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.

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. 

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.

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...

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.

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.