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.