Monday, April 17, 2017

ACL reconstruction surgery – what to expect

Here is everything that happened to me on ACL surgery day. 
If you’ve got your surgery coming up, I thought it’d be useful to post what happened to me, so you know at least in part what to expect. 

**If you want a condensed version, go straight to the end of this post for my Top 5 Must-Do’s and Don’t Do’s of ACL recovery**

I was at Prince of Wales Public Hospital, in Randwick, Sydney, Australia, and my surgeon was Dr David Broe. My physio is Sam Bartlett at Erko Physio (after the surgery I could have had free physio on Medicare but as I’d been seeing Sam for the past eight months since my injury, I wanted to carry on with him). 
I am 31, healthy in every other way, had a fit and active lifestyle and played a lot of sport socially. I didn’t have private healthcare, which led to a longer wait for surgery than recommended, and so all procedures were done through Medicare. I had a complete ACL reconstruction, using the hamstring graft, done through keyhole surgery, I didn’t require a brace afterwards, and it was on my left leg. 

It went something like this. I was pretty scared. I had seen how buggered people were when they first got home from the surgery. I had been pre-warned you are basically a hermit for a week, as you can’t really move, you’re in a lot of pain, and the meds you’re on send you to sleep. 
A couple of days before, the hospital admissions lady, who’d I’d spoken to on and off for the past eight months, called me and told me they had to postpone my surgery, because an emergency one had to be scheduled for the same day. I cried down the phone and explained how frustrated I was that my ‘three-month waitlist’ had already turned into almost nine months, and now it was going to be even longer. Long story short, she hadn’t noticed I was on the ‘emergency’ list too (which guarantees you surgery in three months), some oversight had clearly happened, and she would keep me on the list to have surgery as scheduled a couple of days later. All good. 
The day before surgery, the hospital called me and told me what to expect in terms of arriving at the hospital, what to bring, what to wear etc. They were hopeful I’d get out the same day, but told me to still bring overnight clothes and lots of things to read or entertain me as I might be waiting around a lot. 

On the day, I wore a really baggy dress and flip-flops and packed some leggings and a jumper. I also packed my iPad, a book, and chargers, as well as overnight toiletries such as toothpaste and deodorant. A friend dropped me at the hospital, I admitted myself, and then began to wait. Before too long, a nurse came to get me, and checked things like my date of birth (get ready to say this a LOT), whether I was feeling well, which leg was injured, my date of birth (again), when I’d last eaten etc. She gave me a gown to change into and put my belongings into a locker. I was moved to a day surgery ward and sat in a hospital-style chair (you could adjust it to support the legs etc) for about 20 minutes, until she came back, rechecked a few things and then a porter came with a trolley to take me down to surgery. This was only about 45 minutes after I’d been admitted, so not long at all. 
I was taken down to the pre-operating room, which is basically like a big waiting room of beds, where people are waiting for all sorts of surgeries. Here my surgeon, Dr Broe, came in to have a chat, double-check which leg was being operated on (he marked the leg with permanent marker) and reassure me. I was feeling pretty calm and relaxed at this stage. 

After a wait of about half an hour, a porter came to get me and wheel me to the operating theatre. In there, I met the anaesthetist, who double-checked my name and date of birth, and then put a drip into my arm. He put the general anaesthetic into my arm and I remember the room getting a bit wobbly and feeling a little woozy, but it didn’t happen as quickly as I expected (this was my first GA). Me, the anaesthetist and his assistant were all laughing as I felt like I was drunk, and then I don’t remember anything after that.

I woke up laughing and then immediately began crying. I was told afterwards that I actually woke up and tried to pull my breathing tube out (I don’t remember having a breathing tube) and also knocked out my drip, so they had to reattach that. This is all a bit of a blur – I remember asking for my glasses (which I didn’t need at all!) and then crying a lot because it hurt. Prepare yourself for this. I think I have a pretty high pain tolerance, but I was in soooo much pain. It was pretty localised pain, just around my knee, but it was bad. A lovely nurse gave me more endone immediately, and then it was much better. I was in the recovery room for a couple of hours I think, but I kept going in and out of sleep. Lots of other patients were arriving and leaving, and nurses kept checking on me. After a while, someone from day surgery came to get me and move me back up to the ward I started in. I was in a trolley, but when I got up there I had to move into a chair. 

Moving back into the chair hurt so bloody much. I was still crying a lot but I had already had the full amount of painkillers so they gave me a sandwich instead! Ha. It actually kind of helped. For the next couple of hours, I dosed and was in a total daze. I replied to some texts, but don’t really have a huge amount of memory from this time. After a couple more hours, the hospital physio came to see me. She needed me to try walking (on crutches) but every time I stood up, I felt dizzy. She was super patient and just waited and waited. After a while I felt OK (that sandwich must have kicked in!) and so we very slowly made it down the corridor. The leg felt surprisingly OK – very heavy and still sore, but not too painful. She asked if I would need to go up steps at home (yes) and then we tried going up and down stairs. It was probably only about 15 minutes in total but it was pretty tiring!

My husband had arrived by this point, and then Dr Broe came in to say goodbye and tell me how everything went. To be honest, this whole thing was a blur so I have no idea what he said, but I had a follow-up appointment (which the nurses scheduled before I left) organised for two weeks time. He also gave me an operation report, saying everything that happened in the procedure, and a whole lot of info about rehab in the first few days. Get someone else to listen to this, or take some notes of anything important, because your memory won't be too great. A porter wheeled me in a wheelchair down to the exit and then waited with me while my husband went to get the car and also stop at the pharmacy to get my script/meds (which was anti-inflammatories, Endone, another painkiller called Targin and some anti-constipation drugs – nice. You’ll need them!). The pain was OK getting into the car, going home and getting into my apartment. The main thing I would say at this point is set everything up around you. It was hard getting on and off the sofa so have drinks, something to read or do, snacks, etc, all within arm’s reach. This is relevant for the first couple of days. 

I slept surprisingly fine, although that could have been the result of the GA and endone. I slept on my back, with a towel under my knee, as it was stuck in a bent position. I ate normally (dinner before bed) and then woke a couple of times in the night in pain, but nothing too out of the ordinary or unmanageable. 

Waking up the next day was bad, I was in a lot of pain, but as soon as I took painkillers, I was fine. Showering was super hard, as ours is in a bath and I couldn't lift my leg to get into it. The dressings are waterproof but you still need to tie a plastic bag or something around the leg. I ended up turning the shower head out and standing in the bathroom, treating it more like a wet room. We have a drain in the floor so it worked fine, but I don't know what I would have done otherwise... Buy some wipes for the first couple of days or get someone to help you shower!
One major thing I found this week, was that I couldn’t follow conversations very well. My memory had been badly affected, and I found I couldn’t remember certain words, or keep up with chats. I was super tired and slept a lot. My advice for this week is don’t make any plans and don’t allow too many people to come and visit. You heal while you sleep so do as much of it as you can. I think I probably tried to do a little too much, and as a result I was shattered and my swelling didn’t go down. 

This is something I want to talk a bit about. The first couple of days I was just resting and ice-ing the knee. Then I saw my physio (on Day 4 post-op) and started on some gentle rehab, trying to straighten and bend my leg, and get my quads firing. One thing I really struggled with in the first week was getting the swelling down. It’s a common thing to happen, and in fact most of week 1 rehab is focused on reducing inflammation.
Some good foods to eat for this include: turmeric (black pepper helps release the active ingredient curcumin), green tea and pineapple. However, the biggest thing, which I was unaware of, is don’t drink alcohol! I did (not a whole lot, but a few glasses of wine here and there), and I had no idea that it caused inflammation… as soon as I stopped, the swelling went down, so just do yourself a favour and don’t drink! I’m now four weeks post-op and am still having to ice every few hours, drinking heaps of green tea, no alcohol, and sleeping in compression tights (skins), plus wearing the pressure bandage.
I had a chat with a friend who’s been through this, who reminded me “You only get one recovery”. There’s no point deciding three months in that you’re going to take it seriously. Start strong and give yourself the best chance of the best recovery. 

Week one will be hard at times, totally manageable at times, and even kind of enjoyable at times (what’s not to love about lying on the couch watching Netflix?). It’s different for everyone, but for me the hard times came after the first week, when I really became aware of how little I could do – but it does get better, and you will make progress, I promise! 
Everyone’s experience is different, but hopefully now you’ll know a little more about what to expect on the day. Any other questions, feel free to get in touch by commenting below!  

And if you can’t be bothered to read all this, and just want a few pointers, here’s my round up of Top 5 Do’s and Don’ts….

1 - Pack/wear comfy clothes, and shoes that don’t need lacing up etc (slip-ons are best) to the hospital.

2 - Ask any questions you want to of the medical staff. They’ll help you!

3 - Write down anything important on the day, especially after surgery. My memory of the day is so hazy, I couldn’t remember much at all.

4 - Do your rehab. If you’ve been told to focus on anything in the first week (such as getting the quad firing or working on your extension/flexion, do it! The longer you leave it, the harder it’ll be. 

5 - Be kind to yourself. This surgery, while totally manageable, does suck, so be as nice to yourself as possible. Eat nice foods, light candles, watch sport, do whatever makes you happy. 

1 - Worry! This is a routine procedure and the medical staff all know exactly what they’re doing. They’ll be kind and caring, and they will fix you!

2 - Drink alcohol. It won’t help in the long run, and you want to give yourself the best chance of recovery.

3 - Panic if your memory is bad. It probably will be, so write down anything important, and don’t worry about the rest, it’ll come back.

4 - Do too much on your leg. Being on it (even on crutches) will cause it to swell, and so much of the first week is about trying to get that swelling down.

5 - Plan anything for the first week. You don’t know how you’ll feel but chances are it’ll be tired and sore.

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