Progress Report: 5 Weeks

So far, so good. The thing with cartilage repair is that activity advances soooo slowly, particularly in the early weeks, that it's hard to gauge your progress. The primary goal is to protect the graft site and regain some ROM. There are some real wins here though:

1. Minimal pain. My incision feels very tender. I have a little stiffness and achiness in the morning and at night, but true pain? None. Overall, my pain has been very manageable throughout this process. 
2. Hello VMO! I'm allowed to do a few quad sets in full extension. I've heard that a lot of folks can't get their VMO to fire for months. I was doing my mini quad sets last week and lo and behold, that little bugger fired!
3. Incision. My surgeon made an awfully big incision. It's about 5 inches, but they did close it cosmetically. It's long, but it healed up great and is a very fine (albeit purple) line. It's really a blessing that I've had no complications in that arena. I've started using a scar product called Bio-corneum. Like Mederma, it's silicone based, but it contains sunscreen. It's crazy expensive. I'll let you know how it goes. 
4. Purple leg. There's this crazy thing that happens when you stop bearing weight...your leg forgets how to send blood back to your heart. Normally, your calf muscle contracts when you walk and helps pump blood back to your heart. Since you're not using your calf much, the blood pools in that leg and it turns a delightful shade of Barney. And it hurts. No fun. The good news? This means you've done a GREAT job of staying off that leg and protecting your graft! If your doctor allows, calf/ankle pumps help a lot. Massaging your foot and calf also helps. I'm told this gets better when you advance to full WB status. 
5. Partial weight-bearing. In full extension only. This is going well. I started at 2 weeks. This also really helps with the "purple leg syndrome". One more week until I advance to full WB. Woohoo!
6. Pool. Ok, this isn't fair to pretty much anyone who lives north of Miami, but it's November and I can get in the pool. Oh joy! It feels so darned good. A surgeon I spoke with in Virginia recommended gentle pool exercises. That's going great. 
7. CPM. Still doing about 6 hours of CPM/day. I reached 90 degrees a week ago and I'm not allowed to advance for another week. So I'm just getting real comfortable at 90 for now. Wondering how the next 30 degrees will feel. Stay tuned. 
8. Sleep. This is still a little tough. It's hard to get comfortable and I find myself tossing and turning a bit. Started sleeping without the brace at 4 weeks. Follow your doctor's recommendations, but I wouldn't sleep without it for at least 4 weeks. 

Navigating CPM

WHO/WHAT/WHEN/WHERE/WHY/HOW:

How many hours per day? How many weeks? How much flexion? How fast do I advance? How hard should I push myself? Is this good pain or bad pain? Why the heck am I even doing this?

It turns out that CPM does a few nifty and important things. It helps mold those growing baby cartilage cells so that they conform to the articulation of your own knee joint. It bathes the graft site in synovial fluid to foster growth. It also prevents scar tissue and adhesions and helps you regain your range of motion.

I've gotten my hands on half a dozen different Denovo NT rehab protocols. Most of them prescribe CPM for at least 6 weeks, anywhere from 6-12 hours/day. And most say you should be at 90 degrees by 6 weeks and 120 degrees by 8 weeks. I reached 90 at 4 weeks and I'm holding steady. According to my surgeon, my defect doesn't engage until 90 degrees. 

Most days I do between 6 and 8 hours, a little less on days I have PT. The mornings are tough. It takes a bit to get my range of motion back. I throw a cold pack on my knee when I first start and that helps. I've also noticed that the nights are tough when I've done 8 hours. I seem to have more pain and swelling and warmth at the incision site.

CPM LIFE HACKS:

I highly recommend keeping a journal of your CPM use. Record the hours you use it, how it feels, and the degree of flexion. This becomes important when you feel you aren't making progress. You can look back and see how far you've come!

Get an iPad, find a good book, watch a series on Netflix you haven't seen, learn a new language, start a blog ;). It's a lot of idle hours and you know what they say about idle time. If you have a tendency toward depression (more on that in a future post), it will take some conscious effort to keep your spirits up and your mind on track. Break up the day. Do an hour or two and then go outside for half an hour. Or pick up some light weights and do some upper body exercises. Ask your friends and family to play a game or eat a meal with you while you're CPMing. It makes the time pass.

Set your CPM up in a spare bedroom if you have one. The couch would work too. It needs to be a comfy spot. Put a beach towel under the machine to protect the bed/couch.

Be prepared to fight your DME provider and/or insurance company to pay for the machine past 21 days. You may need for your physician to file an appeal. It runs about $175/week out of pocket.