Skiing Again!

I lied. That wasn't my last post. This might not be either. No promises.

I'm back out there skiing! I was a little tentative at first and have been building up the number of runs/day gradually. I also am practicing some of Harald Harb's Essentials of Skiing exercises. They are great for intermediate skiers who want to move up to the next level. They are a killer on the quads, but that's exactly what I need since I sort of stopped going to the gym. Ooops.

I haven't had any swollenness after any day on the slopes or at the gym. Knock on wood. I think it's because I didn't have any miniscus damage. I have noticed that my opposite knee is feeling a little strained, though, after a day of skiing. I must be favoring it.

OK, that's the latest. Happy New Year.

Farewell Post!

Kayaking in front of Shoup Glacier outside of Valdez.

OK, if I'm able to kayak 16 miles and hike about in Alaska (with a side trip to perform with the Kingikmiut Dancers at the Alaska Native Heritage Center) then I think I'm done with blogging about my torn ACL, the surgery, the rehab, the physical therapy and all the rest. My knee fared pretty well during the trip. I did need to take ibuprofen regularly but it was fine.

I saw my surgeon yesterday. He said the ligament is strong but my quads are still weak. He said I have to get on rebuilding my muscles if I want to go skiing this winter. He also said that I probably caused some irritation with all the activity but it wouldn't have been so bad if I had been stronger! So I went right out and joined a gym. I did a good work out yesterday and didn't hate it (so much).

Good luck to all the newbie ACL reconstruction patients! Choose the best surgeon you can, find a physical therapist you like, and do the exercises. It will all work out. If I can do it, you can do it.

I MADE IT -- HIP, HIP, HOORAY!

Fin.

3 Months

This will probably be my second-to-last post. I'll write one more after my next doctor's appointment in mid August. Then, that's it. Blog over! Thanks for everyone's moral support.

It's been 3 months now since my ACL reconstruction surgery. My knee feels pretty good most of the time. The only time I have any discomfort (usually) is going down stairs and deep knee bends. But I'm sure it's because my muscles are still pretty weak. Which is no real surprise since I haven't done a very good job of keeping up with physical therapy. I missed all this week. And next week I'm off to Alaska for 10 days.

Last night was the first time in a month (just guessing) that I've had trouble falling asleep because of leg pain. It was strange. It was at the top of my tibia, on the anterior side. It felt like bone pain or very deep muscle pain. I'm going to go out on a limb and say it was muscle pain from the home exercises I did two nights ago. I may have over-done things in a misguided attempt to make up for lost time.

Here are some random fun facts.

Range of motion: I can bend my knee 145 degrees now. [That's in the normal range.]

High heels: I wore the tiniest of heel on Tuesday -- it did not feel great. That was probably a bad (but necessary) move.

Hiking: I'm clear to do hiking but I'm not supposed to take any HUGE steps.

Scars: Did I ever write about the scar treatment? I think I did. Well, the scars are fine. They are "loose" if you can imagine what that means (not adhered all the way through the depth of the incisions). I showed my scars off in Chicago to a stranger. He said my knee looks like it has a smiley face on it.

See some of you next week (I hope)!

Wrong Direction

Not doing my home exercises for two weeks finally caught up with me. At physical therapy today it was obvious that I've lost ground in my recovery from ACL reconstruction. Turns out these PTs might know a thing or two afterall! Back to squats, lunges, single-leg squats. And now we're adding some small jumping exercises to retrain my leg and knee to handle running down the stairs.

Holy Disintegrating Allografts, Batman!

I found a fascinating posting today on some site called Big Bob's Knee Blog* or something like that. It's about ACL allografts (i.e. tissue from a cadaver) failing because the tissue disintegrates!

Aaaaaaaaiieeeeeeeee! Something new to worry about.

This discovery led to me searching on "disintegrate allograft ACL". I'm happy to report I haven't found much (yet). But I did learn that a GoreTex synthetic ACL option exists. http://bioweb.usc.edu/courses/2003-spring/documents/bisc406-a.broosan.pdf

It has a high failure rate, so even if I had known about it before my surgery I wouldn't have wanted it. But it is cool to think that some day you could replace an ACL with man-made material.

One of the links to the right covers work early physicians did trying to find a suitable ACL substitute, such as using braided silk thread. Which reminds me that there's a book out there about the evolution of successful blood transfusion. You wouldn't believe what some poor woulded souls had to suffer coursing through their veins all in the name of science -- pig's blood, coconut milk. I heard the author on NPR a long time ago but have never followed up to read the book. The horror of what happens when your body rejects pig's blood has never left me.

Merde! What a morbid post!

*The actual site www.factotem.org/cgi-bin/kneebbs.pl/read/294003

Yoga with Witold

Today I took a private yoga session with Witold at Yogasana.
http://yogasanacenter.com/index.html

I was pleasantly surprised to learn that I can resume yoga classes. I'll go back to Level I. About a year ago I was poised to progress to their Level II classes. So it goes.

Witold gave me a routine to do at home that should help to strengthen both of my legs evenly. He said I should do it every day. It entails a sequence of triangle pose, warrior, and a modified pose that I forget the name of (it's sort of a combination of triangle and warrior). He also showed me how I can modify child's pose -- one of the last areas of flexibility I need to recover is stretching my quads when they're weight bearing and this pose is it.

I'm really happy to be back in yoga! I especially like the notion of working both sides of my body evenly. My hope is that it will help to restore the parity of the size of my thighs ; )

Eight Weeks

I had a big big weekend in Boston. I went to see the Cyndi Lauper et. al True Colors concert with my friend Stanley. It was reasonably good if a little long. Cyndi was the star. Debra Harry was a nightmare. Erasure rocked and the weather was beautiful. (The venue was held in a big tent.)

I wore a dress that I never get to wear. The tshirt concessionaire was selling "true color" tiaras for just $5 so I had to buy one. It went with the dress. It was fun to wear because I got a lot of attention. I think maybe people thought I was a man in drag -- or maybe a woman playing a man in drag. Either way, people thought it was a gas.

My friend Stanley has an old photo of me "dressed in drag." He said he uses the photo as a trick question: "Is this a picture of a man dressed as a woman or a woman dressed as a woman?" Scary! I thought I was just dressed in a flapper costume with a blonde wig.

The latest on my knee is that I can flex it to 133 degrees. It's practically back to normal in terms of straightening and bending. Now I just need to rebuild my quads and work on some lateral stuff. I still can't run for another 8 weeks but I should be skiing on opening day this winter.

Six Weeks

It's been six weeks since my ACL surgery. Overall, I think I'm doing well with recovery. The physical therapist is happy with how straight my leg is when I extend it. It looks almost normal, he says. I have about 15 to 20 degrees left to gain in flexing my knee. The last time they measured it was at 125 degrees after a little warm up.

Today I had ultrasound treatment for the tendonitis. The physical therapist seemed skeptical about the doctor's explanation for the tendonitis. He said that they usually only see that injury in basketball players. He seemed to think that my tendon is more likely irritated by the incision scar tissue that formed. Whatever. The end result is tendonitis and I'm supposed to take it easy and lay off the lunges and step-ups. No big loss in the short run. In the long run, tendonitis is something that is easy to trigger once you've had it once. Kind of a bummer.

Yesterday the surgeon said I will be doing physical therapy twice a week for at least another month. Or did he say two months? One extra benefit to doing this physical therapy is that I should be in good shape for rollerblading pretty soon. Something I've been meaning to do for the last two summers.

Which reminds me. Several people have commented about how athletic or active I am. My friend who writes quarkscrew.org said this to me most recently. It's weird because I really don't feel like an active person. In fact, I feel pretty slothful. Left to my own devices, the most active thing I would do is brush my teeth with a manual toothbrush. Luckily for me I have an active husband who likes to ski. Wait -- that didn't work out for me so well this winter...

Tendonitis

I saw the surgeon today. I've got tendonitis in my patellar tendon. The doc prescribed an anti-inflamatory I've never heard of (meloxicam). And he suggested I wear one of those neoprene sleeves to give my knee a little support. He said this is a common occurrence for ACL surgery patients. During the recovery when the muscles in your upper leg are weak (flacid, ugh) the tendon gets over-used and irritated. Luckily I am past the bone pain from my femur.

The doctor is pleased with my range of motion, strength in my leg, as well as how straight I can extend my leg. He gave me a prescription to give to the physical therapist to address the tendonitis specifically.

My next check-in is the first week of July.

Scars, Adhesions, Crappy Blogs

Yesterday Richard the PT "worked on my scars." That meant he pressed down and moved the skin around my scars. It's hard to explain, but it does not feel good. How come I'm the only person at the PT clinic that is ever yelling outloud? I never hear the nice 97 year old lady yelling out in pain when she's doing work on her hip. Am I that much of a wimp? Perhaps.

This is funny because it's true.
http://dirtymicrobe.com/products/your-crappy-blog/

Endogenous Opioids

I saw the accupuncturist today. She put needles in the joint opposite of where I feel pain; in other words my left elbow. It was a very strange sensation. I felt like my arm was pinned down by a sandbag. And when she manipulated one of the points it caused an electrical shock to run down from my elbow to my hand. I don't know how much (or whether) it helped. I still needed to take a painkiller at 5:00 today. So much for "quantities of endogenous opioids." Maybe tomorrow. She said that I should go two days in a row because the treatments are cumulative. I'd really like to get off these painkillers. They too seem to be cumulative and make me into a zombie.

PK Log:
5:00 PM Vicodin

Bone Pain on Wikipedia

Why does my femur bone hurt so much? Because the periosteum has nerve cells. And that is what the surgeon "smoothed" or "shaved." I watched him do it. It was like watching a stone mason sand a piece of white marble. The physical therapist said that this is going to hurt "for awhile." Great.

Bone
"The exterior of bones (except where they interact with other bones through joints) is covered by the periosteum."
http://en.wikipedia.org/wiki/Bone

Periosteum
"The periosteum is a thin layer of dense, irregular connective tissue membrane that covers the outer surface of a bone in all places except at joints.... As opposed to osseous tissue itself, periosteum has nociceptive nerve endings, making it very sensitive to manipulation."
http://en.wikipedia.org/wiki/Periosteum

Nociceptors
"Somatic pain originates from ligaments, tendons, bones, blood vessels, and even nerves themselves. It is detected with somatic nociceptors. The scarcity of pain receptors in these areas produces a dull, poorly-localized pain of longer duration than cutaneous pain; examples include sprains and broken bones."
http://en.wikipedia.org/wiki/Pain_and_nociception

Accupuncture
"Although the mechanism is not fully understood, it is likely that acupuncture stimulates the release of large quantities of endogenous opioids."
http://en.wikipedia.org/wiki/Pain_and_nociception

I'm seeing an accupuncturist tomorrow.

PK Log:
9:30 am Vicodin
7:00 pm Tylenol
9:00 pm Vicodin

One Month

For those of you keeping score at home, it has been 4 weeks since my ACL reconstruction surgery.

Things are going pretty well. I'm off crutches. I'm walking without a brace. I walk slowly but am getting faster every day. I have just started to take the stairs up like a normal person. It took awhile to be able to flex my injured knee enough to raise it in front of me to the next step, then it took awhile to get the strength to push myself through the movement on that leg. I'm not strong enough to go down stairs leading with my good leg -- it puts too much strain on my knee.

Today is physical therapy. I'm going to warm up on my bike at home before I go. This is the session that came with the "take your painkiller before your next appointment." Lord have mercy.

And if you're wondering how much knee surgery costs -- my doctor billed my insurance company $20,500. My share is $5,272. That's a little higher than I expected.

Lost Weekend

This wouldn't hyperlink, don't know why. Copy and paste the URL into your browser. I don't know who the artist is but I appreciate the sentiment.

http://www.flickr.com/photos/gregbiche/232224439/

I slept most of this weekend. I think I was sleeping off the cumulative effect of painkillers I took Thursday and Friday. Not that I took that many. I think on Friday I had 3 over the course of the day and night. I seriously think I'm having trouble metabolizing these things. Or maybe I take them too frequently?

I avoided taking a PK all day yesterday. I only took Tylenol for the constant, gnawing pain at the abraised spot on my thigh bone (femur). It persisted through the Tyleonol yesterday but I was able to ignore it while I was out walking around. It's impossible to ignore when I'm trying to sleep.

I was up at 11:45 pm, 12:30, 1:45, etc. Eventually just got up, took Tylenol, and read at 4:30. I was hoping I'd get sleepy and go back to bed. No such luck. The throbbing kept me from feeling sleepy.

I'm going to contact the accupuncturist I saw last year to talk to her about pain management. In the meantime, back on PK today. Blah.

PK log
8:00 a.m.
7:00 p.m.

House Hunting

We went to a few open houses today. Here's Brett studying his elaborate spreadsheet, keeping us to a tight schedule. No time for dilly dallying!






This van was parked outside one of the buildings we saw today. It sort of creeps me out, but I have to say I respect the retro-ness of the van.

[click on the photo of the van to see the detail of the window decals]

Lucky

Moby in the backyard. He says, "I fail to see the humor in this."

I made sourdough pancakes today with the sourdough starter my mom made while she was here. They turned out pretty well. Not quite up to the memories of my grandma's sourdough hotcakes though.

Anyway, the egg I used had two yolks in it. Isn't that supposed to be lucky?

SO sleepy!

I was out last night until 11:00. We watched an episode of The Sopranos (Season 5, episode 4) then went to bed at midnight. I slept until 9:30, then went back to sleep at noon and slept until 4:00! That's crazy! I think the heavy sleep today was a direct result of taking painkillers yesterday for the post-physical therapy. The physical therapist will say it has something to do with my "parasympathetic nervous system" blah, blah, blah. I feel like a loser! Who sleeps for 13 1/2 hours? Insane.

I've been in a lot of pain today. It's the spot on my femur where the doc "shaved" or "smoothed" an abrasion. After sleeping so much today I avoided taking any painkillers until after dinner tonight. Balancing pain and reaction to the painkillers is tricky.

113

This is a shot of me "walking up the wall." It's a closed kinetic chain exercise I do at home. I took a picture of my knees because I think my right knee (the rehabbing knee) looks like it's the widest part of my leg. (It is not. But my left thigh is 1" bigger in diameter than my right.)

My knee flexed to 113 degrees today. I should be able to push a bicycle pedal around one full rotation pretty soon. In fact, I think I can do it tonight now that Brett has brought my bike upstairs. We have one of those bike stands to make any bike into a stationary bike.

Ice Cream

We have two apartments above ours in our building. Our neighbor on the third floor brought me sorbet and a Sopranos DVD last week. Our other neighbor heard about that and emailed to see if I need a refill. She is going to bring me ice cream tonight. So sweet!

I'm walking without crutches all the time now. But today I have a long day ahead of me. Going all the way to Harlem for a meeting and then back to Brooklyn for my physical therapy. I had a similar day on Tuesday and was almost unable to walk by the end of the afternoon. Really regretted not having a crutch that day to lean on so today I'm taking one along just in case.

Sleep is still a problem. I woke up at 4:30 am with a lot of pain. Brett brought me an ice pack and Tylenol. I'm surprised I had so much trouble. I had a light day of walking yesterday and spent a good amount of time icing my knee. Drat.

No sleep till Brooklyn!

I'm not sleeping well at all. The brace was not the problem. It's my knee. The ports where they scoped my knee are still healing. The incisions were not long, but they were deep. There are at least 4 incision points on my knee. But there is one major one on each side of my knee cap that are the problem. At the end of the day when my knee is swollen I can't put any pressure on either side of my knee. I'm a side sleeper so every night I wake myself up from turning onto my side and bumping my knee. Last night was bad. And after today's physical therapy, I'm pretty sure tonight will be a tough night as well.

But it's all going to get better eventually.

Blog Title Inspiration:
http://www.youtube.com/watch?v=RI2IyHXJo5M