puts me on hold. For five minutes. I eventually just hung up.

Today Dr B's office called to make sure I bring the bloody MRIs with me on the day of surgery! Oh my G-d! I say, nope. I'm not bringing them. I don't have them and am pretty sure it will be impossible to get them. This staff member is not aware of the travesty that is Dr A's office. I gave her the rundown. She said she'd try calling Dr A's office for me.

Fifteen minutes later Dr B's office calls back. She said NJ answered Dr A's phone. The Manhattan office is closed and not due back until Thursday!

Freaking unbelievable. So now, if Dr B really wants the films I have to pay the radiologists another $100 to get a copy sent to Dr B's office.

Crappy In-Network Insurance Schemes

We have Aetna insurance. They will cover 90% of my surgery if I see an in-network surgeon or 70% if I go to an out-of-network doctor.

I got a recommendation from my primary care physician for an in-network doctor. Then I got a recommendation from a friend who knows a doctor that's performed surgery on a friend of my friends' and my friend's neighbor. (The doctor also saw my friend but did not prescribe surgery.) This doctor is not in my network. Let's call in-network doctor "Doctor A" and out-of-network doctor "Doctor B."

I made appointments to see each doctor, A and B. I saw B first. I felt like Dr. B. was very pragmatic, obviously knew what he was doing, and probably extremely competent based on reputation (both first-hand and from the cover of a magazine he has framed with this headline "Best Doctors in NY").

Dr. A. was 45 minutes late to see me. That put me off. And his exam room was cluttered -- furniture from the 1920s was sloppily filled with supplies from the 80s. This also put me off. It's all I have to go on at this point.

But Dr. A turns up eventually and is very kind and I liked the way he manipulated my lower leg and knee. He has a very reassuring touch. He asked me if I was in pain (N.B. Dr. B did not). And he took my complaint about calf pain so seriously that he arranged for me to see a surgeon right away to get an ultrasound. He wanted to rule out a possible blood clot. This all made me really like Dr. A.

Then I had to decide between the two. Dr. A with his crappy office but gentle bedside manner and Dr. B with his nice office and arms-length patient-doctor relationship.

Cut to the next week when I will be having a follow up with each doctor. I needed to get in touch with Dr. A's office to find out when my appointment was. For some reason, when I was there the first time they hadn't written it down on an appointment card. I actually realized that then and should have spoke up.

Here's what happened when I tried to get in touch with Dr. A's office (and for context, Dr A has an office in Manhattan and an office in New Jersey. 212 is the area code for Manhattan.).

Thursday 3/29/07

I called Dr A's 212 number in Manhattan. NJ picks up. But it takes us both a minute to realize I'm calling from NY and they are in NJ. I explain why I'm calling and this woman tells me that she cannot see the NY appointments. She told me to call the NY office back on Monday.

Monday 4/2/07

Monday morning. I called the 212 number. NJ office picks up. Woman tells me (again) that they can't see the appts for NY. I said I knew that, and reminded her that they told me to call back on Monday. She said they don't know Olivia's schedule and to try after 1:00.

3:00 pm 4/2/07

Called 212 number again. NJ picks up. I state why I'm calling. She says she remembers talking to me in the morning. I said, "So you remember telling me to call back after 1:00." Receptionist says, "Well OBVIOUSLY she's not IN, MA'AM."

Tuesday 2:15 pm 4/3/07

Answering service picks up and says they cannot take non-emergency calls. Said to call back after 2:30.

Tuesday 2:55 pm

Answering service picked up again. Said Olivia should be there from 1:00 to 5:00 but is not picking up.

Questions for Dr A:

How much money is one surgery worth to your practice?

Why do you have an answering service that doesn't take messages?

Why won't the NJ office take a message for Olivia?

Does the your staff realize that patients are customers? That as customers they have a choice in providers? The staff must feel pretty comfortable if they can just out of hand cause you to lose out on the revenue of this surgery and the potential revenue from recommendations.

Luckily, we can afford to pay the 29% premium so I never have to deal with the people at Dr A's office!

Pre-Surgery Testing

Went in to the Hospital for Joint Disease (HJD) today for pre-surgery bloodwork. A nurse took my blood pressure and drew two tubes of blood. I spoke with two different doctors. The second was an anesthesiologist. She asked me if I preferred to have general anesthesia or a spinal block. I asked her questions she says everyone asks.



"If I opt for the general, is there any chance I will be awake and able to feel the surgery but unable to move or speak?" (She said no. But come on -- don't tell me it never happens. I've read the headlines of magazines like Redbook, Ladies Home Journal and Reader's Digest!)

"Is the spinal block the same as what women in labor have?" (Yes. Apparently the needle for women giving birth is bigger for some reason.)

What about the femoral block? Good question. That's just for post-surgery pain. It's not clear to me if they administer that after the surgery but that's what it sounded like.

At the end I had a funny discussion about the "no eating or drinking after midnight the night before surgery." The nurse added "not even gum." Good thing she told me that because I chew a lot of gum! I told her as much and she said that she's addicted to gum and showed me the piece in her mouth (too much information). We ended up comparing our favorite gum flavors! I gave her a piece of Orbitz mint mojito and she gave me some of her Trident tropical twist. Funny.

So, that's it. Next I'll get the CPM (continuous passive motion) machine and surgical brace fitted and then surgery on Tuesday.

I'm also going to talk to my physical therapist about getting her to work out with me in the gym or I have to see someone else. She only does massage and accupressure work. She gives me exercises to do at home but I want to do stuff at the gym with someone. I'm afraid that if it is just up to me that I won't do enough and that it will affect my long-term outcome.

Knee Surgery Countdown: 1 Week from Tomorrow

This is a picture of a tree knocked down in Rutland, VT by the storm of 2007.

I'm stranded in Killington, back at the scene of the crime. Just a little over a month ago I couldn't walk without crutches, couldn't bend my knee 90 degrees or extend it to a full 180 degrees. But apparently that is nothing compared to what Kate Gosselin went through when she had her tummy tuck!!! (I'm watching Surviving Sextuplets and Twins on TLC.) Poor, poor Kate! What an inspiration.

I think I'm supposed to have pre-surgery bloodwork tomorrow but will have to reschedule. As I wrote above, I'm trapped in VT. The big April snowstorm that hit the northeast made driving conditions too perilous to drive the 5 hours back to NY today. My plan is to drive back tomorrow.

ACL Surgery Details

Here's what I know about my surgery. The surgery is out-patient. I will not be staying overnight. I'll be given a spinal block which means I will be awake during my surgery and able to watch it on a monitor. Dr. Sherman says it won't feel like I'm watching my own leg be operated on. I'm pretty sure I will watch it but reserve the right to wimp out at a moment's notice.

I've chosen to use "donor tissue" aka allograft. From what I've read online the graft is bone-ligament-bone from a cadaver. It won't be someone's actual ACL. It will be tendon or ligament.

If you're younger than 40, the doc said they recommend using your own tissue. Over 40? Then they recommend an allograft because donors are typically younger than you -- you end up getting a used, but younger part. I'm not 40 but am close enough. And, besides, there is less pain if you use donor tissue because you aren't recovering from surgery and the spot where they take tendon from (knee or hamstring).

Apparently there is a risk of receiving a virus with the donor tissue. There was a story on NPR recently about this issue. I didn't hear it first hand but I'm supposed to make sure that the tissue bank my doctor uses guarantees that they provide sterilized tissues. When I spoke with the doc about this he said he's never had trouble with donor tissue except for one patient last year. The tissue bank had a scare about tissue from one donor. It just so happened my doctor used tissue from that particular donor in one of his patients. Things turned out fine for this patient and the doc assured me that that tissue bank destroyed any tissue that may have been circumspect.

So I guess the risk of the viral transmission is real. The doc said that the tissue is sterilized (via radiation) but only kills bacteria. In order to destroy viruses, the requisite radiation level would also destroy the tissue.

If I get really freaked out and change my mind about using donor tissue, I can decide at the last second to use my own tissue (patellar tendon or hamstring). As the doc said, I'll be bringing my own tissue with me if I do change my mind.

Brett will be taking the day off and will take me home from the hospital. My mom will be taking care of me for a week. A week might seem a little long, but I've never had surgery and am feeling like a big wimp. I want my mama!

Snowshoe Easter Egg Hunting

We're in Killington. I dropped Brett off at Bear and then took Moby snowshoeing. I took him to a public area near the Killington Town Clerk's office. Moby happily rooted around and found several candy filled plastic eggs leftover from the Easter egg hunt. And since he was wearing his backpack we filled it with colorful eggs!

We were out there for about 40 minutes. I took a little break at the swing set. Apparently Moby has never seen a swing set. He could not get it. He'd coming charging after me when I swung back and then I'd almost hit him coming forward. It was funny.

My knee is feeling good today. I hope I don't get as sore as I did after last week's snowshoeing foray. I came in and stretched for 30 minutes. The therapist said if I had done this last week I wouldn't have gotten so stiff.

There is still a lot of snow out here, and more on the way. We're expecting a Nor'easter.

12 Days of Anxiety

Yesterday was 1 month since my skiing accident. Here's a pic of me taken at Penn Station in NY 1 week after the accident.









Twelve days until ACL reconstruction surgery. In some ways, I feel like I'm getting ready to go away on a big trip. I have all this errata to take care of before I'm laid up. It creates a little excitement until I remember that I'm just getting ready to combat pain, atrophy and cabin fever with painkillers, DVDs and physical therapy.

On the upside of things, I can walk around without crutches or brace. I'm taking the stairs faster than ever. And I don't need to take painkillers at night to sleep anymore. It is nice to see improvements. In fact, I'm already sort of forgetting how it felt to be practically immobile. (Guess I'll get reintroduced to that shortly.)

I've been a little slow getting on with the PT. I'm supposed to get on an eliptical machine or stationary bike every day for 20 minutes. I haven't gotten around to doing that because I'd have to join a gym. I do do the stretches and some strength exercises at home. It's giving me a way to catch up on Six Feet Under, Season 2.