and the day after

At this stage of my new exercise routine I am posting in greater detail than I will later. I want to track what's happening now and compare it.

Last night I had leg cramps. First my right inner thigh, then my left foot, then my left inner thigh. Excruciating. It felt like forever before they eased and I worried that after I got settled in bed it would happen again (this has happened in the past) but it didn't.  It seems that the best I can do for such cramps is to get into a hot shower but it is too difficult even to step one foot on the floor when I am in that pain. Sometimes when it is easing off a little I can limp into the shower and take it from there.

I suspect the bike but it could have been something else that was worked yesterday, like the leg press. I expect these cramps did indeed come from my little workout, and I expect that my muscles will adjust and I won't have this kind of pain after a while.

Second time at the gym

Today I went to the gym to do the set of exercises alone for the first time. It took me a total of 35 minutes.

I started with the recumbent bike. I set it at the same seat distance as last time but realized immediately that my left leg as a lot stiffer than it was last Thursday. Yesterday I did a very small hike but it was probably enough to set off that joint.

After about three minutes that knee seized up suddenly. It didn't actually "seize" but it went into a sudden sharp pain. I had to stop immediately. I pushed the seat back farther and tried again. That took care of the problem and felt good enough that I continued until I had done ten minutes on it, and I kept it at level 2. My workout calls for five minutes but of course ten is better if I can handle it.

Next was the rowing machine. I wasn't sure I chose the right machine but I think so. I did the fifteen reps slowly, cleaned it off and headed for the next. Next, lateral pulldowns. I pulled them down with my right hand to the level where I could grab with my left without pain. I noticed that I tended to use one arm or the other to do all the work sometimes. I think I need to be careful about using both evenly.

The last machine as the leg press. I had to push the seat all the way back to get my legs up there. I wasn't remembering exactly how to do it at first, but then it came back. I took it slowly and I think it went well too.

After the machines there was the window and wall, the arm stretches and the calf stretches. I found that 30 seconds was as much as I wanted to handle on all of those. Each of those, I should say.

I wasn't particularly sweaty but I took a shower and changed so I'd be presentable at Trader Joe's, where I wanted to pick up some groceries. The gym is very close to TJ's so it makes sense to schedule them together when I need to shop.

I feel good now. I think this is the right thing to be doing.

The first training session

I met with Clara, the head trainer, today. She seems very nice and genuinely excited about working with me. She asked about my goals, then moved into the details of my arthritis, and finally we filled out the medical information form for liability purposes. Her conclusion? I'm really healthy inside, it's just the outside, the arthritis, that is holding me back.

While she was asking me about the pain she jotted notes about what exercises she thought would be good and she drew conclusions about what was going on with me in different areas. As we walked up the stairs she went behind me so she could see how I walk. She noticed my severe pronation, of course, and the fact that I am not standing or walking straight. Understandable, of course, because I am trying to adjust to the pain and difficulties of the arthritis. But she had ideas for how to strengthen what I need to compensate for the arthritis damage.

I tried a recumbent bike, then a standard one, and I noticed that I had less pain with the recumbent, so I'll go with that. Then I tried various exercises using Nautilus machines, and last she showed me a couple of things I can do at home with a window sill and a wall. My routine at this time:

Recumbent bike: 5 minutes, level 1 - 3
Row: 25#, 1 X 15 reps
Lat pulldown: 50#, 1 X 15 reps
Leg press: 120# with band around knees, 1 X 20 reps
Walk with band around knees, keep from slipping
Doorway or window: chest stretch - 30-60 sec, 1 - 2X/day each side
Calf stretch against a wall - 30 - 60 sec, 1 - 2X/day each side


She suggested I start out doing this twice a week and work up. She is going to call me Monday to see how I am doing, and we go from there. If I join - and at this point I am sure that I will join - I will get two more sessions free, then will have to pay for individual training from time to time.

When we were done she said she had to revise her plan as we went, because her assumptions were not necessarily correct, and that this may actually be easier than she thought at first. I am really hopeful.

Help with exercise

For years I have resisted going back to a gym, because my experience with the trainers is that they know nothing about arthritis. I would love to do some strength training that will actually help me with my knees, hip, and shoulder, but I don't know what's good and what will simply damage those areas. This may change, though.

A week or so ago I took advantage of an offer a friend had gotten in the mail. We both went to an arthritis seminar at a health club in Arroyo Grande (not far from here). The seminar was led by two physicians from a local hospital, who talked about treatments for knee, hip, and shoulder arthritis. They were surprisingly open about the options, not pushing any particular treatment. Because I had recently read a booklet and watched a video from the Foundation for Informed Medical Decision Making in Boston (a non-profit that gets no funds from any medical industry), I knew that there is no optimal time to have surgery, for example, and that many people do well without it, that treatment is as individual as we are. They even used the term "evidence-based medicine", which is what we all should be using all the time.

One comment got me thinking: one doctor mentioned that the health club has specialized trainers who work with physical therapists to help with pre- and post-operative therapy for patients. My ears perked up. These trainers probably know something about arthritis!

A few days later I got a phone call from the health club, Kennedy Fitness, offering me a four-day pass free. Naturally the reason they sponsored the seminar is that it gave them an opportunity to recruit new members. I said sure, I'd go for it, and the next day I went down to the club nearest me (they have four) to pick up my pass and talk to one of the people there. I asked for a tour and I asked about these specialized trainers. He didn't know much about them but said he'd have the head trainer call me to discuss options.

She didn't call that day or the next but soon I was talking to Clara. She said sure, she could probably help me out. I have an appointment with her today at noon. She will show me exercises that might help with my joints. I will ask her, too, once she sees how I am, what classes I might be able to take as well. I am hopeful, still!

Exercising in water

Exercising with Arthritis: Aquatic Therapy

This is a guest post by Genevieve Lawrence, representative from http://www.Hydroworx.com.

If you are suffering from arthritis, you may enjoy a love/hate relationship with exercise. No doubt you have been told that exercise will help improve your situation in some of the following ways:

* Exercise will help keep you at a healthy weight and reduce pressure from your joints.
* Moderate exercise will help keep the muscles and surrounding tissues strong to improve support for your bones.
* Keeping moving helps reduce painful inflammation and protect your joints from further damage.

But when exercise is agonizing and it may take some time to see the results, it can be difficult to embark on a fitness program. Even though the potential benefits over the short and long term may be huge, the effort is difficult and painful as stiff joints slow you down. One way to make exercise a more enjoyable and effective experience is to start a water-based exercise program. Simply the pressure of the water alone can help decrease swelling and increase circulation!

Aquatic therapy provides many benefits that traditional exercises may not to an arthritic individual. Because of the low-impact environment that water creates, it is an ideal and safe place to gently exercise joints and muscles. The water supports joints, encourages free movement and also acts as a gentle resistance to help improve muscle strength. By being shoulder-high in water, you will have reduced the percentage of your body weight that is acting on your joints down to 10%!

There are many different methods for water exercise, from water aerobics to more condition-specific treatments that use a specialized rehab pool or swim spa. These exercises include range of motion exercises and a gentle cardiovascular exercise. A therapeutic swim spa or pool can be used to warm and massage stiff and aching joints and decrease swelling. You may find one of these at a gym, rehabilitation center, or may be purchased for in home use. There is even a water treadmill for those who like the motion of walking but want to drastically reduce the impact on joints.



There are some precautions and items to consider before embarking on any aquatic exercise program:

* You may need help getting in and out of a spa or pool. Take that into consideration when looking into both public and private pools for aquatic exercise. There are pools and pool equipment specifically design to make access easier. Look for these when considering where you want to exercise.

* Always consult a doctor before starting a new exercise program. If you have any other health conditions that may make an aquatic exercise program less than ideal for you, they will be able to let you know in advance.

* Check the temperature of the pool. Ideal conditions for comfortable exercise are between 83 and 88˚ F according to the Arthritis Foundation. Water that is too cold may not impart the same benefits and too hot water may cause dizziness or nausea.

Finding the right water exercises for you can also be fun! Check with your local health facilities and see what programs they offer. They may not only have the facilities, but also may have groups and classes where you can work out with others, making exercising a fun social activity. Once you find a suitable location, you will find that aquatic therapy is a relaxing and enjoyable way to relieve the pain and stress associated with arthritis.

Major Cramps

Yesterday was sewing class. Mostly I sat in front of my sewing machine and sewed. A few times I got up to use the iron. I did not do any unusual physical activities. Yet last night I had major leg cramps. I don't think I can trace them to a specific action. I think they are a manifestation of arthritis. I suspect this because my friend D, who also has arthritis in her knees, suddenly developed serious cramps in her legs while walking one day. She ultimately had to get a ride to her car.

I woke to the cramps at about 11:30. Intense pain in my right inner thigh. I stretched and adjusted and cried out and finally the cramps eased, after several minutes. Then it happened in my left inner thigh. After both had subsided, after much pain and ineffective attempts to calm them, I lay down again and wham! Both legs exploded in pain. I told myself perhaps I should get to the shower, if I could, to some hot water, but I didn't.

Little by little, with stretches and deep breaths, I calmed them both down again. The relief! Again I thought, maybe I should ease on into the shower, but instead I tried to get back to sleep. Shortly after I was relaxed and ready to sleep, perhaps an hour and a half into this ordeal, my right leg went into spasms again. This time I managed to sit up and grope my way to the bathroom, using the bed, the wall, the door, the counter, to help myself. I turned on the shower, a walk-in shower with two seats and what appears to be a grab bar rather than a towel rack, and when it was hot I worked my way inside. Screaming pain, but in a few minutes, with both shower heads aimed at my legs, the pain eased a bit. I sat in one of the seats and aimed the hot water on top of me as well as on my legs, and I stayed there several minutes. The cramps left me. I stood to make sure. I grabbed the towel, dried myself off, put my nightshirt back on and made my way back to bed. But I stopped to grab one acetaminophen pm tablet, hoping it would help pave the way, even though it was about two a.m. at the time and the tablet would mean I'd wake later than usual.

Could it be wheat?

Yesterday I decided to quit wheat for a week, to see if there may be a noticeable difference in pain. Unfortunately, I woke yesterday with greater-than-usual pain and actually took one tylenol-codeine tablet, something I rarely do. I didn't notice any effect from it, although the pain did gradually lessen yesterday and it isn't so bad today. I'm going to try to stay off any pain meds for this week. We shall see.