Saturday, 28 November 2009

Knee Surgery Part 2: Drugs, Muscle Wastage & Crutch Workout Videos

The Drugs and the Pain
As I mentioned in part 1, I was given morphine when I came round after the surgery. I was still wired via the top of my hand, so they whacked me with "2" (mg I assume) when I reported pain.

"Does it still hurt?"

Boom - another 2.

4 x 2 later, I said "Don't worry about it." I was starting to sound like a junky and it was clear that at this dosage, their willingness to administer the drug was going to run out well before it had a tangible effect. In any case, it was tolerable. It seemed only right I should be in at least some discomfort.

Shortly afterwards, they gave me two codeine and paracetamol tablets (30mg and 500mg respectively, combined). Later, after they had wheeled me to my room, they gave me another tablet, this time diclofenac, a non-steroidal anti-inflammatory.

Add to this two cups of strong coffee and the fading anaesthetic and you've quite a cocktail. I spent an hour sending ill-advised
Blackberry work emails from my hospital bed while I waited for Mrs M to arrive, then half an hour marvelling at the passing street lights.

The first two nights after the surgery were painful. As I mentioned in Part 1, the small scars left after keyhole surgery do not reflect the extent of the trauma underneath.

To fight this pain, I had been armed with a pack of the codeine/paracetamol 30/500's and a pack of diclofenac. Codeine every 4 hours, Diclofenac every 12.

The problem with codeine, as with all opiates, is that it causes constipation. Evidently I am especially sensitive because three days later I realised I was a stranger to the toilet seat; and the trouble with Diclofenac is that, as with all NSAIDs, it's not very good for your stomach.

I therefore went out of my way to medicate on the basis of need, rather than habit. As a result, I awoke squealing in pain once or twice, usually because I had slept with the leg in a bad position. I found the best approach was to avoid the meds during the day, then take them at night, thus ensuring a good night sleep in return for a little suffering while awake.
Muscle Atrophy and Physiotherapy
Never underestimate how quickly a muscle will waste away if you don't use it. Not going to the gym for 3 weeks will not appreciably reduce your leg muscle mass if you are reasonably active - simply walking up stairs is a strong enough signal to your body that you need those quads.

Yet when you put a leg into a brace [click to enlarge], your quad stops being used at all. Here, three weeks later, is the difference in size between mine. Note - this photo was taken in the mirror, so it looks as if the wasted leg is on the wrong side.

I'd been given exercises by the physiotherapist at the hospital. One was designed to progressively introduce bending to the knee, the other to tense the quads and prevent wastage. This latter was pretty lame, as the photo would suggest.

Had I realised the importance, I would have initiated my own program sooner; but it was not until 2 weeks later, when I saw my regular physio, that I realised how much muscle I had lost and that there was much more I could do to prevent it.

Now, I tense the muscle like a posing bodybuilder for 30-60 seconds a few times a day. In addition, I am doing Romanian (straight-legged) deadlift, which the physio also endorsed (I described the most recent session here.) It allows me to give the lower body a serious workout without affecting the knee.
Although I can happily limp around my apartment with the knee brace on, it's not an efficient method of propulsion for longer journeys; and eventually it does start to aggravate the knee.

I took a fine pair of crutches home after the operation, and it has been interesting to experiment with ways to use them for exercise. Here are my top 3 crutch-based workouts.

Crutch Cardio
When using crutches to walk, you can rely completely on your upper body, or only a little. It depends how much you want to protect the affected leg from contact with the ground. Either way, it's actually rather an effective, low level workout because it combines upper and lower body effort. You can aslo move pretty fast once you get used to it.

Note: if, like me, you are crutching for up to an hour per day, it does take a few days to adjust. For the first week I struggled. Doing a few thousand shallow dips per day comes as something of a surprise to the triceps.

Crutch Leg raise
The video says it all - this was a good discovery and I expect to continue to use the crutches when I am working out at home and would like to do leg raises.

Crutch Balancing
As you can see, I need to work on this one... but it's pretty taxing and something to pass the time when you are waiting for trains or buses.

In three weeks the leg brace comes off. I can still only manage 70-80 degrees of flexion. Full fitness should come in two months. No doubt there will be a part 3 to this post.

Knee Surgery Part 1


Grok said...

You're going to fall down and hurt that thing. Careful man.

Methuselah said...

Grok - yup. I guess that's what got me in this mess in the first place ;-)

Asclepius said...

Improvise. Adapt. Overcome! Nice use of the crutches.

Get well soon!

Methuselah said...

Thanks Asclepius. I'm getting there.

Mo said...

If I saw you 'balancing' like that at a bus stop, I'd call the cops!

Drs. Cynthia and David said...

Wasn't paying much attention, and when I look to see what's happening, there's such serious news! So sorry to hear about the injury and the surgery. Patience is probably the best advice, but I'm terrible at it too (still trying to beat my injuries into submission, but they seem to be winning...) Your quads will come back nicely when it's time to use them again.

What would you advise for an ornery hamstring? I need to add some weights to my repertoire I think.


Methuselah said...

Thanks Cynthia. Not sure what to recommend for a bad hamstring - I am sure you are stretching it already. When I had a bad hamstring it turned out to be from too much stretching though - so I suppose that's a possibility. Deadlift using dumbbells with legs kept mostly straight has been a fantastic way to work the hams hard without getting injuries for me, so I would certainly recommend giving it a try. Because it's dumbbells, your arm joints are allowed to stay at their preferred angles, not to mention that your shins and knees are not scraped by a bar. It's also great for the lower back. Let me know how you get on if you try it.

Gary said...

Hope your recovering well. i ruptured my quad tendon in an accident back in August, same routine, 8 weeks leg brace and a right leg which Victoria Beckham would be proud of.Full rom regained but my physio reckons that quad will still be trying to catch up with the good leg a year from now.You always tend to favour the good leg in most situations to, which i think builds the good leg even more.
Just after leg injury was told of high cholesterol 8.5 after bloods.Won't take them statins though and trying to normalize by exercize and diet. Harder to exersize when injured though, great to see you trying the crutch dips,never thought along those lines.Gone Paleo about 7 weeks back,hence finding this site, weight dropping and am feeling good,working on elliptical,static bike, hill walking on treadmill and upper body weights. More bloods this week with results next week, should prove intersting to see if the ol' cholesterol is heading back to more normal! levels.I am hoping they are as the doc thinks i am on the statins he gave me still, as he told me my levels were to high to help by diet means only, would love to prove the bugger wrong and tell nim its all down to diet.Will let you know how it went in couple of weeks, wishing you a speedy recovery.

Methuselah said...

Gary - thanks for sharing your experience. I hope your leg is recovering too. A ruptured quad tendon sounds a lot worse than the tinkering my surgeon did, so you have my sympathy. Right now I have taken off my knee brace a week early and started walking to work. I have also been doing free squats and going up the stairs with dumbbells (as you may have read on ercent posts). The knee complains about all of this but only in a way that feels appropriate. I have been ultra dialled-in on the diet to maximise recovery potential... I guess sleep is the only area I've done badly on, but that's really out of my control at the moment (we have just moved house which is rather stressful).

The whole statins and cholesterol thing is a minefield. I am no expert so would not want to advise you, but I can tell you I have just read a book called "The Great Cholesterol Con" by Malcolm Kendrick and he has convinced me that not only are statins bad for you (which you have clearly already picked up on if you have stopped taking them) but cholesterol is not even the bad guy. Would also be worth poking around the Protein Power and Free the Animal blogs if you have not already done so - these guys have been systematically demolishing the conventional wisdom on statins and cholesterol for some time. Links in the blog roll. All the best - let me know how you get on with your recovery.

gary said...

Hope your progressing well with the leg recovery, mine is painfully slow progress. Good news on the cholesterol though, dropped overall by 25% and ratios have improved dramatically.Doctor didn't believe that i had not taken the Simvastatin then i enlightened him about my recent diet,paleo.he was impressed but still wants me to take a different statin, no way. If paleo/primal eating and limited exercise due to my dodgy leg can do this in under 2 months i'me gonna stick with it for good. How can anyone knock this way of eating/life,the results don't lie and the food tastes good. Grok on|

Methuselah said...

gary, I mentioned your situation to my physio and he agreed that I should count myself lucky with my own situation! I'm doing well, but I think I have irritated my patella with over-zealous one-legged squats. So I'm going to rest it for a few days. Good news on your blood results. Don't let those pesky doctors talk you into taking things you don't want to ;-)