A Good Day

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

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

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

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

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

The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.

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

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

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.