Friday, 30 September, I went in for an ACL reconstruction on my left knee, which I ruptured in training in Dec of 08. Since that time I have worked a programme of rehab, bringing the leg to a solid level of stability and consulted with an orthopaedic who advised to avoid surgery. While I could and have trained around the injury, ultimately there was too much restriction on my activity levels; no running, no competing, modified training. So I got a second opinion from a surgeon recommended to me by a friend who has a PCL injury. He was very clear that reconstruction was the only way to get back to my desired level of activity and avoid any further damage to the knee; happily MRI scans showed that my injury did not include any tear to the meniscus and we wanted to keep it that way. This plan came to fruition on Friday, and as my surgeon noted at our final consultation, ‘The op is only the first 20% of this, the rest is rehab’. As so many of us in the grappling community have knee issues, I’m hoping to chronicle my recovery for you, starting with the day of the op and the aftermath.
There are several approaches to an ACL reconstruction. A common approach in the UK NHS at this time, and the procedure used on my leg, is to use an arthoscope, aka a keyhole procedure, to create two small punctures at the front of the knee and a third incision on the front of the shin through which part of the hamstring ligament may be harvested. Through the two small entry holes, the diagnosis (made by MRI and manipulation of the structures) is confirmed, any cartilage tears are corrected and the ligament used as a graft to recreate the ACL. The procedure is around 1.5 hours long and is carried out under general anaesthetic.
The introduction of anaesthetic was a world-changing development in medicine and allows procedures to be undertaken with far less risk and discomfort to the patient, while allowing for more complicated procedures than were possible before its usage. Local anaesthetic, like Novocain at the dentist, numbs a specific area but the patient is conscious, general anaesthetic renders the patient unconscious. In the NHS there is a tendency to use a cocktail of opiates for general anaesthetic, but it is also possible to use a nerve block to minimise the use of opiates. In my case, I had a nerve block as my previous experience with general anaesthetic was extreme vomiting in the aftermath; my tolerance for drugs is pretty wimptastic, so they used the block to reduce the amount of opiates to just that required to keep me asleep during the procedure.
My Day in Hospital
I had an early admission and reported into the surgical admission lounge for 7AM. I could drink water up to 6AM, which I did and could eat up until 2AM; my last meal was at 10PM the night before; there are restrictions on food and water because of risks associated with general anaesthetic. I had some waiting in the morning before going in. I was third on the list and saw my surgeon, my anaesthetic nurse and several other nurses to confirm all the details over the course of the morning. All the NHS staff were professional and ‘on the ball’. I was nervous when I got on the gurney and the anaesthetic staff were very kind in distracting me while they did their work getting me off to sleep.
When I came round I was extremely drowsy and on some crazy perpetual motion air mattress with a repeating cycle of waves and massage. Happily I did not feel sick at all which was the reason for the block, and I had excellent pain relief as the block was still in effect with a numbness in my thigh to calf, but I was sleepy in the extreme and couldn’t bring myself round. I was desperate to be released that day so was working hard to come out of it, but even on the mad moving bed, I couldn’t really wake up.
I was moved onto my ward after about an hour and my physio soon attended me. My physio, Chris, asked me how I injured myself and I started the spiel about being a grappler that I use with civilians and low and behold this guy is a blue belt in BJJ! Sweet! This started to perk me up and we went through my leg sensitivity and my basic exercises for developing range of motion. We then tried standing with the aim of moving to walking. This is when things took rather a sour turn. I stood on the the crutches and gingerly moved my weight from one leg to the other, while doing so I started to feel faint. I sat down and told the phsyio that I was about to pass out. I fainted and had what appeared to be a small seizure. This has happened to me on occasion and I even had an EEG in my 20s to check for lesions on my brain, but it is related to low blood pressure and low blood sugar, both of which I have a tendency towards. I came to and was very disoriented for a moment and drenched in a heavy, gross sweat and my little episode meant I was in for the night.
Imagine, if you will, being doped to the eyeballs, on a perpetually moving bed so that each time you drift off you are awakened, oxygen is up your nose and you’re being poked and prodded by staff as they check your stats throughout the night. Not entirely pleasant. What was most troubling was the ‘bathroom issue’. I knew I needed to eat and drink to get my blood pressure up and to clear the drugs out of my system. Unhappily, I couldn’t walk to toilet so it had to be a bed pan. I just couldn’t. A new rotation of staff came on and we tried a wheeled commode but that too led to a fainting episode and the instruction that I was not to put my legs on the floor as my blood pressure couldn’t hack it. Meanwhile, I’m forcing down bits of Jamaican ginger cake and water at regular intervals, sucking down 2 litres of liquid. Nature will take its course and after being ‘threatened’ by the thought of a catheter, I finally managed a bed pan pee. Oh man, that is humbling, doing that and seeing it as an achievement. Much to my nurses’ chagrin, troopers that they are, I had 3 bed pans that night; no sleep and just drinking the water and eating the cake little by little, only way I was going to get better. By 5 I was getting an hour of sleep at a time and once the ward opened for biz at 7 I was much improved. The new sisters came on rotation and I was again humbled by the achievement of being able to use a mobile commode instead of the bed pan. Getting stronger! I finally got cleared for having my feet below me and I got wheeled to a proper loo. Thank the Graces! Having basic bodily functions be such a ruling and difficult thing to deal with is a truly humbling experience that has really a made me reflect on ageing, health, disability and the importance of living with gratitude. I’ve got it so dang good and easy!
Hospital Discharge and Day 1 of Recovery
When you’ve been so ill that you can’t imagine being on the other side and then start to see clearly and feel yourself again, that’s a great feeling that readers will recognise in their own experience. Once my blood pressure and blood sugar were strong enough to let me be upright I got rapidly better, ate more and got to work with my physio. We did my walk and stair work and I was cleared for discharge and just had to wait on my meds before being set free into the world at 15:00 on Saturday. What a welcome sight my home was!
Since seeing the physio and getting cleared for out patient status, I’ve been pursing my basic exercises on a ‘little but often’ basis. These exercises are for regaining range of motion and activating the hamstrings, quads and glutes. They include 3-4 reps of each of the following:
- Point, flex and rotate foot to get blood pumping back up towards the body
- Attempt to straighten leg by pushing back of knee down, hold for 3 seconds
- Attempt to bend leg up, hold for 3 seconds
- Squeeze glutes and hold for 3 seconds
I also need to keep walking in short but frequent bursts to keep mobilised and activate the muscles; post op ACL is fully weight bearing and it is important to keep the muscles and blood pumping as much as possible to rebuild the leg and to fight (inevitable) atrophy. I had better than average extension and bending of the knee from the moment I got out of theatre, which is surely down to all the physio I did before going in. At the moment I am at 90 degrees, which is at max considering the compression bandage and dressings and I am getting closer to straight already. I have also started to walk free of crutches; one week, eff dat, try 24 hours. This is very slow walking, on the flat and little infrequent trips. If it feels okay I am encouraged to fully weight bear and my leg is absolutely stable enough for the walking I’ve been doing. Psyched with my progress and I’m gonna do this time, easy. Well, I may be singing a different tune next week…
Thanks for all the well wishes on Facebook and G+, I really appreciate hearing from you and wish speedy recovery to those who are also on this journey.
Want to know more? Check out week 1 of ACL post-op recovery