ACL Surgery: Survival Essentials for the First Week
Hack Shaft is having ACL reconstruction surgery this week. In the interest of helping him and anyone else who might be about to go through this all around lovely experience, I thought I’d share with you the first week survival essentials.
- Giant bags of frozen peas:
My surgeon didn’t recommend using the cryo-cuff (which I hear is fabulous) because he said that ice works just as well. I’ll do you one better. Giant bags of peas in plastic grocery bags are key (and having someone who can break them out of huge chunks is also key). Mr. BBM spent much time slamming my frozen peas into the sidewalk, kitchen counter, etc. I wasn’t willing to go all Bruce Lee on them so that was his job. I’ve found in recent days that icing the underside of the knee along with the top feels awesome. Ice as often as you can, because it really feels good and helps the swelling disappear faster. I iced my knee at least six times a day the first week. - Elevation:
Pillow Set-up for first weekSmall pillows did not do the job for me. That could be because I have insanely long legs. However, king sized pillows and extra soft body pillows are essential. A body pillow folded in half at your foot with a king sized pillow or two on top, slanted down towards your butt is the best position I found to provide some relief. Top that with a bag of peas and that’s the closest you can get to heaven in the first few days after surgery.
Pillow Set-up for after the first week (The Sleeping Beauty pillow, propped on the inside of your foot, helps to keep your leg straight through the night so your ankle doesn’t droop over and get sore.
- Anti-inflammatories: I can not even BEGIN to tell you how much better I started feeling when I was told to add ibuprofen to my pain meds regime.
- Chair for the Shower with Arms:
My first shower was without a chair and it was agony. You have to be able to sit down. If you can also prop your leg up on the outside of the shower to put your leg on, you’ll be even happier. You must also have good help, because getting in and out of the shower is tricky. Here’s the process that I found works best: 1. Turn the water on and get it to the right temp BEFORE getting in the shower. 2. Slide your bottoms down and sit on the lawn chair (I should warn you that it’s going to suck even if you warm it up first), making sure to use the arm rests to evenly lower your weight down. 3. Prop your leg up on the outside the shower chair, and take your brace off. 4. Turn the water on. Prepare for the shock of your life even if it is the right temperature. 5. Shower as usual but for the first few times have someone stay nearby to make sure you feel o.k. and to direct the stream to the right spot so you don’t feel like you’re being water-boarded. 6. Have three towels handy: one for your hair (ladies), one for the body, and one for the leg and then floor. 7. Dry off the floor outside the shower thoroughly. Make sure your crutches are dry too. 8. Have someone help you stand up as you get out of the shower. I know that was hella boring, but you will SO thank me for it later. It took several days to streamline this process properly. - Remote Controls, Book, and Tissues: There is nothing more annoying and/or tear-producing than when something is just out of reach when you need it and you’re in pain. Make sure the things you need are always within reach. It will spare you much annoyance. Although I fully intended on reading through those early days, the pain is such that you can’t concentrate on what you’re reading. So, Tivo some good distracting programs in advance of your surgery or stock up on magazines that don’t require you to think too much. People Magazine anyone?
- Prune Juice, Colace, Senokot:
Meet your new best friend.Yep, you need them all. Since I only drank one glass of prune juice and I plan to never do so again, if you need some, I will totally mail it to you. Take that Colace and Senokot daily. Trust me on this one.
- Good Help: You will need someone to cook for you, bring you food, bring you drinks, bring you your bags of frozen peas, and even help you get dressed the first couple days unless you feel like playing horseshoes, with your underwear as the horseshoe and your foot as the stake. You will get really good at this eventually (I have anyway). If you can find someone who’s not going to get all annoyed at your demands and someone who will wake you in the early days every two-four hours to take pain meds/anti-inflammatories, you will be a much happier person. Thank you Mom, Mr. BBM, Big I and even Lil C (who was awesome at bringing me my crutches when someone had left them propped against the wall too far to reach when I really had to go to the bathroom). I also felt a lot more comfortable during those early days when someone stood in front of me and helped stabilize my crutches when I went up the stairs backwards.
- Pillows in the Car/Car Procedures: You have to sit in the back seat until you can bend your knee comfortably 90 degrees. Here’s how to do it without knocking yourself unconscious. 1. Use the crutches and back yourself up to the back seat. Have someone stand nearby to take your crutches and help you lower your head (police man style) so you don’t hit your head). 2. Sit down on the edge of the seat (using your hands to lower yourself down) and use your good leg to scoot yourself backwards until you are up against the opposite door. 3. IMPORTANT: Make sure your bad leg foot is clearly inside the vehicle and that it won’t get bumped by the closing door (Yes, I found out the hard way). 4. Have a pillow in the car and use it to prop up your leg. (This is key to your comfort the first week). 5. Getting out is done by sliding back across the seat. Use your good leg and arms to help scoot yourself along while using your muscles to hold your bad leg up in the air. Having someone to help stabilize your leg during those first few days is really helpful. Make sure they understand that they should support your leg at two spots. I found the lower back of the thigh and the lower calf to be the best support spots for a helper. Whatever you do, don’t let them grab your heel or ankle. Ouch.
- Sleeping: Unless you’re one of those strange people who enjoys sleeping on your back, sleeping after ACL surgery (especially once you’ve kicked the pain meds) is not at all fun. Having heavy covers over top of the knee was uncomfortable, so I found that leaving my injured leg on top of the usual covers with a lightweight fleece blanket on top of the injured leg helps a lot.
- Let it Out: This surgery is emotionally trying. It is a mental and physical test like no other I have ever experienced. There were days that I sobbed in the shower during that first week, and I needed to do that. I also wrote it all out because it felt better to get it out. It is OK to feel sorry for yourself. Just don’t spent too much time doing so, because it does get better (says the girl who showered by herself this weekend for the first time since before surgery and is currently bonding with her frozen peas once again).
Best of luck to you Hack Shaft, and to anyone else about to endure this challenge.
Why Parents Need to be Involved
I found this article today and it made me so angry. A 39 year old karate school owner took sexual advantage of a 15-year old female student at his karate school. If you read the article, you’ll see that the girl was made to sign an "oath of obedience" for her training. What I want to know is this? Where were the girls parents when she was being asked to sign such a document? No daughter of mine would ever be allowed to sign such a document; and I would NEVER allow my kids to train at a place where I wasn’t allowed to watch every second.
If there is one thing I can’t stand, it’s martial artists who proclaim to uphold the values of the martial arts when their intentions are completely classless. Any adult who takes advantage of a child should rot as far as I’m concerned. This is just one of many incidents like this, where young impressionable students are taken advantage of under the guise of martial arts training. It really is a shame that there is no governing board to take care of disgusting people like this, because this certainly isn’t the first time and it won’t be the last.
As a former teacher in a public school, I had to submit to background checks and finger-printing. I’m starting to think that any type of teacher, including karate teachers, should have to undergo these types of screenings. Anyone can start up a karate school, put up inflated claims about who they are and what they know, and use it as a base for seedy behavior.
How do people like that live with themselves? I hope they throw the book at this guy, teaching others like him a much needed lesson.
Not Just a Random Nick
I am 11 days post ACL reconstruction, and I am finally feeling better. Today, the stitches came out. It was painless minus one of the poke holes which killed because I think it had healed a bit too much, and the biggest bottom incision which was a single running loop stitch. It looked very strange once the steri-strips were taken off, and when the nurse pulled that one out I definitely felt it. "You’re going to feel pressure" is nurse-speak for "this is going to hurt." However, after enduring post ACL surgery pain, what’s a little discomfort when it comes to having stitches removed?
I was happy that the nurse took the steri-strips off and took the stitches out, because doctors are notorious for doing those kinds of things quickly. The nurse took her time and slowly pulled back on those steri-strips. I was expecting agony, but it was nothing. She told me that my doctor usually tries to make the incisions "prettier for girls." I hadn’t really thought about scarring before, but now that it’s over that is certainly nice to know.
The surgeon came into the room after the nurse had placed more little bandages over the incisions. They will stay on until they fall off. One of the incisions (top left) bled a tiny bit so that one looks sort of nasty. Besides that, my knee looks and feels a whole lot better now. I was kind of embarrassed when he first came in. The last time he saw me I was sitting on a bedpan, hardly capable of holding my own head up. We shared a little laugh about that. I’m ready to put that whole experience permanently behind me now.
After gently checking out my knee for a couple seconds, he sat beside me and told me he had pictures. He pulled out two pages full of pictures of the inside of my knee. He showed me where the ACL had completely ripped off the femur. He also showed me the shredded remains of it, which he had to clean out of the PCL. I got to see the drill holes that run entirely through my tibia and femur and I also found out what that random nick on my thigh was from.
Apparently, a long needle was inserted through my tibia, through my femur and out my thigh. It’s how they thread the new graft properly into place, with the right amount of tension. I was pleased to learn that it wasn’t a mistake cut, but the image of a needle going through my leg like that from the inside, sort of makes me wish I didn’t know that part.
The graft I got is an anterior tibialis tendon. It’s one of those super thick ones on the front of the ankle. In other words, I have a very serious graft in there. The surgeon said that my ACL tunnel was really small and tight, so they drilled a bigger hole there since he thought that perhaps my original injury was the result of a rope over a rock type scenario that wore away over time. That makes me a little nervous about my right knee now, but I’m not even going to go there for the time being.
I also found out that I won’t be upsetting any airport security with the screws in my knees. In a years time, they will have turned completely back to bone. That is pretty cool. I asked the surgeon if he had a disk he could give me with the pictures so I could share some nasty internal knee photos with you, but he didn’t. Consider yourselves lucky. It’s sort of weird seeing the internal workings of your body, knowing you were unconscious while some dude was in there with a camera. You’ll have to settle for this picture of the stitch-free knee. See that little reddish mark right below my pulled-up pant leg in the middle of my thigh? That’s where the needle came out. I added a before surgery picture for comparison’s sake. I think you should be able to tell the difference. Before leg: some muscle tone and pen marks; after leg: no muscle tone and dried blood.
I’ll be seeing my surgeon in another four weeks to check on my progress. Once I build my quads back up, I’ll be fitted for my functional brace which will be my best friend once I can go back to karate. He shook my hand, and told me he was going to have my PT "torture" me for a while now.
I know others have said PT is agony, but I enjoy it. Today, I was able to add 2 lb. weights above the knee for my leg lifts. I couldn’t believe how hard it was to do that. I’m going to try over the weekend to put more and more weight on my left leg to get that quad stronger so I can ditch the crutches. I can ditch them as soon as I feel ready. I’m just not there yet. My leg muscles are still rebelling a bit from all the trauma, making things a bit wobbly in the left leg. The last thing I want to do is blow my knee out again, so I’m going to be very patient when it comes to eliminating the crutches and brace.
At the end of my session, my PT measured my flexion and I broke into the triple digits at 103 degrees. That pretty much made my day. It doesn’t seem like it takes a whole lot to do that these days. A triple digit flexion combined with the absence of stitches, combined with less pain and swelling makes for a pretty fabulous day. I think I’ve rounded the corner and am finally beginning to imagine happier days ahead.
And just so we’re clear, I promise I will address some topics other than my all-consuming but fabulously interesting knee very soon. 😉
***The latest reviews are up at The BBM Review. If you’ve ever considered buying a sauna suit, you’ll want to check this one out. If you’re interested in a new educational video website, there’s another review you won’t want to miss.
The ACL Saga Continues
I had PT yesterday (nine days post-op) and unlike many who dread going, I look forward to it. I like making progress; and I like hearing that I’m doing a good job. It boosts me up and when you have this surgery, you need all the boosting you can get.
My PT was instantly shocked and pleased with the appearance of my knee. "I’m LOVING your knee," he said and went on to tell me that he doesn’t think he has ever seen a knee look this good at one week post op from ACL surgery. My knee cap is clearly visible. He said that the knee cap usually takes a couple weeks to make its debut post surgery. My swelling is only minimal now, and despite a pale yellow around the incisions, I never really got the big nasty bruises.
I was also able to support my entire leg without being braced for leg lifts. I’m now allowed to do them without the brace on. At the end of our session, he measured my flexion. I was nervous that it wouldn’t be good. My lowest incision is keeping me from being able to bend comfortably. It feels like it’s pulling. But despite the burning incision and the stretching steri-strips, I was able to hang out at 95 degrees flexion while he measured.
My PT told me he’s writing up a report saying that I’m doing fantastic for the appointment with my surgeon on Friday. Despite only taking some Tylenol before PT today, I’ve not had anything else. (The ibuprofen was starting to kill my stomach.) I’m feeling much more comfortable today and I think that this week will only continue to improve. I’m still taking it very easy, continuing to ice my knee and keep it elevated and stay off of it as much as possible. I’m obviously doing something right.
I needed a good day for a change. Stitches come out tomorrow.
Part III of ACL Surgery: First Shower and Weaning off the Pain Meds
Thursday (Three days Post-Op)
I was allowed to shower today. I just had to make sure not to let the water hit my knee directly, but it was o.k. if I got the stitches wet. With Lil C sleeping in like a teenager, my Mom helped me get up and get a shower. Without the brace on my leg, it felt awful. It also seemed to be a bit more swollen today. While my thigh already appeared to be wasting away, my knee looked so strange and big in comparison. Showering was absolute agony, but it felt so good to get really clean. My Mom stood right by the shower because I felt so unstable. Getting out of the shower was the hardest part. I never could have done it alone. Thank God for awesome Mom’s.
When I got out, I started seeing spots again and had to sit down. The shower felt good, but was so stressful and uncomfortable. Mr. BBM is going to have to rig up something a little easier for me. After icing my knee down, I went through the first round of exercises that I must do every day, three times a day. I was able to complete:
- 20 ankle pumps (to help get the fluids moving out of my knee)
- 20 ankle rotations in each direction to help with ROM and swelling
- 3 sets of 10 leg lifts (My PT said I may need help the first few days doing these, but I did them on my own with no problem.)
- 10 gentle bending stretching sitting on the edge of the bed. My Mom said it looked like I was to about 70-75 degrees which is just awesome for three days post-op.
- 10 quad sets. Today I was actually able to see my knee cap move a bit when I flexed my muscles. That’s improvement from yesterday.
I’m still in bed, making sure to elevate my leg and ice it often. There is definitely throbbing in my knee and the lowest incision is sore (the brace makes contact with it and that hurts), but I’m improving already.
Friday (Four Days Post-Op)
Mr. BBM forgot to set the alarm and wake me up for pain meds. That was a mistake. I got them two hours late and I paid for it. I’m so sore. Getting up this morning was rough. My leg started throbbing as soon as I lowered it down to crutch it into the bathroom. I couldn’t wait to get back in bed. I took my brace off and saw lumps on my legs from the swelling that accumulated in between the brace brackets. Need ice and more elevation now. I wanted to feel even better today. I’m a bit discouraged.
I spoke with my PT on the phone today. He told me to loosen up my brace over my painful incision and to keep my brace loose at night so as to eliminate the fluid pooling in my leg. It was a weepy day today. The pain meds are making me a bit nauseous, so I’ve been trying to cut back. Cutting back has been a bad idea. I think it’s just too early.
My incisions feel fine except for the lowest one. It’s the biggest one and unlike the other, has steri-strips over top of the stitches. I think this is where the drain was which would explain why it’s extra sore and a bit messy looking. I made it through my exercises today with a bit more pain than yesterday and am so thankful for a good friend who sent me a gift of candy cane peppermint tea which has done wonders for the nausea.
Tomorrow night is our family Christmas party at my Mom’s house. I’m going to try to go but am very nervous about the process of getting there and staying comfortable. I’ve been assured I can disappear to a bedroom for a rest if I need it. I’ve been requiring regular naps this week. I think I’m still catching up from all the lost sleep pre and immediately after surgery. Plus, this recovery is as emotionally exhausting as it is physically. I’m looking forward to hitting the one week mark, which I hope will bring greater relief.
I enjoyed a pre-med late night snack of peppermint tea (Thanks TKDDaughter) and English Fairings (Thanks TSDAdam). That was a nice way to end an otherwise uneventful day.
Saturday (Five Days Post-Op)
Despite a healthy dose yesterday of both prune juice and blueberry smoothie with more fiber than a cardboard box, still nothing. The Vicodin and Percoset need to go. As of this morning, I have switched to ibuprofen alone and am hoping that will do the trick. I’m nervous that it won’t but something has got to give here. (I know this is more than you ever wanted to know, but there’s not a whole lot to write about when you’re lying on your back non-stop.)
I woke up this morning without having had pain meds for several hours and getting out of bed was quite an experience. Once my leg is off the bed, the throbbing starts and I start feeling dizzy. I did manage to crutch it around my bedroom a bit and was able to put a bit more weight on my leg today. It doesn’t feel as awful as it did mid-week.
Mr. BBM is currently setting up a plastic chair in the shower and I’m hoping that today’s shower goes more smoothly. I can’t tell you how much I just want to feel normal again.
This morning’s first round of exercises brought a flexion that is knocking at the 90 degree mark. I am almost there. If it wasn’t for the throbbing pain when my leg is hanging off the bed, I think I’d be there. I want to hit that 90 degrees within the next day or two so that it’s easy by the time I see my PT again on Wednesday. It’s funny how much I want to make him happy and proud of me. I think it’s been particularly beneficial that I did a month of physical therapy first. We’ve developed a good rapport. I feel like he really wants to see me succeed and knows how to get me where I want to be.
Everyone kept telling me this was going to be a long road. It really hits you just how long after you have the surgery. Before it’s like "Yeah, yeah, long road, six months, o.k." and after it’s like "They really weren’t kidding when they said it was going to be a long road." You take extreme pleasure at an extra 5 degrees flexion and any decrease in pain is such a welcome sign of recovery that you’re ready to leap for joy. Of course you can’t leap for joy, but you do mentally. I thought that by today, I’d be getting around my house better, but it’s just not happening yet. My bedroom and I are really bonding.
I got a card in the mail today that said something about how I’ll have that black belt before I know it. I sobbed. I can’t even think about it right now because it just seems so far away. It’s not even the belt, just going back to karate in general is going to take so long and be such a mental challenge. I don’t ever want to go through this again, so I’m going to have to be so careful. I think it’s going to be just as hard mentally to go back as it will be physically to get ready.
As a woman, this surgery is also quite a blow to your wardrobe. There is nothing suitable to wear to this party tonight. I very well may end up going in a pair of my husband’s over-sized scrub pants and a sweatshirt. Oh well, they’re lucky I’m even attempting to show up.
I made it through my shower with a plastic squishy lawn chair in the shower and a card table chair outside the shower to allow me to keep my leg up. Mr. BBM had to keep repositioning the shower stream so I didn’t drown. I told him to stay near since I needed him to hand everything to me and be there in case I didn’t feel so great.
As he stood there in the bathroom, keeping an eye on me through the curtain, I started laughing. I’m sure the image of helping your wife shower is so much better in the head than in real life. Here I am, seemingly an 80-year old invalid with a mishapen leg, trying to figure out how to scrub her butt in a lawn chair. I just had no idea it was going to be like this. I don’t think Mr. BBM did either. I have no idea how people do this who don’t have good help. It would be pretty much impossible.
Post shower, I was able to sit up, dry my hair in a chair and GASP! put on make-up. I feel like a human being again and I’m getting around a bit better. I seem to have kicked the heavy pain meds too, as ibupofen seems to be doing the job as long as I’m not looking for complete relief. What is complete relief anyway after this surgery? I can’t wait to find out.
I made it to the Christmas party after remembering a pair of black capri cords I got last year for Christmas that I never wore because I didn’t have the right shoes to wear. I wore my brace over top and it was uncomfortable, but better than showing up in scrubs. I parked myself in a recliner chair with pillows and a rolled up towel for the entire night, minus two trips to the bathroom. It went fine, but I watched that clock like a hawk to make sure I got my ibuprofen on time. I really needed it. My sister’s boyfriend also bumped my foot twice and that made me yell out loud. I made Mr. BBM stand guard at my foot for a little while afterward. I had a couple relatives come over and joke with me, pretending to slam their hand down on my knee. I laughed nervously, and told them I still had one leg and two arms that work properly.
I’ll spare you the details on the "main event" of the night, but I will say this: a Christmas "miracle" occurred (Thank you BobSpar for the prune juice advice). I’m feeling much better in that department. I know that’s a lot of information for the random internet readers; but failing to mention that as an issue after this surgery would be just plain dishonest.
My knee is rebelling against the no vicodin/percoset evening and is pulsing with pain. I’m countering with ice and hoping for the best.
Sunday (Six Days Post-Op)
Last night was a very rough night. I could not get comfortable and did not sleep very well. I also went pretty much the entire night until around 5:30 a.m. with no pain meds at all. I guess that explains the pain. It’s not awful as long as I stay horizontal and keep my leg elevated; but when I’m up and about, I can’t wait to sit back down.
I seem to be stuck in the second plateau here. The first days are the worst by far and now I seem to be stuck in the "it’s not terrible but it’s still not great" phase. I can’t wait until this phase passes and I can be a bit more active. Maybe by Christmas? I don’t want to be miserable all day on Christmas. The one incision is just so sore. The other three don’t seem to be bothering me at all. I can’t wait to get these steri-strips and stitches off and out. I think that will make a big difference. Here’s hoping anyway.
I got a call from the hospital today. An RN called and was checking on my progress and to see how I’m feeling. She also inquired about my stay. I told her the truth, that I had some great RN’s, LPN’s, CNA’s, etc. but that I had two experiences with RN’s that were just awful. I told her in detail about them and she seemed very sympathetic. She said that’s why they make these calls, so they can improve. She offered to let me talk to her manager, but I opted for a name and address instead since I want to write it down, and make sure I have it all. When she gave me the name of the nurse manager, I almost died. I’m hoping that this person is not the same person as the nurse I had the first night. I asked the RN on the phone about it. It’s a possibility. I told her that my biggest complaint was actually against her and asked for her supervisor’s name. She gave me a name and an address. Now I just need to write it up.
I think I’d like to volunteer at the hospital as an advocate for orthopedic patients. Seems to be like there is definitely a need as my experience can’t be the only one like that.
I feel asleep watching "The Bruce Lee Story" tonight on TV. I recorded it on my DVR so that I’ll have it for discouraging days ahead.
Monday (Seven Days Post-Op)
One week post-op and I’m not where I want to be at all. My Mom says I’m expecting too much. I have screws in my legs and that’s going to take some time to feel better. I tried to go without any pain meds today and that was a mistake. I was going to try to take a shower this morning but I couldn’t do it. I had to elevate my knee again. I took some ibuprofen and am going to attempt a shower a bit later.
This morning, I completed my first round of quad sets, stretches, leg lifts and knee bends. I was able to make my heel touch my bed skirt today. That’s 90 degrees. I would have been more excited if it hadn’t hurt so badly. I’m rewarding myself with some chocolate from Adam.
We had visitors from out of town so I made every attempt to be social. After a couple hours down on the couch, it was time for a break. I have my routine down in my bedroom and I’m just not as comfortable when I’m not there.
I was determined to feel the Christmas spirit. Feeling too miserable for church and terrified that I’d be bumped by someone, we skipped this year. It’s the first year I’ve missed Christmas Eve service in a long time. To make up for it, we spent the evening watching Christmas specials and movies on TV and sipping peppermint tea.
I discovered one perk to being out of commission. Mr. BBM had to bring up all the presents by himself. He also had to assemble a train table with over 64 bolts in it for Lil C. I’m glad he had some help from his Dad and his Dad’s fiance.
I’ve gone back to the heavier pain meds for night time. I just can’t make it through the night and/or get comfortable in order to fall asleep without one. I’m not taking the full dose, but it’s just enough to help me fall asleep and stay asleep. Sleeping with an immbolizer on is no treat. I currently have a set-up of about four pillows at various angles to help. It doesn’t help much.
I’m hoping for a Christmas miracle for tomorrow: no pain.
Tuesday (Eight Days Post-Op)
I was able to put on a mostly happy face today despite the continued discomfort. I’ve been corresponding with some fellow ACL reconstruction alumni and that has helped. It’s not just my Mom. I am expecting too much according to pretty much everyone who has gone through this. I’ve been told there’s a big difference after the two week mark, and that after three weeks I won’t be constantly reminded of the ordeal from the throbbing and burning. I’m really looking forward to that.
I’ve never been one to wish my life away, but this is an all out different scenario. If I could jump ahead to when my leg would feel better, I’d gladly do so. I want to feel better as soon as possible. Today I watched my kids playing with their new toys and jumped in with them as much as I could. Lil C was kind enough to bring her brand new Mickey Mouse Clubhouse over to the ottoman I was propping my leg on so that I could play with her a bit.
Everyone got me nice stretchy legged athletic clothing this year for Christmas. It was very thoughtful considering I was thinking I’d have to wear scrubs to PT again tomorrow. I may be hurting tomorrow, but I’ll be stylin’ too.
I hope all of you had a very Merry Christmas. The silver lining to mine? Mr. BBM is going to have to figure out where all the new things will go!
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