Monday, April 16, 2012
I follow several blogs and when I remember to check them every few days, I used to get annoyed if they hadn't been updated. I have turned into one of those people. Many times over the past week, I have thought about updating and what I would type. But then real life gets in the way, or Katy calls, or Caroline needs me to watch her do her exercises, or Emily needs a ride, or I sit and wait for Emily at GK practice and I type a whole post on my phone and hit the back button one two many times and poof, it's all gone.
So here we are. Caroline is 11 days post op. My parents have come and gone, taking with them my ride helper and my chief laundry folder and kitchen organizer. And when I say chief, I MEAN chief!
She is walking around really well on her crutches, trying to work on heel to toe. Doing her PT three times per day, going to PT twice per week. She was able to go to both her soccer games this weekend. It was the farthest she has walked on the new knee and she was tired, aching and swollen when we got home. So far her spirits are up, she is anxious and wanting to know how long before she can start kicking a ball. Ummm, maybe four, five months? I really don't know. She went back to school today. I know she could have gone back last Friday, but she's twelve, and she's my sweetie pie that had pretty major surgery, so another day didn't hurt.
I have had my own anxiety about the heeling process over the past few days. Two new friends have helped me through via phone calls, Facebook and email. They might not know it, but I am so grateful for them. I have learned not to compare patients, even if their surgery was the exact same, on the same day. They are different kids and will heal and progress at their own pace. One isn't better than the other. They are both going to come back stronger than they went out, I truly know that.
Caroline's extension was my biggest source of worry. It seems like her knee is stuck semi bent, and it seems like I am constantly reminding, okay nagging her, to make sure she is working on getting it straight. Several exercises into the PT, it goes a little flatter, and then looks really good when she is finished icing and has her heel propped on the coffee table. Then she gets up to walk upstairs, or when she gets out of the shower, or pretty much any other time, it's back to bent. I know that she wants it straight more than me, ITS HER KNEE!!! And she needs my support and encouragement, not nags and worries. It's a vicious cycle, the massive swelling. You have to move to increase extension, swelling increases with movement, and swelling decreases extension. But she will get through this. She's doing everything the Dr. and PT tell her to do. Her knee will get better, it just takes a llloooooonnnngggggggg time.
Tuesday, April 10, 2012
I think Caroline might have turned the corner today as far as pain and sleep. She hasn't had a Percocet since 8:00 pm last night. I am giving her Tylenol every 6 hours, and Alleve every 8. The Alleve is mostly for the swelling. She has slept more in the past 20 hours than she has in four days. Maybe the Percocet was keeping her awake. They say it affects everyone differently. She is calling her pain level at a four, higher when we are working on her PT. My parents are on the way up from FL, I will go back to work tomorrow. I'm really nervous about leaving her, but she will be in good hands. I am thinking she might back to school on Thursday or Friday. Not sure how that is going to go. Maybe half days at first. She is used to propping her leg up all the time to get greater extension, I guess they will accommodate her at school and let her have a chair in each class. State testing is next week, so she really needs to be there next week from 8:30-11:30, at the every least. Not too worried about school, I have been in contact with all her teachers and the counselor, they have been really sweet.
I think I forgot to mention before that they got her new ACL from her hamstring.
Monday, April 9, 2012
Post-op/PT
First post-op visit this morning. Dr. X said everything looked great. He bent her leg until she said it was uncomfortable, about 30 degrees. This was normal he said. Cleared her to shower, but she chose not to navigate the 16 stairs to the bathroom upstairs when we got home. Tomorrow.
Started PT this afternoon. The physical therapist had her try some leg lifts while she was lying down. She couldn't raise her leg at all. He said this is normal and there is sometimes a disconnect between the brain and the muscles after surgery. They can usually correct it, but sometimes have to do something called e-stim.Once he helped her get her leg up, she could keep it up for a bit and then he had her do some leg raises. Once she got it up and going, she could lower it all the way back down and immediately back up, unassisted. It's the getting going she needed help with. As long as she kept it going, she was good. Not that it didn't hurt, she was fighting tears. These will usually be with her leg locked and straight, but there is a lot of swelling and her leg won't really go completely straight. This is the main thing she will work on for the next few weeks. The PT said the swelling should go down in about a week. He is a really nice guy. Gave her a couple minutes to gather herself and brought another patient over to meet her. It was a really old guy, at least 45...haha. He had ACL surgery two months ago. He told Caroline he came into PT in a wheelchair and that she would get through, he knew it didn't seem like it, but she would.
The PT then showed her how he wanted her to walk with the crutches. She came in using them like her leg was broken, swinging the leg as if it couldn't touch the ground. She now has to walk, very lightly putting her right toes down, supporting herself with the crutches, and then walking on the left. It is much slower and she is convinced she will look "like an idiot at school like this", but its how she will straighten her knee, getting more extension. They absolutely do not want her knee to get used to not being all the way extended.
She also sat on the edge of the table and let her knee just bend naturally, not forcing it. She has to work on this 3x-6x times per day, working up to 10 minutes. This was the only thing he did with bending her knee.
We also were given instructions to have her lie on the couch or bed several times per day with her ankle on about 4-6 pillows, getting a super high leg raise and then she can do her ankle pumps while in that position.
When she was walking out, the new way, the "old guy" told her how great she was doing and that he didn't walk out like that for three sessions. We know, she's a beast.
Needless to say, she was exhausted when we got home. In addition, we are almost out of the Percocet and are weaning her off and onto Tylenol and Alleve. She was a little panicked wanted to know how she was going to sleep. Really?? She's hardly slept in four days. I'm happy to report she went 7 1/2 hours between pills, went down to one, and still took a three hour nap. Then woke up and did her first PT at home.
I read over the surgery report that Dr. X gave us a copy of.
1. Grade two Lachman
2. Grade two pivot shift.
"The patient had a fully torn proximal anterior cruciate ligament that was scarred to the PCL and was retained.."
"We did not put in an interference screw because we could still see some tibial physes."
In plain language, he said her ACL had reattached itself to the PCL and bone and so it was better to leave it in. The tissue would bond to the new ACL creating a larger, stronger structure. The screw part was because he couldn't go through her growth plates in her knee because she is still growing.
Started PT this afternoon. The physical therapist had her try some leg lifts while she was lying down. She couldn't raise her leg at all. He said this is normal and there is sometimes a disconnect between the brain and the muscles after surgery. They can usually correct it, but sometimes have to do something called e-stim.Once he helped her get her leg up, she could keep it up for a bit and then he had her do some leg raises. Once she got it up and going, she could lower it all the way back down and immediately back up, unassisted. It's the getting going she needed help with. As long as she kept it going, she was good. Not that it didn't hurt, she was fighting tears. These will usually be with her leg locked and straight, but there is a lot of swelling and her leg won't really go completely straight. This is the main thing she will work on for the next few weeks. The PT said the swelling should go down in about a week. He is a really nice guy. Gave her a couple minutes to gather herself and brought another patient over to meet her. It was a really old guy, at least 45...haha. He had ACL surgery two months ago. He told Caroline he came into PT in a wheelchair and that she would get through, he knew it didn't seem like it, but she would.
The PT then showed her how he wanted her to walk with the crutches. She came in using them like her leg was broken, swinging the leg as if it couldn't touch the ground. She now has to walk, very lightly putting her right toes down, supporting herself with the crutches, and then walking on the left. It is much slower and she is convinced she will look "like an idiot at school like this", but its how she will straighten her knee, getting more extension. They absolutely do not want her knee to get used to not being all the way extended.
She also sat on the edge of the table and let her knee just bend naturally, not forcing it. She has to work on this 3x-6x times per day, working up to 10 minutes. This was the only thing he did with bending her knee.
We also were given instructions to have her lie on the couch or bed several times per day with her ankle on about 4-6 pillows, getting a super high leg raise and then she can do her ankle pumps while in that position.
When she was walking out, the new way, the "old guy" told her how great she was doing and that he didn't walk out like that for three sessions. We know, she's a beast.
Needless to say, she was exhausted when we got home. In addition, we are almost out of the Percocet and are weaning her off and onto Tylenol and Alleve. She was a little panicked wanted to know how she was going to sleep. Really?? She's hardly slept in four days. I'm happy to report she went 7 1/2 hours between pills, went down to one, and still took a three hour nap. Then woke up and did her first PT at home.
I read over the surgery report that Dr. X gave us a copy of.
1. Grade two Lachman
2. Grade two pivot shift.
"The patient had a fully torn proximal anterior cruciate ligament that was scarred to the PCL and was retained.."
"We did not put in an interference screw because we could still see some tibial physes."
In plain language, he said her ACL had reattached itself to the PCL and bone and so it was better to leave it in. The tissue would bond to the new ACL creating a larger, stronger structure. The screw part was because he couldn't go through her growth plates in her knee because she is still growing.
Saturday, April 7, 2012
Update
Backup to Friday. The surgery center called us in early, Dr. X was running way ahead of schedule. We got up there at 1:30, the took her and I back to the Pre-op area at 1:50. By 2:15 she was in a gown, waiting for the IV. She had a small scab on her right quad, and because of her history of MRSA, Dr. X called from surgery and told the nurses to hold of on the IV, he wanted to look at it first. After seeing it, he decided to call the Infectious Disease Dr. to make sure all was okay. About an hour of phone calls and waiting later, they decided it was a go. She had done all the precautionary pre-surgery Bactraban Nasal for 5 days and Hibaclens for three. They determined that the scab looked nothing like MRSA and all the pre-stuff, it would be alright. Plus, they were administering a strong IV antibiotic before surgery started. I reassured them that I play a doctor at work, and I knew it wasn't like any of the Staphs she has ever had. Dr. X said he was probably not going to take her quad after all, he wanted to stay away from the scab area. I think I may have already posted this stuff, but tough, I'm running on a few hours sleep for the past three nights.
Surgery took about 45-60 minutes. She was the last patient of the day, so Dr. X came out to see us in person. (It's usually a video conference.) He said everything went great. Her ACL was completely torn, near the bone. (I haven't had time to look that up yet.) That he left most of it in her knee because it had already started to reattach to the bone. This should be good, the new ACL and the old should bond together to create a really strong one. We got to go back to see her about 30 minutes later. She was awake, but out of it. Crying hard, saying it really hurt. The anesthesiologist decided to give her a block. (Haven't looked that up either. Mom, hint, hint.)It is something with the nerves, because they brought in an ultrasound machine to be able to guide the needle to the right spot in her hip. We left the room for that part. She stayed in recovery for at least an hour. Crying the whole time of the pain. She would hug my neck and ask if she could play soccer now. Truly broke my heart. They said anesthesia affects everyone differently, but lots of females cry. They said there was also going to be some pain. She took one percocet and had a shot of dilaudid. We are thinking that the pain and crying would stop anytime with all those drugs. WRONG!! We shifted her into a wheelchair and out to the car. She sobbed the whole way home, and pretty much until Friday morning. The post-op nurses suggested one percocet every 4 hours. They said she was too small and young for two. Yet, it said 1-2 every 4-6 hours on the bottle. I gave her one every 3 hours. Never seemed to touch the pain. Got her settled into a recliner we borrowed from a friend and started the ice with the cooler machine, another friend lent to us. These have both proven to be lifesavers. Then she had to go to the bathroom. How the heck is that going to happen?!! That has been the most painful and traumatic thing so far, every trip to the bathroom. We ease her up, and with me under one arm, and Loren under another, we act as her crutches.
More later...
Backup to Friday. The surgery center called us in early, Dr. X was running way ahead of schedule. We got up there at 1:30, the took her and I back to the Pre-op area at 1:50. By 2:15 she was in a gown, waiting for the IV. She had a small scab on her right quad, and because of her history of MRSA, Dr. X called from surgery and told the nurses to hold of on the IV, he wanted to look at it first. After seeing it, he decided to call the Infectious Disease Dr. to make sure all was okay. About an hour of phone calls and waiting later, they decided it was a go. She had done all the precautionary pre-surgery Bactraban Nasal for 5 days and Hibaclens for three. They determined that the scab looked nothing like MRSA and all the pre-stuff, it would be alright. Plus, they were administering a strong IV antibiotic before surgery started. I reassured them that I play a doctor at work, and I knew it wasn't like any of the Staphs she has ever had. Dr. X said he was probably not going to take her quad after all, he wanted to stay away from the scab area. I think I may have already posted this stuff, but tough, I'm running on a few hours sleep for the past three nights.
Surgery took about 45-60 minutes. She was the last patient of the day, so Dr. X came out to see us in person. (It's usually a video conference.) He said everything went great. Her ACL was completely torn, near the bone. (I haven't had time to look that up yet.) That he left most of it in her knee because it had already started to reattach to the bone. This should be good, the new ACL and the old should bond together to create a really strong one. We got to go back to see her about 30 minutes later. She was awake, but out of it. Crying hard, saying it really hurt. The anesthesiologist decided to give her a block. (Haven't looked that up either. Mom, hint, hint.)It is something with the nerves, because they brought in an ultrasound machine to be able to guide the needle to the right spot in her hip. We left the room for that part. She stayed in recovery for at least an hour. Crying the whole time of the pain. She would hug my neck and ask if she could play soccer now. Truly broke my heart. They said anesthesia affects everyone differently, but lots of females cry. They said there was also going to be some pain. She took one percocet and had a shot of dilaudid. We are thinking that the pain and crying would stop anytime with all those drugs. WRONG!! We shifted her into a wheelchair and out to the car. She sobbed the whole way home, and pretty much until Friday morning. The post-op nurses suggested one percocet every 4 hours. They said she was too small and young for two. Yet, it said 1-2 every 4-6 hours on the bottle. I gave her one every 3 hours. Never seemed to touch the pain. Got her settled into a recliner we borrowed from a friend and started the ice with the cooler machine, another friend lent to us. These have both proven to be lifesavers. Then she had to go to the bathroom. How the heck is that going to happen?!! That has been the most painful and traumatic thing so far, every trip to the bathroom. We ease her up, and with me under one arm, and Loren under another, we act as her crutches.
More later...
Thursday, April 5, 2012
Surgery center called around 12:30 and said that Dr. X was running really early and we could come ASAP. We arrived at 1:35, called Caroline back at 1:50. I went with her. She was very calm, probably still on a high from her new iPad she was gifted with this morning. The nurse started to get her ready for the I.V. when Dr. X called from the OR, where he was operating on Emily's former teammate, to say hold off, he wanted to look at a small scab on her thigh, right above the knee and on the quad. He came in to look, and called an Infectious Disease specialist to be sure everything was okay. He said they don't take any chances, especially with a history of MRSA. After about 20-30 minutes of calls and exams, the ID Dr gave the go ahead. Whew! Caroline said, "I am going to be really ticked if they don't do this today." Great nurses and staff. Started the IV antibiotics and fluids. Caroline took it like the champ she is. Me, on the very, very brink of a total cryfest. There were also two Emory Univ. medical students that helped push the "loopy" medicine. Which immediately lived up to its name, according to Caroline. A few very well concealed tears from Caroline, a few not so well concealed from me, a blessing and a kiss, and she was off. And now we sit and wait.
It's today.
Going to be a long day. I barely slept. I stayed up late with Caroline, well, it was a little past midnight, but I'm forty now, that's late. She went to bed in the playroom so she could stay up later watching tv, I heard her on the phone at 2:00, but the later she sleeps today, the better. Her surgery has been pushed back to 4:15, we have to be there at 2:15. No food or drink past midnight. She's not a breakfast eater, but that's a little crazy. She told me yesterday that she really wasn't nervous. Thank you God! I'll take the nerves, wish I could take it all.
Tuesday, April 3, 2012
Found out today that Caroline has to be at the surgery center at 12:15 on Thursday. She has been doing all the pre-op prep that the Dr. ordered. She has a history of staph, so they are taking extra precautions. Her pain has been steadily increasing. Not sure why, maybe its just the unstable knee. She has been riding the stationary bike 20 minutes per day, almost five miles, and doing all the PT exercises. She is determined to come back quick and strong.
Saturday, March 31, 2012
Injury and Diagnosis
I decided to start a blog on the advice of a soccer dad whose daughter has been through this twice in 12 months. It seems like a good way for family and good friends to keep up with Caroline's progress. (I am mother's daughter, I love details. I like to tell them, I like to hear them. So a lot of these are for me, and my mom. And Katy. And for Caroline when she's older.)
Timeline of events:
March 8th-Caroline was at soccer practice. In her words, she was running, stopped, her leg straightened, she felt two pops, she took another step, lots of pain, and she went down. She told me later in the car that she thinks she cried out and cried, which she was embarrassed and a little shocked about. The asst. coach from her team saw it happen and called me later that evening to check on her and tell me what happened, I was across the street with Emily at practice. Coach Brett said it looked like she hyper-extended her knee. There was no other player involved, no contact. When we got home, she could bear some weight with pain, and we iced her knee until she went to sleep.
March 9th-When Caroline woke up, she had a lot more difficulty walking and a lot more pain. We were able to get her in to an Orthopedic in Newnan that we have been to several times, most recently in Feb. when Emily had a high ankle sprain. She didn't go to school (you know she hates that, NOT). The x-rays were normal and the Dr. said her symptoms were consistent with hyper-extension. He thought her ACL seemed stable and said she most likely had a deep bone bruise, which could take two weeks to four months to heal. He told us to get a knee brace, take Alleve, and use crutches for a few days. (We have had crutches in the closet for years, and the girls always used to love to play with them. It's not so fun when you have to use them, apparently.)
We made a follow-up appointment for the 19th.
March 10-14 Caroline used crutches and iced her knee. Started to feel a lot better. Swelling went down somewhat, and she could bear more weight on it. Straightening all the way was the most pain. No crutches past the 12th. She missed the first regular season soccer game. First game she hasn't started since she was about, oh, EVER. It was a hard day.
March 15- Caroline told me she thought she was going to be fine and probably didn't even need to go to the Dr. on the 19th. (In case you are a non-club soccer reader, you go to practice and games, even if you are injured. You sit on the sidelines, observe, and cheer on your team..) So on this day, I took Caroline to practice with her begging to play a little. (Okay, hindsight, I should have said no way. But, it could have happened at school or home too) I called her coach and we agreed to let her move around a teeny, tiny bit at practice. Which she did. I saw her go down this time. She was literally walking, and her legs buckled underneath her. It was kind of slow motion. She said she felt a pop. Her coach helped her up and off the field. He later told me that's when he got worried it was ACL.
March 16-18 Back to crutches and more frequent ice and Alleve.
March 19- Back to the Newnan Ortho- He did more stability tests and said her knee still felt pretty stable, but with her pain and knee giving out, ordered an MRI, which they did that afternoon.
March 20-22 NO crutches, feeling a little better. Still can't straighten.
March 22- Newnan Dr. said MRI results show partially torn ACL. He recommended four weeks of twice per week physical therapy, have a custom ACL brace made that she will wear from now on, forever at soccer, then another follow-up exam. He was hoping that if her ACL was partially torn, there would be enough fibers still receiving blood flow, that it would heal on its own. BUT, there was a 50% chance that it wouldn't be stable enough for soccer and she could go down again. He said she might be good to play in 1-4 months. WHAT??!! He obviously doesn't know this kid, she plays soccer about 5-7 days per week. That is not going to work!!
Timeout on the timeline. We know a lot of soccer kids that have torn their ACL. It is happening more and more. Emily has two girls on her club team that just came back in August from ACL tears the year before. One of those girls just tore the other one last week in a high school game. So when Caroline got hurt, we said we know its not going to be ACL, but if it was, we would call Dr. X.
Back to March 22- Leave Newnan Dr's office with a prescription for PT and a custom ACL brace, send about 100 texts, frantically find out Dr X's real name so I can get through before 5:00. It's 4:30. In the parking lot. Trying not to cry. Can't make an appt without a referral, our pediatrician is closed. CRAP!!! Caroline is pretty quiet.
March 23- Because Caroline is 12, I get to talk to Dr. X's assistant. Apparently being 12 and tearing your ACL is special. She tells me fax to her MRI, he will look them over and decide if she needs to be seen. AKA, needs surgery. I know this because when I called Thursday to try to get an appt and couldn't without a referral, the front desk said he sees only surgical patients. I can't get it faxed from the Newnan office, so I go pick up a copy and I drive it up there so he will have it Monday morning. Pat, the assistant promises to call me before lunch on Monday. It's a long weekend for all of us.
Dr X's resume
http://www.emoryhealthcare.org/sports-medicine/sports-medicine-physicians/john-xerogeanes.html
March 26-Pat calls me before 10:30, she is awesome. Dr. X thinks Caro's ACL is torn, he wants to see her Weds. DOUBLE CRAP!!! I did a ton of research over the weekend and talked to four sets of parents of players from our team/club who tore their ACL and three had Dr. X do the surgery. I knew pretty much what the choices were and what the surgery and recovery were, from talking to these soccer friends.
March 28- Met Dr. X. I feel really weird referring to him like this, but I really have no idea how to pronounce his last name. He is super nice, was great with Caroline, made us feel very comfortable. He did all kinds of stability tests that they didn't do in Newnan. (Let me clarify that I have nothing against the Dr. in Newnan. We just wanted a specialist. Someone that did ACLs all the time.) He showed us her MRI and said that while it was poor quality, it showed that her ACL was completely torn. He said it would not grow back. And that we could choose not to do surgery, but her knee would never be stable enough to play sports.Obviously, that's not gonna work!
So here's where we stand today.
Caroline is having ACL reconstruction surgery to replace her torn ACL on Thursday, April 5th. We should receive a call Tuesday letting us know what time. It's outpatient, she will be home by late afternoon. Dr. X plans to get her new ACL from her quad, which he said are beautiful. There will be about a one inch incision on the bottom of her quad, right above her knee. Her surgery is a tiny bit more tricky because she is still growing, but he will not go through her growth plates, and she will be fine. The rest of the surgery will be through three small holes around her knee. I will copy some links for anyone that wants to know that details, but they essentially take out the torn ACL, drill holes in her femur and tibia, and thread the new ACL through like a needle and thread. I can't really think about all that without tearing up. The recovery period is long for contact sports that require a lot of cutting and turning. It will be 8-10 months before she is able to play soccer again.
Please keep Caroline in your thoughts and prayers. She has received tons of support from her family, her coaches, her friends, and her teammates. She will continue to need it. Tonight she is anxious and restless, wishing it was behind her. She went to PT on Friday, just to get established with her therapist. He gave her some pre-surgery exercises to do, which bothered her knee quite a bit.
(While you're at it, please send some prayers and wishes to Sydney, Emily's friend and teammate who tore her second ACL two weeks ago at a game, surgery is the 17th. And to Kylie, another friend and former teammate who is having ACL surgery the same day as Caro, another Dr. X patient.)
A few interesting facts I have learned this week:
This is a really simple, yet complete explanation of the knee and ACL.
http://ehealthmd.com/content/what-anterior-cruciate-ligament
7 of the 21 players on the USWNT have torn their ACL. Rapinoe tore one ACL twice, Rampone has torn both. (Caroline's goal is to play center back for the USWNT.)
According to Dr. X, if Caroline had a twin brother, she would be 4.5 times more likely to tear her ACL than her twin brother.
Timeline of events:
March 8th-Caroline was at soccer practice. In her words, she was running, stopped, her leg straightened, she felt two pops, she took another step, lots of pain, and she went down. She told me later in the car that she thinks she cried out and cried, which she was embarrassed and a little shocked about. The asst. coach from her team saw it happen and called me later that evening to check on her and tell me what happened, I was across the street with Emily at practice. Coach Brett said it looked like she hyper-extended her knee. There was no other player involved, no contact. When we got home, she could bear some weight with pain, and we iced her knee until she went to sleep.
March 9th-When Caroline woke up, she had a lot more difficulty walking and a lot more pain. We were able to get her in to an Orthopedic in Newnan that we have been to several times, most recently in Feb. when Emily had a high ankle sprain. She didn't go to school (you know she hates that, NOT). The x-rays were normal and the Dr. said her symptoms were consistent with hyper-extension. He thought her ACL seemed stable and said she most likely had a deep bone bruise, which could take two weeks to four months to heal. He told us to get a knee brace, take Alleve, and use crutches for a few days. (We have had crutches in the closet for years, and the girls always used to love to play with them. It's not so fun when you have to use them, apparently.)
We made a follow-up appointment for the 19th.
March 10-14 Caroline used crutches and iced her knee. Started to feel a lot better. Swelling went down somewhat, and she could bear more weight on it. Straightening all the way was the most pain. No crutches past the 12th. She missed the first regular season soccer game. First game she hasn't started since she was about, oh, EVER. It was a hard day.
March 15- Caroline told me she thought she was going to be fine and probably didn't even need to go to the Dr. on the 19th. (In case you are a non-club soccer reader, you go to practice and games, even if you are injured. You sit on the sidelines, observe, and cheer on your team..) So on this day, I took Caroline to practice with her begging to play a little. (Okay, hindsight, I should have said no way. But, it could have happened at school or home too) I called her coach and we agreed to let her move around a teeny, tiny bit at practice. Which she did. I saw her go down this time. She was literally walking, and her legs buckled underneath her. It was kind of slow motion. She said she felt a pop. Her coach helped her up and off the field. He later told me that's when he got worried it was ACL.
March 16-18 Back to crutches and more frequent ice and Alleve.
March 19- Back to the Newnan Ortho- He did more stability tests and said her knee still felt pretty stable, but with her pain and knee giving out, ordered an MRI, which they did that afternoon.
March 20-22 NO crutches, feeling a little better. Still can't straighten.
March 22- Newnan Dr. said MRI results show partially torn ACL. He recommended four weeks of twice per week physical therapy, have a custom ACL brace made that she will wear from now on, forever at soccer, then another follow-up exam. He was hoping that if her ACL was partially torn, there would be enough fibers still receiving blood flow, that it would heal on its own. BUT, there was a 50% chance that it wouldn't be stable enough for soccer and she could go down again. He said she might be good to play in 1-4 months. WHAT??!! He obviously doesn't know this kid, she plays soccer about 5-7 days per week. That is not going to work!!
Timeout on the timeline. We know a lot of soccer kids that have torn their ACL. It is happening more and more. Emily has two girls on her club team that just came back in August from ACL tears the year before. One of those girls just tore the other one last week in a high school game. So when Caroline got hurt, we said we know its not going to be ACL, but if it was, we would call Dr. X.
Back to March 22- Leave Newnan Dr's office with a prescription for PT and a custom ACL brace, send about 100 texts, frantically find out Dr X's real name so I can get through before 5:00. It's 4:30. In the parking lot. Trying not to cry. Can't make an appt without a referral, our pediatrician is closed. CRAP!!! Caroline is pretty quiet.
March 23- Because Caroline is 12, I get to talk to Dr. X's assistant. Apparently being 12 and tearing your ACL is special. She tells me fax to her MRI, he will look them over and decide if she needs to be seen. AKA, needs surgery. I know this because when I called Thursday to try to get an appt and couldn't without a referral, the front desk said he sees only surgical patients. I can't get it faxed from the Newnan office, so I go pick up a copy and I drive it up there so he will have it Monday morning. Pat, the assistant promises to call me before lunch on Monday. It's a long weekend for all of us.
Dr X's resume
http://www.emoryhealthcare.org/sports-medicine/sports-medicine-physicians/john-xerogeanes.html
March 26-Pat calls me before 10:30, she is awesome. Dr. X thinks Caro's ACL is torn, he wants to see her Weds. DOUBLE CRAP!!! I did a ton of research over the weekend and talked to four sets of parents of players from our team/club who tore their ACL and three had Dr. X do the surgery. I knew pretty much what the choices were and what the surgery and recovery were, from talking to these soccer friends.
March 28- Met Dr. X. I feel really weird referring to him like this, but I really have no idea how to pronounce his last name. He is super nice, was great with Caroline, made us feel very comfortable. He did all kinds of stability tests that they didn't do in Newnan. (Let me clarify that I have nothing against the Dr. in Newnan. We just wanted a specialist. Someone that did ACLs all the time.) He showed us her MRI and said that while it was poor quality, it showed that her ACL was completely torn. He said it would not grow back. And that we could choose not to do surgery, but her knee would never be stable enough to play sports.Obviously, that's not gonna work!
So here's where we stand today.
Caroline is having ACL reconstruction surgery to replace her torn ACL on Thursday, April 5th. We should receive a call Tuesday letting us know what time. It's outpatient, she will be home by late afternoon. Dr. X plans to get her new ACL from her quad, which he said are beautiful. There will be about a one inch incision on the bottom of her quad, right above her knee. Her surgery is a tiny bit more tricky because she is still growing, but he will not go through her growth plates, and she will be fine. The rest of the surgery will be through three small holes around her knee. I will copy some links for anyone that wants to know that details, but they essentially take out the torn ACL, drill holes in her femur and tibia, and thread the new ACL through like a needle and thread. I can't really think about all that without tearing up. The recovery period is long for contact sports that require a lot of cutting and turning. It will be 8-10 months before she is able to play soccer again.
Please keep Caroline in your thoughts and prayers. She has received tons of support from her family, her coaches, her friends, and her teammates. She will continue to need it. Tonight she is anxious and restless, wishing it was behind her. She went to PT on Friday, just to get established with her therapist. He gave her some pre-surgery exercises to do, which bothered her knee quite a bit.
(While you're at it, please send some prayers and wishes to Sydney, Emily's friend and teammate who tore her second ACL two weeks ago at a game, surgery is the 17th. And to Kylie, another friend and former teammate who is having ACL surgery the same day as Caro, another Dr. X patient.)
A few interesting facts I have learned this week:
This is a really simple, yet complete explanation of the knee and ACL.
http://ehealthmd.com/content/what-anterior-cruciate-ligament
7 of the 21 players on the USWNT have torn their ACL. Rapinoe tore one ACL twice, Rampone has torn both. (Caroline's goal is to play center back for the USWNT.)
According to Dr. X, if Caroline had a twin brother, she would be 4.5 times more likely to tear her ACL than her twin brother.
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