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Sunday, June 19, 2011

Another Pedi

Today I got another pedicure. Second one since I came out from the brace. I mention the first one in this post. Seems I had a harder time that day but I was also busier. I had no trouble bending my knee or holding my leg straight for various parts of the pedicure. Everything felt completely normal.

I also went to Costco to discuss phones and to the nearby Starbucks for a soy vanilla latte. Not as much walking as the last time I got a pedi, but I suspect I could have done that walking with better results today.

I realized that when I first got rid of the brace I was using the car for one or two things every two days or so. Now I get out there and make numerous stops and I do not feel any more tired. I am developing greater endurance.

Another improvement: I am taking two percocets in the evenings and usually nothing else, and it seems like I am doing better at night. I spend a lot of time awake still but only a small part of that time is really really uncomfortable. I haven't sat and sobbed for many days. I think things are looking up.

Thursday, June 16, 2011

9-1/2 Weeks

The only similarity between my 9-1/2 Weeks and the movie of the same name is the inclusion of pain. In my case, the pain serves a purpose. And I don't experience a whole ton of it at a time.

Today, for example, in physical therapy, after doing the bike, the total gym, the leg extension and leg curl machines, and the foot-on-ball balance thingie and the step-up and the mini-squats and side-steps, none of which actually caused pain but instead helped strengthen muscles, I got to sit on the table and have the intern do some "mobes" on my knee. "Mobe" is short for "mobilizations" and refers to various moves the therapist makes, the hands-on stuff that is where the rubber meets the road, in my opinion. My leg was straight out in front of me and he pressed down on the thigh side of the knee, gently but surely, until it was way uncomfortable, pushing it straight. I remember from childbirth classes that we say "uncomfortable" when we really mean "painful" - but even though I realize it's a trick I think it works.

After the mobes I got hooked up to the stim machine again, both legs, with a roll under my knees. Every time the stim came on (ten seconds on, ten off) I got to straighten both legs, lifting them up as well as pressing the knee into the roll. While I was doing this I noticed that the left leg was straighter than the right! This is progress!

But perhaps I get a little ahead of my story here. Last night I hardly slept at all and this afternoon, when I tried to nap a little both legs went into uncontrolled "restlessness". Hate it. Couldn't stretch it out, couldn't walk it out. I went to PT this way and by the time I was done the restlessness was gone. I felt such a wonderful lightness and sense of well-being. There are indeed days when I come out feeling ready to take on the world. Tired as I still am.

As for the nights. I am now taking two to three percocets a night, no sleeping drug at all. And I have been doing better. Fewer spasms, fewer restless times. I may be getting over this part of the recovery. I am not going to hold my breath but it's looking hopeful.

What's ahead: my doc wants me to get to 0 and therefore has prescribed more physical therapy, essentially I think I'll be going until I get there. Yay! So happy to find that out.  I will also be getting a thing called a DynaSplint (see illustration at left). This thing gets to stay on my leg for longer and longer periods, until it gets straight (it adjusts to straighter and straighter).  Preferably 6-8 hours - during sleep, in other words.  I think this will really help.

Thursday, June 9, 2011

Eight and a Half Weeks

I'm feeling a little tired right now, a little headachey. I cut out all meds four nights in a row, to see if there was a difference. By the fourth night I realized that the meds probably were helping a little. I had so little sleep that I was up in the middle of the night watching television and still I could not sleep in later. And I had crying jags. So last night I did not forego meds. I took three tylenol pms. That actually did not help much either, to get me to sleep. It was hours of adjusting and stretching and taking showers and sitting on the side of the bed with my head in my hands. Finally, after I dropped off I was up a few more times to go to the bathroom, and once again I awoke with a spasm in my leg. I still feel vaguely hungover.

I am a bit at a loss here as to what to do. I really want to be off the drugs at night, and I figure time has got to help. I don't want magic meds. Well, yes, I'd like that, but more than that I want this to be over, no more need for meds.

At the therapist's office I talked to another knee patient a few days ago and he said that he too still has difficulty at night, has spasms and that he has more trouble sleeping now than he did right after surgery. I am not alone, and that actually is a kind of comfort.

So that's my primary complaint at this stage, at eight and a half weeks. The secondary complaint is that I find it painful to walk, or at least uncomfortable. Third, when I get out of my car I find it painful to stand up again.

The walking is a bit of a mystery to me. A few weeks ago I was walking somewhat stiffly but there wasn't much pain. It may be that I am not allowing my muscles enough rest. It does not seem to me that I am overworking anything but I am working the same muscles in the gym T Th S that I work in the therapy sessions M W F - so I am working them six days in a row. That may not be the wisest course. It may be smarter for me to do my gym routines on the same days as I do therapy.  I hope to get this straight when I start working with Clara, the trainer at the gym. Another component of the walking problem is, of course, my right leg. There are times that it feels incredibly weak, like it's going to cave in, and it hurts to put my weight on it. I do use my cane at these times, to take some of the load off it, but that is not any kind of long-term solution. Today at the gym I found it really hard on that knee to climb the stairs to the second floor, so I took the elevator down when I was done with my workout.

As to what I am doing at the gym. Very similar to what I was doing before surgery, but I have cut some things out and added one machine, and modified some settings:

Bike: I now set the seat at 8, whereas before it was at 9. This is a triumph of sorts. I can bend my knees better now. I bike at level 9 (before I went to 10) for twenty minutes (before I did fifteen) and I work up to my training heart rate and stay there every time (I did not get there before). So when I get off the bike I am sweating.

Leg Press: The goal here now is simply to strengthen my thighs. Previously a big part of the goal was to straighten my legs. I do two sets of ten (same as before) at 120 pounds (previously 140).

Leg Extension: The difference on this one is that I don't go all the way up to a straight-leg position, based on what Paul said he'd learned about using the machines for this purpose. I go about 80% of the way and then back again. I think I'm at just 30 pounds - I don't remember! Two sets of ten.

Seated Leg Curl: I had not been doing this before so I had to figure out how to set the machine. I'm not at all sure I am doing it entirely correctly. I do one set of fifteen at ...what?? I think 65 pounds.

Hip Abductor: I am using this a little differently. When I do "clamshells" on my bed at home I am supposed to lift my leg and hold it for ten seconds. So now when I push open the machine I hold it for a few seconds at the outer limit, then return it to the start. Two sets of fifteen, I think 65 pounds.

Lat pulldowns or row or both: same as before, two sets of ten, 95 pounds.

Sometimes I stand at the railing and do some leg pushbacks (I do not know the correct term) but mostly I do not.

So that's the T Th S routine. I hope it changes after I meet with Clara. Change is good.

Overall I know my progress is good. I am doing well enough to expect a good recovery at the end of this road. I need to be more patient than I am. I look forward to rereading this post some weeks hence and thinking, wow, things have changed...

Saturday, June 4, 2011

On a Dark and Rainy Day, Dark and Rainy Thoughts

I actually like rain. I'll admit, though, that I am tired of being cold. I keep pulling on jackets, climbing under blankets, trying to get warm. I turn up the heat but it doesn't seem to penetrate.

I blame the cold for my not being particularly active today. I went to the gym earlier, and came out at least as stiff as when I went in. That's another thing that's bugging me. It seems like I was walking better a couple of weeks ago than I am now. What has happened in the meantime? Although I am making advances through physical therapy, I am more active overall and I suspect the activities are annoying some of my joints. When I try to rest I can't get comfortable, and when I sit at the computer I stiffen up again. My right leg, particularly the hip, is not feeling good. So I catch myself limping and grabbing onto things. I pull myself up and try to overcome or at least ignore the discomfort and pain but it simply does not work.

I love rain. I would love to be out there, walking in it, preferably on a path, checking streams, looking at what gets caught up in the creeks. But instead I sit inside and grow stiff. Then I get up, try to loosen up, land on some place else and stiffen up again. On Monday it will be eight weeks since the surgery. I had hopes that I could be farther along by now. Or I am just impatient.

Thursday, June 2, 2011

Some Kind of Wonderful?

I admit that I used that subject line to draw attention. I don't know about "wonderful" unless it's defined differently than I thought. However, I am reporting on some kind of changes.

Last night I think I had the best sleep since the operation. I woke up less often, stayed up not as long. Still spent quite a bit of time hanging around awake but less! I hope it's a trend. I'll also keep trying to stay awake longer, which is quite a challenge for me. When night starts to descend so does my energy. It's hard for me to do anything at all except read.

Yesterday at physical therapy I went through the same equipment as the last time, in a different order, and also did some steps up without walker assistance and tried standing on one foot. I am just terrible at that. My balance sucks the big one. I have tried doing the balancing a couple of times since, at home. No better, frankly.

I have also pushed my knee down while on the couch, both with my hands and from within, and I have put my foot on the coffee table, let my leg hang there with about four pounds of weight on my thigh. I did it long enough for it to hurt like hell. Then took the leg off and pushed it into the couch again and again. I want change here. I want straight. I need to keep this up.

At the gym this morning I did the bike - 20 minutes, level 9, 60 rpm, 125 beats per minute heart rate. Also did leg press, leg extension, and seated leg curl - this last took a bit of time because I had not used the machine before and had to figure out how to adjust it. Then did some lat pulldowns for good measure and finally hip abduction machine, holding each hip extension for a second or two before bringing it back in. At the railing I did some pushing back of my left leg. That is, I stood on my right leg and swung my left back and held it there for a count of ten.  Just did five of those, trying to keep my form right -shoulders down, chest up, stomach in.

Tomorrow: Aqua in the morning, therapy in the afternoon. I don't know if this is the best arrangement but it's all I got for now.

Oh, I forgot! We had Barb for Aqua yesterday, as is usual Wednesdays. I call Barb the Interval Queen. We do intervals of twisting, suspended. We do intervals of leg work, described in another of these posts. We do intervals, and they do work parts of the bod and I feel it. Yesterday I felt so good. I could do them, I felt strong, I felt, "I'm baaaack!" So maybe there is some kind of wonderful. No "maybe" about it.

Wednesday, June 1, 2011

On the Right Leg and Work at the Gym

Yesterday afternoon I had another appointment with Paul, the physical therapist. Almost immediately I asked him about the difficulties I am having in my right leg. He said it may be because I am not putting my full weight on the left leg, so the right is picking up too much. I said no, I am not skimping on using my full weight on the left. So he suggested that I try using my cane in the other hand for a few days to see if the legs can even out the load. I'm trying that.

He worked on pressing the knee down more, then flexing it, then pressing, then flexing. Most of the work initially was on straightening the knee. At the end of this part of the session he measured the range of motion and the extension - I am up to about 122 degrees flex and down to -5 degrees extension. That last five degrees reminds me of "that last five pounds". The hardest to get rid of.

The rest of the workout involved machines: the Total Gym, which allows me to do a modified squat, without putting my full weight on my legs, first. I found it harder to do for some reason, than last time. But certainly easier to get to a lower squat than I can do on the leg press at the gym. Following the squats I did leg curls, then leg extensions. And here a difference: Paul went to a class within the last six months and learned that doing a full extension (pushing all the way up and forcing it) on the leg extension machine is not advisable. Because the feet are not grounded, not carrying weight, there is a chance of damaging other parts of the leg, as I understand it. So he said to go about 3/4 - maybe 7/8 - of the way up, do not extend fully using that machine.

Then the bike, ten minutes at level 5 as compared to fifteen at level 4, which I did handily, again, averaging probably 65 rotations per minute. I guess that's hardly fast, is it?? But good enough. Lastly I got the stim machine again, this time both legs, ten minutes of straightening both for ten seconds on, ten seconds off. I'm glad we're paying some extra attention to the right leg too now.

I told Paul I'd be meeting with trainer Clara soon and what might I tell her about what I can work on. He said the extension (as explained), the bike of course, the leg press - but ask if there is another piece of equipment similar to the Total Gym for that. And he said she can call him. I felt like he was more open to my using the gym this time than the last time I asked, probably because I said the name Clara. She can make sure I don't hurt myself.

I made my way home stiffly, as usual. What will I do when I no longer have a physical therapist to look forward to? Honestly, it's going to be hard!  I am so glad that I have managed to stretch it out as long as I have.