with a vengeance

Yesterday was the last day for the prednisone. I missed some times so ended up stretching it out a little longer.

Today the rash is back and so is pain in my left leg. I woke with stiffness and pain in my left leg, the calf area, and it has been there all day. I swam a bit at the gym (the Aqua class was cancelled - not enough people came out for it in the rain), hoping the swimming would ease the stiffness. It didn't. I later went to a few places to shop and again, no change.

So I am limping around the house, trying to get things done and just hating it.

Respite of a different kind

I am on the third day of a course of prednisone, prescribed to treat an odd skin rash. I knew when it was prescribed that I would get a break from some of the pain of arthritis as well, and I welcomed it.

Because prednisone reduces inflammation, what I am noticing is the reduced pain that is attributed to inflammation. It does nothing for the built-up fluid in my left knee, nor for the pings and occasional sharp biting pains that are probably associated with bone-on-bone activity. What I notice is that when I am sitting for a little while it is not hard to get up again, and generally I can move more freely and some of the exercises I do are easier. During this rather hard pain time, I am enjoying the break.

It will all go away again, of course, when the prednisone wears out. I may have a few days beyond that end. Might even make it to Christmas. Nice.

Respite

This morning, when I awoke at about five a.m., I got up to feed the cats, who were hounding me mercilessly. The pain in my left calf and knee was bad. I had to hold onto the wall and work my way down the hall, taking deep breaths, trying to stay upright. I went back to bed and slept for another two hours, and when I woke again the pain was much less. As I got dressed it was less and less and I was able to do my usual workout at the gym without incident, except for one time. I was doing "resisted hip" exercises - extension, abduction, adduction - with my left leg in a loop, my right holding the floor down, when suddenly my left calf went into another pain strike, similar to what was happening yesterday. Fortunately, it  came out of it and I was able to finish my workout and get home without any further incidents.

For the rest of the day it has been its old self. I am even reminded of what it is like after I have a particularly bad headache: it seems better than before. I don't think it actually is better but I feel such relief that I almost float.

And it continues

Unfortunately, after a bit of respite earlier today, the pain in my left calf and knee returned, with a vengeance.  I had some plans for the afternoon but the pain sent me limping, holding onto whatever I could get, to my bed. I took another codeine-acetaminophen tablet and a nap and woke still in pain. I made my way back down the hall, bent over and sobbing, wondering if this was it, if it would ever get any better.

Little by little I got up and down, walked as well as I could, worked my way around the kitchen, and the pain subsided enough.  I can now get around the house without searing pain. I am hoping that I wake tomorrow over this! Over it!

Pushing through

I have had lower back pain for the past several days. I get back pain now and then but usually it only lasts a day. Not this time. It is hard to do things when my back hurts, needless to say.

This morning I woke with back pain again but it was a little less. My legs, though, were doing worse. It was very painful straightening my legs out for some of my morning exercises. But, as usual, it helped a little just to do them. I found my way to the couch and my computer finally and thought I would do all right. Then I got up to get ready for Aqua class and a sharp pain hit my left calf, from knee on down. It was excruciating. I limped to the counter, which I grabbed, and considered not going to class. I could hardly walk.

The pain was so intense I decided to take an acetaminophen and codeine tablet. Just one. I can sometimes avoid nausea if I take just one. It was soon after that I got my stuff together for Aqua. During the class there were many times my knees and calves hurt, but it was manageable. I could not tell if the pain reliever made a difference or not. Just moving helped.

Lately I realize that I go to the gym more for day-to-day living than for longer-term goals. I find that the exercises help loosen me up a little, make me a little stronger, help me through the day. I know when I go that I will likely leave the gym feeling a little better than when I arrived. It's enough of a reason. And so it was today. I was able to go to the store and do a little shopping without much pain.

Having pain, even these bouts of extreme, burning pain, is not enough of a reason to avoid exercise. Especially because the exercise can help and rarely makes it worse.

Cool in the Pool

I live in a place that has a mild climate. Rarely does the temperature dip below 60 degrees F during the day. But there is wind, and in an outdoor pool a temperature of 60 and a bit of wind can make for a chilly experience.

Monday was the first day I really felt it. We were moving actively, as we always are in Aqua class, yet every time my shoulders were outside the water I felt the chill, the goosebumps, on my arms. The water was warm then, however, so it was nice to stay as much under it as possible.

Today it was perhaps chillier and the water was not particularly warm. Probably warm enough for a summer day but not so much for right now. I heard different stories about this: 1)  that usually the pool gets cranked up a bit in the winter but perhaps the staff was caught unawares by the sudden temperature drop; and 2) the pool heater is broken and needs to be fixed.  I could buy either one of those. This is a nice gym but some things are neglected, obvious things, which I don't know if I will ever understand. Could be just a lack of consistent management or a real maintenance plan.

Barb, the cheerleader, was our leader today. She is the queen of the intervals and today she was really into that, to keep us warm. For example: We twisted, suspended (no feet on the pool bottom), as fast as we could, for these intervals:

30 sec, 15 sec break
45 sec, 15 sec break
60 sec, 15 sec break
60 sec, 15 sec break
45 sec, 15 sec break
30 sec, 10 sec break
60 sec, 5 sec break
45 sec, 5 sec break
30 sec

The "breaks" were times we put our feet down and usually did jacks instead of twists.  Following these intervals, we did five minutes of kicks, noodles under our arms and legs extended in front of us, kicks from the hip, alternating flexed and pointed feet. Five minutes is a LONG time doing that.  We did several other activities in intense concentration as well. I will say it did get us warm, as warm as possible given we were not entirely under water. When we "bicycled" in the water with our hands in the air our hands froze. I was reminded of that commercial: "I can't feel my feet!"

There is another class member who always wears a wetsuit top that covers her head as well as part of her face, plus a hat on top. She is practically unrecognizable out of the water. I asked her about her outfit and she said she was still cold but that she had tested the top by not wearing it one time and there is a big difference. She said it is very worth the cost. So I am seriously thinking I'll get me one before the next Aqua class.

The good thing is that all this activity, which really was not different from an average aqua class with Barb, just colder, did seem to be good for my joints. I was able to go to a market and do a little shopping without pain. And now I am moving around the house all right. Much different from yesterday.

More Pain

I had a hard time last night, limping around the house, because my right leg - from the thigh to the knee to the calf to the foot - hurt so much. I took a couple of tylenol arthritis capsules when I went to bed, but woke at about 1:00 am in such pain that I actually cried. I tried pushing my right knee into the bed (one of the twice-daily exercises), an exercise that was so painful I gave it up. I finally took two more capsules of tylenol arthritis and tried to sleep. I found some ways of placing my leg that helped ease the pain a little and finally dropped off to sleep again.

This morning that leg was much better. Still not back to "normal" but more manageable.

I don't like taking pain relievers because I feel they distort my experience with arthritis and skew how it feels (among other reasons). But last night I even looked hard at a bottle of acetaminophen with codeine, just for a moment. That stuff takes away pain, most of the time, but it does so by making me so nauseous and headachey that I usually cannot tolerate taking it. So it was last night. I left it on the shelf.

Some Pain Here, Some Pain There

A couple of nights ago I woke two or three times because of sudden pain in my left calf. It wasn't a cramp. I don't know exactly what it was, but it was sudden and sharp and impossible to ignore. By morning it was okay again.

Last night I had pain in my right leg, the calf area also. I limped around a bit and when I arrived at the gym I had sudden pain in my right hip. I managed to get through the gym routine and was feeling a lot better afterwards. But by the time I was off to sewing class, less than an hour later, I was feeling a lot of pain in my right foot. This pain remained throughout class and beyond, and is still with me. I limped around all day, feeling discouraged but trying to stand straight as much as I could.

I may go for tylenol pm tonight.

Up From Pain and Slipping at Times

After my few days of unusually bad pain  I went back to a "normal" that isn't so bad. I have managed to get around without a whole lot of pain, my times on the treadmill have generally not included pain, I have felt well enough to get up and do some cleaning and shopping. Not all wonderful but better.

There are times that I do slip from the path. Last night, for example, I just watched television and did not do my nighttime exercises. If I do not get them done earlier in the evening chances are I will not do them at all. I forgive myself. I am human. It doesn't happen often.

Also, yesterday morning I got started later than usual and skipped the resistance band exercises at the gym, along with the left arm stretches with the wooden stick. These are all exercises that I could skip one day a week, really, considering that I do similar moves in Aqua and that my arms and shoulders are doing much better than my knees and hip. I planned to pull out the bands at home and do them after sewing class anyway, but I didn't do it.

This blog is as much a confessional as a record of pain and progress. I am not looking for advice unless it relates to what I am doing. I am not looking for cheerleaders or coaches, telling me to buck up, get going, don't ever skip an exercise. I know what I need to do and I am doing it. If sometimes I slip that does not mean I need anyone standing over me reminding me that I need to keep this up. Do I not know that?

Pain Days

For the last few days I have had more pain in my knees and my feet. Not in my hip, fortunately. When I wake in the mornings and do the bed exercises I find the first ones quite painful because I am so stiff and in pain.

Today I felt like skipping the gym and I think I could have justified it, but I know that, as they say, that way lies disaster. I can miss a day now and then but I have to get back to it quickly.

Here's the thing with me: I don't seem to develop habits. Good habits, that is. I have the habit of reading my life away. I have the habit of eating when I watch television. But when it comes to things like brushing teeth or doing exercises I have to decide every single day to do them. It doesn't happen automatically. So if I miss several days in a row I'm surely in danger of missing a lot more. Today I felt sluggish and in pain and I had to talk my way through the fifteen minutes on the bike, but I knew I had to get through it. I have learned that it is important not to give in to those bad feelings too often.

Consumer Reports Agrees with Me (generally)

I got an email from Consumer Reports Health today, that included a blurb about knee arthritis. It said exercise helps knee arthritis but the jury is still out on whether it helps hip arthritis. I went to the site to read the whole article and discovered that I have to subscribe to that particular division of Consumer Reports to read it. I had not subscribed before ($19 a year) because it seemed the health advice was similar to what is reported elsewhere.

However, Consumer Reports has no ties to any commercial interest. Along with Best Pills, Worst Pills, then (a division of Public Citizen, an old respected consumer organization), it is a source that can be trusted, as far as it goes. So I went ahead and subscribed today.

In part, the article notes:

Do they work?

Yes. If you have osteoarthritis of the knee, exercise can reduce your pain and disability and help you lead a more normal life. We're not sure how well it works for osteoarthritis of the hip.

Other physical therapies, including applying superficial and deep heat or applying ice, are popular for dealing with osteoarthritis. But there isn't any good evidence that these treatments help, although they might make your joint feel better for a short time.

What are they?

Exercise for osteoarthritis can be either general exercises for your whole body, like walking, swimming or aerobic exercises, or it can be specific exercises for the joint that is troubling you. The best specific exercises for the knee may be those that strengthen the muscle at the front of the thigh.

There are many different exercises that may help your osteoarthritis. You should discuss what might work best for you with your doctor or a physical therapist. An exercise program may include strengthening and stretching exercises.

The article then offers a couple of examples of exercises that help:

Knee exercises

These are strengthening exercises for the muscles at the front of your thighs. In one exercise, you lift your leg straight up in the air. You do 200 of these straight leg-raises a day. Your knee joint doesn't actually move, but you strengthen the muscles that support it.

Resistance exercise

You lie flat and lift your heel straight up until it's 12 inches off the ground. You bend your foot up and down and side to side in a T shape, and you repeat this pattern three times.

Resistance exercise may help your osteoarthritis.

You may then move on to an exercise in which you stand against a wall and slide so your knee is bent to 30 degrees. You hold this for 10 seconds to 15 seconds and repeat three times.

General aerobic exercise

This form of exercise is designed to make you more fit overall. It improves the ability of your heart to pump blood around your body and the ability of your lungs to take in air. It can help you lose weight and feel good about yourself. Aerobic exercise should increase your heart rate (your pulse).

These exercises are similar to (but not identical to) some that I do every day.

The web page includes the evidence, something I am always wanting. I can look up the actual studies and the conclusions.

Lately I have become a little discouraged and have even missed one day of Aqua and part of my evening exercise routine. But I am calling that a break and moving on, fully charged. There is no sense in regretting what I have not done, because it is past. My next goal is to pull together all of the pieces and describe here exactly what my routines include now. At times I forget myself!

A Walk

Today I went on a Walk for Farm Animals. This is a walk to raise awareness of the plight of farmed animals, and it is the third year in a row that I have done it. Our local walk simply makes a loop around the downtown area, and takes about 45 minutes. With stopping at stoplights it takes a while to get anywhere. I'd guess the route is about a mile or a little more.

I was still in some pain when I got to the start of the walk. I had just returned from a trip south last night, driving both ways, and trips do make me stiffer than usual. Still, I thought I would relax a bit and get more comfortable as the walk went on. It didn't. It was painful from start to finish. I focused on walking on the inside of my feet and holding myself as straight as I could but it was clear I was limping a little and that I was in pain. I had really hoped that by this time I would be walking more easily but it is not to be.

I have been reading a book about the lives of some individual farmed animals who were rescued. Because of the way chickens and pigs are bred, they gain weight rapidly and their bones cannot take the weight easily. The factory farms where they are raised are not concerned with this condition because they slaughter the animals when they are still babies - six weeks to six months old. But the lucky ones, the ones who are rescued, are left to suffer with the results of this breeding. Turkeys, chickens, and pigs reach a point when their fragile bones cannot support their weight. The hens are further depleted by the egg-laying. A factory-farm hen lays several times as many eggs per year as a hen who has not been bred for this purpose, and the laying depletes the calcium in their bones.

Thus all of these animals have trouble walking, too. I can relate. I don't carry as much weight as they do relative to my bones but I can relate.

A Fourth Meeting with Clara

On Thursday, October 7, I met with Clara again. Clara is the trainer at the gym who has been helping me build my strength where I need it to counteract the effects of arthritis. I showed her the new exercises given me by Paul, the physical therapist, and I told her that overall I felt I was at a higher level, experiencing less pain in general, than I was when we first met in April of this year.  We went upstairs to the weight room area.

She showed me a machine where I could the new hip exercises, using a band around my ankle and weights.

We discussed the sitting and standing routine, and decided I could do that on the high box that sits in the weight room area. I can also sit on that box to do the raising and lowering of my leg, with ankle weights.  Unfortunately, the gym does not have ankle weights so I will need to find mine and bring them with me.

Finally, I asked her about alternative ways to do some of the things I am doing already. She showed me a new way to do lat pulldowns, sitting on a large ball, thus efficiently working the sitting and standing muscles as well. I also learned how to do the compound row using a different machine.

I will continue to do the remaining exercises as before, except that I will alternate using the different machines for lat pulldowns and compound rows.

In the last few weeks I have lowered the weight on some things and raised it on others. I felt I needed to keep it down more on the leg press so that I could focus more on keeping my knees apart.

Since meeting with Clara I have done the new routine a few times. I found I rather enjoy using the new machines. They are a little different in how they work so they probably work my body a little differently, but also just manipulating different machines gives me more a feeling of mastery, and I am more likely to find machines I can use when I travel.

At this time I am doing the rising and lowering to a seat rather sporadically. I think I need to work in at least one time a day when I do that consciously, regularly. Similarly, I haven't gotten the sitting leg raises and curls with ankle weights in at all, because I haven't found my weights.

The visit with Clara took only a half-hour. We will meet again if I feel the need or after my next visit with Paul. So far this way of adjusting the routine is not turning out to be costly for me, which I appreciate. I don't need anyone holding my hand or walking me through the routines regularly, as I can pick up and do them myself. I can also adjust as recommended.

The Foot Pain

Today the foot pain was gone when I woke up. I think this pain is the gradual manifestation of arthritis in my foot.

So my getting around was better, my walking was better. Even standing was okay. Not that I did a lot of it, but I did it with my weight toward my big toes rather than the outside of my feet.

Right Foot Pain

For the last few days I have been happy to adjust my walk by putting my weight on my heel, then moving to my big toe and the big toe "knuckle".  Most of the time this means I walk deliberately and perhaps a little slower but the pain is less than it was. Or at least it seems that way.

This morning I woke with pain in my right foot. I managed to get down the hall to feed the cats but the pain was hard to manage and did not get better. By the time I finished my morning exercises (on my bed) and brushed my teeth and got dressed, the pain had subsided some, and my foot did not seem too bad by the time I got to the gym. However, it surged again on my way out the door and as I prepared for sewing class. It was with me throughout the class, causing me to limp to some extent. I still tried to walk the right way but I was not rewarded with less pain.

The pain is on the right side of my foot, toward the heel but in front of the ankle, and radiates through that section, from bottom to top. The top seems to be the most painful.  When I point my toe the pain worsens.  I haven't found a position that takes the pain away. I might even indulge in some tylenol for the first time in quite a while. 

At the gym I did not do my usual five and a half minutes on the treadmill, because no treadmills were available each time I looked. So I do not know if walking on it would have helped or hurt.

Learning to Walk Again, and Other Stories

not my knees but they could be

I have been trying to put my finger on what especially disappointed me about my last visit to the physical therapist. Paul answered any questions I had but I did not know what to ask, perhaps. As I thought about it later I realized I wanted more of a "test". I wanted to know more about what I have accomplished, and the tools at Paul's disposal would not really give me that. I have thought about this some more and figure eventually I will get a complete physical, or at any rate a near-complete one, perhaps when I first can start on Medicare, which is next January.  That won't tell me where I've been but it will provide a marker for the future.

In the meantime I have been trying to work in the new Paul exercises. I haven't done all of them yet even and I haven't worked out when I will do them or how often. I am thinking I'll blend them with my morning routine eventually, but I will also fit some in throughout the day.

One of the new exercises is the rising from a chair one, without hands. I have been doing that somewhat randomly, as it occurs to me and when I am in the right frame to do it. I have found that if I have been sitting for a while it is going to be too painful. So when I am near a higher chair or the bed I try it then, a few times up and down.  This is going to be tremendously important as time goes on. As I am better able to rise and sit without hands my life is going to be different, better.

Similarly walking. I have been trying to focus on my steps every time I walk now. At first it was awkward but it is getting easier and it seems to be causing me less pain. I sometimes think of myself and "my new legs", feeling such hope that as I adjust my gait the pain will gradually lessen and again my life will be better.

None of it is instant. Wouldn't it be wonderful if Paul said, "Have you tried X?" and I try it and say, "Wow!! I can walk without pain now!" No instant therapy here. Yet I feel these latest exercises are coming closer to what will really help and I will see a difference, I will be able to tell maybe in a month.

Second Time with the Physical Therapist

This morning I met with Paul, the physical therapist, for the second time. It has been about two and a half months since we last met. I hoped to see clear positive changes from the work I've been doing.

There were some, but they are small. I should have expected that because Paul said it would take a long time for changes to be measurable. The positive changes were in the range of motion for my knees. They have both increased. There may have been improvement in other areas as well, but not as measurable. The alignment of my knees is just about the same. As Paul said, "It's not worse!", which is true.

I felt a little deflated that there wasn't some huge improvement that was magically measurable. But we moved into additional areas and I see some real potential for improvement here:

* Paul showed me how I should be walking on my feet. I told him my feet felt off-balance and he watched me walk and showed me what I need to emphasize. I need to start with my heel and then move to my big toe and the "knuckle" of the foot. I have been walking more on the outside of my foot for so many years I can't remember any other way. As soon as I tried walking the right way it seemed that walking was less painful. It takes a bit more effort so I don't see this changing overnight. But now I am aware of specifically how to place my feet and this will make a difference.

* He showed me a "test" for rising from a chair. It involves rising from an 18"-high chair with arms crossed in front, continuously for 30 seconds. That is, seeing how many times one can rise from the chair in 30 seconds. I did it six times. The average for my age is about 12 - 15 times. So that's my goal, get to average. And to get there I will start out with higher seats and rise very slowly and lower very slowly. Honestly, I was surprised that I could get up that way at all! I think some of the exercises I have been doing have started to give me enough strength to do so, and I am very encouraged and even excited about this. Getting up from a seat without using my arms is something I have wanted to be able to do for a very long time.

He gave me more hip exercises that I can do with resistance bands, and something for my knee - unfortunately, we forgot to get me copies of that exercise. I will have to ask. Let me see if I can remember, though:

Sit on a high surface and place a weight on my ankle. Let it swing comfortably for a bit, then raise up and hold, then bend inward and hold. I think this one is to extend the range of motion of the knee.

My next step, then, is to make another appointment with Clara and discuss these new exercises with her so we can work out changes to the gym routine.

Glucosamine and Chondroitin are no help

From McDougall's newsletter Sept 2010:

Glucosamine and Chondroitin Do Not Help Arthritis

Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis by Simon Wandel, published in the September 22, 2010 issue of the British Medical Journal concluded, “Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged.”¹ They went on to say, “Our network meta-analysis of all 10 available large scale patient blind randomised trials in 3803 patients with knee or hip osteoarthritis showed no clinically relevant effect of chondroitin, glucosamine, or their combination on perceived joint pain.”

Comment: The most common form of arthritis afflicting humans is osteoarthritis, often referred to as degenerative arthritis, because the joints slowly deteriorate as a result of “normal wear and tear associated with aging.” Doctors commonly advise people to lose weight, especially if they have disease of the joints of the lower extremities, and to avoid prolonged and strenuous use of the affected joints. Non-steroidal anti-inflammatory drugs (NSAIDs), such as Motrin and Advil, are commonly taken for pain relief. Paradoxically, these NSAIDs also accelerate the loss of cartilage in the joints and delay bone healing.^2,3 This then worsens the osteoarthritis.

Taking cartilage constituents, such as glucosamine and chondroitin, has been recommended for osteoarthritis, and many studies support its use. In my April 2004 newsletter I recommended glucosamine for arthritis based on the research I had available then. However, in the past six years I can recall no patients telling me of pain relief or improved mobility that they have achieved from taking this cartilage supplement. Therefore, I am changing my recommendation. Because of the low cost and few side effects, you may still wish to do your own personal trial with glucosamine, but I can no longer tell you that I believe it is beneficial. (I reserve the right to change my opinions on all medications and supplements because the research is always changing and most of it cannot be trusted as reliable in the first place. In case you are wondering, I will not be changing my opinion on the best diet for you.) I have never recommended chondroitin because it is derived from cow cartilage. This cow matter may contain infectious microbes, such as those that have been found to cause mad cow disease.⁴

The overall benefits of a healthier diet and weight loss for osteoarthritis are well established.⁵ Three-hundred and sixteen older, overweight or obese, sedentary men and women with x-ray evidence of knee osteoarthritis were randomly assigned to one of four 18-month treatments: healthy lifestyle control, diet-induced weight loss, exercise, and diet plus exercise. Those who lost weight due to an improved diet showed a decrease in inflammation measured by a variety of tests. Exercise did not seem to make a positive difference in this study.

I recommend people with osteoarthritis take very good care of their diseased joints. This means in many cases that they should avoid certain exercise. Someone with disease of their hips, knees, or ankles should not be running, and maybe should limit their walking. Instead, exercise for them should be bicycling, swimming, and/or rowing. The best diet for weight loss and overall joint health is the McDougall diet.

1) Wandel S, J¸ni P, Tendal B, N¸esch E, Villiger PM, Welton NJ, Reichenbach S, Trelle S. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis.BMJ. 2010 Sep 16;341:c4675. doi: 10.1136/bmj.c4675.

2) Vuolteenaho K, Moilanen T, Moilanen E. Non-steroidal anti-inflammatory drugs, cyclooxygenase-2 and the bone healing process. Basic Clin Pharmacol Toxicol. 2008 Jan;102(1):10-4.

3) Ding C, Cicuttini F, Jones G. Do NSAIDs affect longitudinal changes in knee cartilage volume and knee cartilage defects in older adults? Am J Med. 2009 Sep;122(9):836-42.

4) Mad cow disease and chondroitin sulfate. Harv Health Lett. 2001 May;26(7):3.

5) Nicklas BJ. Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial. Am J Clin Nutr. 2004 Apr;79(4):544-51.

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The comments above are by Dr. McDougall. I notice that in his recommendations he says "exercise did not seem to have a positive effect in this study". Meaning exercise alone did not reduce pain. 

He goes on to recommend for and against certain types of exercise - swim, don't walk, for example. Take care of your joints.  And eat a low-fat vegan diet. I already eat a whole-foods vegan diet so do not believe that the inflammation in my joints comes from my food (I have done some limited tests). I do tend to stray from low-fat from time to time, sorry to say.

I think certain types of exercise can in fact reduce pain. But the exercises do need to be specific to the source of pain, which is the type that I am doing now. I have noticed some differences in the pain - both in the intensity and the length of time I am in pain, and I hope to find some specific changes when I go to the physical therapist tomorrow.

Moving ahead

This morning, at the gym, I felt no pain while on the treadmill, for the full five minutes. I still felt a little discomfort, stiffness, but it did not bother me. It was a short time and I did not want to tempt fate by staying on the treadmill longer, but it felt good.

Earlier I had felt more pain in my right knee than usual. Lately my knees have been sharing their pain with me more while my right hip offers less. I like to think of this as a kind of progress, because I think the overriding hip pain was blocking out the knee pain for so long, and now the hip pain is less, so the knees are coming back.

Tomorrow I have my second appointment with Paul, the physical therapist. I will see what progress I have made and I hope I will remember to ask about the resurgence of knee pain.

Getting the Strength Back

I was sick on my trip. The first three days I was too sick to even think about exercise (although I continued to do my PT* routines). Then I started feeling better and better. I drove home Wednesday, three days ago, and I am now working on getting back where I was. I've been back to the gym three times, twice doing my weight machine routine and once to an aqua class. I have backed off the weights for most machines both times, and even then I felt tired. But I did them! I keep remembering one tip from the Arthritis Foundation: keep on doing the exercises even when you don't feel tip-top. Thing is, we arthritis folks don't tend to feel tip-top a whole lot, or at least I don't. So if I let the little setbacks throw me I'd never get anywhere.

I came home to find my gimp placard in the mail. So I have been enjoying driving up to the front of the gym, not having to hike in from the farther reaches of the parking lot.



* PT: Physical Therapist - see this and this.

Ears and Thighs

I woke yesterday with a cold. I made it to the gym for my regular routine, then off to sewing class, and finally got home to pack for a trip to Las Vegas. I left home at almost 5:30 yesterday afternoon, planning to stop halfway and continue the trip today. I felt so sick I found it hard to pack and get moving.

I did make it to Mojave as planned, and into my favorite Motel 6. The trains here are very loud but it seemed like I only started hearing them this morning, so they did not interrupt my sleep. My sickness and more interrupted my sleep, though.

At one point I blew my nose and felt a sharp pain in my right ear. I hope I have not done anything seriously wrong to that ear. I don't think so. I woke several times feeling hung over, but without having had the benefit of the alcohol.

Then in the middle of the night I awoke with cramps in my inner thighs. You'd think that with the exercises I do specifically for this part of my body that I would avoid these cramps, but no. I managed to ease out of them by breathing deeply and stretching and drinking water. I don't know how the water helps but it seems to. I am hoping that the rest of the drive will not lead to another set of cramps tonight. Also hoping that I won't get sleepy from the decongestant I hope to be taking soon. I need to stay awake at least until I reach Las Vegas!

A Chatty Morning

I went to the gym to do my usual routine this morning. I met someone I know from my sewing class and we chatted a little (I hate it when people sit on machines and chat with others, and yet I did that!).

Then somebody near me remarked on my Brianhead T-shirt. She asked if I skied. I said no, I went to Brianhead in the summer and yes, it is really beautiful. We talked some about Utah. We both love it and would like to live there except for the provincial nature of many of the residents. Somehow we got to discussing the gym.

She told me I'm really making progress.

I said, "How do you know?"

"I've been watching you since you first started coming here!"

I told her it was hard for me to see any progress, frankly, and that I just keep going. She said she notices it, she can tell the difference. She was not specific but I'll believe her. Why not? I told her I am in pain most of the time and she said she can see that, but that I seem "more alive". Well, I'll take that, whatever that means. We talked of arthritis and pain killers and physical therapy a bit, both said we don't really want to talk about it(!) and finally parted ways.

As I continued my workout, doing my resistance band exercises, I thought about how I am in general. It is hard to see progress when it is so very slow and not always forward-moving. Yet there are small changes I do notice:

* Overall I feel like I am in less pain. It takes less time to reach some comfort level each day.
* I have fewer and shorter instances of hip pain.
* As I've mentioned here before, I have very little shoulder pain now. No pain when I fasten a bra behind my back, for example, and no pain dropping a package in the mailbox from my car.
* When I do my resistance band exercises I do not feel pain in my legs. When I first started doing these one of the hardest parts for me was that standing at the railing simply hurt. It hurts very little or not at all now.

I have even thought about the Active classes. I want so much to be able to do that class without pain. I don't think I am quite there yet but I see light at the end of that tunnel.  I think I am actually achieving something.

Five Gyms on Vacation

My last trip was to Las Vegas and to Acapulco. I spent a few days in Las Vegas on either side of my four days in Acapulco.  During this vacation I went to the gym almost every day. But what gym?? Five different ones.

I was glad that I had talked to Clara about these trips. I brought along my resistance bands, which as it happens I used only a couple of times.  I also knew I could do the five basic physical-therapist exercises on my bed, morning and evening.  Apart from that, I had to adjust to whatever was available. Among the options were, for example:

* The cardio movie room in Henderson, Nevada. The Gold's Gym there has a room that is dark and contains a full-size movie screen. Instead of seats it has cardio machines. Mary and I chose bikes and treadmills and watched part of The Bourne Supremacy, as I recall.  Lots of car chases and people speaking Russian in hurried whispers. Actually filmed in Moscow. It was funny to try to set the machine variables in the dark (people use their cell phones for the light).

* Another Gold's Gym in Las Vegas, very nice, equipped with railings where I could use the resistance bands (the cardio gym didn't have the railings), lots of cool up-to-date equipment. None of the equipment in any of the gyms was like equipment in other gyms, so I was constantly hunting down leg presses, leg extensions, row machines and so on.

* Aqua aerobics at Las Vegas Athletic Club. There is a special separated pool, next to the lap pools, where the aqua classes are held. The water is the same level the whole distance, and it was about four feet, maybe a little more. For me, it was not high enough. The class was led by someone who was clearly not a regular group trainer, but instead appeared to be someone like the rest of us who went through specific training for this class. In a way, it's a nice way to go because a class member is not going to be intimidated by someone who looks like she or he does. I could see that she was following the basic rules - so much time for aerobic, so much time for weight training, and so forth, but she didn't have enough experience to move from one thing to another quickly. Thus, "What shall we do now?" Also, she did not emphasize form as much as I would have liked. Still, I got it done, it was worth the time, it helped me.

* Machines in the gym at a hotel in Acapulco. We stayed at the Las Brisas hotel, which is a fifties-era resort hotel built up a hillside. A lovely place. We had a casita high up the hill and had to call for a ride (in a pink and white jeep) every time we wanted to go somewhere in the hotel (except when Mary walked or ran and sometimes dragged me along). The gym is in a separate building overlooking the bay and has a few bikes, treadmills, a couple of universal type machines, and some other odd massage like tables. I did the bike and figured out some ways to do some of the other exercises on the universal machines. Not a complete workout but not bad, considering I also walked and swam most days.

* Weight room at the Henderson Multigenerational Center. Great place. It has two pools (one olympic-sized, used that day for water polo competition), a water park, an indoor running track, several classrooms, and more. I am able to get most of my routine done in the weight room, with the bikes and machines.  Sometimes when i visit my daughter and grandson come too and we all use the indoor pool.

It was an adventure just working out how to get into these gyms. I think the most reliable type when you visit another city is the gym in your hotel, if there is one. Otherwise, I'd be using the resistance bands and trying to find a good way to get some cardio in. I'm lucky in Las Vegas because my daughters live there so I can find ways to get in, at least once, to some gyms.  If I were able to walk more consistently there would be many more options available. For now, I am grateful for what there is.

It's been a while

It's funny how common these machines have become. The machine on the left is a hip abductor-adductor machine. I use the abductor part, pushing my legs from closed to wide open.  The machine is open in that pic, about as wide as I am able to push it actually. I use it to help my hips, which have arthritis, to strengthen them so that I do not feel as much pain from the joint disintegration.

The first gym I joined was Jack LaLanne's, in Alhambra, California or somewhere near there, in the late sixties, early seventies. It had, along with various machines, one of those belts that were supposed to jiggle the fat off you, and the trainer recommended a high-protein, high-fat diet - was Jack the first to promote that? I tried it and lost weight but felt so weighed down I gave it up. I did not feel healthy, just a little thinner. I've been in and out of gyms since then.  I have been on this current kick since April and am making less frequent posts about it now that I have settled into a routine and not a lot changes.

I have noticed recently that I am having hip pain less often. I used to feel it almost every time I got out of bed in the morning, and definitely every time I walked down the hall after getting dressed. Less so now, and less so throughout the day. That machine up there may in part be a reason. I also do simple "clamshell" exercises every morning and every night, and in our Aqua classes we often do things that require that I open and close my legs similarly. I think it's all adding up.

My knees, not so much. Still stiffen when I sit for a few minutes, still cause pain when I walk more than a short distance. It is hard to see any difference. "Alignment, alignment, alignment," says the physical therapist. And the alignment of my knees is where there is so much damage it is hard for me to imagine that I can make a marked change through exercise alone. But I am trying to do so.

I met with the physical therapist for the first time July 21. He suggested that I come back after two months. So in about three weeks I will see if there have been any measurable changes.

Adding to the routine

Yesterday I met with trainer Clara. I showed her the exercises given me by the physical therapist and asked if she might be able to come up with machines that I could use for some of them, when I am at the gym. She said yes, for two of the five. I told her about the pain in my right foot and how it feels and she suggested that we try some feet stretching exercises. And I asked if she could recommend a few things I can do in the pool when I am there. We then went upstairs to the weight room areas.

She showed me the leg extension and hip adduction machines, and I tried both of those. I then tried different ways to do both the calf stretches and the squats, because neither were working very well for me.  By the end of my trials and Clara's observations, I had an expanded routine (including minor changes I have added over time):

machines:
15 minutes on upright bike at level 10
5 minutes on treadmill - walk normally, focusing on feet, knees, posture. Could go longer if it weren't for my hip pain. I now have added 30 - 60 seconds of walking with my toes pointed up as part of the five minutes. This is one of the foot stretches.
1 set of 15 reps on row machine at 95 lbs
1 set of 15 reps on lat pulldown machine at 95 lbs
1 set of 20 reps on leg press at 180 lbs
2 sets of 10, increasing to 15, on hip abduction machine at 80 lbs
2 sets of 10, increasing to 15, on leg extension machine at 35 lbs, focusing on VMO

rubber band exercises:
compound row, red and green bands, 3 sets of 15
shoulder external rotation, red, 3 sets of 15
empty can, green, 3 sets of 15
lat pulldown, red, 3 sets of 15 - I often don't do this because it's hard to find a door or other place in the gym that I can use.

chest stretch, 30 sec each side

calf stretch, 30 sec each foot: changed to one foot behind the other

squats at rail - put feet toes right at the wall, hold on for support, dip, do not hold
stick stretch - I'm doing two stretches where my right arm helps stretch my left (the problem arm). Right now I am stretching three sets of fifteen seconds each
Foot - sit and point and flex for 30 - 60 seconds total each foot (also when foot pain flares up)

When I said this might take me to an hour total, Clara suggested alternatives: doing upper body one day, lower another, for four days total, or stay with three days and have the upper body the middle day. I did the whole thing today and it did not go a full hour. I think I will stay with three days a week doing it all.

In addition to the gym routine, I am doing the PT exercises every day, trying for twice a day (sometimes I just forget or am too tired for the second set). And of course I continue to do Aqua three days a week. I may exchange one of those days for swimming. I haven't decided yet. The PT exercises are:

quadriceps muscle set
short arc quad
hip and knee flexion
clamshell
bridge
All twice a day, most held for 10 seconds, total 10-15 times

When two months has passed from the PT appt I will have another PT appt. After that, I will get together with Clara again and we'll see if changes need to be made.

Lately I seem to be having less pain overall. Still hard to walk at time, hip pain at times, but less often. I am having more better times.

A Good Day

I honestly can't remember the last time I was able to walk around for any length of time without pain. Maybe for a minute after a class or a workout I would feel less uncomfortable but then the pains would go back into my hip and I would be telling myself to straighten up, suck in my stomach, stay as straight as I could.

Today, though, I did feel significantly less pain, right from the moment I got up. I am not saying I strode into the bathroom like a twenty-year-old but I was able to brush my teeth without that discomfort from both legs and when I walked down the hall later I noticed that I could walk comfortably without pain. I put on my sandals for Aqua class and found that when I got out of the car to go into the gym I was still feeling good.

There were moments in Aqua when I had a gust of pain - in my left calf particularly - but eventually those went away and I left the pool not doing too badly. I pushed my luck a little, not going straight home but instead stopping at Starbucks, Michael's, and then a fabric store. I don't think I could have done a pain-free hike but most of this time I was okay.

Either this is one of those momentary relief days or it's a sign of better things to come. I am hoping the latter.

Some signs of something

The other day, in Aqua class, the teacher asked, after several "interval" trials, "Are you ready for a break?" and of course somebody said yes. I said "no!" My main reason was that I knew this teacher had strategy - she doesn't give us breaks until we no longer need them, or else until we don't want them...I'm not sure, but usually the right answer is not what you think. So I tried for the right answer.

But in fact, although my arms in particular were aching from pushing hard and fast, back and forth, while my legs were twisting, suspended above the bottom, I knew I could go more. I knew I was feeling strong, and it occurred to me in general that I can do more longer than I could several weeks ago.

These experiences don't always translate to pain-free walks and happy hips but I do think they are part of the solution. And it is always nice to feel strong.

Sounds in the Gym

The other day, when I was on the treadmill at the gym, I suddenly became aware of all the squeaking coming from the machines all around me. Each machine seems to have a distinct squeak; my treadmill had multiple sounds. I wondered if anyone else noticed this, or if the music that saturates the gym overrode it, or the music in headphones. There are distractions aplenty: magazines to read, several television stations to watch (I have enjoyed bits of the Tour de France, especially today, watching the riders in the wet fog; I can feel the cold, I swear, and I felt transported at times, found myself on a bicycle there, thinking, "what the hell am I doing here? It's damned uncomfortable."), and of course some people come with their own sounds.

It isn't actually a large gym, as gyms go. It's large for this small community. I read some online reviews of the gym not long ago, and laughed at the one that complained that it wasn't large enough, it isn't open enough hours, blah blah blah. You aren't going to find a larger gym here, and probably not one open more hours.  I laughed at the time yet I thought about the comment that some of the machines are "outdated" and need to be replaced.  This negative review got me thinking and re-evaluating.

The machines are too close together, the treadmills fill up fast (but only during peak hours), maybe some of the equipment is not the latest greatest, the soap pumps in the women's locker room are always screwing up, there aren't enough flat weight benches, sometimes machines are labeled "out of order" for several days in a row, and...there is the squeaking. Perhaps they need to be oiled more often? I found my view of the place changing.

Before I had read the review I was loving the family-friendliness of the place, the ozone-treated pool, the expertise of some trainers, the inclusion of a full basketball court (along with a squash court and racquetball court) and a sand volleyball court. I like that there are lounge chairs by the pool and a lounge area with large-screen television inside.  All of that is still there, still true.  It isn't perfect but it's probably the best in town. Otherwise it's hard to understand why so many people go there.

No, there is no arthritis point to this post. Perhaps just that the gym has become such a large part of my life that I think about it and evaluate it and want to make it better. And boy do I have ideas.

Getting with the Physical Therapist

After a Physician's Assistant at my doctor's office gave me a prescription for six sessions of physical therapy (at my request), I asked my gym trainer, Clara, for a recommendation. I asked if she could recommend somebody she herself could work with and has worked with. She recommended Paul T. here in town. I made an appointment and met with Paul for the first time today.

He runs a one-man office in a converted older house on a busy street where all of the older homes are now businesses. When I arrived he was working with an older woman on some equipment in his office, and nobody was at the front desk. I could see that he is a relaxed, friendly sort of person who doesn't stand on ceremony. I learned a little later (when I paid the bill) that he also doesn't deal well with modern conveniences like microwaves and credit cards.

I had filled out the forms ahead of time, because they were available on the website, except one intake form that wasn't. So I was ready to go. When my time finally came Paul led me to a side room that has some patient exam tables and other equipment in it. I sat on the exam table while Paul asked questions about what is going on with me and made notes.  We then moved into the exam part. He tested various parts of me, focusing on my legs and feet (I didn't bring up the shoulder issues because they have become less of a problem). Tests involved strength tests of my legs in different positions, range of motion tests, angles of alignment (knees and hips), and even the degree of flatness of my feet (not all that bad, actually; he said the arthritis makes them seem worse than they are). He also tested reflexes in my knees and feet, and discovered I have none in my ankles. I was a little alarmed by this but apparently it isn't that unusual in older persons.

He then showed me exercises that can help the alignment of my legs. He feels this is the major problem and that when it is relieved to some extent the accompanying pain and pressure should also be relieved. "Alignment, alignment, alignment!", he said, repeating some mantra of a top kinesiologist in San Diego who tends to sports stars (I am wanting to know more now, wondering if this guy has a book or two out).

He said to show these to Clara and that she may have some machines that can do some of the same things as the exercises, and that she can call him if she has questions. Because I am working at a gym I will be doing most of my work there and can check in to find out my progress from time to time. I asked how long I should wait to make the next appointment, and he said "two months". It will take at least six weeks before any measurable change happens, he said.

This is exactly the kind of assistance I was looking for.  I was also very interested in getting all of these measurements down. It is very difficult for me to determine if I am making any progress, and this will change that.

I got what I wanted.

I scheduled an appointment at my doctor's office for today. My regular doc doesn't have any openings until the end of August so I took a chance on a Physician's Assistant. I came in with my disabled parking placard application, wanting to be sure to get a signature on that, at the very least.

I told the PA that I'd been having increasing pain in my hip and whole right leg and foot and I wanted to confirm that it's arthritis and not something else. I also said I thought it might be helpful for me to connect with a physical therapist who can evaluate where I am and help me with the exercises I need to be doing to get stronger where I most need to. The PA agreed that this would be a good idea and arranged for x-rays of my hip, saying we already know you have arthritis in your knees so no new info would be gained from doing that. (saves me money too)

The x-rays confirmed arthritis and did not show anything else of interest. A radiologist will look at them, too, and I should get a call about what is found. Therefore, the PA gave me a prescription for six sessions with a physical therapist and she signed my parking placard app. So I got what I wanted! Now I just need to choose a PT in this area, perhaps not the easiest thing to do. I may ask Clara.

So now I'm a critic

I started at the gym in April. I took my first Aqua class on April 15. I am now getting to the gym regularly six days a week, three of them for Aqua classes. This week and last I had two new Aqua instructors, both on Monday. Kerry is no longer the Monday person, so there is a new person in the morning, and the gym has now opened up two new evening Aqua classes, Monday and Wednesday.

I found Alisa boring. She is the Monday morning replacement. I kept looking at the clock. She would tell us to do something and demonstrate briefly, then stand around until it was time to tell us to do something else. She didn't keep demonstrating, didn't keep moving, and neither did we. There was a disjointedness to it. I was not actively engaged so I kept looking at the clock to see how much longer.

This last Monday I tried the evening class instead of the morning. I don't really like the idea of doing this in the evening but like the idea that these classes are available if the morning ones just don't work out. I found that most of the people in there were, of course, people who work during the day. The class was smaller than the usual morning ones but okay, nine people.  This instructor, whose name I now forget, was a little timid about opening up two lanes (she admitted to being a little afraid of the swimmers). Then she was a bit similar to Alisa, in demonstrating and then not staying with it. She did more but I felt we would almost stop before going on to the next move. Incredibly, I felt I was not getting enough of a workout! Usually I am desperate to cut it back!

I have been trying to figure out what the difference is among the different instructors. Each has her own style but there are some things the connect the ones I like better: we are always moving and they are always moving. There is a rhythm, a sense of direction, to the moves. The good ones push us, even as they offer "back-off" options for those who can't do something.

As for me, I am wondering what I will do now. Either go with the Monday morning and just grin and bear it, or see how I do swimming, is how I see it now.

pain and more pain

Today I made it into Aqua with a lot of pain. During the class my right hip - leg - frequently had trouble and my left knee did, too sometimes. At times it was fine, fortunately. When I got out my lower back hurt. I managed to go to Trader Joe's to get some groceries and get them home and put away but I still hurt. Took Tylenol Arthritis. Still have pain. I'm not enjoying this.

Some kind of progress

As promised, I do not write in here every single day, I do not report on every single workout now. I have settled into a routine where there are not significant changes, or even small changes, every day.

I had a few nights of cramps in my inner thighs and in my feet. These may have corresponded to a change in the Monday instructor of Aqua. I am not sure I did everything correctly and I know we did not do great stretches at the end. Another possibility is my use of arch supports. After I started wearing them I started having pain in my right foot, right around where the support is. So yesterday I pulled them out and I am going without for a few days to see if there are changes. It appears that the pain is going away so that part I may have guessed right.

Otherwise, not a whole lot has changed. I still have significant pain in my right leg-hip area. When I wake in the morning I limp, bent over, to the kitchen to feed the cats. Gradually I get myself straightened up and can limp, not quite so bent over. I continue to remind myself to stand and walk as straight as I can and to pull in my stomach. Usually, after a workout, I feel a bit more loose and am able to walk a little more easily.

The past few days I have noticed that I am a little more active in the afternoons. I work on something, perhaps just making dinner, and when there is a lull I clean something up or organize something. It smacks of having a little more energy. Could be. Energy, though, is such a fickle thing. It seems to depend more on my state of mind than on my state of body.

As to my regular workouts. I have upped the weights on the rowing and pulldown machines to 85 pounds and the leg press to 180 pounds. The rest is about the same. I do 15 minutes on the upright bike and five minutes on the treadmill. I could do more if it weren't for the pain. Damned pain. More pain on the treadmill than on the bike, as a rule. I used to love walking. I want to again.

It seems time to schedule another appointment with Clara. I think, though, that I should get an appointment with my doc first. I want to confirm arthritis in my hip and shoulder and ask about physical therapy. Maybe I can get a physical therapist who can test where I am more specifically.

Now the right arm?

Three days ago I awoke with pain in my right arm, the upper outside part - triceps? I am not sure what the part is called. It wasn't the same as the left arm pain and not as bad, fortunately, but still quite painful. I have been working it at the gym, where I did the stretches on that arm as well as the left (with the stick) and in the Aqua classes, where it has to be used for one thing or another. I think the activity is helping relieve the pain. It isn't gone yet but I feel it won't take that long.

My right leg continues to be a problem, including the right foot. I haven't yet made an appointment with a doctor to check the foot. I am thinking about how I want to approach such an appointment to get the most out of it.

Baby steps

Over the past few workouts I have made some minor changes to my routine. So now it is:

13 .5 minutes on upright bike at level 9
1 set of 15 reps on row machine at 80 lbs
1 set of 15 reps on lat pulldown machine at 80 lbs
1 set of 20 reps on leg press at 180 lbs
chest stretch, 30 sec each side
calf stretch, 30 sec each foot

rubber band exercises:
compound row, red & green bands, 3 sets of 15
shoulder external rotation, red, 3 sets of 15
empty can, green, 3 sets of 15
lat pulldown, red, 3 sets of 15 - I often don't do this because it's hard to find a door or other place in the gym that I can use.

squats on ball on wall - I put large ball in small of my back, put weight in heels, do squats - I'm doing five, sometimes six
squats at rail - weight in heels too, I'm doing five, carefully, sometimes two sets of five
stick stretch - I'm doing two stretches where my right arm helps stretch my left (the problem arm). Right now I am stretching three sets of ten seconds each
treadmill - walk normally, focusing on feet, knees, posture - I am up to 5.5 minutes. Could go longer if it weren't for my hip pain.

Lately I have been a little discouraged by the hip pain. It makes it hard to get around and I am disappointed in myself when my daughters visit - or I visit them - and I am unable to do the things they want to do. No hiking, no walking around malls, no strolling near the ocean.  I am considering making another appointment with a doctor to consider two things: possibly get corticosteroid injection in hip, if that's a reasonable pain relief alternative, and possibly referral to physical therapist.

Study finds persons with knee arthritis often choose own treatment

The Arthritis Foundation reports on a study done in Canada that suggests that a majority of persons with arthritis of the knee choose their own course of treatment. The participants in the study were recruited by pharmacists and the majority were white heavy women, average age 63. (The report calls them "overweight" or "obese". I reject these terms because there is no perfect weight and "obese" is a word with no medical basis. I am fine with calling myself "fat".) I laughed because I fit that description, almost perfectly.

The researchers were surprised to find that so many of these participants started exercise programs or took drugs or supplements without advice from a doctor. Interestingly, at the start of the study about half of the participants exercised regularly, and at the end over 3/4 did. This is far higher than the average in this country, where about 15% of adults exercise regularly. This suggests to me that this is a group of take-charge persons.

It does not surprise me that so many went out on their own, without medical advice. The times I have gone to doctors for help with my arthritis have been many, and the assistance I have gotten has been minimal. In the early days of my arthritis, when I was in my 30s, the condition was not even diagnosed but I was sent to a physical therapist a couple of times. I think this was good but I did not keep it up and it was only when I started bicycling (something I did on my own) that I started to see results.

I cannot recall any suggestion from any physician that a physical fitness program could be designed specifically for me. Losing weight has been suggested and of course that's a good idea (easier to recommend than to do) but the main treatments suggested have been the use of drugs and, if possible, knee replacement. More than once I have been in such pain that I left the medical office feeling I was not heard, that my pain was not recognized. Perhaps because arthritis is not life-threatening it is also just not interesting enough. Many people have it so it's a big boring pain to the medical personnel as well.

Wouldn't it be nice if some of these doctors really thought, "How can this person really be helped?" Wouldn't it be great if some of them were enthusiastic about working with us to achieve results? When I met with Clara, my "trainer", I was most struck by her enthusiasm and hope for me, as well as her care in determining just what was hurting and how I responded to different moves. Would that I had even heard that it would be possible to design a workout specifically for me, from a doctor.

Seems like same ol' same ol'

Today I went to the gym feeling pain and left feeling a little less pain. That seems to be the story every day. But it isn't all of the story. And because I am documenting this trip to help myself and others, I want to be more specific.

Today's pain was in my right leg mostly, in my ankle, foot, calf. It hurt to walk when I got to the gym and I was happy to find a parking space nearby. Sometimes when I plod up the stairs to the weight room I find it hard to imagine that this body can do anything at all. Yet I get through the steps. The bike: for much of the ride I felt some discomfort in that right leg and foot but it wasn't real pain, and I considered going more than 13 minutes, but didn't. Walking on the treadmill was similar in that I felt some pain with every step but it wasn't enough to make me stifle a self-pitying cry.

I think I like my workout in general. I don't do any one thing for a really long time so it never gets tedious. I get through one thing, move to the next, and when I do the resistance band exercises I often use the breaks between sets to do other things, like shoulder stretches, calf stretches, and squats at the rail. I get it done in about 45 minutes and I feel better, sometimes the tiniest smidgeon but a little better.

It doesn't always last or it doesn't seem to. I went to the farmers' market afterwards and found it painful to walk through it. I struggled up the small set of steps into my house, dragging my bags. Sometimes I just want to lie down. I wonder, though, how I would feel if I didn't do any of this at all? I do think I'd feel worse.

Pain here, pain there

This morning I had to get to the gym early because I had a dentist appointment at 8:40. So I set out limping. The pain was in my right leg, more in the calf and foot and knee than in the hip, which is how it's been for the past couple of days. It hurt a lot just to get up to get a cup of water.

After my regular workout I walked down the steps with less pain and went to the dentist (all is well) and came home, still improved. So maybe the good results are starting to hold longer?

Today

Today I went to the gym to do my regular routine. I did it, except the pull-downs with the resistance bands, as usual. When I went into the gym I was limping an hurting and when I left I was feeling much better. I had less pain and I felt more hopeful.

I did five minutes on the treadmill and I didn't feel pain as I usually do. Let this continue!

I did 13 minutes on the bike and it went fine. My left knee was giving me trouble but even though I limped away from the bike I felt better.

The machine exercises went well. I had upped the weights the last time and this time it seemed already I was adjusting to them.

I felt hopeful. I still do.

Some range-of-motion exercises

The Arthritis Foundation offers these exercises for getting started. Range-of-motion.

1.  Head turns
   1. Look straight ahead
   2. Turn your head to look over your shoulder
   3. Hold for three seconds
   4. Return to front
   5. Repeat to other side
2. Forward arm reach
   1. Put arms out in front, palms facing one another
   2. Raise one or both arms as high as possible (one arm may help the other if needed)
   3. Lower your arms slowly
3. 
   
   
   
4. Knee Lift
   1. Sit in good posture
   2. Lift one knee three or four inches off chair
   3. Hold for three seconds and lower
   4. Repeat with other knee (you may help by lifting with your hands under your thigh
5. Back pat and rub
   1. Reach one arm up to pat back
   2. Reach the other arm behind lower back
   3. Slide hands toward each other
   4. Hold for three seconds
   5. Alternate arm position
6. Elbow bend and turn
   1. With arms at your sides, bend the elbows bringing palms towards the shoulders
   2. Turn palms down as you straighten elbows down to your sides
7. By performing these exercises daily, you can begin to reap the benefits of improved flexibility and movement. Before starting this exercise regimen, keep these tips in mind:
   • Always cool down after exercising
   • Keep a positive attitude about yourself and your exercise program
   • You will get better at doing these exercises the more you do them
   • The more you do them the better you will feel
   
   
   
   

Some good advice, I'd say. I do think, though, that it helps a lot to have somebody specific to help you through this process. Doing these moves is good but then what? And I wonder what happened to number 3?

No shame to cutting it short

Today I decided to try a hike. The hike I had in mind is at the end of Madonna Road here in San Luis Obispo, a hike in the Irish Hills. It is a bit steep going up, then levels a while, winds around, comes down again. Nice views, particularly if you get up high.

I left my new stick at home, and I forgot to bring my water with me, so I started out at a bit of a disadvantage. Then my back started to hurt a bit and I felt a little off-balance. Not unusual for me, that. I kept climbing up, taking pix and stopping here and there, and then decided I had had enough after just 20 minutes. I went back the way I came, just shy of forty minutes total.

There have been times in the past when I have felt driven to finish a hike or I would be really disappointed in myself. Not finishing seemed like not doing it at all. I didn't feel that way this time. I got out there, did some climbs, turned around. Better than nothing and it gave me a sense of where I am physically.

I am drinking some grapefruit juice now. I don't often buy juices but today grapefruit called to me. SO good.

upping it

Today, as I promised myself, I increased weights on the machines. So as of today, this is my routine:

12 minutes on upright bike at level 9
1 set of 15 reps on row machine at 80 lbs
1 set of 15 reps on lat pulldown machine at 80 lbs
1 set of 20 reps on leg press at 160 lbs
chest stretch, 30 sec each side
calf stretch, 30 sec each foot

rubber band exercises:
compound row, red & green bands, 3 sets of 15
shoulder external rotation, red, 3 sets of 15
empty can, green, 3 sets of 15
lat pulldown, red, 3 sets of 15 - I often don't do this because it's hard to find a door or other place in the gym that I can use.

squats on ball on wall - I put large ball in small of my back, put weight in heels, do squats - I'm doing five, sometimes six
squats at rail - weight in heels too, I'm doing five, carefully, sometimes two sets of five
stick stretch - I'm doing two stretches where my right arm helps stretch my left (the problem arm). Right now I am stretching three sets of ten seconds each
treadmill - walk normally, focusing on feet, knees, posture - I have managed all of four minutes

Today the gym was crowded when I came and I did not get on the treadmill and I did not get to a weight bench with the stick. On my way home I purchased a rake handle to use as a stick at home and I did the stick stretches at home. I am thinking that I will go on the treadmill twice the next time. Four minutes isn't much but it hurts and I don't want to keep doing things when they hurt, so that's where I end it for now.

Arch Support

The first time I met with Clara she mentioned arch supports, noting that I have flat feet or whatever they call it. I said that I used to wear Birkenstock's arch supports, 3/4 length, because they were recommended by a physical therapist I was seeing years ago. I used them in my Earth shoes initially but later took them out when it seemed like the two things - the design of the shoe and the arch support - might be contradicting each other.

I decided to add arch supports back in. Today I went to CVS and found Dr. Scholl's Arthritis Pain Relief supports. They are supposed to relieve pain from knee, foot, or hip. You can read what Dr. Scholl's says about them.  I put them in just a little while ago and I think they may actually be helping! I don't know if they negate the value of the Earth shoes, but I don't think so.

hanging in

I continue to do my workout about three days a week and do Aqua classes three other days, and sometimes I do something else the seventh day. I have moved up to a huge 12 minutes on the upright bike and four on the treadmill. The rest of the elements are about the same. I had the sense today that I could up the weights on the machines now, that I'm ready for the next step.

I have continued pain, especially in my right leg (the hip - thigh) and getting up and ready in the morning is not very much fun. After a workout I am usually a little looser - it doesn't last but that seems like a good thing. No major changes other than the ability to swim, albeit awkwardly, without much pain.

Pain and Progress

For the last two or three nights I have woken in the night with pain in my legs - usually my right leg in particular - that did not want to calm. My calf was stiff and there was a pain saturating the calf, usually involving part of the foot and the knee as well. I have been unable to stretch it into submission so I stumble out of bed and try to walk it out a bit until it calms down. One of the nights I took a hot shower.

I think these were nights after days when I have walked and used my legs more than usual. In the long run I am not experiencing any damage from these experiences but it's uncomfortable while it lasts.

Yesterday I went to the gym and swam ten laps - 500 yards. It isn't much but it's more than two! My left arm is far from having its full range of motion but I did not feel any pain in it during the swim. My swimming is awkward but possible. Today I swam four more laps after Aqua class and felt good about that. I call this progress and I'm hanging onto it to keep myself motivated. I do feel tired after class and I don't always feel looser or without pain but later I do seem to move better. It's hard to see and feel progress. I see it in my swimming, though, in being able to swim at all.

Back to the gym

Yesterday I did an Aqua class in spite of feeling back pain and leg pain and in spite of having pain in my right leg when I drove (pressed on accelerator). After the class I did all of two laps of swimming! My left arm is not all there yet and I don't expect it will be completely recovered for quite some time but I was able to make my way across the pool all right.

Today I did my regular routine, feeling punk again when I left for the gym but better later. I have to remember that this is how it is. Just keep doing it unless there is something way off with my body. Today I no longer had the pain in my right leg when I drove. Improvement! I also slept well last night, just some getting up for the bathroom and a brief time reading in bed. I'd say B+ for the sleep.

A Day Off

So I took yesterday off from exercise. I went to sewing class and made it through that without difficulty. I had pain in my right leg - hip, knee, calf - but not too awful. When I left the class and drove home I felt some of that same pain in my calf and knee when I used the accelerator that I had felt the day before, driving home from Palm Springs. Overall, not too awful a day.

I slept well and woke without as much pain as yesterday morning. I am going to Aqua this morning, still in pain, remembering I must do this even when I am not feeling all that well. If I avoided exercise every time something acted up I'd soon quit altogether.

Not-so-good road trip

I drove home from Palm Springs today. Usually the biggest worry for that trip is the traffic. Today it was my right leg. Right from the start I felt searing pains in my right calf, thigh, and sometimes foot when I used it on the accelerator.  It felt like it would when I've been already driving eight hours. As much as possible I switched to cruise control but that option was not always a reasonable one, so I stopped here and there, tried to walk out the pain, and took a couple of cat naps on the side of the road. But the pain was soon back again when I  got back behind the wheel. At one point I was wondering if I could even make it home, was thinking, "I should call someone". But I didn't.

I have no idea what caused this extra pain in that leg. I am hoping that over the next few days it eases off so I can get back to my regular routine here. I have already decided I won't be going to the gym tomorrow. A day off cannot hurt right now.

Wheelchair!

Today was not one of my best days. So when this afternoon came and I found myself at the PS museum again, with the possibility of standing while talking, I accepted the offer of a wheelchair. It was an odd experience. I was grateful for not having to endure the pain in my right leg especially but I felt a little out of it, being the one sitting down while talking to three people who were standing up. I can see a disadvantage in being in a wheelchair for this reason alone.

It was nice to be accommodated this way, I have to admit, to have somebody recognize the signs of pain and offer help.

Doing it on the road

For the last few days I have gotten on the exercycle where I'm staying, and then done the resistance band exercises as well, except for the lat pulldowns - I didn't find a chair in the vicinity until I realized there were some outside, which I then dragged in today. After doing these exercises I hit the pool next door (our gang is using two homes) and did some water exercises, as I mentioned in the last post, and swam some. So I have been getting something done.

Today I woke with back pain and leg pain and it was a while before I felt a bit better. It isn't a great day for my body, exercise or no, but I suspect it would be worse if I were not doing anything.

I do feel some control over my fate, so to speak, by having the resistance bands with me and knowing what to do with them. And now that I can more-or-less swim again I can do a bit of that, too.

Changes

Yesterday, when I left home, my legs hurt, my back hurt, and I just generally felt lousy. I figured I'd really be a basket case by the time I hit Palm Springs. I stopped a couple of times on the way to get my legs working and get snacks but I did the last hundred miles, about, without stopping. And I wasn't worse when I arrived. A bit stiff but not even as much in pain as when I left home.

I did take some tylenol arthritis on the way, which may have helped. The dry hot air may help, too, although I can never be sure of that.

Yesterday I went up and down the driveway a few times, going from my guest house space to the main house, and I noticed that I was not having that much trouble climbing the driveway. It isn't super steep but I suspect I would have had a harder time a few months ago.

Last night and again this morning I used one of the exercycles in the guest house, for 11 minutes each time. That's the time I have been giving to the bike when at the gym, before I do the strength training stuff. I'm trying to work up the time I spend on a bike so my seat gets comfortable with it and I can ride a regular bike and eventually the special "spinning" bikes. After my bike time last night I did the rubber band exercises, except for the lat pulldowns. I could find doors but no chairs. I'll have to work that part out. This morning I did two of the exercises with the bands. i will do more later. Then later I put on my swim suit and hit the pool here.

I did some cycling, some cross-country, some stretches, some running in place in the water. Then I moved into a swimming position and tried to swim. I was able to swim with just a bit of an issue with my left arm, much much better than I was the last time I tried swimming, which was also in Palm Springs.

The exercises are starting to work! These little changes are encouraging me to keep on. Nothing like a little success to keep me going.

Not a gym rat, but...

Today I woke, straightened the bed, took a shower, got dressed. Just like old times. Today I am not going to the gym so I will not be showering there and I have a little time to get things ready for my trip. It seems funny not going to the gym. Already I expect it of myself. I did pack up my elastic bands, as well as the simple rubber bands in case Mary might want to use those. I can't remember how just yet.

I slept well, waking for the bathroom and to read a little. My legs hurt and my lower back hurts. I have been limping around the house, packing, tidying a little. I am leaving my dining table covered with sewing stuff and machines, my office desk covered with papers, and possibly my piano covered with folded clothes.

It is another day

Last night I slept well. I have slept well for the past few days, with just occasional wake-ups  for water or bathroom and for one time when my right foot was a little crampy. Sleeping well means, of course, that when I get up it is a while before I can stand up straight because I haven't been up for several hours.

That was certainly true this morning. Bent over, trying to regain good posture, put my weight in my heels, suck my tummy in, I got the cats fed, did my usual early morning chores, and got a bit ready for my next trip, which is tomorrow, checked email, did some small stuff. By ten I was ready to head out to Aqua class, not really looking forward to it but knowing it would be good.

My right hip was bothering me and getting up and down was painful and getting into the gym was painful. By the time I left the gym I was loosened up a bit and finding it easier to walk and to concentrate on my posture and on not limping.  My theory is that as I continue to work the muscles and build strength, over time the extra strength will be there when I need it and I will find it easier to walk all the time.

I was feeling pretty perky so I took myself out to lunch and got myself an all-fruit smoothie afterwards, from Jamba Juice. By the time I got home I was feeling a little taxed and I lay down to take a nap. An hour or so later I got up, folded clean clothes, fed cats again, and realized I am doing better. My hip still hurts but I am managing it better.

Tomorrow I will head out of town and bring my resistance bands. I would like to get a stick to bring along, too, so I may head out to find something, a broom handle or something like that, in a bit. This trip will be a test of how well I do away from the gym. There is a pool where I am going, so I can do some water exercises in addition to the elastic band ones. I can't wait - well, I have to but I don't want to - until I can walk well enough to take hikes again!

If its Tuesday it must be sewing class

Yesterday I did the Aqua class with Kerry. It was cool and wet so the class size was small, so Kerry jumped in the water with us. I liked that. I managed pretty well, having most trouble with the "core" activities. I can't believe my abs are that weak! Maybe they are.

I took some tylenol yesterday and again this morning to take the edge off the right hip pain. The pain is most certainly back now. I did my regular workout this morning before sewing class and managed all right in class but when I left I went to Costco to pick a few things up and the pain was just awful. Of course concrete floors don't help but it was beyond that.

For my record: I am doing three sets of ten seconds each on the stick stretches, and I am doing all of three minutes on the treadmill at 1.6 mph. Or 1.6 whatever it is. I am managing five weak squats on the ball and again at the rail.

I am tired and hurting. Just a bad day for the hip, mainly.