The Good, the Bad, and the Ugly

(The end of this post has pictures of my stitches. If stitches gross you out please don't scroll all the way down!)

The Good:

I thought I'd have more time sitting on the couch than I knew what to do with, but it's been such a busy few days. On Thursday, John, Kel, and my nephews came over, and my parents made steak, asparagus, salad and baked potatoes for dinner. I was provided with hours of entertainment.

John sang the ABCs to me multiple times. 

I got to hold James! I swear he smiled two seconds after this, and I'm not trying to eat him.

Kevin and John played a game, and I cheered them on. Kevin threw the ball up to the balcony, and John threw it back down. He thought it was hilarious when Kevin would miss or if the ball got stuck between the rungs.

Kevin also juggled for me, but I can't get the video on here at the moment. I got to just hang out with everyone and relax for the rest of the night. The pain was pretty bad by the time time I went to bed though. It's been the worst at night so far.

Friday evening, my Aunt Barb, Uncle Dan, Grace (my cousin), Luke (her husband), and LJ (their two year old son) came in on their way  back home to Chautauqua Lake, NY from Nashville, and my parents had everyone over for dinner. We had a full house. 

After dinner, I was so antsy to get out of the house and was feeling pretty good, so Kevin and I went to Menchie's with Nate and Kylie. Getting in the car was quite a hassle. I sat in Kevin's front seat with the seat reclined. Not super comfortable with the brace.

I also got an incredibly sweet get well card from Grandma Baker and Zeek,

and enjoyed the beautiful spring flowers.

Saturday, my baby sister had her senior prom! I hobbled around on crutches to help take pictures of her and her boyfriend Joey.

Saturday evening, we went to my friend Jessica's graduation party. She just completed her Special Education degree from Ohio University. Congratulations, Jessica! This time, I sat in the back seat which was a bit easier. I managed to play corn hole standing on one leg, and we all played Cards Against Humanity. It was an awesome party, and it was wonderful being out of the house. 

The Bad (and also a little TMI):

I am frustrated with how long it takes to do everything since I am used to moving around so quickly. Getting up to pee is a 10 minute process, and I have a tiny bladder so this happens quite often. I am still trying to figure out how to go to the bathroom with a full leg brace on, because the million ways I've tried so far are incredibly uncomfortable. 

Showering is quite an ordeal, and so far I've only sponge bathed because of my stitches. Kevin installed a long-handled shower head in our downstairs bathroom, and my mom tried to wash my hair while I sat next to the tub. The chair didn't quite reach to the tub, and the floor was soaked within about 10 seconds of her trying to wash my hair. 

She wiped up the floor so I wouldn't slip, and I stood with my brace on hunched over the tub washing my own hair. Then I sat in a chair and washed myself with a soapy washcloth. What normally takes 15 minutes turned into an hour long process, and was was completely worn out by the end of it. I felt a million times better though since I had felt so disgusting since the surgery. This is definitely giving me more perspective to what my patients go through. 

The CPM (continuous passive motion) machine is becoming more painful the more degrees of ROM (range of motion) that I have to add. It feel like my skin is stretching way too far, and that the stitches are going to rip. I dread it now. 

I am in a battle between wanting the relief of the pain meds, and not wanting the side effects. I spoke too soon when I said I wasn't getting any side effects! I have been incredibly nauseous the past few days, and I'm not sure if it's the meds or a bug that went through my family. Half of of my family has had a 48 hour stomach bug this week, so it may be that. 

Here comes the TMI part...apparently pain meds are notorious for causing constipation. Combine that with not being nearly as active as normal and finding it difficult to even sit on a toilet because of a full leg brace...and you know where this is going. It's causing quite the problem, so I'm trying to only take the pain meds when I absolutely need them. So far, that has been every time I use that awful leg bending machine. These have been staples in my diet the past few days:

Coffee, Metamucil, Colace, and hot water. Plus tons of fruits and veggies.

I've also been taking extra strength probiotics because my body doesn't handle antibiotics well, and they pumped tons of antibiotics in my IV during surgery to prevent infection. I'm trying to prevent any additional problems the antibiotics may cause. 

Overall, I am lucky and the recovery process is going incredibly well, but there are definitely frustrating moments. 

The Ugly:

Here

.

..

...

..

.

come

.

..

...

..

.

the

.

..

...

..

.

.

stitches! 

You were warned. They actually really aren't bad at all, but I know some people are easily grossed out. I unwrapped the bulky bandages for the first time last night, and my knee looked about how I expected it to. The doctor signed my leg before surgery to be sure of which leg he was operating on. 

Lastly, I have my follow-up appointment tomorrow morning. I am not looking forward to getting the stitches out. I'm not sure if that happens tomorrow, or later. Hopefully everything looks good though! 

Post-Op Day 1 (Thursday 5/2)

I have always been pretty empathetic, but having this surgery has given me a completely new perspective for all of my patients that I saw during fieldwork that had knee surgeries. I find it ironic that they were the patients I was always scared to move in and out of bed because of how much pain they seemed to be in, and how any wrong bend could cause more pain. My fears while helping them transfer were correct; any wrong movement is very painful!

It is also giving me a lot of insight for how to treat my future patients who are in pain, who have had surgery, and who have big changes in their current plans or little detours towards their long-term goals and dreams. I am also quickly learning how much of an impact even small limitations can have on us participating in meaningful occupations (there's the OT in me), and how lucky I am to have such a great support system. 

Last night, I didn't get much sleep because the painkillers really don't seem to be doing anything to reduce pain or to knock me out. I am also not having any side effects from them, which is fantastic, because usually I get every side effect known to mankind. My body tends to be super sensitive with just about everything. Even after not sleeping well, I woke up feeling pretty good! I am putting almost all of my weight on my left leg already (with the brace on), and using the crutches just a little. 

It is definitely painful. For most of the beginning of the day, I'd say it's been a 7-8/10 on a pain scale. I think more of the pain is on the outside from the tightly wrapped bandage rubbing against the stitches than in the actual femur. I'm not sure how many incisions there are yet. I get to take the bandage off on Saturday. I've been trying to balance resting and working through the pain to do all of the exercises I'm supposed to be doing. I thought I'd be bored, but the first day flew by with the amount of things I'm supposed to do each day to help the recovery process!

Fancy-schmancy CPM machine that bends/straightens my knee.

What I am Doing to Take Care of My Knee (what the doctors, nurses, and physical therapist said to do):

1. Taking all medications as needed
2. Icing to reduce swelling, on 20 minutes and off  60 minutes all day
3. Completing physical therapy exercises (I have to do some of them 200 TIMES per DAY! This is why I went into OT, not PT. We assign sane amounts of home exercises. Although I'm sure they will be beneficial in the long run.)
4. Using the CPM (continuous passive motion) machine 3x/day, 2 hours each time. This machine flexes and extends my knee repeatedly to ensure that I maintain my ROM (range of motion). I started at 30 degrees today, and I'm supposed to add 4-6 degrees per day.
5. I'm drinking TONS of water, trying to eat pretty healthily, and drinking lots of green tea. I just feel like I should be treating my body the best that I can so that it can heal as quickly as possible.

I am so grateful for Kevin, my family, and my friends. My parents have been cooking for me and picking up my medications, Nathan has been helping to set up the CPM machine (that thing is heavy!), Kevin is keeping me company and providing tons of support, Kylie helps get my ice packs, Caitlyn gives me tips and tricks on wearing the bulky brace since she was in a similar one all of last summer, and my nephews provide endless entertainment. Everyone at my house has helped me adjust the excessive amount of pillows that I have been using countless times to try to make me comfortable, and my extended family and friends have been checking up on me and calling daily. Kevin's parents sent awesome balloons with a wonderful note. They came when my knee felt particularly terrible, and they look so cheerful! The balloons instantly made me feel better. 

I am incredibly thankful for all of the support from everyone around me. Day 1 wasn't so bad thanks to all of you, and I hear the first 48 hours are the worst!

 Get-well balloons from the Andersons. Thank you!!

Day of Surgery

My surgery was scheduled for noon at OSU East, and we were supposed to get there two hours early for check in. Kevin and I got there at 10, and my parents met us there shortly after. We figured we might need two cars depending on how I'd have to sit on the way home. We checked in, and they gave my parents and Kevin my "tracking number" (and a free coffee!). They have a big TV screen in the waiting area and in the cafeteria with each patient's number, and it changes from registration to pre-op to surgery, post-op, recovery, and finally discharged. 

  OSU East (Picture taken from OSU's website)

The longer we sat there, the more nervous I became. Around 11:30am, the receptionist came over and asked if we had been seen by the nurse yet. We hadn't, so he went to figure out what was going on. All of the pre-op beds were full, so I just had to wait in waiting room until one opened up. That was actually fine with me because I had more time with Kevin and my parents! Around 12:15pm, the nurse finally came to get me. My parents and Kevin couldn't come with me at this point, so we said our goodbyes and then they went to get lunch and enjoy the beautiful weather in the courtyard while they waited.

I went to pre-op and did a million things to get me ready for surgery, one of which was the seemingly easy task of peeing in a cup. I had already gone to the bathroom about ten times since we arrived at the hospital due to nerves and I didn't think I had anything left, but when the nurse said she'd flush my bladder if I wasn't able to go in the cup I somehow managed to go a little because that sounded horrific. 

ID band, allergies, and being a fall risk. I also got a party hat (as the nurses call it), bright red socks, and a lovely hospital gown.

The nurses were all incredibly friendly, the anesthesiologist was awesome (he also confirmed that redheads actually do need more anesthesia), and the PA was great. They were very good at keeping me calm and answering any questions I had. The surgeon came in and initialed my knee to make sure he'd operate on the correct one, and I eventually left for the operating room a little after 2pm. I was trying to thank the nurses for being so kind but couldn't get the words out as I quickly dozed off.  I (thankfully) don't remember anything after that until waking up in the recovery room. 

Kevin and my parents came in and saw me around 4:30pm. I was totally coherent and awake, which was much different from my previous experiences with anesthesia. I didn't feel too nauseous either, which was awesome. I am telling you, the anesthesiologist was fantastic! He said they use these monitors on your forehead to measure your brainwaves during surgery to see how asleep you are in order to adjust the amount of anesthesia they give you, and he gave me a few extra anti-nausea medications.

I was in quite a bit of pain and had a massive brace on, but I was SO excited to see Kevin and my parents and to be out of surgery. I also found out some AWESOME news right after surgery; The part that they operated on was further back in my femur than they expected, and it ended up being in a non-weight bearing part of my bone. This means I can weight-bear as tolerated and that I only need to use crutches for a day to a week instead of six weeks!! I still need to wear the massive brace for six weeks, but I'll gladly take that over non-weight bearing for six weeks.

They ended up using a bone void plug made out of cadaver bone instead of synthetic material. He said that they are ground up and made into a matrix that my healthy bone will mesh with. Eventually the cadaver bone will be totally dissolved and my healthy bone will completely replace it. Here is a picture the surgeon drew and showed my parents and Kevin of what they did in surgery:

The bottom picture is removing all the dead bone. The top is removing a little bit of the healthy bone in order for it to mesh with the cadaver bone and ensure a snug fit while putting the bone plug in.

Once we got back home, I got all settled in the reclining chair on one couch, and Kevin settled into the other recliner. He was more exhausted than me and passed out right away. It was quite a long day of waiting (10am-4:30pm, and we finally got home around 6:30pm. Thanks for coming, Kevin!). Hayes and Erin came to visit, too! It was nice to have some friends to talk to to distract me from focusing on my knee. It hurt pretty badly once the meds from the hospital wore off. I ended up staying up until about 3am trying to get comfortable and waiting for the pain to ease up a little since the painkillers that were prescribed weren't really kicking in.  

Nap time.

Giant ice pack with the brace opened up.

My super tan (iodine) leg!

Luckily, we have a guest bedroom with a bathroom downstairs. My mom stayed downstairs with me for the night to make sure I could make it around okay. She is awesome! Kevin and everyone in my family have been incredibly helpful and supportive throughout this whole process, and I am so thankful for all of them.

Osteochondritis Dissecans (OCD of the Knee)

"Osteochondritis dissecans (OCD) is complete or incomplete separation of a portion of joint cartilage and underlying bone, usually involving the knee, associated with epiphyseal aseptic necrosis" which basically means that part (usually the end) of a bone dies a little bit. They think that it's caused from lack of blood supply or repetitive stress, and that there may be a genetic component.

In my case, the end of my femur (thigh bone) died a bit, and depending on the stage some pieces have either broken off or they're smashed up just hanging in there with the cartilage. The doctors aren't sure if the cartilage is in tact or damaged either. They can't really tell until they go in and look, but they think mine is stage 3. Here are the stages:

Stage I—Thickening of articular cartilage and low signal changes (stable)

Stage II—Articular cartilage breached, low-signal rim behind fragment indicating fibrous attachment (stable)

Stage III—Articular cartilage breached, high-signal changes behind fragment and underlying subchondral bone (unstable)

Stage IV—Loose body (unstable) (from http://www.aafp.org/afp/2000/0101/p151.html)

Mine may have been caused from doing gymnastics for 8 years, track, cheerleading, or marching band since they are all high impact. My dad and brother also had it. Back when my dad had it, they casted his legs. For my brother, they drilled into his bone to restore the blood flow to the dead bone which is usually successful for teenagers. The doctors say mine probably started in late elementary school or middle school since that's when I remember my knees beginning to hurt. 

An MRI of my left knee from the side. The arrow is pointing to the crack in the bone, and the fluid building up around it.

MRI of my left leg. The top two parts are the bottom of my femur, and the bottom part is my tibia. This if the view of if you were to "slice the leg like a loaf of bread" in the middle/top part of me knee according to the doctor. The circled part is the damaged area. 

X-rays of both knees bent, from behind. This is my left knee compared to my right. the darker area on the left is the damaged part when compared to the healthier right knee. 

There were many different surgery options, some involving some pretty cool science. One doctor wanted to clear out the dead bone on my femur (thigh bone) then take part of my tibia (shin bone) and screw it into the femur. If the cartilage is damaged, he was going to take some of my cells and send them to a lab in Boston to grow more of my own cartilage, then put my new cartilage back in my knee. 

The other doctor (the one I'm going with) wants to clear out the dead bone, then replace it with a synthetic "plug" that will fit into the space he clears out. My healthy bone and cartilage around it will eventually take over the degradable plug and kind of eat it up, replacing it with healthy bone and cartilage. I can't find much online about it because I'm not sure of the exact name of the plug. I'm going with this procedure because they should only have to open my knee 1 time instead of what could be potentially 3 times. They also won't have to take part of my tibia out, which I think would hurt as much as the femur part. 

So...that's the plan for what's happening during surgery tomorrow. I'm trying to just pray and relax, but I'm still quite a bit nervous. Hopefully it all goes well.  

For more info about osteochondritis dissecans:

This website has a quick description of it (and the definition from above): http://www.medicalnewstoday.com/articles/166764.php  

This one is from the Mayo Clinic and is more detailed: 
http://www.mayoclinic.com/health/osteochondritis-dissecans/DS00741

And this one has current research about osteochondritis dissecans:
http://www.osteochondritisdissecans.org/

A New Job and Bad Knees and Surgery, Oh My!

It's been a while since I've posted on my old blog (over 2 years!), so I decided to make a new one. Mostly because I don't use the email address associated with the old one, and I can't figure out a way to completely switch it to my new email address. Anyway...

SO much has happened since then. I became an aunt (twice!). I met a prince charming :) I traveled to Europe, Los Angeles, Chicago, Siesta Key, Harrisburg, Montgomery, and went on a cruise. We unfortunately had to put our oldest dog, Teddy down, and we have now added a turtle to all of our pets. There have been many weddings, sadly a few funerals, and some friends and family now have new babies in their families. I finished my grad school classes, survived 6 months of fieldwork, graduated and earned my Master's of Occupational Therapy, studied like crazy and passed my NBCOT exam to become board-certified, became a licensed occupational therapist in Ohio, and got a job! Or almost got a job. I lost the job the day after accepting it due to a random knee injury. Because of my knee, I'll be having quite a bit of free time, so I figured I'd start writing a little bit again in a new blog.

Everyone who came to my hooding ceremony a day before graduation

My sweet little nephews, John (23 months) and James (2 months) 

Kevin and I on the cruise 

After all of the stress and chaos of grad school and boards, life started to finally calm down. I applied for a bunch of jobs, and one was my dream job; a position in pediatric acute care at the exact hospital I want to work at. I was initially told they typically like a bit more experience for that position, so I wasn't incredibly hopeful about it, but there was still a little bit of my heart going "You never know! Maybe they will call!" A few days later I received that call to set up an interview!! I was a nervous wreck for the interview because it meant so much to me.

I interviewed on a Tuesday (4/9), and thought it went pretty well, but wasn't quite sure. I absolutely loved all of the OTs and manager that I met, and the tour of the hospital was phenomenal. I felt like I really fit in there, and could see myself enjoying working there so much. Two days before the interview, I felt some pain in my knee while I was getting into bed, and I thought it was weird but not too crazy since both of my knees have always hurt for as long as I can remember. Two days after the interview (4/11) , I was sitting on the ground playing with my nephews. I went to stand up and could barely put any weight on my left leg because it hurt so terribly. Here is how the next week went:

Friday 4/12: Doctor Appointment and X-rays. Dr. #1 says it's either osteochondritis dissecans or a torn meniscus and orders an MRI. He tells me to brace it and walk on it.
Monday 4/15: MRI. I got to sit up in a dentist-like chair and just stick my leg in a little tube, which everyone told me I was lucky about since I didn't have to have my head in the machine. My butt went completely numb from sitting for so long, causing me to wiggle around a little, but luckily it didn't compromise the MRI.
Tuesday 4/16: Appointment with Doctor #1. Dr. #1 says it's definitely osteochondritis dissecans, that he's 50/50 on if I should have surgery, and that he wouldn't get surgery if he were me. He also talked about a patient who knits her own socks for about 10 minutes of my appointment, then (thankfully) referred me to a doctor that specializes in cartilage repair because he said he just had no idea what to do for me. My mom came with me to this appointment and she referes to him as the "nutty professor" now.
Wednesday 4/17: Got the Job! The hospital I applied to offered me the position, and I was THRILLED, but very scared about the whole knee thing. I asked them if I could think about it, hoping that I wouldn't need knee surgery since I had another doctor appointment coming up. I really wanted to just jump up and down screaming with excitement and immediately accept it though.
Thursday 4/18: Accepted the Job! After calling a few professional mentors/friends that I trust and asking their opinion on if I should accept it after hurting my knee, everyone said go for it since I wasn't sure what was going to happen with the knee anyway and since I really wanted the position. I called and accepted it, and was beyond excited but still so nervous about the knee.
Friday 4/19: Appointment with Doctor #2: The more specialized doctor said I definitely need surgery, and explained how he'd do it. Kevin came with me for a second set of ears, and gave his stamp of approval. Kevin knows exactly what kinds of questions to ask, and always makes sure he understands absolutely everything clearly, so it was comforting having him there to make sure we really understood what was going on.This doctor was definitely more knowledgable than the first, and explained everything better.

After finding out that I would definitely need surgery, I called the HR person and my future manager to explain what had happened. I had accepted the job because I initially thought I would be able to wear a brace and work for a while. I could have tried to work a few weeks, secured the job, then scheduled the surgery, but it was getting more and more painful to walk and I just couldn't do that knowing they urgently needed someone to start as soon as possible and that I'd immediately need quite a bit of time off. I am honestly not even sure if I would have made it through orientation because I'm limping so much, and I definitely wouldn't have been able to be on my feet all day in such a fast-paced setting. As much as it stinks that I don't have the job now, I'm glad I was honest with them. The HR person said she'd try to work with me when I'm all recovered, so hopefully another opportunity will come up!

Yesterday, I went to an appointment with Doctor #3 that I originally didn't think I'd be able to go to, because yesterday was supposed to be my first day of work. Doctor #3 did knee surgery on my younger brother when he was in high school 6-7 years ago, and my parents loved him and really wanted me to see what he had to say. Doctor #3 is incredibly nice, and actually listened. I am very picky with doctors, and it's tough to find doctors who really listen to what you have to say. My dad came with me to this appointment, and really likes him. I've been concerned about my right knee as well since they've both always hurt the same amount until this random left thing happened, and Doctor #3 is the first one who said he'd like to do an MRI of the right too. The other doctors were very dismissive and practically ignored my concerns with the right knee, which is incredibly frustrating. My gut keeps saying to get it checked out too. We're all hoping it's just normal aches and pains and not osteochondritis in both.

I ended up choosing Doctor #3 (this sounds like a weird dating game now) for a few reasons. He seems like he genuinely cares, he's one of the best knee surgeons in the country according to some online research, his surgery sounded less extensive than other options, and he listened about my right knee. Also, we know a lot of family friends who have had him do surgery on their knees in addition to my brother's knee, so we ended up going with him. He could fit me in this week, and surgery is scheduled for tomorrow.

I'm hoping everything goes smoothly and is complication free, and that I recover quickly. I'm incredibly anxious over having surgery, and scared for the pain that I'll likely be in after. I'm also terrified of waking up in the middle of it. I know that many other people have way more severe, complex surgeries though, so I should be thankful that it's arthroscopic. The plan after surgery is:

Six weeks of non-weight bearing and using crutches
Six weeks  of very careful walking, being cautious with stairs, and gradually increasing the weight I put on my left leg
At the 12 week mark I'll start slightly more intensive physical therapy

Which brings me back to why I'm beginning to blog again. Six weeks of using crutches with my upper body strength (or lack thereof) will probably mean I won't be doing much physical activity. Since I'm used to being pretty busy and active, I'm trying to come up with new ways of occupying my time, and this is one of them.