Facing arthritis

Stretching It

2012-01-18T17:34:00.000-08:00

The focus of my work in physical therapy is stretching my leg so it will get straight and stay straight. I now sit on the modern version of the rack for ten minutes, while it stretches both legs. It's as much as I can take. When I am home I also work on stretching by placing a five-pound weight on my knee while it is resting on a low stool, straight.

The other day I did the ten minutes and later the weights at home. When I went to bed that night I had a bad time with spasms - restless-legs. It went on and on and made a hell out of the night.

My theory is that the stretching brings on the spasms later. It makes sense, particularly because the leg that is pushed the hardest - the right- is the one usually going into the spasms. If this is so, then there should come a time when my legs are straight and the spasms slow down and even stop. I hope this is the case.

In general, I am walking better. I have been going without my cane some of the time now and I am starting to walk down stairs alternating legs, rather than stepping down with my right leg and then bringing my left down to meet it. I think I'm making real progress.

Adding Weight

2012-01-11T22:29:00.000-08:00

At the end of my physical therapy session today, the therapist asked if I were stretching my knee at home. I said I used some weights but they are light, I need heavier weight. He went to another table and grabbed a heavy weight, asked me to lie back down on the table, and he attached the weight to my knee. Said to take it home, borrow it, put it on when I am sitting with my leg on a short stool, keep it on for several minutes.

I have put it on several times today and intend to use it several times a day. Hoping it helps. Certainly can't hurt.

I think I'm walking a bit better in general. I wonder if the leg-straightening is part of the reason.

A Good Day

2012-01-10T17:46:00.000-08:00

It didn't start out with a lot of promise. As usual, I caned my way to the kitchen to feed the cats early this morning, bent over and feeling pressure and pain in my right leg. Each time I got up I had to grab the cane. Finally it got close to time to get ready for Aqua.

I changed into my swim suit and swim shirt, added jeans, socks, and shoes, and packed my gym bag. I grabbed my cane and made my way to the car.

At that point I thought maybe things were going a little better. I used my cane to help myself down the steps but it was not arduous, it was pretty easy. By the time I got to the gym and out of the car I knew it was a good day.

I walked in, flashed my tag, walked to the locker room without limping. I did not take my cane in with me. Once ready, I walked out onto the cold concrete deck, swearing yet again that I would get some kind of deck shoes for these cold winter months, and headed to pick up the bouys and noodles, then for the water. So nice. No pain. Pressure, stiffness, but no pain. Another classmate noticed and commented on it. She assumed this was a permanent change but I know better. Still...maybe it's a sign? Yesterday, after all, Chuck, the therapist, said, "Good!" in a way that was different, after pushing my knees down. Straighter, is what he meant. We are getting there.

I went to the dollar store after class. My right hip pain kicked in and made that not the best experience but I could recognize that it was the hip, not the knee.

Another sign that it's a pretty good day: I have been cleaning up spots on the carpet, washing and sorting clothes. Doing a little vacuuming. When my legs feel better I have more energy.

That's Stretch behind me in the pic.

Stuck

2012-01-07T19:35:00.000-08:00

It seems like I am stuck. Suspended. No change, or change for the worse. I recall feeling less pain a week after surgery than I do now. Of course I was taking painkillers at the time and not feeling it all. But the memory haunts me, makes me wonder what I've done wrong.

There is no percentage to thinking like this. No gain to be had from dwelling on my disappointments.

But there might be a gain from listing them here. Listing them may help me free myself from them, from dwelling, and of course it will help down the line to see where I was at this point. Useful information.

Walking. I usually feel a tension, a tightness, in both legs, when I walk, and a part of that is a kind of pain in my right leg. I often now have more pain in my right hip and in my right foot than in my right knee. Seems like I might have expected that, given that I broke my foot in 12th grade, so it is a natural place for arthritis to thrive, and the arthritis in my right hip is well established. So I still walk in pain or in discomfort if not pain, but maybe the pain of my knee is the least of it.

Stiffness. I am very much aware of the stiffness in both knees when I do Aqua classes at the gym. We do a lot of exercises that call for raising my legs, kicking them, marching type moves, and more, and when we stretch at the end I can never grab my ankle when I bend my knee back. Either ankle.

The cane. I hate that I am so dependent on my cane. I thought I'd be tossing that thing out within a few weeks of the operation. But it hurts too much to go without it, most of the time.

Getting up. Still there is discomfort when I get up from sleeping or from sitting for a little while. I want so much to be able to jump out of bed without considering ahead of time how I am going to avoid pain.

Restless legs. Seems to be getting worse, happening during the day as well as night. It is mostly my right leg, though, which suggests that this condition might lessen as I get better, as the knee heels completely.

Getting in and out of the car. It still hurts. I can usually drive all right, without pain. Just getting in and out is hard.

My body is a cage. Let my body free. Let my spirit free.

Waiting to Sleep

2012-01-02T22:53:00.000-08:00

I went to bed at about nine, with a book. I took a hydroxyzine tablet (for the recurring hives) and a ropinirole tab (aka Requip) for my right very restless leg. It would not quiet down. I took another a while later, and then took a shower, tried relaxation techniques, then took a third ropinirole tablet. And here I am, almost two hours later, my leg just as uncomfortable as it was at the start.

Fortunately, this does not happen every night. I wish I could figure out if there is a trigger or something that I do to either set it off or prevent it happening. I have not been able to come up with connections yet.

Perhaps I will scan some medical bills, write a book review...

Inauspicious Beginning

2012-01-01T16:41:00.000-08:00

Like many others, I like to do something symbolic around New Year's Day to suggest a change for the better. Today I did not do much of anything, and certainly nothing symbolic. I tried to talk myself into going to the gym but did not get there. In my defense, I am still recovering from a cold and I have three cold sores on my lips, which does not make me persona grata anywhere I can think of.

But here it is, January 2012 and I need to take a look at myself. Look back at 2011, see where I've been and where I am headed.

Not a great pic but it's current, taken today. You can see that my legs are straight, meaning no longer knock-kneed. In April of 2011 my left knee was replaced. In October my right knee was replaced. So it was the Year of the Knees. My focus for the whole year was on my knees. Not much else got done, frankly. And I am still at it.

Some signs of progress: It doesn't hurt to drive any more. It still hurts to get in and out of a car. My left knee generally does not hurt. Every now and then there is a bit of pain at night but mostly it is just stiff. Very nice. I feel discomfort when I have to stand for any length of time. My legs both feel a kind of tension, and uncomfortable tension, and often my right knee or my right hip will hurt as well.

I do time in physical therapy three days a week. I bike fifteen minutes, isokinetic. Then step (on a sitting-step machine) fifteen minutes, at level four. Then leg press: four sets of twelve with both legs, then four sets of twelve with one leg, 3.5 lbs for both, 2 lbs for one leg. Then the isokinetic leg kicks, 8 sets of ten, followed by curls- four sets of twelve, then extensions, four sets of twelve, and finally a seven minute stretch of both knees, all at 12.5lbs. Finally I land on the table, where Chuck, the therapist, pushes and pushes both knees. We're gradually softening the muscle, working to get the legs to zero extension. What a dream! Will this spring be the time it happens??

When I am not sick, I also go to Aqua classes three days a week. I am considering doing more work in the gym either on the Aqua days or the therapy days, focusing on arms and aerobic activity for now.

I am no longer taking pain meds. I was taking one vicodin per night but when I ran out the PA at the surgeon's office left a message that they don't normally continue addictive substances longer than I've been on it, that I should go to OTC NSAIDs. Never mind that I can't take NSAIDs. I get tired of having to remind them of that little detail. So I'm off all pain meds unless I take a bit of tylenol now and then. I am still waking up with my right leg in pain for hours, but not every night. Fortunately. I seem to be sleeping more hours between wakeups.

Not much of a report but I think it will be helpful to review later, when some of the remaining issues have been resolved.

Isokinetic exercise

2011-12-12T11:54:00.000-08:00

i·so·ki·net·ic exercise (s-k-ntk, -k-)

Exercise performed with a specialized apparatus that provides variable resistance to a movement, so that no matter how much effort is exerted, the movement takes place at a constant speed. Such exercise is used to test and improve muscular strength and endurance, especially after injury.

I first heard the word "isokinetic" at the physical therapist's office where I worked on my left knee. Paul, the therapist, was testing an intern, asking her what it meant. She did not know. I guessed from the name something close to what it means. In essence, however hard you work, the machine or exercise responds with an equal resistance.

In my present therapist's office is an isokinetic machine hooked up to a seat with a removable leg holder. My leg goes into the holder, is strapped in with a soft padded brace and velcro, and the machine is set. Right now I do eight sets of ten leg lifts using this apparatus. The harder I work the harder it works. But never beyond what I can handle.

When I am on the stepper - a step machine in which I sit and step in a recumbent position - the machine is also set to "isokinetic". The harder I work the harder it works. So far, from my looks at the gauge, I don't work it particularly hard. But what I seem to get most from that machine is a stretch. I stretch each leg each time I push the step.

Swimming is a type of isokinetic exercise. If you move your arms slowly through the water you encounter a minimum resistance. The faster you move, though, the greater the resistance of the water. This may be one (of many) reasons swimming is such a good all-around exercise for just about everybody. I do wish I liked it more!

Today's therapy went well. I felt better, moved better, and Chuck noticed I was walking better too. Over this past weekend I have felt like I turned a corner. I still have a lot of pain walking much of the time, but I am noticing that more and more often the pain is not centered as much in my knee as in other body parts. My foot. My hip. Perhaps this is because they are adjusting to this new alignment. I still have pain in my knee, particularly in one place, and I just have to ride that out.

Just Cut off the Legs, Please

2011-12-10T07:28:00.001-08:00

Yesterday my therapist joked, "just leave the leg here and I'll fix it". If only. I keep trying to find a way to detach myself from the hard part of therapy, the pushing done by hand. It not only hurts because it is stretching those long-tight muscles in back, but also because I am still having trouble with some pain spots on either side of the knee.

Lately I am having more restless leg issues, both during the day and during the night. I have increased the dose and used up all but one of the Requip (Ropinirole) tablets already. I need to get back to the doc to get the prescription amped up. But yesterday I looked at askapatient.com as well as medline to find out more about patients' experiences with this drug. Over 300 people had reported on their experience with it on askapatient, and some of the reports were frightening: "I wish I had never started it." "I want to get off it but can't". "I am taking more all the time". Signs of addiction, in other words. Among other "side effects".

I know of no other alternatives. I tried many remedies before heading for the doctor, and none worked. I used to think I'd have this nerve manifestation less often if I were more active but it seems to get me no matter how active I've been. I am going to try to get into the doctor's office today because it is open on weekends and even into the evenings. Unfortunately, their early fame to short waiting times and on-time appointments have mostly been thrown away by an increased patient load. I'll bring a book, of course.

Getting On

2011-12-09T12:56:00.001-08:00

I am feeling hopeful again. For the last few nights I have awoken less often and had less difficulty getting out of bed - less pain. I felt I got going more easily this morning. And the therapist continues to be confident that we'll get my legs straight.

I asked him today if we can get Medicare to pay for the extra therapy that is needed to get those straight legs and he said absolutely. My condition warrants it and my goals are reasonable - to have straight legs so I can walk right.

I will be going to Las Vegas for Christmas, spending ten days, so I also asked Chuck, the therapist, if he can let me know what I can do at Las Vegas gyms while there to help stay on track. He will do this. He's very easy in this way, flexible and helpful. He also has 42 years' experience, which pretty well speaks for itself. If the number of clients didn't already, including many with sports injuries. I learn different stories all the time, making my time there seem pretty darned mild in comparison sometimes.

Chuck told me that the stiffest leg he ever dealt with was on a nine-year-old boy. The boy had injured it skiing and it did not need surgery but it would not bend. He evaluated it in conjunction with the boy's doctor and found that he could bent it less than an inch. The boy was going around with crutches and a useless leg. The surgeon decided to do a "manipulation". This means the boy gets put under anesthesia and the surgeon then bends the leg. No cutting, just bending. The surgeon invited Chuck to join him in the operating room and the two of them tried to get the leg bent while the boy was under anesthesia and it still would not budge! So it was not merely a matter of the boy's fear. This is how they approached it: they put him in a rehab center, in bed with a Continual Passive Motion machine bending the leg as best as it could 24/7, for a LONG time. I do not know how long, but until it started to overcome the resistance and show some softening. Once he got to that point, he got to get out of bed and undergo more traditional physical therapy four times a day. And this way they got it to bend again. He is now in high school and remembers those days well, Chuck said. Doing well.

And here I am, going to PT three times a week and getting to the gym for Aqua classes three times a week and I moan about pain and inability to do everything I want. Seriously!

Driving is still painful but a wee bit less so. I figure I'll take the plunge and drive myself to the Santa Maria airport for my trip this time. Extending the effort.

In general I am trying to get up and move around more frequently. I was doing this while seeing a home therapist but somehow lost my habit when I moved to outpatient. Get up, move around, sit down again. Rest, get up and go again. I am using my iPad and my iMac to play favorite music on iTunes a lot more, too. It just cheers me up. Cat Stevens right now. What can I say? Some things don't get old.

A Status Check

2011-11-30T20:32:00.001-08:00

I went for therapy this morning, then later to my surgeon's office for a recheck. The therapist measured my range of motion: flex is at 125 degrees, extension is about 14 degrees from zero. The extension is the major concern, of course, but the therapist, Chuck, is confident that we will get there with both knees. He said that my bent legs make it harder for me to walk straight and tire me out sooner. With straight legs I will go further and with less pain.

He himself has a bad knee, he said, and he noted that it too is bent and that he can't straighten it because it is too painful. He has not yet scheduled the surgery because the recovery time is so great. In his favor, of course, is the fact that he can get as much therapy as he wants and needs as long as he likes. I would expect that after the first couple of weeks he could be back at work and on the machines himself from time to time.

I took the info on my range of motion to the doctor. He continues to be concerned about getting my leg straight and mentioned the Dyna-splint again - I nixed that one, saying I simply could not tolerate it the last time. Then he said there was the option of using progressive casts, holding the leg in one position for a while, then moving to a straighter cast. I simply could not abide the idea, frankly, especially because the therapist is confident that we can get me there. I would much rather get there by going to therapy three days a week, stretching both legs as part of that experience, than by walking around with a cast on. If he had said we could try a special brace that might relieve the pain you're having I'd have gone for it. But no, that was not in the picture. The pain doesn't seem to register with him the way it does with me. He's out for the straight leg, period. We agreed that I would continue to see the therapist and he, the doc, will be happy to extend the prescription for therapy to give me the time I need to get this done. He did not say to return for a recheck and when I checked at the counter the person there said that if he did not give me a recheck time then I do not need to come back. Well, that's fine if I can just keep up with therapy.

This isn't the way I envisioned it, of course. I thought I might swim through this second surgery, and initially I really did. But things like these tight legs, which have been tight for so many years, cannot be corrected so easily.

Bragging Rights

2011-11-30T12:24:00.001-08:00

Today's challenge (and the end of the 30-day challenge!):

Play that horn. Want to hear a secret? You’re awesome. (It’s actually not even really a secret.) This is going to be hard for you, O Modest One, but you gotta give yourself props today. Write three things you love about yourself – things you’re great at – or just want to share. Don’t you dare signpost or undercut those self-compliments!

1. I am honest and ethical. I won't say I have never lied. Everybody lies. But I try to be as honest as I can be without unnecessarily hurting others. I look at what I say and do as if it were to be posted in the newspaper the next day. Some days that paper would say, "Lautner barely moved all day. Hooked on Real Housewives". I'd admit that anyway.

I understand what it means to do the right thing. It is not always obvious and sometimes the "right thing" could actually be more than one choice. I try to do my best, without slanting the action in favor of myself. My brother made me executor of his will and he could not have made a better choice. I knew from the start that I was representing him, not his heirs, and I did my best to represent him as he would have wanted me to. At times it was difficult because others in the family did not agree with my decisions. But I knew what it meant to have this responsibility and I did not shirk it to make somebody else happy.

2. I am compassionate. It may be that my own early experiences prepared me. I was fat and dirty as a child and other children ridiculed me. I learned, on the one hand, how to ignore those who were cruel to me, and on the other, how it feels to be on the outside. Ever after I felt compassion for others in similar situations, from small children to difficult adults to farmed animals. What makes me most proud, though, is that I did not shut down my feelings. I feel deeply. It hurts to feel pain deep inside me but I do not shut it out. I embrace it. And this, too, helps me feel for others.

3. I am big on reading. I read for pleasure and for information. Even books read for pleasure often have in them feelings, emotions, experiences that move me, make me somehow different. I have read such a wide variety of books over the years that I feel this reading has shaped my view of the world. It is as if I were a world traveler or even a time traveler in that I understand much of other cultures, other times, as well as the world within our heads, the way our brains work. I am no expert in any of these things but the accumulation of such wealth makes me see the world more clearly and be able to question assumptions, even those I have held since childhood. I believe that reading has opened my mind in the best possible way.

I'll take this opportunity to mention a few things I am good at, just to gild the lily: photography, cooking, teaching one-on-one, sewing, writing, math, music. In this I follow in the footsteps of my mother and grandmother, both of whom pursued several interests through their lives. Let us celebrate this Jill-of-all-trades-but-master-of-none, for it makes for an interesting person.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Greetings

2011-11-29T08:23:00.001-08:00

Today's challenge:

Greeting card post! The greeting card industry is all about writing generally universal feelings in a presentable way that you can use to express yourself when you just can’t think of the words to say. Write a greeting card for someone in your community to help them express themselves about a new diagnosis, treatment, or experience.

Here we go:

Front:

Congratulations!

Inside:

On not one but TWO new knees!! More fun! More therapy! More pain! Life with two is just MORE.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Say WHAT?

2011-11-28T09:08:00.001-08:00

Today's challenge:

Say WHAT?! What’s the most ridiculous thing you’ve heard about health or your condition. Was there any context? What did you think at the time you heard it – and what do you think of it now?

So many choices! Not many about arthritis that I can think of, but many about health.

What many may think is not ridiculous but is: the assertion that depression is caused by a chemical imbalance. If you read the fine print you will see that the advertisers are quick to say "it is thought that..." rather than outright lie. The scientists have been trying to prove this theory for over 50 years and have not been able to, which suggests strongly that the theory is wrong. There are several books debunking this so-called "common wisdom". One that I especially like is Blaming the Brain by Elliot Valenstein. If you're curious you can read my review of it.

I have heard the "chemical imbalance" theory so often that I cannot pick a certain time. It is ridiculous every time.

Another claim that I have heard often is that vegetarians are weak. Again, this is such a commonly-held belief that I cannot place it together with one specific person. Typically I read this online. People do not say it to my face. I am vegetarian - vegan, in fact. NO animal products. I am strong. But of course don't take just my word for it. There are several world-class athletes who are vegan. Here is just one article on tough vegans.

About arthritis: I clearly had arthritis over 30 years ago but it was no diagnosed. I went to see the doctors in my thirties and while some doctors said it might be arthritis they ruled it out, thinking I was too young. It was only many years later that I was able to see the x-rays that show the extensive damage done to my knee joints through osteoarthritis. Was this ridiculous? That the doctors did not figure it out? I think so.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Quote

2011-11-27T09:51:00.001-08:00

Today's challenge:

Quote Unquote. Grab a quote from this site (wegohealth.com) (type in any word – see what comes up!) and use that quote to set you writing.

The following excerpt is from a blog post on WegoHealth:

According to the Mayo Clinic:

Restless legs syndrome (RLS) is a condition in which your legs feel extremely uncomfortable while you're sitting or lying down. It makes you feel like getting up and moving around. When you do so, the unpleasant feeling of restless legs syndrome temporarily goes away.
Restless legs syndrome can begin at any age and generally worsens as you get older. Women are more likely than men to develop this condition. Restless legs syndrome can disrupt sleep — leading to daytime drowsiness — and make traveling difficult.

The reality for many - who have RLS - is so much worse than that description. Their lives are miserable - with symptoms that almost never go away, and never having enough sleep. The RLS symptoms alone can make it a depressing, and demoralizing existence. When you add in most people's misunderstanding - including many doctors - about this disorder, patients often feel as if they are alone - with no support system.

I have Restless Legs Syndrome. At least, it appears that I do. It was diagnosed by a Physician's Assistant based on my symptoms, which I described. I am always suspicious of diagnoses made this way but perhaps there is no biological way to diagnose this condition. Like many people, I tend to downplay the condition because it is not life-threatening. It is an inconvenience. But as many of my posts in the blog have shown, as well as in the full blog post excerpted above, it can be much more than inconvenient.

In the past several years I have had an occasional episode of RLS. It did not continue for days on end so I never considered it a really difficult situation. After surgery on my left knee, however (total knee replacement), that leg went into frequent bouts of RLS. They became so constant that I could hardly sleep. At the recovery center I mentioned them but nobody had a solution other than taking the maximum amount of Percocet allowed me. This really did not do the job. I mentioned the situation to physical therapists, who were concerned and relayed the information to the surgeon, and then to the surgeon, who essentially shrugged. I think he was sympathetic but he had no solution.

After months of dealing with it I went to my regular physician office and saw the PA noted above, who prescribed Requip at a very low dose, to see how it goes. She had the good sense to order blood tests and a thyroid test as well, to rule out disorders that have restless legs as a symptom. The tests were all negative so we are assuming I have a neurological condition, that RLS is nerve-based.

The Requip is working. Sometimes I have to take an additional dose but most of the time one dose at night takes care of it. Sometimes I go without, just to see, and sometimes that works. When I travel on a plane I make sure I have the medication within easy reach and that I take some before boarding. I am starting to take it when going to see a movie as well. Recently I saw a movie with family and took one, then another later, and still, by the end, was uncomfortable. I am sure that my stretching and getting up and down was as discomforting to my family as it was for me.

I am bothered that it appears that this condition is in the same place as Chronic Pain Syndrome, for example - no clear biological proof that it exists. I hope that this changes in the future and that future treatment is based on the biological cause. I tend to be embarrassed to admit that I have it, yet whenever I do the response is sympathetic and real, and I learn that many others are dealing with it as well.

My surgeon and the PA had no explanation why the surgery might have brought on the increased incidence of RLS. However, about 72% of persons with RLS also have osteoarthritis. I hope, too, that this connection is explained in time.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

This Is How It Is

2011-11-26T17:21:00.001-08:00

I called in two prescriptions Friday afternoon, when I got home from Las Vegas. One of them had no refills so the Costco pharmacy had to fax in a request for it to be filled. The other had another refill available. This morning I checked on them and found out that the request had not been answered yet but the other prescription was filled and ready to pick up.

I went to an Aqua class at the gym this morning and felt pretty good at getting through it well. But my knee still hurt and my foot hurt as well. I have just begun to realize that my right foot hurting has been another part of my current situation. I really did not want to make my way over that concrete floor after crossing the wide concrete expanse outside the building to pick up that one prescription. But as the day, today, wore on, I thought that I might have difficulty picking it up tomorrow when the pharmacy is closed.

So I reluctantly went out at about 3:30, cats nipping at my heels, wanting to be fed before I left. Walking from my car (all the disabled spots were taken as usual) to the building and all the way to the pharmacy against the far wall was really uncomfortable. I kept waiting for the pain to let up but it did not. I took my time, used my cane. At the door the greeter asked if I wanted to use one of the motorized chairs and I said no. I still have such trouble being seen in a wheelchair. But oh, how much I really wanted it.

I got there, was so happy to see that there was nobody in front of me. Waiting in line is not comfortable either, not yet. I got my prescription and took my time back and eased my way into the car, hurting.

Driving is still not without pain. It seems to have settled at a steady level of pain, not getting worse but not getting better either. I think the foot pain contributes here. I made it home, stopping at the mailbox for another painful effort, getting out to get the mail and returning to the car, and finally into my driveway.

I am walking around without my shoes now and I feel a little bit better but only a little. This is how it is now, right now. There have not been too many times when I have been without pain. I'm trying to figure it out.

I Still Remember

2011-11-26T12:09:00.001-08:00

Today's challenge:

I still remember... Free write a post that starts with the line “I still remember...”

I still remember the day I did a long hike at Montana de Oro in Los Osos, CA, about 13 miles from my home. I was in my fifties and feeling good. I was of average weight and my knees were not giving me too much trouble. I loved hiking then as I do now but I was not in the habit of doing long climbs. That was another level for me. I decided to take a chance, try it, one day.

I prefer to hike alone, usually. Unless I am with a family member who doesn't mind my pace. I don't care to go with groups who are gracious enough to stop from time to time to let me catch up. One thing they may not realize is that by the time I catch up they have gotten their little break. And I still need one. So I like to take as long as it takes for my own body and for my mind. I do not hike to break speed records but for the beauty of it, the feel of the breeze, the smells of the native vegetation and the occasional treat of a wild animal crossing my path. I bring my camera. One time I caught a bobcat with my camera. All I could think about was getting that picture, not getting to safety. Not that a bobcat is likely to attack me.

This day that I did the long hike I took several breaks as I climbed higher and higher. When I reached the peak I was so pumped. I took out my camera and grabbed a photo of myself from below, looking out, and it captured the feeling I had then, very well. If I run across that photo I will insert it here later.

Then it was time to return. I started down the path and somehow got my signals mixed. There are several trails in and around that area and I did not take the same one back that I came up on. I do not remember if I had expected or planned to do some sort of circuit, a loop, rather than out-and-back. Whatever the reason, I was on a different trail. After some time I realized I was really on the wrong trail. I did not seem to be getting much closer to the trailhead at all. But I was descending, which was a good thing, and I figured I would get there eventually. I started to see signs of the ocean in the distance and I headed that way. I got to the point where my legs were so tired that I had to talk myself into taking each step. I also remembered a tip my sister gave me when I was quite young: to "detach" my legs from my body. I tried to divorce them so I would not feel them. It does help to do this, but just so much.

Eventually I did get back to the trailhead, or perhaps a different trailhead, I don't remember. From there it was not far to my car and I was ever so happy to see it. I was proud and exhausted at the same time.

I very much want to reach the point where I can consider this type hike again, where I feel so good it seems like a reasonable challenge.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Friday's Challenge: Never Have I

2011-11-26T08:12:00.001-08:00

Friday's challenge:

Never Have I Ever. You stick to your guns – now tell us about what. What is something you’ve never done but want to. What’s something you’ve never done and won’t budge on?

I have never sung a solo. I love to sing but have never taken lessons. I took a class in voice in college, a requirement for the music major I was pursuing (my focus was piano). In that class the teacher managed to bring out a hint of the voice I might have and she was excited about it. But I have never followed through. I have sung in choirs to keep my hand in, to be able to perform music without too much responsibility. But I have never sung a solo. I have had visions of doing this, over the years. I would not ask for something impossible - a solo in a small production with a small audience would be fine. A church solo would be fine, if I belonged to a church. A solo at a wedding or funeral would be such an honor. I am sixty-five years old. Is it too late for this dream?

I have never ...

This is harder than I thought it would be. I am a highly ethical person and yet:

I have lied.
I have stolen.
I have cheated.
I have hurt others.

Milder confessions:

I have skipped school.
I have smoked pot.

And I can't say I would never do any of these things again, under the right circumstances.

I have never murdered. I can say with 99% assurance that I never will, but again, there may be circumstances that would lead me to do so.

I have never married and am unlikely to do so but it isn't something I'd not budge on.

I have never blackmailed someone. But would I? Again, to protect somebody else I just might.

Here we go:

I have never surrendered an animal to a shelter that kills animals who are not adopted. And I never will. Similarly, I have never entered an animal in a judging contest at a fair, and I never will. I have never bought a cat or dog from a pet store and I never will, nor have I ever bought an animal from a breeder and I never will.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Thanksgiving Day Post - Delayed

2011-11-26T07:53:00.001-08:00

Thanksgiving was simply too busy a day for arthritic me. I was too tired to tackle the day's challenge and will do that now.

Thursday's challenge:

My Mascot! Give your condition, community, or self a mascot. Who is it? What do they represent? What is their battle cry?

Yikes! I am drawing a blank on this one! I could choose a dog or cat, both of whom do get arthritis too. But perhaps a creature that represents coping, aging, non-glamorous acceptance. No flashy character, but one that everyone knows, that stays in the background for the most part. For my money, a mockingbird.

When I first came to California from Michigan and heard these birds singing in the middle of the night (which they do in mating season), I was astounded. I had never heard such a thing. It was wondrous, other-worldly, and I quickly had to find out what it was. It was the ubiquitous mockingbird, singing its little heart out at least as lustily as it does during the day. So many people ignore this bird and even curse it when it wakens them from a sound sleep. Yet for me its song energizes and makes me feel that much more alive. So why not? Why not have this symbol of strength and song carry us along?

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Anything Goes

2011-11-23T22:21:00.001-08:00

Today's challenge - I think this time we get to write about whatever we want. I left my list at home and I haven't found a list easily online. One blogger wrote that we could write about whatever we want so I'm going for it.

It is the day before Thanksgiving, and like many other families, ours has been preparing for tomorrow. We try to keep things simple but we do want to have something of a traditional thanksgiving. Traditional for us, that is. I offered to make pumpkin pies, because I had just made some last week for a special event and they got rave reviews (new recipe, not my own).

We worked out the day today, which was to include shopping for what's missing. I made a list. I wanted to get in a water exercise class, too. So, using my son-in-law's pass to his gym, I took a class at 10:30. My daughter took a yoga class at 10:45. We got out of the gym at noon and had scheduled a stop at the library, then lunch. We did these things and by then my grandson of 23 months was needing a nap. So was I.

The class and the subsequent time at the library and the lunch out took it out of me. My knee was hurting and I felt almost exhausted. This is rather the thing about healing and getting old and feeling pain - one can get tired more easily. What with one thing and another I did not get to making the pies until just about 20 minutes ago. They are in the oven now. when they come out I will put them in the fridge, then pack my few remaining things and walk to my other daughter's house, which is literally around the corner. This daughter called me a "procrastinator" because this has taken so long. She simply does not comprehend how difficult it can be for me to do a lot of simple things, and how those efforts can quickly tire me. It won't always be so! When this knee is healed I will have a lot less pain and my alignment should be better and I should be able and happy to go hiking again. When that time comes I will have more energy and I will be able to do more things. For now, I simply have to hang on and take the time it takes. That is a huge part of healing.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Description

2011-11-22T16:06:00.001-08:00

Today's #NHBPM Day 22 Prompt is: Be present. Describe a scene with lots of imagery. Show, don't tell! My bedroom. I am over 400 miles away from it right now but it is present in my mind. When I walk into it I first see the bed. IT is queen-sized, head up against the far wall. It is covered with a blue and white striped-design comforter, on top of which are three pillows. The pillows are spread across the head of the bed. Two are of a green flowery design and the third is plain off-white. The white one sits in the middle. LIght from the window to the right of the bed flows in to create a comfortable afternoon wash: no glare, just soft light. I can pull the dark maroon curtains to cover the window, the material reaching to the floor, but I don't. I usually hook them on the one large hook on the right side of the window, and swirl the curtains over the hook a few times, to form something like a knot.The room is larger than others I have had in past years, but not what most people would call "large". It takes up all but about six feet of the width of the house, the 20' width, and it is about fourteen feet deep. The bed is almost against the left wall, but there is a gap of about two feet there, allowing me to get in from that side and to make the bed. A black two-tiered bedside table sits in the corner, with a lamp, the type that can be bent to face down or up, at the back of it, against the wall. Also on the table are books - usually two or three, a small alarm clock, black, with glowing numerals, a pink plastic tray with a matching plastic pitcher, and at night some medicines I am currently taking. Right now there is a glass on the tray. It is what I think they call an "old fashioned" glass, but I could be wrong. It is about three inches high, sturdy, with a heavy bottom. It has a green pattern stamped around the outside. Why is the bed so far to the left when there is so much room? Because a 7-foot long "parlor grand" piano sits lengthwise on the right side. The keyboard faces the rear wall, with about two feet or so between the piano and the wall. A heavy wooden bench that has seen better days takes most of that space. The piano lid is closed but the keys are exposed. On top of the lid are piles of music, in random order, always knocked about by my cats.On the main part of the lid are odds and ends of things, like clothes that need to be put away or a laundry basket or some jewelry or a suitcase that I have not emptied since the last trip. Under the piano are a couple of bags of fabric and related materials, for sewing. There is also a basket with all sorts of odd stuff in it, culled from other places. I need to sort through that mess. One of the house's four cat litter boxes is next to the piano but not under it. It is green, fairly large, with a domed cover. There is a set of "stairs" inside the box, allowing a cat to enter by going up this ramp and into the box. The bottom steps usually have an accumulating of litter on them, often wet from one of the cats peeing right there.In the near right corner as I face into the room is a music cabinet that I inherited from my grandmother. IT has an old-fashioned type lock and I have lost the key. Inside are beautiful little trays that slide out, drawers for sheet music. The case is a dark wood, I am not sure what kind, and it is neatly carved but not elaborately.Just to my right is a black two-tiered table, about three feet high, containing my "boom box". IT is in three parts: the center part and one speaker are on the lower level while the other speaker is on top. Some odds and ends sit next to the upper speaker. To my right is a tall bookcase, Ikea, with doors covering the bottom half. the doors donwt line up exactly right. I did something wrong in putting it together. The upper shelves are stuffed with books, some layered on top of others. ON top of the shelf are a large puzzle in a box and some games.This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Ekphrasis

2011-11-21T12:25:00.001-08:00

Today's challenge:

Ekphrasis post. Ekphrasis (writing about another art form) – Find a Flickr Image in Creative Commons that inspires you in some way (positively or negatively) and free write about it. Give yourself exactly 15 minutes to write without stopping. Don’t think! Brave bonus: Publish to your blog without editing! (You can include a disclaimer)

I searched for "creative commons images" and found, through a post on that site, CadYou, a site for 2D and 3D cad images of high quality. What a great concept! I joined and did a quick look around and chose this image:

NO IMAGE...turns out the images are available in formats that do not work here, and I do not want to take the time to download the program I would need to convert any of the images. Perhaps in a later post I will look into this page more, though, because it looks, to me, very cool.

So instead! I went to WikiMedia. And chose a "random image".

And so begins the 15 minutes:

The owl sits on a fence post outside a conservation park in the United Kingdom. I visited some parts of the UK in 2008 and when I saw this photo I was immediately reminded of that visit. My sister Cathy and I took two weeks first in Ireland and then Scotland. Our week in Ireland was spent in the Dingle peninsula, in a vacation house - a cottage rented by the week by its owner. An old cottage outside the community of Dingle, in the countryside, but with several neighbors, including many sheep. We met the neighbors across the street and we had beer at the pub down the street.

The Dingle peninsula has to be among the most beautiful places in teh world, and it is somewhat primitive as well. We looked out on craggy rocks in the ocean (Atlantic), took sheep paths, drove on tiny windy roads and kept running into walls on the sides of the roads. We got to know the local body shop in Dingle quite well. They did a great job of rubbing out the scratches in our rental car. And replacing tires. Tyres, I guess they are really.

Dingle is a great little town, old and "quaint" but hardly full of itself. It's a real place, with all the mod cons, more or less, including an internet cafe and a phone place where we could make inexpensive trans-atlantic calls. But I really shouldn't be making this some sort of travelogue. Lordy. We loved it there but also loved Edinburgh. I was determined, when we got to that Scottish city, to find some areas written about in the books by Alexander McCall Smith, who lives there. I found one of the pubs, and it fit the descriptions very well. I loved Edinburgh. We knocked about there, looking at castles and a lot more, but at one point I was dealing with a lot of stomach pain and while we were in a restaurant for lunch I nearly fainted. This is when Cathy called for serious action and got me to a hospital. It was a little complicated - we made our way back to the older little hotel where we were staying and called on the concierge or whatever she was to guide us. Then I took a cab to the hospital. Spent four days there, with a hole in my stomach. This made us have to extend our stay, and changing our plane tickets was not really a treat. Had to pay for that one. Didn't get the insurance. Who'd a thunk??

How much time have I used? Eight minutes? Oh heck.

I loved being in that country. I love the oldness of it, the customs, the walking, the way one could come up on a treasure unexpectedly, like the cemetery that was up high - on a roof, it seemed like, but couldn't have been. And the portrait museum. But this is still being a travelogue. Surely I can do better than that.

The television is playing an episode of Glee right now. It is one I have seen so I am not missing it. I will want to watch the one after this one. I am watching through Hulu Plus, using my Roku. I am trying to wean myself off cable television (which I have not yet cut out, however). I watch episode after episode of so many shows. I can't remember when I last watched so much television. I do have an excuse. I am recovering from knee surgery, remember?? And I need a lot of rest and I need to do many little exercises sitting on the couch. However, I am flying to Las Vegas tonight so I should not be watching anything but instead packing and cleaning up. Trouble is, I still hurt. I figured why not get this blog post done first. 12 minutes in.

My body feels done in. I went to physical therapy this morning and iced my knee when I came back. Now, perhaps, I will get more warmed up, feel better, get my bag packed, get ready. I am not checking a bag so I am getting by with a carry-on. It will be interesting to see how well I do packing. I usually fill my car with stuff. No extras this time. No computer even - but I am bringing my iPad and I'll use that to continue with blog posts while in Vegas. Plus the computer keyboard I am using now, the one that goes with my iMac. It's seriously time to get out of here and into...there you are! 15 minutes.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Laughing Out Loud?

2011-11-20T17:01:00.001-08:00

Today's challenge:

LOL post. Write a post about a moment that made you laugh. Or a video, picture, blog post, or something else that made you.

I can't help it. It's a video of a cat. The cat was lying on a chair, next to a soft mask of a rabbit head. The cat pushed the mask onto its head and lay back, showing off its bunny ears. It is hilarious and I did laugh out loud. I guess there will never be a shortage of cat videos online.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

"best of"

2011-11-19T19:00:00.001-08:00

Today's challenge:

“Best of” post. Grab a post from your archives and repost it! Add a few sentences at the beginning to frame it. Why you chose it. Why you liked it. And why it should be shared again.

I chose this post from June 15, 2010. I was in the midst of working in the gym to relieve the effects of my arthritis. I worked with a personal trainer who specializes in working with older people and I had visited with a physical therapist to do some measurements and get recommendations. I developed this program somewhat by accident - by learning, in a seminar at a gym, that some gyms have trainers who work with people before and after orthopedic surgery. I had a flash that these trainers might be able to work with someone who is trying to overcome the limitations of arthritis, a person who is not considering surgery. In this post I wonder why it took an accident for me to come up with this program. I am still wondering.

-----

June 15, 2010

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.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Return to Aqua

2011-11-18T15:00:00.001-08:00

Yesterday I returned to an Aqua class at my gym. The Thursday leader is one of the milder ones, so I felt it was a good way to get back in. However, after 20 minutes, she relinquished the class to Cindy, one of the Movement Maniacs, who finished the class with us.

Cindy is a personable, highly active fifty-something teacher, who knows all of us. She remembers my name, what has been going on with me, the fact that I have daughters in Las Vegas, and more. She remembers these things about everyone! I have other instructors who have never even asked my name. Cindy is way at the opposite end.

And she is famous for keeping us moving. Back and forth, up and down, high and low. Yesterday she got into the pool with us because there were only five of us and it was cold. The numbers always decrease as the weather gets colder but I do keep going on the days I have chosen.

There were a few times I felt the twinge, especially when we had to do things that called for quick high bending of the knees and bicycling type moves. I made it through all right but I knew it had taken a bit out of me.

Afterwards I went to Costco to pick up a prescription refill for pain killers. I needed them, or else I would have waited and gone straight home. I found it painful to walk across that concrete floor, even though I had my cane with me. I went home as soon as I got the pills and propped up my knee with an ice pack on it. That helped. Got to work that into the plan for now, until I get better adjusted.

When I went into therapy at 8:30 this morning the therapist said I was already walking better. Clearly the Aqua class didn't hurt anything and it probably helped. My plan for now is to do therapy MWF and Aqua TThS. I may adjust that as I feel stronger, increasing my time at the gym.

Blog post comment: Translating the Jargon

2011-11-18T13:31:00.001-08:00

Today's challenge:

A comment as a blog post. Pick someone else’s post (from the past or from today) and write a comment to them. Write that comment as your blog post for today. Link back to them to let them know you were inspired.

I responded to tmana's post on being a "polyglot". I hope I am not misstating her point: that those of us who are health activists translate the jargon of the various medical trades to patients and to others in other related trades.

As a city planner, I did something of the same thing: "translated" laws to the people who used them. Even more importantly, I often had the chance to write those laws, and did so, to the extent possible, in plain English. I think it's important to leave the jargon behind, no matter how fond of it you are, and speak in clear English. If you cannot explain a situation in plain English I believe that you do not fully understand it yourself.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Let it be

2011-11-17T18:23:00.001-08:00

Today's challenge:

Let It Be. What’s something that bothers you or weighs on you? Let it go. Talk out the letting go process and how you’re going to be better to yourself for it.

Sad to say, my weight is what has always weighed on me. I was a chubby child who grew into a really fat child and extra-large adult. At my heaviest I was challenging 300 pounds. Not that I was checking at that time, or not too often anyway. How do I let this go? I don't let it go completely. I don't know any way to do that, and believe me I've tried.

What I can let go is the belief that my weight defines anything at all about who I am. I have made this a mantra, frankly, and I repeat it often. I discourage cheering when I lose weight and I try to show up when I gain. I know that part of my perception of how I am received is in my head, but I also know that part of it is fact. I can't ignore the actions of others when they spell out what they think, when they treat me with condescension or fail to include me in activities where they feel maybe I wouldn't fit in.

From childhood I have felt that I was not as good as those of normal weight. Other children, especially boys, helped me solidify these feelings. I became defensive and was especially sensitive to anything that seemed humiliating. Over the years I have let go of a lot of that! I am much less defensive now and I have even sought humiliation (that's for another post- another blog!). I am creeping up on the fat thing.

Letting go of consciousness of my weight has freed me from inhibitions, allowing me to jump into ballroom dance classes, kayaking, and other activities that could easily make me look ridiculous. I gave up a fear of looking ridiculous and gained some confidence. I go to the gym regularly, not caring how I compare to the fitness freaks (fortunately, there are a LOT of us in the same category).

Although I have not completely let go of the fat thing I have come far enough to realize significant gains: have been able to open up more, become more vulnerable and let more of life in. I look forward to more of that.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Second time at outpatient clinic

2011-11-16T18:10:00.001-08:00

I drove myself to my therapy this morning. Therefore, I did not take drugs to blur the pain, because driving is not compatible with pain killers. Yet it went all right. I was quite stiff when I got there, and in pain. What I did:

The bike: 12 minutes. I felt pain in both my knee and my ankle, but it eased some by the end.
The recumbent stepper: 15 minutes. Warmed up more, and the stepping helps stretch my legs a bit.
The lying-down leg press: four sets of 12 with both feet, then four sets of 12 with just the right leg (lower weight)
Leg extension: three sets of ten
Leg curl: three - or was it four? - sets of ten
Leg stretch: 7 minutes - BOTH legs. Cool. Light weight so I won't resist it.
Then, as usual, time on the table, when the therapist pushed the leg back several times, to increase flex, then pressed it down several times, with me helping at the end. This is the painful part, the most painful part, but he didn't make it last too long.

I feel hopeful. I love these machines. They really seem to work just what I need. The therapist is sensitive to pain and goes slowly. Here's a cool thing: I am scheduled to go there Friday but I can go at any time! If I feel up for it I can get there at seven, or I can sleep in and come in later, or even up to seven at night. I think this is possible because there are duplicates of all machines, enough to accommodate many clients.

After therapy I went to Panera Bread and had a bagel and latte, feeling the freedom even as I still was dealing with some pain while driving. I felt that the pain was reducing, though. I'm hopeful, hopeful, and considering going to an Aqua class tomorrow morning.

I think I can...

2011-11-16T17:41:00.001-08:00

Today's challenge:

Write a list post with 10-15 lines that start each with “I think I can…” Write 5 lines at the end that start with “I know I can.”

I think I can hike again.
I think I can get back into real photography.
I think I can organize my office!
I think I can keep my house reasonably clean.
I think I can write a book.
I think I can get over my addiction to the Real Housewives.
I think I can find a way to sleep well at night and not so much during the day.
I think I can reach 130 degrees flex with my right knee.
I think I can get to zero degrees extension with my right knee, and closer to zero with my left.
I know I can get stronger.
I know I can learn to walk well.
I know I can get back to regular visits to the gym.
I know I can hike again!
I know I can hike again!
I know I can hike again!
I know I can get to zero degrees extension with my right knee, and closer to zero with my left.

Very much related to my recovery from knee surgery. I wonder what I would have written if this challenge had come at another time.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

This one's for you

2011-11-15T18:19:00.001-08:00

Today's challenge:

This one’s for you, baby. Dedicate a song to your condition. Why did you pick that song? Find a youtube or link to a version to embed in your post.

I am dedicating The Beatles' Blackbird to my arthritis. "Take these broken wings and learn to fly" says it all for me - find a way to live and thrive with arthritis, as I have been doing in my blog. Arthritis is a crippling condition that leaves so many of us disabled, but there is a lot of hope for many, particularly for those of us with osteoarthritis. I am aiming to learn to fly again.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Belated Post: Elevator Blog

2011-11-15T18:18:00.001-08:00

Yesterday's challenge:

Elevator blog. If you were in an elevator with someone and they asked about your blog. What would you tell them? Make a version for a 30 second elevator ride. Make a version for a 1 minute elevator ride.
Make a version for a 2 minute elevator ride.

30 seconds.

I write about my experiences with arthritis, about how I am coping with it and what I have done about it. I do it for myself as well as for others, to keep track of specific details in my experiences.

1 minute.

I have arthritis, particularly in my knees. I have had it for over 30 years. It has become progressively worse and I experimented, over the years of the blog (and before) with different ways to relieve the pain. I write about these experiences to keep track of what might be promising and what not, and to add to the information others gather about this disease and its treatments.

My latest effort has been total knee replacements of both knees. I am currently in recovery of the right knee surgery, and recording how I feel and what I am doing.

2 minutes.

I have had arthritis, particularly in my knees, for over 30 years. Early on, I was sent to physical therapy, which worked to some extent, but eventually did not help. The clinic I went to in those years never actually diagnosed it as arthritis, so I do not know what I might have tried had I known.

I started this blog several years ago when I came upon a book called Arthritis Rx. It is by a doctor at a prestigious medical center who has many patients with arthritis. Interestingly, he developed a program that calls for changes in diet, inclusion of some yoga-style exercises, and the use of supplements. Although he is a doctor he felt most people could alleviate their pain with these simple changes and avoid more invasive efforts. I did the exercises, made the changes, for many months. recording them in my blog. Eventually I found myself looking further out, into related techniques, to expand the effort. I tried elimination diets, additional exercises, and more. I started going to a gym that had a trainer who specialized in working with elderly people and who understands arthritis. My goal was to overcome the damage done to my knee joints by increasing the strength in different muscles, to compensate.

After being on this track for nearly a year I found I was not improving, although I was quite diligent. I read information on knee treatments provided by the Foundation for Informed Medical Decision-Making and realized that a knee replacement was likely the only course that could make a significant difference for me. I have since had both knees replaced and have recorded those experiences.
This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Back to Outpatient

2011-11-14T13:32:00.001-08:00

Coincidentally, I ended up going to outpatient therapy at six weeks - today - just as I did with the left knee. I just checked my journal notes for that time, in May, and saw that I was at about the same place with flex and extend as I was with the left knee too.

I am going to a different therapist this time. I thought I'd try something different, see if somebody else might hear me better when I mention the gym and not get distracted as much while I am on various machines. I went for the ortho center that is in the same building as my surgeon's office. Same door, in fact.

I liked it. I like the machines. There are many different types, more tuned to conditions like mine. I used a step machine that is "recumbent" - I sit down while stepping. And I did leg presses while lying down. I suspect these types of changes enable the machine to focus on what is needed here. After a fairly conventional bike, I also used an interesting combo machine that let me do leg extensions (weight on top of leg), leg curls (weight under leg), and even leg stretches. This last was the most ingenious. You'll never see machines like these at the gym. I liked the therapist,too. He seemed a very comfortable person and he did not push me too far and he was encouraging. We started a low weights, which was just jolly to me. I like that. Finally he asked if I wanted to ice there or at home and I said let's do it here. I wanted to see how he did it. I sat on a comfortable soft thing with my head leaning against pillows (I was sitting up) against the wall, and my leg sitting on a pillow. Blue ice bags were set under and on top of my leg, no barriers. I managed it without too much discomfort. I guess I have been a baby about the ice at home!

The therapist - whose name I did not catch - said he'd like to work some on my right leg, too. Perfect. I want to get really good at walking nice and straight. It's quite a challenge.

While there, I talked to a guy who had surgery around the same time as I had, but he came straight home and had in-home care, then came to outpatient, so he had been coming to outpatient therapy longer than I had. He had developed an infection, which had to clear up, and then he went ahead, and he seems to be doing very well. I had thoughts that maybe I should have gone straight to outpatient after transitional care. I was concerned about getting rides, though. Maryann kindly gave me a ride today, but gradually I am going to try to do this myself.

A Book! A Book!

2011-11-13T22:21:00.001-08:00

Today's challenge:

Open a book. Point to a page. Free write for 10-15 minutes on that word or passage. Post without editing if you can!

This one is SO up my alley! I have hundreds of books, even though I am always "releasing them". Others creep in to take the place of the ones that have left. The question for today is - which book? The book I am reading? Which is A Million Little Pieces, by James Frey, aka A Million Little Lies? No, I think I'll leave that for now.

Just to make it more interesting I am also watching Psych on television at the same time.

The book is Tangled Webs, by James B. Stewart. Page 114, first new section. The sentence:

Doug Faneuil was working at the art gallery when one of his lawyers called with the news.

I have no idea who this Doug guy is but the Psych episode I am watching is no. 1 from season 4, and it is about an art thief. Interesting coincidence. The news Doug received was that his favorite artist had been robbed,and not for the first time. Shirley Prattle was famous for her collages. The bigger the better, so the collages were visible all over the state, especially in public buildings. So one being stolen was big news indeed.

Shirley was not just Doug's favorite artist. She was a good friend. Doug felt he felt he felt he - oh boy, I am starting to write like James Frey - Doug felt like he had been stabbed, it hurt so much. Doug was dusting the paintings in the gallery when he heard the news, and the brush slipped out of his hand and landed on the floor. He started to step down the ladder and slipped and fell onto the brush, which caused a bruise on his side. He yelled.

Shirley had called Doug first, and when she heard the crash over the phone she hung up and finally called the police about the stolen collage. They were tired of hearing about her losses, because this was the third one. How could anyone load such huge pieces of art onto a truck and not be seen? Needless to say, they were suspicious.

I guess this is why I don't write much fiction...

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

A Class Act

2011-11-12T16:51:00.001-08:00

Today's challenge:

Teach a class. What’s something that you’re uniquely great at and could teach a class on? Write the tutorial in a blog post. Bonus points for images, links to resources, and video.

I am good at "technical writing", at writing instructions. That should help. I have learned how to overcome fears. So I'll have a go at a tutorial on overcoming fears.

1. Define the fear. Is it fear of heights? Of the dark? Of a haunted house? This step is usually simple, but sometimes the fear is hard to define. In that case, ask yourself questions until you get to it, until you feel it in your gut. (I apologize for the lack of detail in this post. It could really take a book.)

2. Ask yourself why you fear this thing. Because you might die if you fall down a steep height? Because you might bump into things in the dark or be accosted in the dark? What is it specifically that you fear?

3. Now challenge yourself. What are the chances that your fear will be realized? How likely is it that you will fall over that balcony or be shot by an intruder in the dark? What is the more likely situation? If the worst is to come then what would be the result? You will die? You will be embarrassed? And if you die what then? No more fear. Consider the likelihood question seriously. What is the real risk? You are likely to discover that there may be certain situations that are dangerous but that in general there is little likelihood of a bad outcome if you engage in the activity.

4. Do the activity. But don't just do it. While you are standing on that balcony, continuously challenge your fears. Every time you face a fear challenge it. Don't just let it be. In time you will discover that your inner voice will be less afraid. It may happen quickly or it may take some time. Some people need help and ask a trusting person to help them through this. Many therapists, I have discovered, use a similar method, going with their clients to the source of the fear and challenging it and helping the client learn that they will not die.

Admittedly, this is a really short version of the method. But trust me, if you try it you'll find it works. Please ask me questions if you have any. I'd love to answer them.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Belated Blog: If it's not broke...

2011-11-12T16:47:00.001-08:00

Today's challenge: (Or rather, yesterday's challenge)

If it’s not broke, don’t fix it. What is working well in your community, healthcare, blogs, social media, or your work in particular? What do you like about it?

I like that my arthritis blog is easy to get to, to update, to change in appearance, to post in. I love the ease of publication because it makes it much more likely that I will go ahead when inspired to write, and not put it off - as I did this one!

My blog is a simple one-person effort, which means that I have complete control. There are no external deadlines, except when I sign up for a challenge like this one. Challenges can be fun largely because they have an end! Not so much fun if they go on forever.

My blog is whatever I want it to be. I do not have to meet anyone else's expectations.

All good.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Some Specifics

2011-11-10T16:05:00.001-08:00

I am 5-1/2 weeks in from surgery on my right knee. Today these things are true about me:

* It hurts to stand on my right foot for any length of time.
* Walking is still not pain-free. But not bad.
* I am still taking pain meds, day and night. And becoming sleepy often.
* Nighttime pain seems a little less. I am crying out less.
* I have yet to have a really comfortable shower, standing up.

Future Online Activism

2011-11-10T15:41:00.001-08:00

Today's challenge:

The future of online activism. Our favorite social media sites are constantly undergoing renovations to become quicker to navigate, easier to interact with, all encompassing, mobile, and everywhere. Imagine the same thing about your community – how will they evolve, improve, and grow?

I have not given this much thought. I think the coolest action right now is with the mobile devices. Being able to see your favorite health blogger's posts on your Android or iPhone or iPad will increase their visibility. Using tools to copy posts to your facebook page automatically is another way to spread. Facebook is killing their own app that allows automatic copies of posts but there are other options, like networkedblogs.com, that I hope will continue to work.

My wish is that we bring in more nonprofits that are focused on evidence-based medicine, and incorporate information from their sites into our blogs. The Foundation for Informed Medical Decision Making is one such nonprofit. Worst Pills, Best Pills is another. We need to get away from relying on medical websites that are supported by advertising by medical corporations. The conflicts of interest are obvious.

The health blog sites that I belong to are changing so rapidly that I am at a loss to suggest much more at this time!

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

My Brand?

2011-11-09T14:40:00.000-08:00

Today's challenge:

My personal brand. As a Health Activist, you are a front-facing leader. What do you imagine you look like to your readers? What qualities do you possess. It’s ok to toot your own horn today – you have full permission to indulge. And don’t hold back.

I am what they call a "patient expert" or something like that. It means I tell the world what it is like to be me with this particular health condition. I have arthritis and I have been writing about what it feels like, what has gone well and what has not, for me, over the past several years.

The primary quality I have is my honesty and my ability to convey what is true to me. I don't pretend to know what I don't, or to be able to do what I can't. I admit it when I try something and it does not work or when I do not give my all to an effort. I admit to my fundamental laziness. You can take to the bank what I say, for what that's worth. Because we all have such differing experiences with arthritis, of course, my experiences aren't really "bankable". But they can provide some insight into the condition and some treatments. I also offer as many details as I think make sense so that others can have a better idea how a particular activity will actually be.

Another quality I have is a realistic view of the world. I like evidence. I look for it and try to find it in my own experiences. It is not always easy to measure improvement so I try to find tools or to expand my observational skills so that I can see differences when they exist.

I believe I am less fearful than many. I have noticed that many people will not attempt some things that might make them better because they are afraid of possible pain or other consequence. I consider the possibilities - what are the chances, honestly, that this action will harm me? - and take action accordingly. In my writing I clearly advocate evidence-based action and facing of fear, for I believe that we have a great deal more power over our own pain and abilities than we may think. If there is one message I hope I convey through my writing it is this, that we have the power, we are not victims.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

110 degrees and counting

2011-11-09T13:32:00.000-08:00

My recovery from my second total knee replacement is similar to that of the first, but also different. According to all of the therapists I have seen (and that's a lot), every knee is different, even on the same person. In fact, some people who go for both knees at the same time (a concept I find nuts) usually have different experiences with each knee, one doing better than the other. Even at the same time, with the same treatment exactly.

In the case of this knee, my right, I am having more pain now than I was at five weeks with the left knee. It isn't unusual, but it has been dissatisfying for me. I find myself wondering what I should have done differently, which is an exercise in futility. I am here now and the best thing is to go forward and to expect a good outcome. Which I do, honestly, down the line. I have been a little discouraged about not making much progress in the flex and extension departments.

Today, though, after focusing more the last two days on elevating and icing, as well as on some specific flex exercises, more than before, I reached 110 degrees flex. A solid 110. I had been stuck at about 104 so this really charges me. I feel more capable and energized. I just need to keep up the good work and hope I see the same results with the extension on Friday.

Tentatively I am scheduled to go for outpatient therapy starting next week, but if I don't feel ready for it I can keep the home therapy going longer. I am beginning to understand the advantages of each:

Home therapy: One therapist focuses entirely on me. No distractions. I get from 45 minutes to an hour (even more today, as it happened) of undivided attention. I also don't have to find a ride. The therapy comes to me.

Outpatient therapy: Appointment times may be more consistent, but this varies with the therapist, of course. There is a lot of equipment available which I do not have at home. I feel more capable because I am outside of my house.

Clearly, the disadvantages fall from a comparison of the two: with home therapy I sometimes have to make more appointment changes, based often on traffic, for example, or longer stays with the previous patient than anticipated. I also have to use what equipment I have at home, which is limited. I would love to be able to use a bike of some sort. And those stim machines available in PT offices can be helpful, although I have now learned of home "tens units" that are really inexpensive and yet effective for pain relief. Different focus, though.

With outpatient therapy the biggest disadvantage is the need for the therapist to work with more than one patient at a time. So I get stuck on a machine and left until he or she returns to me. I keep feeling I could do this sort of thing at home or at the gym. The actual time spent with specialized therapy - like "mobes" and "stims" is rather small, it seems, in comparison to home therapy.

Outpatient therapy, though, is a sign of progress. So I welcome it. I also don't need to vacuum before my appointment.

Three true things and one lie

2011-11-08T18:51:00.000-08:00

Today's challenge is to tell three things that are true about me, my condition, my health activism, or my life. And one lie. Will you be able to tell the difference if I mix them up?

* I have had arthritis for over 30 years, and I am 65 now.
* I drink apple cider vinegar every day and it helps reduce joint pain.
* I have learned how to overcome fears, starting with a fear of heights that I had all my life.
* I eat a plant-based diet. When I went vegan my migraine headaches went away. Was it the cheese?

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

2011-11-07T18:41:00.000-08:00

For today: Write about something that gets you down, burns you out, or makes you sad. Purge it in a blog post. Turn it around at the end. Tell Tuesday why you’re ready for it.
-------

What gets me down today is personal. I am essentially a lazy person who has to be pushed to get something done. During my work years I managed to stay on top of things, hating to turn things in late, but now I find it hard to keep from couch-potatoeing all day long. Most of the time I don't particularly mind this about myself. I have put in the time, after all. I don't pretend to be anything other than who I am.

During this "enforced" imprisonment - recovering from knee surgery - I am unable to get around on my own because I am taking pain meds and am not sufficiently recovered to be able to drive easily. So I slog around even more so than usual, doing less and less, finding it hard just to do the little physical therapy exercises that I have taken the time to list in a chart. Admittedly, some of these activities involve some pain and I avoid them. But several of the others are uncomfortable at most and it is just laziness that keeps me from doing them. So I get down on myself. It does make me sad. All around me people are actually accomplishing things. I can't even get myself to finish sewing an apron I started a couple of weeks ago.

But I do have the ability to put things in perspective. Getting it down in writing is the first step, then coming up with little plans and taking one step at a time helps me to get past difficulties that make me sad.

In about a week I expect to be back out on my own, going for outpatient therapy and doing more outside of the house. Even though I may have to ask for rides to do it. Once I am getting out of the house I will feel more in control of my life and will actually get more done. This is my pattern. I should be able to get back to the gym as well, even if only for a few days a week at first. The imprisonment, then, is nearing its end and brighter lights shine ahead.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

If I could do anything...

2011-11-06T14:14:00.000-08:00

Oh lordy. Today's challenge:

If I could do anything as a Health Activist... Get aspirational. Money is no longer an option. What is your biggest goal that is now possible? How could you get there? Now bring it back down to size. How much of this can you accomplish now, in a year, in five years?

An aspiration. I can't say that my main goal in life is to be a health activist. At this point, in fact, I have no aspirations. I do have wishes and frustrations, so perhaps I am not altogether free of wanting.

Admittedly, my biggest goal is not really possible. I would like to see people facing their fears and thinking for themselves. Not relying strictly on doctors or other health professionals or even on favorite medical websites. Be skeptical, pay attention to the fine print, ask if the treatment suggested is the best, based on real evidence. Evidence-based medicine - that's what I want for this world. And a citizenry that asks the questions that need to be asked.

Start with medications. If you take any medications now are you absolutely sure that they are doing what you think they are? That they are really necessary? That they are the best medications for the purpose? That you actually need any meds at all - in other words, are you sure there is no other way to approach whatever medical problem you have? So many people take so many medications that are not as advertised and would be surprised to learn that they are not doing the job and may even be dangerous. A good start would be to contact a consulting pharmacist. I do not know how one goes about this, but a Google search is probably a good start. These pharmacists mainly work with elderly persons on many medications, but you don't have to be elderly to need one. You just need to be taking meds. In many cases these pharmacists are more familiar with a wide range of drugs and can recommend changes that reduce the number you take and even save you money (as well as improve your life).

I am going to take this a bit farther, down the near-impossible track. I realize I am not following today's challenge exactly but I am exploring and setting out my own beliefs and hopes and offering advice based on my extensive reading.

Another move to make is to do some research. Read the labels carefully and ask questions about side effects. Check with websites like Worst Pills, Best Pills, for less-biased information on drugs and for alerts on possible dangers with medications (to get full benefits from this website you have to get a subscription. It isn't that expensive and it's worth it, in my opinion). The Worst Pills website may be a little alarmist for your taste but it speaks plainly and you can easily follow up on the information it offers and make your own decisions.

If you are contemplating surgery or some other treatment look into the foundation for Informed Medical Decision Making. This organization is non-profit and dedicated to helping patients make informed decisions, without bias, about medical treatments. Their booklets and DVDs can help you understand the condition you have, success rates for different types of treatment, and other patients' experience with the different approaches. This can be very helpful. I read their information and watched their DVD on total knee replacement surgery when I was considering this option and it clarified a great many issues for me. Unfortunately, the foundation has only begun its work and does not have information about every condition.

In general: read. Be skeptical. Get the treatment that real evidence shows is effective. Do not rely on your doctor's advice alone; many doctors are so busy that they are not able to keep up with all of the information that affects their practice, unfortunately. They may well not be aware that the treatments they recommend are not optimal.

Finally, switch to a plant-based diet. Ideally, no animal products at all, but if you can keep those products to under 10% of total calories your health will thank you. There is overwhelming evidence that this type diet is effective in reversing heart disease, diabetes, and many other serious medical conditions, and of course it helps avoid getting those conditions in the first place. Admittedly my own experience is anecdotal but when the doctors and nurses looked at my medical tests prior to and after knee surgery they said it was very unusual to have somebody with such normal readings, at my age, and of course especially unusual considering I take no regular medications. I eat a plant-based diet, no animal products, and while I overeat (a lifelong habit!) still I have good blood pressure, cholesterol, and other numbers - without really trying.

This is what I'd love to see happen in this world. I do not see how to get there. But I'll keep writing about these same recommendations.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Trying it out again

2011-11-06T13:24:00.000-08:00

Friday I belatedly called for a refill of my pain medication. I went through automated systems and did not even confirm that the doctor's office had indeed authorized a refill (the prescription had no more refills authorized; the pharmacy had to fax a request to the doctor's office). Why did I wait until Friday afternoon and why did I not confirm? If the prescription were not refilled then I would have to make it through the weekend without it. I think that part of me wanted to see how I would manage.

Nevertheless, on Saturday morning I called the Costco pharmacy to see if the prescription was ready. And it was. I decided to take this opportunity to try driving again, and to pick up cat food and kitty litter while out.

I was surviving on no pain meds by the time I set out and had been in pain since I awoke. But still I thought I might do all right. Not so much. From getting into the car to pressing on the gas to moving to the brake pedal to getting out of the car it was nothing but pain. Not excruciating but damned uncomfortable. I managed to get to Costco, wait in line at the pharmacy (cursing the fact that they don't have a "take a number" system so I could just sit down on their bench), get the prescription, drive to PetCo, buy food and litter (plus the usual bag of cat food for the feline network, which was having an adoption day outside of the store), and even go to Vons to buy some groceries.

It was no picnic and by the time I got home I was very much ready to take some of that pain medication, which helped. I realized that 1) I am not yet ready to drive regularly and 2) I am not yet ready to go off the pain meds. It's disheartening but I must take deep breaths and accept where I am. I am just shy of five weeks from surgery and not progressing as quickly as I would like but there is no reason for me to expect that I won't get there.

Five Things

2011-11-05T19:19:00.000-07:00

Five things that changed my life as a patient, caregiver, or health activist. For better or worse. That's the challenge for today (see last line, below).

I am not much of a health activist, in my opinion, and yet I have worked to change my own life and sometimes to help others change theirs.

The first thing to come to mind in that respect was the book Mad in America, by Robert Whitaker. The first page of this book told me of a World Health Organization study that discovered that so-called schizophrenics fare far better in third-world countries than they do in the western world. The main factor that they found different in the treatment of these patients was that in these poor countries they did not have access to anti-psychotics. The schizophrenics in poor countries actually got better, whereas in the U.S., for example, we have come to think of them as permanently ill. I had long held that belief, too, that schizophrenia is incurable, only manageable. When I learned that this was not true, I began to delve further into the use of other drugs on patients called "mentally ill", including, especially, antidepressants. Ever since, I have campaigned against the lies, the misunderstandings, the so-called "conventional wisdom"about psych drugs. In at least one case, a woman who was using antidepressants, I have gotten through, while in many others I have encountered anger, rage, disbelief, unwillingness to consider the possibility that doctors don't always know what they are doing. It may be that this one book opened my mind to looking at the world a little differently, and with a great deal more cynicism and watchfulness.

My experience with arthritis may be another case. I first started having difficulty with my knees in my 30s. I went to the medical clinic and was told I had damaged something, they did not know how or what, but that physical therapy could help. The first time I entered the physical therapy department, which was relegated to the basement, I was amazed. I had no idea that these people actually existed, not in a conscious way, anyway. I remember thinking, with some joy, that these were the health professionals who do the real work, the hard work, and they are mostly unsung. I have continued to have that opinion since, and I have seen many physical therapists as part of my knee replacement therapy. I cannot say enough about these life-changing professionals. This is on-the-ground, real help. How often do we get that?

I suffered with migraines most of my life. My mother took me to an allergist as well as to other doctors, hoping to find a cause, but none was found. When I was young - seven is when they started, as I recall - the headaches would get so bad that I would throw up, then fall asleep, and when I woke I would feel better. As I got older the migraines changed, and as an older adult they sometimes lasted for several days, which was truly horrifying. I felt at times that I would welcome a bullet to the head. Several years ago I happened upon Oliver Sacks' book, Migraine. In this book I learned about the many kinds of migraines (I never had the visual effects but some people only get those, and no headache, but it's all part of the same thing), and the many different ways people are treated. Sacks discovered that when one treatment fixed the headache then the patient tended to have a problem elsewhere. It was as if it was just shoved to another part of the body. Ultimately, after exploring all of the ways migraines are treated (not to mention the interesting history of the condition), Sacks finally recommended taking two aspirins and lying down in a dark room. Just let the migraine have its way, don't fight it. This book certainly changed my mind about my headaches.

As a young adult I was depressive, to say the least. I fell into depressions frequently, sometimes suicidal. My stepmother recommended a book - A Guide to Rational Living, by Albert Ellis and others. The book suggests that we can control how we feel by controlling how we think. The idea seemed absurd to me at the time and my buddies and I had a lot of laughs about the concept. But still, I dipped into it. I read it. And it drew me in. Gradually it won me over. The basic idea behind what is now called "cognitive behavioral therapy" was born here, although Ellis gave it another name. The book is still in print, in an updated version (although much of the 70s language is still there, outdated but readable enough), which suggests that I was not the only one to be affected by it. This book, along with a therapy group I belonged to for one year (for free!), taught me the tools I needed to counteract depression when it started up. I did not immediately eliminate depression from my life but over time the incidents were fewer and fewer, and each time I knew what I had to do. I feel so sorry for those who have been told that they have no control over their depressions, that they must be on drugs all their lives. They are living half-lives, prisoners to the drug companies, when they could be as free as I am. This book and this group were life-changing for me. I believe strongly that we are much more powerful than many of us believe, that we do have the goods. We do not need to be victims. This point of view has colored the way I treat all health issues in my life. It is a major part of who I am now.

Years ago I worked with a "life coach" for a little while. I was trying to get other parts of my life in order. I told her that writing is important to me but I am not doing much with it. She found LiveJournal, the site where I could keep a journal online. Initially I used it to write spontaneously, just to write. But in time it became the place where I could pour out my feelings and thoughts, and thereby release them from inside me. It became a way for me to deal with issues in my life. Since then, I have always had some kind of journal (or "blog") and I write in them all the time. The act of writing about my feelings, both physical and emotional, has been immensely healing for me. In some cases, as with this journal, it is also a way to track how I have dealt with certain types of physical issues, to see if I am getting better. Writing this way has become a huge part of who I am.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

After Publication

2011-11-04T14:47:00.000-07:00

Today's challenge (see note at the bottom of this post) is to write about what I do immediately after publishing a blog post.

* I look at it in published form, reread it. If I find mistakes, I correct them and republish.
* In the case of this blog, I check to see if it has published on Facebook yet. Networked Blogs is a reliable way to do this, I have discovered.
* When it is one of these "challenge" posts I post a link to it on WEGO Health. Then I "tweet" that one from that page.
* I move on to the next thing - which may mean I take a nap.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Dear 18-year-old me

2011-11-03T19:51:00.000-07:00

The third prompt in the National Health Blog Post Month is to write to my 18-year-old self, advising myself on what to do more of, what less of, and what I have to look forward to in the next few years. It's rather a loaded prompt, this one. Which might mean it's worth doing.

Dear 18-year-old Judy,

You have graduated from high school and are looking forward to college. You dream of becoming a concert pianist. You know that you have not devoted as much effort to practice as you should have, although in the last four years you stepped it up. You have dreams.

Nobody disputes your intelligence, sense of humor, or musicianship. Where you tend to fall down is in the social world. You will find that college offers you friends, real friends, for the first time, that you feel like you are in the right place at last. College is, in many ways, a great time for you. You will become part of little groups of friends, sharing each other's ups and downs and even, at times, competing for members of the opposite sex.

This has always been a problem for you, in no small part because you are so large. You are not only tall, almost six feet, but also wide. And you are only just beginning to learn how to take care of your big body and clothing. You take showers regularly, wash your clothes more often. It takes a little longer for you to get more consistent in brushing your teeth, but you get there.

Is this too much information? For some, of course it is. But it's relevant.

I hope I can offer some advice. I know that you tend to become defensive and don't want to hear advice, but it's from you! Remember that! You turned out all right, honestly, but if you take this advice you might be able to avoid some of the difficulties along the way.

* First, gradually cut out the animal products. You will do this eventually, and if you do so now so much the better. You'll feel better and start to lose weight and it will be easier for you to lose that weight and keep some of it off. Keeping your weight down will help a lot in the degeneration that is arthritis. It is unlikely that you will avoid the disease entirely but it may never have to affect you severely.

* Take stock, leave fear behind. It wouldn't hurt for you to start looking at your fears and facing them, not just by themselves, but with knowledge. Learn about your fears. What are the chances of your worst nightmare happening? What if you make a fool of yourself from time to time? Will it end the world? Actually, it won't. I guarantee it. Other people are more interested in themselves and won't care if you try something new and fail at it. And if they do laugh at you, laugh with them. Laugh ahead of them. Face the fears head on and don't be afraid to face humiliation too.

* Get into some regular habits. Exercise - don't overdo it but do it regularly. Write - every morning or evening. Take time for yourself. Insist on it.

* Learn to ask for help. You may be able to do some things but often others can do them better and others actually like doing them. Ask. You may be surprised to learn that you are actually giving a gift when you do so.

You have many years of good work ahead. You will have children, who will be the lights of your life. You will have peak experiences and low ones. You'll fall and get up, again and again, and this will become your chief strength. Might as well get started now.

Love,
Your 65-year-old self

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Arthritis as sitcom? drama?

2011-11-02T11:16:00.000-07:00

Today's challenge (see note at bottom of this post) is to think of this blog as the basis of a television show. My first thought was to make it a situation comedy, although arthritis needs something of a hook to make it funny. A support group for arthritics? This would mean a ton of old-people jokes. Been done to death. Could, however, be more like the Golden Girls. For example, my Aqua class might make a good sitcom. Let's think about this a minute:

* Aqua classes are notorious for the chatter. The teacher has to struggle to be heard above all the conversation in the pool.
* People do get to know each other. My class often has potlucks, right by the pool. We've even had off-gym parties.
* There are a lot of Total Knee Replacement (aka TKR) patients in aqua classes. Every physical therapist and doc seems to recommend it as a safe exercise.

Thus I could envision a group of TKR people in an Aqua class. Some might be pre-surgery, some recent surgeries, some might have had the surgery years ago. There may be discussions about an upcoming surgery or comparisons of knees. The comparisons might even rise to the level of competition - I got to 125 degrees flex. How about you? Mine was 127, and my extension is better than zero! How long were you in therapy? Six weeks? I got out in four. I'm having a little trouble taking this anywhere that is really funny.

How about a drama? Perhaps a lifetime series? The Home. A short-term rehab home. Small, no more than 24 patients. Staff nurse (RN), several LVNs, various orderlies, several physical therapists and occupational therapists. I think there is potential here. This would spring from some of my experiences but would not really be my blog-turned-television, which means it doesn't meet the criteria well.

Or a television drama. One woman, years of frustration, loss of hope, finally the knee replacements. With information at the end about knee replacements, about arthritis support groups. There isn't a whole lot of drama in this scenario. We would need some sort of crisis to make it work.

Finally, a one-woman "dramedy". Perhaps a half-hour show. Woman in her sixties coping with life alone, visiting children, trying to stay out of sibling rivalries, going on trips alone, joining classes, meeting others, going to the gym. That's who I am, like it or not. Oh, with four cats - does that help? Might show how she manages various household chores with her arthritic knees, and how she gets her exercises in after knee surgery, how she responds to treatment, to physical therapy. This is closest to my blog so I'm taking it. Let's meet and discuss particulars before I start co-writing.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

A Turning Point?

2011-11-02T10:09:00.000-07:00

I have been fretting because I am still dealing with a lot of pain, especially at night, and I have had difficulty even taking short walks without pain or other discomfort.

Yesterday my appt with the physical therapist was for 9:30 am. I was up and ready when he called to say he was having scheduling difficulties and could I reschedule for later? I said sure, I'm not going anywhere. We rescheduled for about noon. He called again later and rescheduled for 12:30 - 1:00, saying don't hate me if I get there a bit earlier or later than that. I said of course I won't. He arrived some time after one.

The extra time got me moving. I got the trash into the dumpster, the recycling into the bin, I swept the kitchen floor, watered plants on the porch, went for a short walk around my little block. I got up and moved around more and sat less. I worked in some knee exercises. By the time Wade arrived I was feeling pretty warmed up and ready to go. Among other things, we walked on the grass and broken concrete in the park across the street from my house, and as we neared the mailboxes I said shucks, I should have brought my key. Wade said that I could come back later, then! Which I did, after he left.

It is funny how I got locked into the idea that I would do this one little block walk and anything more would be too much. I know that doing too much increases inflammation, which is not good, but there are some spaces in between, windows of opportunity. I can do more than one walk per day! Somehow this idea has freed me, made me feel more capable and ready to go.

I still had a bad night last night, although not as bad as the worst. One time when I woke in pain and cried out "ow! ow! ow!" but otherwise mostly a matter of finding a comfortable way to rest. I took pain pills every four hours and I think that's good at this stage. When my knee hurts it hurts. There is a section on the left side of the knee and another on the right that are particularly sore, hurting. The one on the right appears to be a bruise. I have been bothered by that one since the beginning (right after surgery), and I wonder if there was maybe a little more force used to install the new knee than needed? The rest of the knee just generally hurts, and sometimes the pain goes down into the calf as well.

Right now I'm at about a two on that d**$%med universal scale of pain. Not bad. I will go for a little walk soon. My first of the day.

My Future Book

2011-11-01T20:09:00.000-07:00

From time to time I consider writing a book. I have thought about writing simply about my life, about my experiences with my father, about health. I've thought about fiction, too. If I were to write a book about arthritis I would need to take into account:

* I am not a medical professional
* I am not an expert researcher
* I am insightful
* I have lived with it for a very long time
* I have learned a few things.

The book that makes the most sense is my own life experience, essentially turning this blog into a book. Possible titles:

30 Years with Arthritis
Know Your Knees
Arthur-who? Making Friends with Arthritis
Making the Leap Year After Year
Arthritis: Don't Let it Stop You

Synopsis:

Arthritis affects over half of the over-60 population. This degenerative disease takes on knees, ankles, wrists, shoulders, any joint in fact. And people deal with it in many different ways. Lautner's journey is longer than most: she started feeling pain in her knees while in her thirties, and watched it accelerate on into her 60s, when after many ups and downs and after trying many different methods for compensating for the damage, she finally went in for knee replacements. Follow her as she plunges into various exercise programs, changes in diet, and surgery and beyond, and learn something about fear, fitness, and starting over.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

A Day in the Life

2011-10-30T10:33:00.000-07:00

I wake up after a series of waking-ups, not quite ready to meet the world. More often than not, my left arm is pinned down and my right leg stiff and in pain. I don't want to get up but I do. I kick off the covers, best as I can, and slide my feet over the edge of my bed, where I let them swing a little before placing them on the ground.

I stand by pushing my fists into the mattress, pushing myself up on my stiff, still-swollen right leg, and I realize that my left leg feels fine. I anticipate searing pain when I stand but that doesn't happen. It's more a deep soreness that does not want to go anywhere. I know that lying down again will not help anything, so I grab my cane and lean my way into the bathroom. By the time I have finished my shower I am still stiff but moving better. I get dressed. Often at this time I lie back down again on the bed and raise my right leg, placing it on an upside-down laundry basket, the oblong type, which is covered by a soft pillow. I elevate the leg for twenty minutes, reading to keep my mind off it.

Finally I get dressed and make my way into the office, kitchen, living room. I check email and Facebook, sometimes get involved in writing a book review or reading something, until I realize i have been sitting too long. Getting up brings back the discomfort.

There are two points on my knee that are especially painful. On the right side there is a small lump that is very sensitive. On the right is a wider area that feels sore. If I massage my calf area I'll discover pain there, too, an indication of edema. The swelling has gone down considerably but there is still enough there. I try massaging the left leg and find no pain there. Good job left leg!

If I'm up for it I put on my shoes. I must walk. A short walk around the small block on which my house sits. It is usually not too uncomfortable, but most of the time I don't feel up for more than this short distance. On PT days the therapist shows up and we do some things, and sometimes it helps. I feel inspired to work harder on my own. I just recently made a chart, listing each exercise, the reps and set lengths, and what the exercise works. Each day now I mark the chart every time I do that exercise, aiming to meet the goal number of sets.

It feels like I've lost ground. I was able to walk rather comfortably not that long ago, a few weeks ago. I don't know why it has become not as easy. Part of me wants to push it but when I do I invite inflammation and that makes things worse. I tend to take the easy way: I sit on the couch or chair, reading or watching television, and get up to fix food or do an exercise or two. I will eat, take naps, sometimes on the couch, sometimes on my bed, do some exercises. Take drugs. The drugs I am taking for pain now are somewhat helpful. IF I could take two at a time they would be more helpful, but two makes me queasy, and the quease lasts for hours. And before I know it the cats are asking for their afternoon meal, then it's dinner time, and finally I am just waiting for time to go to bed.

I think I will feel much better about myself when I am able to go back out into the world and especially when I go back to the gym. Going to the gym will help me feel better physically and mentally. It is easier for me to maintain a regular set of exercises if I do them at the gym, where others are doing the same thing. Even those that can be done at home. I can't drive yet, and I'm not sure I am up for a full set of gym exercises, but I could work up to that.

Time for me to take a walk.

A Short Drive

2011-10-28T19:52:00.000-07:00

This afternoon I decided to try driving. I drove to a nearby shopping center to buy a few things at the drugstore. Here is how it went:

First, it was a little painful getting into the car. Not too bad, though.

Then, when I got on the road I found that switching from the accelerator to the brake called for a bit of a twist of my foot, which was painful. Pressing the accelerator was not too bad but a bit uncomfortable.

My conclusion: not yet ready. Need more flex, less pain. Perhaps in a week?

Moving on

2011-10-24T16:11:00.000-07:00

Last week was Roberto. This week I have Wade again. I had Wade for my three weeks of in-home therapy for my left knee, so I got to know him well, and like him very much. Wade does not see me simply as a knee. He came for the first time today. We expect I'll have him just this one week.

I told him about my difficulties controlling the pain. He said I should tell the nurse and see if the surgeon can come up with a better solution - perhaps back to the patch, for example. To both help with knee movement and the pain, he did some "mobes" (joint mobilizations) on my knee today, working to get the upper and lower parts of the knee to slide back and forth more easily. This should help in loosening the joint. I felt less pain when he was done with that. He said to work on one exercise especially:

While sitting watching television or reading, slide my heel back and forth a few times, then stop it at a bent point and pull in toward me and stop it there, foot flat on the ground. I should feel a stretch that hurts a little but is bearable. Hold it there to let it get used to the stretch, until it feels ready to stretch more. Then slide my butt forward a little to increase the bend and let that sit for a while. This way I gradually yet gently increase the flexibility.

In addition, he said to keep going on little walks and icing and elevating as needed. When I have a bad day don't push it, but when I feel good give it some more time. It all seems like common sense, yet I have been feeling I had to push through everything and work on everything until it hurts majorly. I feel encouraged. The last few days have not been wonderful and I am going to get past it.

Too Soon

2011-10-22T20:19:00.000-07:00

My physical therapist for last week, Roberto, reminded me that I need to make working on my knee my job right now. It is tempting, though, to jump out into the world, celebrating the progress I have made and stretching myself. Today I did just that, by going to a one-day sewing class. The class was led by Linda, who has taught sewing classes for years, and I have been in many in the past few years. The cool part is that our class has formed bonds with each other, so it is a pleasure just to be there, among friends.

Today's class was "holiday aprons". We all made aprons from the same pattern, with our own material. It went from ten a.m. to two p.m., with a break for lunch, provided by Linda. During that time I was mostly sitting but got up frequently, mainly to use the iron. I did not elevate my foot (where was I to do that?), did not ice my knee (again, where?) and I only did one exercise, one I was able to do while standing at the ironing board. I felt that it was a little exhausting but I did all right.

Until I got home. Then the pain started. I tried lying down with my leg up, but could not get rid of the pain. I took more pain relievers, iced the knee, tried different positions, simply could not get any relief. It was hours before I could get myself anywhere near comfortable, and now I sit here looking at my puffy leg and foot and sighing.

It was too soon. I need to focus on my knee, make sure I elevate, ice, get up and move around short distances. I need to stay on track and leave the excursions for later.

Hurting

2011-10-22T08:06:00.000-07:00

Yesterday, when the physical therapist was here, I told him about the pain I have in the mornings, in bed. He asked if it were getting worse or staying the same. I said it seems to be staying the same. He said that with the work I am doing that staying the same would indicate an improvement, in a way.

Today I woke again with excruciating pain. The pain is in my knee itself, mostly on the sides - where the drain was and on the opposite side. I tried and tried to get comfortable and found myself just bawling out loud (good thing I live alone) for several minutes.

I just looked back in this journal to my pain with my left knee at about three weeks. I was dealing with restless leg pain mostly, at night, and nothing like this morning's pain. I don't know what this means, especially given that I had a leg brace on at the time. That brace may have actually helped with the pain in some ways. I noticed that my flex was about the same at this point as it is now, so I am less worried about that than I was. I thought that maybe I sacrificed some flexibility by leaving SLTC so soon. The bicycle wheels in particular were really helpful in stretching, improving the bend. I wish I had one of those here.

Today Maryann is picking me up to go to an apron-sewing class! It is the same teacher as we have for our regular sewing class so I know I can manage somehow. I will get up and move around and do what exercises I can during the class. No good to be freezing up. I thought it would be a good thing overall, to go to this one class, start getting a little bit social again.

How it's Going

2011-10-20T11:00:00.000-07:00

I have been out of transitional care since last Saturday, five days. It's been a busy time for a couch potato like me. Daughter Elaine was here until yesterday, when she flew home again. She stocked up on groceries, vacuumed, washed clothes, sent spiders off on new journeys. She took me to my appointment with my surgeon Tuesday and sat in on it (everything looks terrific). So her time was another kind of transition for me, a way for me to break slowly back into my old home routine.

Saturday I attended a wedding! But wait. It was a low-key affair and I left after the ceremony, did not wait for the food, much as I am sure I would have enjoyed it (daughter Elaine dropped me off and picked me up). I am happy to report that I have had very little nausea or other food discomfort, compared to last time. When I had surgery on my left knee I did not actually lose my appetite or my taste but food was simply not interesting for several weeks. I ate just as much but did not enjoy it. Not so this time. I have been enjoying it from the first bite of - what did they give us that first day? applesauce? Something like that.

Sunday I mostly vegged, watched Breaking Bad with Elaine. I think I took a small walk. Monday I met with the home-care nurse, Sandy, for the first time. She was impressed by my progress and my overall good health, surprised at the small number of meds I am taking.

Over the weekend and into Monday I did not do much in the way of exercise. I had the packet of exercises from SLTC (San Luis Transitional Care) and I knew others I could do, but I just relaxed instead. I was not surprised when the physical therapist, Roberto, measured my flex and extension on Tuesday and found that I had lost a little of what I gained at SLTC. Neither of us was worried about it, though. Roberto went through the SLTC packet of exercises and circled those he thought I should focus on, and filled in the number of sets and reps for each. He said, though, that he is pleased when his patients do any exercises at all on their own. I have heard this a lot. I am not so gung-ho that I do everything every day but I believe I am more conscientious than many others. He echoed Sandy's comments that I am doing very well and he anticipated that I would move to outpatient therapy in two weeks.

Roberto emphasized the need for elevating my foot and was happy to hear that I am big on reading. It is easier to get patients to elevate when they have something like reading to do. He suggested that I lie on the floor and put my leg on the couch to get the right height. Later, I tried this, and had a helluva time getting back up again. I moved myself over to my knees, and my right knee is so very much not ready to kneel. Getting up was too painful.

Wednesday I saw Roberto again. We went through all of the recommended exercises and I went up and down the front steps as well. I told him my trouble getting up from the floor and he showed me another way to do it, which works much better. I have done it a few times since then.

The pain. It seems like a lot. I wake up in pain and have trouble loosening up enough to calm it down. This morning it took over an hour to feel relief, even after I took some pain relievers. I think most of this difficulty is from the swelling - the edema. It is going down but has a ways to go yet. I don't remember feeling this much pain the last time but on the other hand I do have a vague recollection of having some concerns about it. I was so happy when I could go off pain relievers altogether, which happened somewhere around six weeks after surgery, as I recall (I was still using something at night).

I need to get up and move around and do a few more exercises. This is the best path to pain relief and flexibility. I will do that in just a few minutes.

Sandy came for the second time this morning. She said I was healing so well that she figures one more visit will do it. I do not need nursing. Most of her patients are much sicker than I am.

I am loving all these positive reports from all the health care professionals. There is no doubt in my mind that the time I spent in the gym paid off, as did my plant-based diet.

Going Home

2011-10-15T08:47:00.001-07:00

My checkout time is 11:00 this morning. Elaine plans to arrive at about 10:30 to help me load my stuff into the car and to take me home when all the paperwork is done. She arrived yesterday morning and spent time with me here twice yesterday, even having dinner with me last night (the center will prepare an extra meal for $5. Quite a bargain).I am excited about going home. There is a lot to like about the San Luis Transitional Care Center, but seriously, any care center worth its salt is going to want its residents to get antsy eventually. In my case it may have happened sooner than typically simply because I am not the best fit for this center. I suspect that most people who like their independence as much as I do never go to a rehab center in the first place. They take their chances at home, with the in-home therapists and nurses and occupational therapists (as needed). I knew from the outset that my knees would really benefit from a lot of physical therapy and I knew, as well, that if left to my own devices I could never provide as much on my own as I could get here. Three times a week does not compare with twice a day.So I do have mixed feelings. I am now going to be more on my own, having to remind myself to get up and work on my knee at various times during the day. I tend not to push myself as much as a PT will, either. I do believe, though, that I have gotten enough of a good start here that I will continue to improve, even with my less-intense home workouts. Not only that, but I will be able to take little walks around the park, paying close attention to every step, as I did for the other knee. I will also enjoy being able to spend time with Elaine, just the two of us and my four cats. For now, though, I am suddenly sleepy! Time for a little nap.

Visitors!

2011-10-11T19:50:00.001-07:00

Yesterday I had two visitors and two again today. Both times my visitors were able to watch some of my physical therapy. I really appreciate that SLTCC recognizes residents' needs for wide-open visits. Meaning our dogs can come to see us. Meaning our friends can watch our physical therapy. This way they get to see what I am up to and for some of them to imagine what might be in their own futures as well. Visitors can also have coffee or tea if they like, all of which makes me look like a good host. If you think this means you are welcome to come see me in the short time I have left here, you're right!Barb, one of today's visitors, brought a get-well card from my sewing class. This sewing class is way more than a class. It is a support group, a potluck club, a group where no topic is off-limits (well, almost). When I first joined I thought I was going to be learning more about sewing. For a hermit like me, it has turned out to be so much more. And yes, we do learn more about sewing.Physical therapy has ranged all over the rehab room and outside grounds lately. My many therapists have different approaches but keep some things the same, and all are helping me reach that zero-degree extension (as well as, of course, a decent flex). I don't see that happening while I am here because it takes a lot just to get one degree of extension, but I believe I have made enough progress to suggest that success is in my future. For the record my flex reached 105 degrees and my extension about a -7 or -8 degrees today. In comparison, when I left physical therapy for my left leg I had been stuck at about -12 degrees for several visits. Tomorrow will be my last day of occupational therapy. I will take another shower. There just has been no good reason to continue considering I've been down this road already and I know the tricks.

Getting Out

2011-10-11T11:50:00.001-07:00

All these physical therapy, occupational therapy, food service, and other activity interruptions are getting into the way of my life!Seriously, it did seem that way this morning but here's why: I got up latish because I had a stomach ache. I got dressed, finally, and got my pain killers, and got into physical therapy first thing. No time for email checks or writing here. When I was done with PT I lay down with my leg elevated, with ice on it, for fifteen minutes. When I was done with that I went out to the living area and sat on the couch to read a bit. I had very little time to read before the occupational therapist showed up. We did that but before I was even done one of the physical therapists, who was having a hellish scheduling time, asked if I would be willing to go for PT then with her and not wait for Tim later. I said I wanted a break! So I got one.The stomach pain did go away. I have no idea what it was. I just don't want it to come back. I have been lucky this time in that Ive had very little nausea or any other type of stomach pain. I am now debating the pain killer question once again: I do not know when Tim will be by for my second session of PT and I would like to be revved up for it, which is to say I want the pain killers to be working. There really is no answer for this because even Tim won't know when he will come by for me.Another interruption was the person who arranges for discharges. She said she noticed how well I am doing and thought we should talk about when I go home. We decided on this Saturday. That way I get both PT sessions Friday and can start home PT Monday, and I get to go to the wedding of a friend Sat afternoon. So you heard it here first: I am going home this Saturday.

Comparisons

2011-10-10T00:23:00.001-07:00

All of the physical therapists I asked told me that their patients who had one knee replacement after the other said that the second one was easier. Not because it was necessarily physically easier but mainly because they knew what to expect and were therefore calmer. I fully expected this second surgery to go more easily. It has, for the most part. But there are aspects that are harder.A comparison:Pain level and sleeping:Out of the box the second surgery was more painful. But over time it is less so, or I am tolerating it better. When I woke from surgery the pain of the first surgery was less than that of the second. I was shocked at how sharp and intense the pain was. But, possibly because of the three-hour interval for Percocet, I have found it easier to bear the pain over time, and to sleep better. I have meds for the rash (and I know what it is) and for the restless leg syndrome, so getting to sleep is easier than it was the first time around.Moving the leg:It seems that walking and generally moving around is similar the second time to the first. However, I believe that the pain and difficulty of moving my surgical leg on the bed is worse the second time around. I wonder if the brace helped with movement by stabilizing the whole leg the first time.Swelling:It seems like the swelling of the leg is about the same for both times. I was unable to see the naked leg often the first time around, though, so my impression is that the knee swelling was smaller the first time - but that may not be the case. It probably is about the same.Overall, because I am sleeping better and tolerating the pain better, I feel the experience is much better the second time around.

Who'da Thunk it?

2011-10-09T16:59:00.001-07:00

There was no physical therapy for me today but that does not mean my Sunday was without adventure.I took a long nap in the morning...no, that's not one of the adventures. AFter lunch this afternoon I was visited by a young man from the kitchen. He said he didn't know anything about vegan cooking but he wants to know more. He said we're having sloppy joes for dinner and he knows I could not have that. I said but yes, I could - just replace the meat with chili beans or corn or rice or whatever looks like a good texture for it. He said he had never thought of that, and that he wants to be sure I get enough protein. I said fruit is about the only thing that doesn't have protein in it. He was surprised by that. So, I said, don't worry about it. He was surprised and pleased and headed back to the kitchen. Not much later he returned, saying he had come up with a dish with brown rice and mixed vegetables and it is simmering on the stove and he thinks it is going to be good! So that was a real pleasure. It is so rare for a cook in an institution to be curious. Mostly they just want to be rid of me.I understand that, but frankly, with all of the versions of diets these days it is a lot easier, I think, to go the curious route than the woe is me.Later I was surprised by a visit from Kristen! Carrying a decaf soy mocha! My wish!! She also brought a vegan cookie, which I am saving for a little later, after dinner if I can resist that long. We had a nice little chat and she went on her way. As if my heart could stand all the adventure, I went into the living area, where the rec person was showing a man named Wally how to use the Wii. I stepped in to offer myself as another player and the rec person took this as an opportunity to turn it over to me. So I bowled with Wally while she went on walks with other residents, checking in from time to time, and while some other residents watched us from the sidelines. Nobody else wanted to play, but maybe they will next week. I won one game and Wally won the next.Kris also brought some magazines. One is Veg News, to which I subscribe. I might offer it to the person from the kitchen - or not. The recipes are often aimed at people like me, who really enjoy cooking. In any case, it's a good one to have around here for others to read.And that's just how it is here at the ever-exciting SLO Transitional Care Center.

Sunday

2011-10-09T09:08:00.001-07:00

It's Sunday at the rehab center. I am sitting on the edge of my bed, still in my long comfy nightgown. This morning I have had my vitals taken, my weight measured, meds given, and breakfast brought to me. I asked for peanut butter for the toast because the meal was a wee bit skimpy (toast, sliced tomatoes, small fruit bowl, juice, tea). We are all hanging around like the rich, waiting to be taken care of.It seems funny to have this day. Of course wounds continue to heal and we do our little bits of exercise in our beds, but in general not a lot of effort goes to the main goal. The staff works just as hard nevertheless. Maybe harder.In a little while I will choose some clothes and go brush my teeth, wash my face, do a quick-clean of my bod, and get dressed. Then perhaps I will wander around the center. Outside and inside. Only thing to complete the morning would be a fresh soy decaf mocha. That isn't going to happen. For some reason, SLO TCC does not offer fancy coffee drinks. Yet.

Alarming

2011-10-08T09:43:00.001-07:00

There are many sounds here at the Transitional Care Center - hereinafter called the Rehab center, maybe. Whenever one of us "residents" wants assistance, we press our little red button and somebody magically appears. There is a blinking light on top of our door indicating this is the one, and a beep beep sound. Some residents need a little more monitoring. They get a sensor clipped on their bodies somewhere. When the resident falls or otherwise causes a disruption to that sensor, an alarm goes off, a rather more serious siren-sounding alarm. People really jump at that one. Just recently a new system has been installed, an alarm system for the building. Since I have been here - since last Thursday afternoon - it has gone off several times. On at least one of those times a sliding door closed off our side of the building. That is more of the "get out" type alarms that we hear in schools, and we usually look around to see if it's the real deal and if we all need to hobble on out of here. So far it's all been testing or mistakes.Televisions play a pretty big part of life here. There is a large-screen tv in each living room, and in the afternoons (sometimes mornings too, but that is usually for some kind of game) the set goes on and one or more people sit around watching it. And it tends to be quite loud. If we are watching our own sets it is sometimes necessary to shut our doors to hear them.And yet, as I mentioned in a post some months ago, no piped in music. So I continue to be very happy at the choice of noises offered here. IF one of them gets to me (and usually that's going to be some other resident talking too much) I do have a couple of ear plugs.

I know it's corporate, but...

2011-10-07T12:05:00.001-07:00

It's almost like coming home here at SLO Transitional Care Center. There is no escaping the genuine caring, genuine smiles, genuine encouragement. I feel lifted.This morning I worked with the occupational therapist - Tracy? I forgot already! - to take a shower. We just used the standup shower in the bathroom attached to my room, so there was less complication. The wound is "sealed" so there was no need for plastic wrap. This is apparently a new thing just since I had the first op. It's rather like that spray-on bandage, in fact that may be what it is, sealing the wound, protecting it from water and other invasions. Made it so I could have a shower right away.After I rested up from the shower (!) Tim took me to the PT room, where I did a number of small things:* pressed a ball between my knees* pulled outward against a rubber band tied around my knees* Walked forward and backward with the parallel bars* stood up on my toes, then rocked by to my heels* While standing, raised my leg up, then returned to the floor (short distance)* "kicked" backward, similar to above* touched the ball of my foot to a short stool, then returned to floor* sat in chair, worked the bicycle wheels back and forth (but not all the way around)* took short walk with Tim, outside, and climbed steps up and downand more I can't rememberTim says he is really impressed by how well I am doing, that the swelling is about the only thing holding me back now. To that end, he layered my leg with ice when I got back to my room and on my bed. I have been meeting staff people I remember from before. I saw Gary in the hall today. Gary was the nurse I liked so much last time. He is now working in the office most of the time, but still has the floor one day a week, so I may see him again before I leave. I joked with Doug last night and was happy to see several of the same physical therapists. I will be working with one of the "hands-on" ones this afternoon - Laurie. She makes one work for it but she's kind and thoughtful, albeit a little of a renegade, it seems.A nice image: on a coffee table in the living room is a tray with coffee, hot water, tea bags, and several brightly-colored coffee cups. There is also a glass urn of lemon-water for the taking. As I was fixing myself some tea there, another resident (we are residents, not patients, remember) stopped by to say how beautiful it all was and how it makes such a difference (her words were better than that but I don't remember them). I had to agree. Honestly, somebody is doing something right here.

First Friday

2011-10-07T07:16:00.001-07:00

I woke a couple of times to go to the bathroom. Then I was awoken at 6:30 for the daily blood-letting. 6:30, not 4:30. And the person was from the French hospital lab. Somehow I do not think they needed to take my blood at 4:30 for my benefit. It was for theirs.I had called for percocet about two hours ago, so I decided to loosen up my leg here in bed before getting up. I did some leg lifts, some knee presses, butt crunches and pulley knee lifts. I think these are good to warm my leg up enough so that when I do get up I will be in less pain and be less stiff. I have found, from the months of doing fairly simple exercises in the gym, that it all adds up.The bed is comfortable. I did sleep well. Admittedly I had hydroxyzine, Requip, and Ambien to help me along. I did not take any Ambien in the hospital. If I take it here will I be less able to sleep on my own? Worth looking into. I haven't felt anything like restless legs since the op I don't know if that means the Requip is working or that I simply am not having any episodes now.The combo of iPad and keyboard is working well now. However, editing on the iPad can be a pain. I have to put my finger where I want the cursor to go and it just doesn't always go where I want, so I end up erasing more than I intended, then rewriting. At home I have a little stylus - I forgot to bring it. That is a little more helpful.My challenge for the day: to get dressed. I would like to take a shower but I have to arrange that ahead of time (or pick a time when the bathroom is not in hig demand). I can get everything else on, but my right sock and shoe is a challenge. I discussed this with the occupatioal therapist and she brought out a grabber and long shoehorn. This combination does work. I could use another grabber, so may ask Maryann to pick one up. In any case, I doubt I will need it more than a week - for the knee. I will still find it useful at home for other purposes, though.I think there may be a window here for me to hit the bathroom with my bucket of supplies.

It's as if I never left

2011-10-06T18:58:00.001-07:00

I am sitting in my room at the SLO Transitional Care Center. I am tired but see no real hope to get any rest just yet. My roomie, Bernice, is a confessed television addict and the television in the sitting room is on some kind of game, loudly. My space is nicer than the hospital room I left this morning. It's funny how we expect that, yet the hospital will charge so much more. Seems like they could provide, say, a bathroom equipped for the disabled. The bathroom is sort of equipped but far too small to accommodate anything beyond a walker. tHe bed here is also far better than the one in the hospital. I can sit on it comfortably, and that is what I am doing now. It's a good setup for me with my iPad. I am again dealing with the many blocked websites, though. But I've got that covered this time: my phone has "wifi hotspot" enabled. So neener neener.But perhaps we should go back to this morning, or even last night. I slept all right last night, with the usual interruptions, both from my wanting to go to the bathroom and from hospital folks traipsing in. My favorite was the young woman who came at 4:30 every morning to take my blood. I asked her "why 4:30 am?" and she said that they can get the results to the doc before he comes to see me, in case some change needs to be made in blood thinner. She laughed then, and said she shows up at her other location at 2:30 am. I guess I should have felt better.Every morning I have to work out when to ask for pain meds. If I take them too soon, I may not be fully protected by the time I get into physical therapy. Ideally I should have taken the drugs about an hour before PT. This morning I called for drugs at about 5:45 but got no response. I called again and again and finally got the drugs at 6:15. I knew this could be a problem. And yes, the physical therapist showed at 9:15, right when I was due to take the drugs again. I toughed it out, and it really wasn't that difficult, fortunately. Today was the day to go to my new residence. At first I was told to show up there (here, SLO transitional care) at 12:30. Then, after I had arranged with Maryann to pick me up at 12 noon, they told me no, ten o'clock. I changed arrangements with Maryann and then was told 11:00. I said forget it, I'll just have to ask Maryann to wait. So that's what happened. We sat and chatted and talked a bit with my roommate Natalie. Natalie had a hip replacement and yesterday had some sharp pains and felt a "pop" on the side of her new hip. She screamed each time. When her doc came to see her he said it was nothing, it was "almost impossible" for the hip to be popped out of its socket. But then it happened again and he said let's get an x-ray and Natalie stays another night.And here at SLO TC? It's good. It's very much as I remembered it, and several of the staff members remember me and have been complimentary about how well I am getting around and how good I look. I thought that, because they did remember me, we might have a shorter initiation. NOt to be. The food people asked many questions, the PT person talked forever about his views on therapy (and he explained all of the exercises in his booklet, which I had already gotten and actually used since the last time), the nurse asked more questions and did a "skin check" and got me to sign millions of pages of legal documents. I guess I have given away my home and my first-born. I was finally set free, somewhat, and I made my way to the gathering area outside my room. This is a kind of living room, with tables and chairs and television and a snack table. I was cold, so I brought my book to the couch out there and read for a while. A younger woman came in with a chubby chihuahua. I asked if I could say hi and we got into a long and interesting conversation. She is 40 and a runner and is visiting her father, who has congestive heart failure. She now lives in New York and is returning there Saturday, but is very worried about her father. We talked about New York and heart trouble and a number of other things. The dog is her father's, and was visiting too.That's one of the nice things here: you can bring a dog to visit a patient. There is one woman here, though, who comes with her own assistance dog. It appears that she is there for some sort of respiratory therapy. She walks well enough, gets around easily, and has this dog with her, with his therapy dog vest. It is perhaps a kind of Golden Retriever, very dark though. Very nice dog. BUT. When the chichuahua came in and yipped at the larger dog, this woman pulled the assistance dog away and yelled at him, hit him, and told him unkindly to lie down. I could then understand why this beautiful dog walks the way she does - submissively. Later Maryann noticed that he (or she) is wearing some sort of choke collar as well. Assistance dogs are so well trained that I cannot think of any excuse for this collar other than the pure ignorance of this woman. It makes me upset every time I see her now. ANd I, without any dogs of my own and with no training degrees, can hardly step in and demand that she not do these things. I could, but it would do no good.As for getting any work done here: the occupational therapist talked a whole lot about what she does (and she knows that I know what she does) and kept telling me about how we'd be doing things that, frankly, I have been doing forever. She did not seem to understand that I really do not need her at all. I have dealt with knee pain for years. I have worked things out. I am hoping she bows out very quickly so I can catch up on my reading.But seriously. I've been reading quite a lot, in spite of interruptions. I released a book at the book cart in French Hospital, and got a very big thank you from the woman who manages the cart. Embarrassing. Just think if I'd given her two or three!I walked into SLO TC using my cane, and by doing so I have set the stage. I think I will move quickly. I really am hoping for some greater reduction in swelling, almost more than anything else. Oh, did I mention my flex is up to 100 degrees? Wooo!!!

As I lay thinking. . .

2011-10-06T06:54:00.001-07:00

When I was through surgery on Monday, I awoke connected to many tubes. Each had a different purpose,shape, and length. And movement was difficult because I kept tangling them up. The gowns are now made so every kind of tube can be attached to a body, through,over, under the gown. I wonder how it would be if somebody like Steve jobs thought about this issue and designed ways to plug patients in without threatening them with strangulation. Sometimes I think apple products are a little too "elegant" and would like just a little more instruction and less reliance on intuition (our intuitions do not always see things the same way). Nevertheless, I think an apple-designed hospital could revolutionize healthcare.

Omg

2011-10-06T06:41:00.001-07:00

I went a whole day there without posting! Or did I? The doc took out the drainage Thing in the morning, freeing me from all tethers. one of the first things I did after that was change into my own night shirt, a pretty blue patterned simple flannel gown, same length as the dread hospital gowns. Of course the hospital gowns afford us all opportunities to loosen up with roomies and nurses, but hey, I can live without that. I took more walks, of course, and it is getting easier and easier.The one thing that seems worse this second time around is that it is very hard to lift my leg. Hurts a whole lot, even with pain meds. I wonder if the full-leg brace somehow helped in that department. I would never have guessed it.Sleeping is both better and worse. It is easier to fall asleep and get back to sleep after waking up. But I am unable to sleep on My side. So i sleep on my back, which causes lower back pain after a while. Getting up not easy.Today I go to transitional care, at about noon.there will be a bit more freedom there and I look forward to getting this leg working well. So far the results are promising.

Soon to move again

2011-10-05T14:27:00.001-07:00

Early days mean faster improvement, I think. Today I made more strides, literally and figuratively. In the morning I walked to the entrance to the "garden walk", just so I could look out at the rain. For the most part, being in the hospital has isolated us from the weather, which is unfortunate.When I wanted to make a larger circuit the physical therapist said better not, or might not be allowed into the transitional care home. I don't think he was joking This aft the therapist - yet another one - emphasized how to walk. Heel to toe, stretching in the right places and flexing in the right places. I think one reason the therapists always emphasize walking is that this mo ement uses all of the flex and extension that I am working on. Of course, walking became more difficult while I tried to remember everything.The extension is at about ten degrees from zero and the flex is already at 95 degrees. So I am progressing at a faster pace than I did with the left leg.I just noticed that our nurses for today are named breanna and lynaia. Spelling!

Freedom beckons

2011-10-04T14:50:00.001-07:00

Today I took myself to the bathroom twice. Had to call a nurse to haul iv stand behind me. So the second time I said I couldn't wait until that bag was empty. One of the nurses had said that would be the last bag. Fortunately, the nurse with me this aft said he could make a case for undoing it early. I thus down to just one cable - the drainage bag from my knee. That goes tomorrow.I would not do well as a longterm patient, hooked up all the time. I break the rules, escape when I can, and generally am a problem patient. Of course, I am always reminded how important it is to move so the caretakers usually applaud my efforts.In pain again...still.

No pain no gain

2011-10-04T10:20:00.001-07:00

I think I have to accept that old saw when it comes to the knee therapy. Again and again nurses and others say one has to keep pain meds in the system so that therapy will not be very painful and therefore make progress. I used to want the pain to be blocked altogether and would be impatient when it did not happen. Of course, in a perfect world, I would get that. I have personally observed four people who have had knee or hip replacements and all of them have had trouble finding pain meds that worked for them. The first days are usually the worst but in my own case I struggled nearly until I went off the meds altogether. I am trying to take more deep breaths and reduce my expectations in this department. Today the therapist - Ron this time - had me do some tiny leg lifts, then ankle bends and the pulley lift, and finally he struggled to get all the cables put aside soi could get up with the walker and walk down the hall and back. It got easier and much better than yesterday. Yesterday my knee buckled whe I tried to stand straight up. I stopped at the bathroom on the way back, to my great relief. My one attempt to use a bedpan this morning was not encouraging. Little by little I am regaining independence. Perhaps it is a good thing that I am so impatient.

No walk in the park

2011-10-04T05:11:00.001-07:00

Oh the misconceptions. This knee was going to be easier than the last. I was going to power through the pain. Let's just admit up front that I am as much of a wimp as ever. I lost count of the different pain meds I have been on so far. Celebrex to start,along with oxycontin. A spinal anesthesia along with some sleepy stuff, a tranquilizer? Later two or three of something I do not remember,then an injection of Demerol. Which I got to repeat last night. Finished up with two percocets. My knee is hard to move. I am managing to wiggle toes both ways now and flex my foot, sort of. I have done the pulley exercises five or six times, last night. Need to rig that up again. The nurse was in here maybe a dozen times last night. Replacing iv bags, checking meds, and so on. It is a miracle i slept at all, even given all the drugs.One day at a time is my motto for now. I know that improvement will come, that I will celebrate small victories.

Understaffed or something else?

2011-10-03T19:45:00.001-07:00

It is after7:30 and my dinner tray is still here. And the things that go around my legs to keep the circulation going and mi imize edema are still sitting on the end of the bed. And I don't know if I am going to get my usual reqip and hydroxyzine. I asked about it some time ago.These things don't surprise me. I have become used to waiting in this hospital. I have noticed tha this for-profit hospital uses a lot of volunteers,too. It is hard to figure it out except that these are cost-cutting measures to maximize profits. AM I just cynical?Edit oct 6: I have since discovered that French hospital is "not-for-profit". I don't know if it has always been. And of course that does not mean "non-profit" technically. I should look that up.

P t and the pursuit of happiness

2011-10-03T16:35:00.001-07:00

The pain persisted so the nurse - brad - said he'd get me an injection in between physical therapy. I like this physical therapist. He s very thorough and thoughtful. The goal for today was to get up and into a wheelchair and to hang there for a while And I did it. Also I am hooked up to the pulley apparatus and am pulling my leg up to bend it every now and then. I got to 75 degrees when I did it for the PT, so that was good.I feel hopeful because I know it will get better.And maybe this last drug - injected - will be the answer for the pain. Frankly, I'm willing to go with injections if it works.Lunch was liquid. Heavy liquid, including a blended vegetable soup. And the infamous artificially sweetened and flavored sorbet. As for using my iPad for these journal entries - both good and bad. I prefer to use my iMac keyboard but arranging everything so I can see is a little challenge. A small laptop would be better, to be honest. However, the iPad is small and I can use it alone, without the keyboard, particularly for short answers to emails.

In the grip

2011-10-03T14:20:00.001-07:00

The surgery went well. I woke,however, in a lot of pain. The nurses gave me all that they could over the period of time that I was in the recovery room, and then when I went into my regular room I got still more. I woke up at about 9:30 am and it is now 2:10 and I am embarrassed at how much pain relief I have been given. It's better but far from comfortable. I had some trouble adjusting pain meds the last time but I do not recall waking up in such pain and having it continue as it has. This is not entirely unusual, of course. People have different experiences, even the same person at different time. I am in a room with a woman I met in the waiting room, just like last time. Only this time she had hip surgery and she will not be going to Transitional Care. She has a husband and daughter to help her at home. I was right when I remembered how dark these rooms are. Finally I have some light. I could not figure out where the light was until the nurse showed me and hooked it to the pillow like last time. Between the two of us and our machines there is some kind of beeping going off practically every few minutes. IV bag empty. Malfunction of something or other. There is also room for a third patient in between us, so I'd say the room is spacious. I wish I could get up right now and walk around it, but the pain makes that seem impossible. When the physical therapist arrives I hope I will be able to stand up. That might even help, once I get past the initial pain of moving off the bed. Oh, yes. The good news is that there is no full-length brace on my leg this time! I hope this means everything will proceed a little bit more easily.

The Day Of

2011-10-03T04:49:00.000-07:00

And so here I am, 4:30 in the morning or so, on the day of my second surgery.

I got so worried last night that I would not be ready and that I would not wake up that I got pretty much everything done, except pack a second suitcase. I have also left some domestic chores for...whenever. As I sit here, though, I remember a couple of things I need to bring, so I am going to go get them and put them in my bag.

All right. That's done. But the new kitty litter is not yet where it should be. I like to mix two kinds so I keep a covered wastebasket near one of the litter boxes and I layer it in there, ready to scoop for freshening the boxes. I need to at least have the litter near that wastebasket. Gonna do that now.

All right. Did that. I'm feeling better, ready to go. In spite of hardly sleeping at all last night. Good thing I don't have to drive anywhere. Or be alert. Just alert enough to tell them which knee to mark.

As Usual, Far From Ready

2011-10-02T21:33:00.000-07:00

I am not fully packed yet for my surgical and transitional stays. I am bringing one smaller bag to the hospital, with just a few things in it plus my iPad. Then I am leaving one packed bag for Transitional Care in my car, so friend Maryann can come drive me there and we'll take the fresh suitcase. If I get it together I will fix yet a third bag, which Maryann can trade for my dirty laundry down the line...we'll see!

The hospital now requires a "ticket" when I arrive. This is an 8-1/2X11 colored sheet of paper with a large checklist on it. I am supposed to check that I have had nothing to eat or drink after midnight tonight, that I brushed my teeth in the morning, that I have had all of my pre-op appointments, and so on. Cute. Not really. But I can see why they do it. I have often wondered how many people fail to follow all of the directions before surgery and before pre-op appointments. It isn't as if anyone is calling to remind us.

In another way I am more than ready. I have had a lot of pain in my right leg for a long time. I really hope this new knee goes a LONG way to taking that away, that I do not have to wait for a new hip. I won't know, really, until I am off pain meds, though, more than likely.

Two days

2011-09-30T20:55:00.001-07:00

I have the weekend to go,then back to the hospital for surgery on my right knee. All is in order, all is lined up. All of my tests were normal, something both the nurse and surgeon said is not particularly common. Everyone who has told me about second knees assures me that the second surgery goes more easily. Not because there is less work but just because the patient knows what is ahead. Certainly for me the knowledge means a lot. So much was up in the air the last time. I have a better handle on what meds work and about how long it will take for me to get back on my own. This weekend, then, is mainly for tidying up. When I return home it won't be long before a nurse and physical therapist show up at the door. I want to be generally ready for them. I am excited. I have had a lot of pain in my right leg and I really hope to see improvement.

Changes!

2011-09-09T19:09:00.000-07:00

I did see a massage therapist. In fact, I have seen her several times now, initially every week and now every two weeks. She works mostly on my legs but moves to wherever the need seems greatest. Yesterday she focused primarily on my right hip, the current bane of my existence.The Restless Leg Syndrome has decreased. It is still there but it is not as jolting and monstrous as it was. I manage, even without drugs, to get some sleep (although without drugs I still tend to wake frequently and even with drugs this is often true). I am not having long sleepless nights as I did before. As a result I have more energy. I am able to make little forays into parts of my home (cleaning and organizing) and go out in the world (errands) without feeling exhausted.

As for drugs. I did get a prescription for Requip, at a very low dosage (.25 mg), one per night. It helps me get to sleep but it does not keep me there. It does work, I repeat. I am relieved that I will have these with me when I am on a plane next week, not to mention when I am trying to get some sleep wherever I am. I do not want to be on drugs for the rest of my life so I will continue to look for alternative treatments. It does seem like massage helps. Maybe over time RLS will just become a vague memory.

Sleep: Is it a dream?

2011-08-18T12:11:00.000-07:00

The last two days I have had almost no sleep at all. Tuesday night my cold kept me up - sneezing, coughing, generally feeling miserable. Last night my right leg went into almost-regular spasms. The top of the thigh would jerk into a painful spasm so frequently I could not get settled enough to fall asleep. I feel seriously deprived of sleep.

Yesterday afternoon I met with a friend who wanted to hear more about my knee surgery experience because she sees the same thing in her future. I was happy to talk to her. I am almost always glad for an ear. In the course of our long conversation the Restless Leg Syndrome (RLS) came up. She has it too, and has had success with a prescription drug - Requip. Requip is used for Parkinson's symptoms as well as RLS. It has a number of side effects, the most dangerous of which appears to be the potential for falling asleep suddenly (like when driving). My friend said she takes it only at night, which makes sense, so this may not be an issue if I were to use it. I am going to make an appointment with my regular doc to see about trying Requip. It would be wonderful if I had this issue somewhat resolved before I go into the hospital again.

Last Stage

2011-07-31T09:18:00.000-07:00

I met with the surgeon last Wednesday. He saw that my knee is still not straight and he said it probably will be eventually and that he has had other patients who do fine without having it completely straight. I asked him for a prescription for massage, which he gave me, but said insurance may not cover it. True enough. I asked about the next surgery and he said "any time". I said how about early October and he said he'd set it up. I should get calls from Nancy soon, with a date and instructions.

So this means I am on my own right now. No therapy, no future doc visits on this leg. I am continuing with work at the gym and at home, interrupted by trips (right now I am in Las Vegas). It's an odd feeling, free really, and I don't mind it.

Some Good, Some Not so Good

2011-07-22T22:13:00.000-07:00

It seems like so much time has passed since last I wrote in here. I think that's because I have been busy doing other things, things unrelated to my body. These activities have worn me out and made me feel like not writing. But worse than that, which I'll explain in a minute.

I have been traveling a lot for events that are hosted by a foundation I belong to (and am vice-president of). I have had to make car trips to Los Angeles and back three times within a short period of time. On the good side, it seems like my knee handles the trips rather well, meaning I feel okay when I get to my destination, not too much stiffness or pain in that knee. And one night, Friday night a week ago, I slept without drugs and went to sleep quickly. I woke later and was up a bit but overall it was n amazing night, almost like old times. The next two nights weren't as good but still weren't the worst either, and I was still without nighttime drugs.

Lately it's all gone to crap, though. The restless-leg syndrome has accelerated, is affecting both knees, sometimes for hours. And now my back hurts and I feel worse today than I have in a long time. I think all the driving is adding up to the need for possible chiropractic intervention.

But before I go that way I will continue with massage, which I started a little over two weeks ago. I have had two massages using mainly "trigger point" massage, working on those adhesions. I feel some hope for this type massage in helping both with the restless legs and with the straightening of the surgical leg.

I may be at the end of my time with physical therapy. The prescription ran out last Wednesday, two days ago. I see the surgeon again next Wed and it's possible he will not renew the prescription. Mainly because my knee is not straight and in particular is not any straighter than it was six weeks ago. In spite of all of my and Paul's efforts. It's been discouraging but I still think it's possible that I will be able to get it straighter over a longer stretch of time, like one or two years, or even more. If there is no more prescription I am going to be rather more on my own, which will be a little sad. I hope that if I no longer get to see Paul that he will take a little time to talke to Clara, my gym trainer, about where to go from here. I want to keep up with whatever I can.

A Good Day

2011-07-09T12:36:00.000-07:00

After several days of feeling both emotionally and physically unwell, I am feeling much better today. The pain in my knees is minimal and I felt enough energy to stop at a hardware store for various items after going to the gym. At home I worked on a graphic design that I have not had the energy to deal with. Perhaps this is a kind of reward for going through so much shit.

So what else might I do? I might make a fleece blanket for a little foster grandson. I might do more organizing of sewing materials. I might make me lunch and veg out a while!

That Restless Leg Thing

2011-07-08T22:02:00.000-07:00

I have mentioned getting that "restless leg" feeling frequently, particularly in my "surgical leg". Lately I've been feeling it in both legs, sometimes more in the right than in the left. Today it's been bothering me almost nonstop since I got home from physical therapy at about two.

I occasionally take a look online. To me, this kind of feeling is not a "medical condition" so much as a discomfort for which there should be some simple solution. I used to think it happened when I had not exercised enough, because stretching and moving around does relieve it. However, I am exercising plenty now and I can't, obviously, get any sleep if I am getting up and wandering around to relieve this symptom.

There does not seem to be a single cause for "restless leg syndrome". Sometimes it is caused by a lack of iron, so today I bought an iron supplement (even though I am no supplement fan). There are other drugs developed for this condition but I am not willing to go there yet. I can't help but think these are neurological drugs that, in the long run, will do more harm than good. Also, they don't specifically target this condition, which is why they don't work for everyone. I hate taking drugs that I may have to take all my life. I'd rather find a better solution to end the situation.

I would love to hear from others who might have found a good solution.

The Horrible, Terrible, Very Bad Night

2011-07-08T08:29:00.000-07:00

Last night I went out to dinner with a group, came home and did not get the dynasplint on until about 8:30. I went to bed close to ten and tried to sleep. As usual I could not get to sleep for quite some time but finally dropped off.

When I woke at about midnight everything felt wrong. I took off the splint but that was not enough. My left arm ached and my right knee hurt. My stomach felt queasy. Was I getting sick?

The worst was that I could not stop crying. I bawled and bawled, big sobbing messes, uncontrollable, inconsolable. I went into the bathroom, took a shower, came out still crying. I splashed cool water on my face, still crying. I lay down in bed and felt my body again shake with sobs.

I finally fell asleep, fitfully, woke a few times, managed to stay reasonably calm. I woke, still feeling (and sounding) funny in my tummy but at least no more crying.

I hurt, yes, but it did not seem that the aching and knee pain were the main reasons for the crying. I don't know what was.

Go Figure

2011-07-06T23:12:00.000-07:00

Today I met with the DynaSplint rep for a followup, just before I had a scheduled PT appointment. I wasn't feeling particularly well, had some stomach issues, but they seemed to be evened out enough by the time I had the appointment, fortunately.

We went over how I put the splint on, adjusting the straps, and she read all of my comments and noted the progress I had made. She said I was doing really well, just as she expected I would. She recommended that I stay at level 9 for three or four days, trying to up the hours, then gradually move up, increasing the tension only every few days or so rather than every day as I have been. I had mistakenly thought that I had to pull the straps to the same place every day, even when one or two were biting into my flesh. It was good to hear that no, I just needed to get it on right and adjust as needed.

After the rep left I went straight into PT as usual. I felt, for some reason, unusually tired. It may be that I had lost some energy with the stomach issue, whatever it was. I suspect I ate something suspicious. I did not say anything about how I felt, just plunged ahead, pushing my body a little farther than I really wanted to, frankly.

I see an old pattern emerging. When people in authority do not let me know how I am doing I tend to work extra hard and feel resentful at the same time. I have dropped comments from time to time about what I do outside of PT, hoping that I will get a chance to describe exactly what my gym routines are, for example, because I think it would be helpful for them to know, to be able to adjust what I do at the PT office. Nobody has taken me up on these hints so I just keep plugging along. At this point I feel I am doing as much as I care to do, as much as is reasonable to expect of me, frankly. Six days a week at the gym, over an hour every day. I think it's enough, especially added to the three days a week at the PT office, which counts as another workout.

So there I was, pushing the leg extension and leg curl machines beyond what I really wanted to do, to a kind of breaking point. I don't think I hurt anything but I wanted to show that I am up for it, that I do not try to get out of work. (Believe me, I am not talking about a hell of a lot of work; just enough to make my legs feel, at the time, that they cannot do more.)

After PT I went to the beach. I went to Avila, found a disabled parking space, walked down the stairs to the ocean, took off my shoes, and walked in. I stayed there a while, enjoying the waves pushing against my legs, and then came back in and walked to the grocery there to have a sandwich. Not a strenuous effort but simply an enjoyable one.

Yet when I got home I felt so exhausted. I did not do any more today than I do many many days. So I don't know what was going on with me. I dozed a bit while watching one television show and finally turned off the set at nine and headed for bed.

Yet, in spite of feeling so tired and in spite of taking sleeping pills (Advil pm) and pain pills (Percocet) I am still awake. I lay there minute after minute, hour after hour, making adjustments to the dynasplint, to how my leg was laying, trying to get to sleep, and not succeeding. I never get to sleep before midnight any more, and often even later than that. I am hoping that by coming here to write this up I might have added yet another layer of tired and will be able to nod off quietly and stay that way.

Twelve Weeks

2011-07-04T13:20:00.000-07:00

Today marks twelve weeks since the surgery on my left knee. My recent posts indicate that all is not going entirely swimmingly. Mostly I am having difficulty with walking because of my right leg - knee, calf, and even foot at times, as well as hip, depending on the day - and difficulty sleeping because my left knee goes into restless leg stuff, exacerbated by the DynaSplint. My wake-sleep patterns are skewed. I often find myself fully awake in the middle of the night and I just give in to it. My hope is that eventually night times will even out and get somewhat normal (for me) again.

Because progress is gradual I don't always notice improvements. So I'll mention a few things I've noticed recently:

I am no longer heading for the shower in the middle of the night (at least not most of the time) to calm my knee. I am able to do full workouts in the gym and like it. I have even gone down a couple of notches on the bike settings - from height setting 9 to setting 7, meaning I can bend my knee far more than I could in the past. I can walk up and down stairs, one foot at a time, if I am reasonably warmed up and not going through a particularly bad day. I do Aqua classes completely and rarely have pain in them. I am getting more comfortable with standing up straight and keeping my stomach pulled in (no, not all the time, but much of the time). I can get in and out of my car with little discomfort, and I can drive with the clutch. I look better and generally feel better.

Most of all I can see the future. I am working on my right leg as well as my left and expect this work to pay off in an easier recovery time after that surgery (but I don't expect miracles). I think it's possible that after surgery on the right knee I will be hiking again! I can see it out there.

Dyna, Dyna, Won't You Cooperate?

2011-07-03T23:39:00.000-07:00

I have been diligently using the DynaSplint. If I have a chance to stay put on the couch for a while I put it on there, during the day, and later put it on when going to bed. I am trying to get up to at least six hours a day. It's been difficult.

Almost every time my leg goes into that "restless leg" feeling after the splint has been on there for a bit, usually under an hour. It happened again tonight, when I had an hour and a half to go to reach my goal of four and a half hours. I tried and tried but could not stand it. I took it off early. This is the first time my record will show me not meeting or exceeding my daily goal.

I think the only way it could happen is if I had very strong pain relief or something that simply knocks me out. One thing I have not yet tried is marijuana. Arthritis is one of the diseases that qualifies one for medical marijuana and I have learned of a dispensary in town. I think it's worth a try.

The Dynamic DynaSplint

2011-07-01T01:30:00.000-07:00

Last Friday (a week ago) I got my DynaSplint. The rep came to the physical therapy office to fit it on me and show me how it works. It didn't take long to get a good fit and I picked up how to put it on and adjust it quickly.

The splint is held in place by four velcro tabs, two above the knee and two below. There is a set of two cams, one on each side of the knee, that assist in applying pressure to the leg, from two linear adjustment pipes below the cams. The rep started my splint out at level 3. She said she starts everyone there. It gives a lot of wiggle room. I am supposed to work up to wearing the splint from six to eight hours a day, preferably while I sleep. With my sleep problems I am not seeing this happen particularly easily. After taking off the splint, my knee is expected to feel stiff for a while. If it is stiff for less than an hour it is time to increase the tension. If it is stiff much longer than an hour or if it causes pain it is time to reduce the tension by a half-step. The goal is to get my knee straight! Zero degrees.

I have been wearing the splint for more than one session per day, and have worked up to about 3-1/2 hours total. Today the level is at six.

Unfortunately, the splint seems to encourage that "restless leg" feeling, so I tend to take it off often. However, I have had some longer stretches of time, asleep, no discomfort. As with everything else, I think the key is to get myself into a good solid sleep, which is much harder than it sounds.

Meanwhile, I continue with therapy as usual, no change. The various machines, then step-ups, maybe some rubber-band sideways steps, some "mobes" to help straighten the knee, then finally the infamous stim machine for fifteen minutes, both legs. All of these activities together, added to the work I do at the gym, should be helping with the straightening as well as the strengthening of the thigh muscles.

I have added a few more exercises to the gym routine after meeting again with Clara last week: rolling my thighs on a foam roll, to massage the soft tissue (pain!) and pressing a 12-lb medicine ball between my legs (quite effective). I find that I enjoy hanging out on the mat after doing the bike and other machines at the gym. I feel like I can take my time there and get it all done.

I just read the title of an article that says you can do your exercises at home, you don't need a gym. I know that I don't need a gym but I find it much easier to get the work done there than I do at home. It is well worth it to me and I get the added benefit of having others around me encouraging me or offering additional examples of what I might achieve over time. If I devoted as much energy to keeping my house clean it would be some kind of miracle.

My right leg continues to cause me problems, although not all the time. I try not to let it discourage me.

Another Pedi

2011-06-19T21:07:00.000-07:00

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.

9-1/2 Weeks

2011-06-16T18:15:00.000-07:00

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.

Eight and a Half Weeks

2011-06-09T17:33:00.000-07:00

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...

On a Dark and Rainy Day, Dark and Rainy Thoughts

2011-06-04T13:14:00.000-07:00

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.

Some Kind of Wonderful?

2011-06-02T18:50:00.000-07:00

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.

On the Right Leg and Work at the Gym

2011-06-01T06:45:00.000-07:00

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.

Contemplating the Night

2011-05-31T21:48:00.000-07:00

A week or so ago it occurred to me that if I were more active I might sleep better. That has usually been the case. Last Wednesday I returned to the gym, taking an Aqua class, and I have gone there every day since, except Sunday. I either do Aqua or I do a set of exercises upstairs, using the equipment. In addition, I am going to physical therapy three days a week, and these sessions tend to last about an hour and ten minutes, a workout in themselves in a different way.

By night, my leg feels stiff and I am not walking smoothly. I have to talk myself into standing tall, placing one foot down and then the other, putting my weight on the inside of my feet, pulling my stomach in. I don't always do all of this because I feel achey.

So off to the shower I go. It feels nice while it lasts, and I am for sure racking up the therms on the gas meter. But the calm does not last, not in my leg anyway.

And so I lay in bed, my leg occasionally seizing up or going into a spasm or just plain aching. The theory isn't working; more activity is not helping.

I have also started taking melatonin, two three-mg tablets at night. It hasn't hurt anything that I can tell and it might be helping. I am not taking tylenol pm but I seem to get about the same amount of sleep, fitful and interrupted though it is. I also take Vicodin, but that supply has now run out, so I'll go back to Percocet. Hard to tell any difference between the two.

I'll admit it: I'm writing this as another means to divert my attention from sleep and my wanting it.

Off to the Theatre

2011-05-30T15:59:00.000-07:00

This afternoon I went to see a movie. I had gone to Aqua class and then enjoyed a potluck at the gym, and I thought it would be good to see if I could actually sit through a movie.

I could. Yes, I was stiff, damn it, and I had to set everything down before I could help myself get up, but it was okay. The film? The Greatest Movie Ever Sold, by Morgan Spurlock. See it! It's very funny and alarmingly true. Spurlock seems to have recovered fully from being supersized, too. He looks good.

I was wearing a jacket in the theater yet I was still cold. It seems like I am cold a lot. Could be because it's been cold this spring. I hope that's the reason and it isn't because some meter in me has stopped working correctly.

Revenge of the Right

2011-05-29T18:11:00.000-07:00

Today I went to the Strawberry Festival in Arroyo Grande, about 13 miles from home. This is a giant street fair, covering many streets up and down and back and forth in the "Village", which is the older commercial part of town. I parked on a dirt lot some distance away and took the shuttle to the festival. I spent about an hour walking up and down and around and finally back to the bus pick-up spot so I could return to my car, carrying strawberries of course.

Lately, and especially today, my right leg has started to complain when I walk. My hip hurts, my knee hurts, I feel twinges in different parts of my leg. My last therapist warned me that this would happen, that the change in alignment of my body would start to aggravate the pain in that leg. The ultimate solution is the right knee replacement, but for now I have one straight and one crooked leg and I have to figure out how to deal.

I thought maybe if I just walk longer it will ease up. It did seem to ease, just a little, but not much. I'm fretting about this a bit because I don't want to be limping on that side, I don't want to be just as gimpy as I was before surgery. I want to walk as normally as I can and feel as good as I can. So I will continue to work it very slowly and carefully, and when I see Paul on Tuesday I will ask about it.

And at Night

2011-05-28T23:50:00.000-07:00

I occupy myself as long as I can manage, which often isn't long, before I head for the bathroom to take some acetaminophen p.m.. I have tried different combinations of drugs at different times. Mostly, now, I take the sleep pills at eight or eight-thirty at night, and wait, if I can, for at least an hour before I head for bed. Sometimes I take Vicodin at the same time. Sometimes I wait. Always I am wanting to not take any pain pills at all, and so far always I have failed. I always take some, lately two earlier, two later, total four.

I try to find a comfortable position in bed, and sometimes I can do so right away. I read but am not sleepy. Finally, after reading a while and adjusting my position several times, I do start feeling a little sleepy. I put the book on the table and switch off the light.

The demons in my leg will often surface at this time. It's something like "restless legs", a discomfort that I cannot ignore. I try different positions again, slow down my breathing, try to let go of thoughts. It doesn't work. I switch on the light and sit up, turning my body to the edge of the bed, letting my legs fall over the side, hang there a while. I may just sit there a while or I may pick up a book again, read some. Then I may try to find a good position to sleep again, may turn off the light again, but more likely I will pull my leg up onto the bed and stretch it, pushing the knee into the soft blankets and sheet beneath it.

I look at the clock. It might be ten now, it might even be eleven or a little later. I may take more Vicodin, two more tablets. Deep breathing. A shower. Most nights I eventually get up and take a hot shower, letting the hot water cascade over my knee, over my shoulders, onto my back, then over my front, back to the leg. Sometimes I will sit and let it pour down over me, a waterfall of heat. When I leave the shower I quickly dry off and put my nightgown back on. It is usually not too cold and I do feel some relief from the discomfort.

I sit on the edge of the bed again. I pick up a book and read some. I try getting under the covers again, place a pillow there between my legs or under the left leg. I turn to the opposite side, adjust the pillow again. I pull out the pillow and put one leg, bent, ahead of the other, both on the sheet. Then the other side, same thing. I take deep breaths, sit up again on the side of the bed, read more. Lie down, read on my side, read on my back, read on the other side.

Sometimes I am able to doze for a little while. Next thing I know it is one o'clock. Then one-fifteen. If I did not take some before I may now take more Vicodin because my legs are calling to me again, my left leg, not the right. Some time around two or later I will fall, unaware, into sleep, and not wake again until it is almost five in the morning.

The cats are bothering me. Knowing that one of them in particular will not let up, I finally get up and stumble down the hall, trying to hold myself upright, pull in my stomach, walk on the inside of my feet: in other words, trying to maintain alignment and proper posture. Rarely do I achieve it at this early time. I dig into the cat food container with the cup measure, filling it, and then pour a third of a cup into each of three cat food dishes, each in its own special location. I return the cup to the cat food bin, close it, return to bed, turning out the lights on the way and shutting my bedroom door to prevent any further cat interruptions.

Again, more arranging under the covers. Sometimes I am able to get back to sleep after a while. Other times I lie there restlessly until the hour is more decent, and then I pull myself up, slide my feet over the edge, sit there a while, finally get up. I pull the covers up, roughly making the bed. Go to my closet to grab some clothes, lay them on the bed. I might take another shower or I might just get dressed. Before dressing, though, I sit on the end of the bed and massage the knee scar, then work the patella back and forth, and up and down, trying to loosen it. I may do some of my regular exercises then, or not. Once I am dressed I open the bedroom door and head for the office to check email.

It should not be surprising that I will sometimes feel an overwhelming sleepiness once, twice, even three times during the day. I know that if I ignore it and try not to nap I may have a better chance at night. But I rarely can ignore it, and I often will take short naps, on the couch or on my bed, trying to get warm, and again trying to get comfortable. It seems like I can get comfortable more easily at these times than I could earlier. Yet in the in-between times I feel awake, not deprived of sleep. I manage to take my little walk, go to the gym, do various errands. Some days I go for physical therapy in the afternoon. I hope to wear myself out enough to fall dead asleep right away and stay there. So far it has not happened.

Getting There is Half the Fun

2011-05-27T17:21:00.000-07:00

I went to Aqua again this morning and to therapy in the afternoon. In therapy, the intern worked on the capsule a bit, then we worked on straightening again, to little effect. Paul then brought in a blood pressure cuff, pumped it up, and put it under my leg. When I pressed down we could see the amount of pressure I applied. I got up to six pounds of pressure. Then he used it on the right ("good") leg and I did ten pounds on there. When it got back to the left knee I was pressing about eight, as I recall. Later, at the end of my time there, I got the stim machine on again and was again pressing ten seconds, resting ten seconds, for however long it was set.

Work on the flex showed that I am clearly up to 120 degrees, which compares to 125 degrees on the right leg, and is a functional number. I may not get much past that - but I'd like to.

I then did some step-ups, which were similar to what I do on the stairs outside every day, but which did not require that I use my left leg entirely to raise my right leg. I could let my right leg do part of the work, spring off some. The intern noticed that I was working on perfecting the move, that I was actually "enjoying" it. I guess I was. I then did leg extensions, using a machine, and leg curls on another. All strengthening work. From there to the bike for 15 minutes, then some calf stretches, and finally the stim machine.

I have come to expect a couple of things from therapy: one is at least a portion of the time I will be dealing with fairly intense pain. Another is I expect to be corrected on form and alignment. I didn't get as much pain this time and I was focusing on alignment myself so perhaps I was doing a decent job. In any case, I have to take full responsibility for form and alignment all the time now. I do not want to slip. I find myself looking for my reflection when I can to see if I am doing things correctly. More and more it's on me to do this right.

I honestly don't look forward to being set entirely free. I believe I have three more weeks with Paul and that's going to be that. However, I can extend the work on my own if I learn what I can do at the gym. I really want to have a good plan for afterwards, working with Clara at the gym. I have not had a chance to discuss this with Paul, but I started to bring it up with his intern. I'll try to remember to bring it up at the start of the next session.

I Feel Good! Like I Knew I Would!

2011-05-26T12:02:00.000-07:00

Life for me is a series of ups and downs. I expect it's that way for most people. Today I'm on a high and I did not want to miss reporting it.

I went to the gym this morning and did 20 minutes on the bike, working the resistance up to where I was getting a heart rate of 125 beats per minute. At the physical therapy office yesterday the goal was to reach the level of work that would get me to 120 beats per minute and I wasn't entirely sure what that felt like. I think I've got it now. My knee felt a slight strain with every turn on the bike, which suggests to me that it was working the flex just a bit, which is a good thing.

After the bike I did two sets of ten on the leg press, with 140 pounds. I think I can start to bend my knees more on the leg press. Trouble is, with the Nautilus machine I have to bend to the max when I first get on it. I'd like a different design, please.

The leg press at the gym is similar to this.

After the leg press I moved to the hip abductor-adductor machine, to do abductor work. This is similar to the clamshells I am supposed to do at home but with both knees at once so I don't think I can eliminate the clams, unfortunately. Still, I like this machine so I use it.

And that was it for the gym today. Light workout. Which is good. We need to work up to some things. After spending a few minutes in the steam room and taking a shower and getting dressed, I headed over to Trader Joe's for a few groceries, and then to Roxanne's Birkenstocks in the hopes of finding yet another identical pair of shoes to the Earth shoes I wear all the time. Well. Earth shoes no longer makes exactly that pair and what they do make that is similar was not in stock. Poor me. I ordered the replacement shoes. Also admired some new sandals that are built to be easier on your feet and look good. But they did not have any in my size, of course.

Back home then, to put the groceries away. And to revel in this feeling of Good. When I get in and out of the car now I no longer feel any pain in my knee because I have achieved a high enough level of flex. I can now walk down stairs one foot at a time (no two-stepping). I was able to go from the gym to Trader Joe's to downtown without feeling worn out. These things are terrific achievements for me. Finally I am seeing real change and loving it.

I worked hard at achieving change without getting knee surgery and I was only able to get to a certain point and stay pretty much level after that. I am now making noticeable changes week by week and it is just wonderful. At least that's how it feels right now.

Feeling Good about Feeling Not So Good

2011-05-25T20:05:00.000-07:00

Today I went back to Aqua class for the first time since before the surgery. I was welcomed back by those who remembered where I had gone, and encouraged to do what I could but not push it. I went ahead and did everything. There were some things that I did not do as well as before but I suspect I did some other things better. Throughout I felt the knee and its stiffness. It felt great being able to handle the class, to answer that question.

A few hours later I went in for my second PT appt with Paul T. This one was quite different from the last which was mostly measuring. At the beginning I sat on one of the soft tables while Paul pressed my knee down. Straightened it, in other words. This move is never pleasant for me (Wade did it too, of course) but I know it's necessary to get that movement eventually. To get it straight. So I managed to take deep breaths and hang on as long as I could, and managed to joke a little through the pain. I know what needs to be done. After the straightening he then had me bend it, and as usual I found it a little painful to move from one extreme to the other. But I managed, did okay in that area. Flex is easier to get because there is wiggle room in the knee to get more bending, even when it is somewhat inflamed. Straight is harder to get, particularly for me, because for years the knee was not straight. So we are breaking new ground in a very real sense.

Then I was off to a bike. I got it going well enough, feeling good that I could do a bike, but when Paul asked how it was I had to admit it was not difficult enough, I was not reaching the level he wanted, which was "moderate difficulty". I pushed it harder, faster, brought it up to a new level, and started to feel like I was working. Did this for ten minutes, felt pretty good about it. From here I got to use a machine I forget the name of - I lay on it on the diagonal and bent my knees until I couldn't any more, until I reached a stop point, and then slowly raised myself again. Because of the diagonal I wasn't putting all my weight on my legs and I was able to manage this rather well, got some good bending in. Up to 120 degrees, in fact, which is 10 degrees greater than was measured last Monday. I don't think I need to worry about this part, the bending.

Finally, I got to work on straightening my leg. The leg got hooked up to a stim machine, which stimulated the muscle for ten seconds, then laid off for ten seconds. Every time it went on I had to straighten the knee. Kept it up for fifteen minutes. This was one of the longest fifteen minutes in my life.

Before I left I asked Paul what I could do at the gym. He said the bike and the leg press, but that is all, and don't put too much weight on it. Tomorrow I will do that. Along with the regular at-home exercises.

After leaving the PT office I went to a market and picked up a few things. Although my knee felt like it had been through a wringer I still managed to focus on walking and standing correctly as best as I could. I drove home and unloaded my groceries and sat on the couch, satisfied. I feel well used. The real test will be how well I sleep tonight. I'm looking for some relief.