If you’re just joining, go ahead and catch up on our pediatric ACL
saga tear with the first 4 posts about my daughter’s ACL injury here, here, here and here. We are one week post modified adult ACL surgery and I thought I’d share how the first week has gone.
Day 1 – ACL Surgery
The day of surgery was pretty well taken up with the surgery itself. Doctor came out with fairly cool and completely unidentifiable photos of the inside of Jaeda’s knee. We were home by 3:30 and while Jaeda was still a bit woozy and light headed, she was up and about on her crutches without much pain at all. We came home to the cutest flowers from a friend and grandma. Tip: Jaeda loved being thought of (I haven’t downloaded from my camera yet – but will add a pic later.) The nerve block was still in place and she slept well without much hassle. Tip: The doctor said a small percent of patients feel pain on the back of their knee that isn’t blocked by the nerve block. Jaeda felt that pain upon waking up and the nurse in charge said “The majority of kids hurt there when they wake up.” We needed to keep the ice machine running and on her leg constantly for the first 24 hours so I got up at 12 am and 4 am to trade out the water for fresh ice and check on her. Tip: The ice machine says trade water every hour, but hospital staff said it’s fine for 4 to 5 hours.
Day 2 – Top of the World
Jaeda started the day in great spirits. The day could be best described by one of Jaeda’s statements that day:
“This doesn’t hurt as much as I thought it would.”
She felt up for visitors so one of her friends came over to say hello, she was up and about on her crutches and laughing. Tip: I had to buy ice since the ice machine is an ice HOG and my freezer couldn’t keep up. Tip: Bring very loose shorts or a skirt to the hospital for your patient to wear home. She came out of the operating room in the full brace and bandage and the clothes need to fit over it all. We rented a couple of movies and the day was great. Then, I assume the nerve block wore off. There was pain. There were tears. There was panic about the pain and if it was going to get worse. It was a rough hour. Then she was due for another Oxycontin pill plus I gave her the supplemental pill and a half (Oxycodon) she was allowed for what the surgeon dubbed “break through pain”. The drama/pain/medication combination resulted in dropping off to sleep pretty soon thereafter and she slept great. We were past the 24 hours of constant ice so I didn’t have to get up in the middle of the night (which I appreciated).
Day 3 – Managing.
Wednesday was probably the worst day because Jaeda was feeling the pain and very anxious about the pain getting worse. That anxiety caused tight muscles which caused discomfort which caused anxiety which caused tight muscles…and the cycle spun round and round. The supplemental pain pill (Oxycodon) was distributed pretty regularly which handled the pain, but then she started to complain that she felt sick – headachy, tummy ache, icky. I assume side effect of the Oxycodon. Today was also the day the surgeon said she could take a shower so it was the first day we had a look at her knee post surgery. Although pretty swollen, it looked much better than I expected. The shower was an ordeal and I got in with her to give her some comfort. She was extremely nervous about standing up without a brace or crutches, teary from anxiety, and just all around unhappy. But clean.
Day 4 – Physical Therapy
Thursday was on par with Wednesday other than Jaeda didn’t feel as much pain and she refused to take the Oxycodon because of how icky it made her feel. Our big issue this day was the first physical therapy session post operation. Jaeda was extremely nervous that it would hurt and cried the entire time we were in the appointment. Her nerves made it pretty difficult to get much done, but the PT (Jeremy of Rocky Mountain Spine and Sport) did a great job taking it slowly and easing her fears, being patient with her anxiety and easing her into it. Her extension (straight) was great – 4 deg and flexion (how far it could bend) wasn’t bad at 23 deg. Tip: Make sure your selected physical therapist has experience with child and teen patients. I knew Jaeda wasn’t feeling great because during the day she said a couple of times that “Tevan will be so mad at me if I decide I don’t want to go camping this weekend.” Meanwhile this is the kid that upon waking up in the hospital said “I still want to go camping, Mom.” The fact that she was rethinking our trip was a pretty good indicator that she wasn’t feeling great. She was also very self conscious about her leg “looks fat.” Me: “No way! It looks like a leg with a brace on it. Not fat.” She’s anything but fat, but she has been very focused on her leg looking fat with all her “gear” on. It worries me about body image, self confidence, and all the rest that parents struggle with during tween and teen years. I suppose that I should be grateful I’ve had this peek into how she’s thinking and feeling so I can start looking for teaching moments and opportunities to discuss physical beauty, weight, etc. Mostly though I’m nervous and the idea of ramping up the talks about body image is daunting.
Day 5 – Physical Therapy & Camping
The second session of physical therapy went SO much more smoothly than the first one. Jaeda wasn’t afraid this time and was a rock star. Just in one day she got to 2 deg extension and 32 deg flexion and was a great patient. She even got on the bike!
She was feeling much better and decided she did want to go camping after all. So we did. Friday night we tent camped and she was a trooper, no complaints. The drive up was a bit difficult to keep her leg on the seat but not have the dog sit on her leg was quite a struggle.
Day 6 – Camping
She was a little sore, but not wanting the Oxycodon. Thankfully some people we were camping with brought Advil which did the trick. Emotionally she was upset she couldn’t participate in most of the activities the other kids were doing such as swimming, zip lines, playground, etc. Although she wasn’t quite as upset that she wasn’t expected to set up camp :). It was about this time that the length of time it would take for recovery hit her and some time and emotion was spend wishing it had never happened. I agreed – we all wish it hadn’t happened, but let’s look forward.
Day 7 – Home Again
We headed home from camping. Jaeda’s leg was getting pretty sore and she was ready to be home. We managed a better arrangement for the drive back that didn’t have her sitting with the dog worried that she was going to step or sit on Jaeda’s leg. Getting ice on her knee when we got home helped a lot, as did just laying down on the couch with it elevated.
Day 8 – Huge Improvement
Physical therapy was awesome. Jaeda had -2 degrees in extension meaning her knee was beyond straight and even into hyperextension (her normal) so she hit that milestone. Her flexion was 90 degrees – awesome! And what the surgeon hoped to see 2 weeks out versus 1. Her lag on quad engagement prior to getting her leg to lift was 24 deg and fairly common. Big goal of PT is getting her quad engaging again and strong. No pain. No anxiety. Walking on it solidly and comfortable showering alone and taking the brace off for laying around.
Day 10 – Progress
PT measurements continued to improve. She achieved full extension last session and maintained it, plus went to 108 deg flexion, and reduced quad lag to 10 deg. Got on the bike and was able to go the full way around even. Mental is great, feeling confident and doing well with all her everyday activities without help. Awesome.
I wanted to give you an idea of what the first week looks like because things change so rapidly, but from here out it’s just going to be PT improvements and 2 week, 2 month and 6 month check ups with the surgeon. We have PT 3 times a week until she starts school and then I think we’ll drop it to 2 times a week now that she’s getting the major milestones and can do more at home. Life is gaining some normalcy! Next up? Back to school in 6 days.