After A Long Respite... I Am Back

My biggest fear was not ever being able to run again.

I had to take a break from blogging last spring. When I started this journey of surgery and recovery I thought it would take me a year to get myself back in form. I am relatively young, healthy and a fast healer (so I thought). Whoever said "life is what happens to you when you are making other plans" was so right on. My life was definitely not in my control. All I could do was push forward and hope for the best.

I had been planning on being back racing by summer (not fast but being able to complete a significant distance). I wanted my Ironman that I had lost in 2008. I just wanted to finish but surgery #2 took away all that. By the the end of August all I could do was cycle was 2 hours and my running was limited to 75 minutes. These times were not anything that was imposed on me by my doctor or PT, this is what literally my body told me was enough. So being a smart girl, I dropped the Ironman from my schedule.

Recovery from the second surgery was far easier than the first. After the initial 4 weeks, I was able to increase my resistance on the leg press by 40 pounds (on my surgical leg) in the next two weeks. Originally, I was told I would be running by mid to late June. I took my first strides on a treadmill in May. The running felt ridiculous and I was winded after 10 minutes. It was a start.

I progressed enough to be able to race my first triathlon, a sprint, on August 18. I ended up finishing 3rd, 7 minutes off my time the previous year. My run pace was 7:35 per mile for the 5K, a respectable time.

My real breakthrough this year did not even involve triathlon. I signed up with a team to run Dances With Dirt in Hell, MI. It is a 50k team relay. I ran about 13 miles over trails and through mudholes that went up to my chest. The last leg I ran, I had to drag "lefty" up the remaining hills because my muscles had basically called it a day. However, no matter how bad I felt after I finished, my leg was intact and after this race I finally started feeling that everything was going to be alright.

I have decided to continue bloggin but I am retiring this one in favor of a new one. I need the clean break from the surgerical issues that I have had over the past year. The new one is going to be a fresh start, more conditioning and (hopefully) racing. I still have a long way to go. The left leg is still smaller and I run with a funny gait sometimes. And my endurance is definitely not Ironman ready. But I have a renewed sense of hope that all of this is now behind me.

Getting Bored

I am having a love-hate affair with the leg press. Right now, I can press 65 pounds with my left leg. This is compared to the 130 that I was pushing prior to the second surgery. I need to hit at least 120 to start running again. It is a bit frustrating because I try to push but I'm hitting a wall. What people don't always realize is that after a surgery, muscles around the area tend to shut down. With the knee, it is the quads. It takes about 6 weeks for the muscle to regain the neuromuscular function and to start getting bigger. So no matter how much weight I try to push, there is no getting around these 6 weeks. The compounding effect of 2 surgeries plus and injury may make make strengh gains proceed more slowly. Only time will tell.

In PT I'm doing pretty much the same as I have been doing: Leg press (single and double leg), hip flexion and extention, calve raises, balance drills, squats on an unstable platform. I started working on going down stairs. Right now, I can go down step over step if I have a handrail. I just don't have all the strength back in order to lower myself under all my own power. Even with this muscle weakness, I have to say that this is the best I've done going down stairs since my injury last August. I'm not very fast but I'm better than I have been.

On a brighter note, I got back into the pool on Monday. The first 1000 yards it felt like I was swimming in mud. After that, it got a little easier. It will still be several weeks though until I get my strength and endurance back in the pool.

The Toughest Thing About Recovery...

...is being patient.

The major difference between these two surgeries (besides the actual type of surgery) is the fact that after this one I feel so good. I am just waiting for my body to catch up with the rest of me so that I can start training. At this point after Surgery 1 I was still dragging my leg around with me. Now I can officially do stairs. At least going up. Going down requires a lot of weight on the hand rail.

Two weeks out from surgery: I have full range, less swelling and mushy quads. Just the quads. Everything else is still strong. It will get better but it is going to take a while. I've been told by my PT that June 15 is the day I can go back to running. So long. I'll be on the elliptical before then and that is almost like running. Sort of.

I'm in PT twice a week right now and I fit in one extra day of lifting on my own (just to give those a little extra oomph). The other days I've been on the trainer pedaling away. The more I pedal the better it feels so as long as I keep the resistance low I can spin, spin, spin.

Another thing I am dealing with is some swelling around the port sites that do not want to go down.
I got the idea from PT to start adding some extra compression with gauze and tape.

Then I place the compression sleeve over the entire thing. It just helps to keep everything down. Yesterday, it looked like it was starting to go down so I ended up leaving the tape on overnight. The only time I have been taking it off is to do my stretching because the tape pulls on the main incision and it is still a little tender.

I've got a great collection of compression stockings and sleeves. This one is from Zensah but the main ones I use are just some cheaper compression hose that I got from PT that you can cut whatever length you want. They come in different degrees of compression so I tend to wear a lighter compression one at night.

Post-Surgery Update And A Photo of Beans

I do not have children... yet. It's just my cat in the background that sounds like a crying baby.

This is what I have to tell people when they are on the phone with me.

This is my first update since my most recent surgery. I admit, I've been a bit lazy, a bit busy, but mostly just exhausted. This whole process to get my knee back healthy has been a little more than I was originally prepared for. However, this most recent bump in the road may have been just what I needed.

It all started last week the Monday (March 29) before my surgery. I found out that I needed authorization for the surgery. This wouldn't have been a big deal if I had found a little sooner. The insurance company originally told us we didn't need it. Then, two days before surgery, they told us that I did AND that it usually takes 72 hours to RUSH an authorization through. I was in tears and beyond stressed. To top it all off, the insurance company told us that I wasn't even authorized for my first surgery even though they had paid for it in full. Talk about lack of communication. Eventually everything got straightened out, my authorization done in under 72 hours. The day before surgery I found out everything was okay.

After that, surgery was nothing. This was done by the same doctor, but in a different hospital site. This site had a TV so Aaron didn't have to entertain me the whole time. This time I was also allowed clear liquids and black coffee up to 6 hours before surgery. I really think that helped to make a difference because I didn't feel so bad coming out of surgery. I went in at 3pm (I even remember them putting the oxygen mask over my face) and woke up a little after 4pm feeling great. In fact, I felt amazing. I had no pain. For the first time since my injury, my knee felt right. While I was waiting for the doctor I started bending it up and straightening it back out, just to see how far it would go. It turns out that I had a very large cyclops lesion (I was right!!!). The doctor manipulated the knee (bending and and straightening it and cutting out scar tissue) and took out the screw. The screw was working it's way out on it's own and I was forming bone around it. The incisions were placed in the same place as the last time so I won't have any new scars. I couldn't have hoped for an easier time.

The next two days I headed to physical therapy. Dale went really easy on me the first day. Lots of gentle movement, some straight leg raises and then hooking my quad up to electric stim. The day after that, I did a little more. Some squats on the shuttle press, calf raises and more stretching.

This week is when things started to get tougher. I got to do some serious strength training. Most of the swelling has gone down and it actually makes walking harder because my quad is so weak and my balance is really bad. I am actually more afraid of falling now than I was last week. I did leg press, dead lifts, tons of squats and cycling. I was so sore and tired midweek that I could hardly get myself off the floor. It isn't even the muscles that I am trying to train. My right leg is actually more sore than the left. It takes all the work than the left can't do.

My leg press weight is really bad. I think that I topped out at 55 pounds this week. I need 125 ideally to start running again. My doctor told me that at the earliest I could start back running 4 weeks after surgery. I'm hoping than since I have been doing so much strength training these past few months that my muscles will bounce back faster. I'm scheduled for PT two times a week for the next month and I plan on doing a third day of lifting on my own. Last time 3 days of lifting per week got my strength back in about 6-8 weeks.

Scar Tissue, Manipulation, and Screws

I went for my pre-op appointment with my surgeon yesterday. From looking at the MRI he doesn't think that I have a cyclops lesion. I looked at the images myself and I THOUGHT that I saw one. It wasn't really obvious. I had to look at them several times and reference online before I located it. We'll find out who's right when he goes in next week. There has to be something there. Why else would my quad be atrophying?

So I'm scheduled for scar tissue removal, manipulation (this is when they bend the hell out of your leg to loosen up everything) and... screw removal. Apparently, these screws (used to hold the new ACL down in the beginning) don't dissolve as well as they are supposed to. Mine seems to be working it's way out of the bone. Fun. My surgeon says that in the best case scenario, they are able to just use a screwdriver and back the thing out. This idea has me more creeped out than the manipulation. I was tempted to just tell him to leave it in but I remembered a woman who had several screws put in after a knee surgery. Her body was rejecting the screws and she was having a lot of difficulty getting the strength back in her leg. He's going in anyway, might as well get the darn screw.

I've been cleared to start physical therapy the day after surgery. However, my doctor warned me about pushing to hard after surgery. Part of the reason I am going to PT is because if left to my own devices that is what I am likely to do. Also, my big fear is not being able to get full motion back in my knee like last time. I am not going in for another surgery so what I get after this one, is what I get.

Well, At Least I Can Swim

It is a little over a week until I go back in for surgery. My knee has calmed down quite a bit now that I'm not doing things that make it unhappy. That means I have had to cut out the leg press and forgo any aggressive stretching until the scar tissue is taken out. Running in any form is out, this includes the elliptical. I can still cycle indoors but the only thing that I seem to be able to do without any restrictions is swimming.



So I have been swimming and swimming and swimming a lot. This is the most that I've done since before my first surgery. I know that I am going to have to take a couple weeks off from swimming after the proceducre. I'm trying to get as much training in now so that maybe I'll bounce back faster once I can get in the pool.



We had a couple of our cats, Strider and Beans, farmed out to be watched by another family while inspections were being done in our apartment complex. It got delayed so they ended up being gone for 5 days. Beans had a great time playing with his friend, Oliver. Oliver was the cat that we had watched a couple weeks ago. However, our other cat, Strider, refused to eat during that time. He holed up in a room by himself for days at the house. The person who was watching them is my husband's coworker. He started calling him Ghandi. The day before we went to pick him up from the house, Strider disappeared. They searched their house. We searched their house. No Strider. We started calling him Houdini. Yesterday he was finally found by Oliver, holed up near the ductwork in the ceiling of the basement. Poor little guy. He was so thin and sad when we finally got there to get him. Now that he is home, he's eating well although he's still a little skittish. I guess we'll be having in-home house sitters from now on.

Get It All

I'm a bit calmer today after resigning myself to the fate of another incision. I now know what to completely expect: the pain, the stiffness, the swelling. This time should be different. This time it should turn out better (or so I am told). What I am finding out this time is that I'm not that afraid of the surgery, it is the rehab that has my stomach in a knot.

I'm returning to the site of my last clinical for my rehab. I stopped over there yesterday because after contacting Dale he told me to rule out a meniscal injury. I really didn't think it was that because I didn't have the symptoms in the right place. Everything that is clicking and grinding is right underneath the kneecap. Right now, scar tissue looks like the culprit. My patella has adhered down and is not moving well. And if your kneecap doesn't move, neither does the rest of the knee.

So I've been told, if the surgeon is going in, make sure he gets EVERYTHING and that I get full flexion and extension with surgery. Remind him several times, if need be. Apparently, my body likes to make scar tissue so removal of the offending stuff is crucial along with early mobility of the knee. Remembering from last time, it is going to kill. However, I am hoping that the pain tolerance I have developed from rehab after my last surgery is going to carry over to this time.

Later on, I got my MRI taken. This time, they made me wear a gown (no safety pins flying out of my pocket this time!) and I didn't get any music to listen to. Just ear plugs. I only had to go in partway because it is my knee that they were looking at. I spent my time trying to figure out all the buttons on the machine. I found the emergency stop buttons. Those were bright red. The whole thing was done in about 30 minutes and I got to leave with a copy of the images. I tried to look at them this morning but I can't see much. It looks like there is some tissue under the kneecap. I found my new ACL. It was near the PCL. The reason I found it is because it doesn't look "normal". It is where the ACL would be but it looks different and there are suture lines in it. Or something like that. As long as it holds, I'm fine with it.

I head back to the doctor in a week. I don't expect him to change his mind on surgery. And unless there is a way to take a chisel to it, I don't expect the scar tissue to disappear on its own.

Under The Knife... Again!

Yep, I'm headed back into surgery. I had a check up with my doctor on Monday and he wasn't happy about the clicking in my knee. Or the fact that my quad is slowly turning back into mush.
Late last week, I had tried jogging again (only made it 5 minutes!) and then did my usual strength routine. Later that evening I was stretching my leg out on the couch and I heard a "pop". No pain, I must have just broken through some scar tissue. In fact, I think my knee gained a little extension after that.

I didn't lift again for a couple days and was back in the gym on Saturday. It was there that I noticed my knee swelling a little more and I couldn't push nearly as hard on the leg press with my left compared to my right. The two used to be nearly equal.

All this I brought up to my doc and it took literally 2 minutes for him to tell me that he wants to do surgery (Again!). Actually part of me was relieved to hear this because I've felt like I've plateaued in my recovery. I'm not happy at all with the state of my knee the way it is. It feels like something is pinching inside there when I bend it. I think that this is the reason why it has been so painful getting back this last bit of motion.

So what is it? Most likely, a piece of free-floating scar tissue or a cyclops lesions. I've heard that cyclops lesions often form if you don't get back your extension right away and scar tissue forms between the two condyles of the femur. With full extension, the ACL sits in that space preventing them from occuring. Apparently, it occurs in about 10-15% of cases. Sometimes being problematic (as in my case).

So what is the cure? Physical therapy is one option although I am so far along that it is unlikely to help. Something is irritating my knee that has to come out. Surgery (or a arthroscopic resection) is the other that I know of.

Granted, we still don't know for sure what is going on with my knee. It could be a number of things but scar tissue is the most likely culprit. Tomorrow I go in for an MRI (have to remember not to request rock music since they want me to sit still) and next week, my doctor will see me and we'll follow through with surgery if this does not magically resolve by then.

I also have a script for physical therapy which I plan on starting the day after surgery.

I Still Can't Squat

When I first got my injury and then subsequent surgery 6 months ago, I pictured things to be a little different by the time that I reached this point. I thought I would have all my motion back and I'd be starting my run progression and other than getting used to the impact again, my knee would not be talking to me quite so much. Wrong!!!

I think that I have been very patient with myself. I've adapted to having a stiff knee. Perhaps a little too well. I realized today that I still can't squat down onto the floor using both knees. I have to kick my left one out behind me and do a sort of lunge or one knee down sort of thing. This is sad. I was in such great shape last summer and I'm not anywhere close to that anymore. (Yes, this is me feeling sorry for myself.)

I really should have gone to physical therapy a couple months ago after I left my last clinical. Since then, my progress has slowed a bit and I think that I have actually lost muscle in my left leg. The motion continues to get better but not as fast as it would if I had more time. This clinical, even though I'm working the same number of hours this week, has been a lot more draining than the last one. I think a lot of it is because I worked through my break this winter and went straight to the site that I am currently at. That and the patients are a lot weaker and sicker. It just zaps the energy right out of me to be there. Then I come home and I'm too tired to work out as hard as I could be. Mind you, I still work out and ride my bike almost daily. It is just by the time I get to mid-week, I'm exhausted and all I want to do is sleep. Or vegetate in front of the TV. I've already gotten sick twice in the past 3 weeks.

I seriously just need a break.

I'm headed to the doctors on Monday: my surgeon for my 6 month check up and a family practice doctor for a script for physical therapy. THe plan is to start physical therapy sessions and try to aggressively get back my strengh and motion. If that doesn't work, I'm planning on getting an MRI to determine if there is something in my knee joint that is blocking the motion. I don't know where I am going to find time to fit all this in since I work 8:30-5:30 five days per week. But I have to make the effort because if I don't have my health, then I don't have anything.

The Plateau

You know you have poor control over your dog when you call and call and then you see her tearing across the neighborhood. In Sparta's case, she was chasing rabbits and there wasn't much I could do except wait for her to get tired, notice that I was calling for her and come back.

Today has been a rough day. I've been concerned about the state of my knee. I've been working so hard trying to stretch and strengthen my knee but none of it seems to be working. I've been thinking that there might be something else wrong with my knee (other than the fact I had surgery). It just feels like there is something inside it that keeps rubbing. It used to be a larger area. It has gotten smaller but hasn't gone away. At my last clinical, there was some joking about my possibly having a cyclops lesion. Now it doesn't seem to be out of the realm of possiblity. A cyclops lesion is an area of scar tissue that forms in the middle of the knee, usually in the intercondylar notch. One of the main signs is a loss of extension (which I have). If I do have something like this, it means that I'll have to have surgery again to remove the offending tissue.

If anything, I've hit a plateau. Since February and now into March I haven't seen much improvement.

So I'm calling in reinforcements. I am already seeing my ortho doc next Monday. I'm also going to my regular doc for a physical therapy script and a referral for an MRI. Between all these things, something has to be figured out. Whether it is more conditioning, some manual therapy, or going under the knife again, who knows?

Poor Joseph

I've been really busy these past couple weeks. So busy that I would have felt guilty if I had spent some of it blogging. Last week we sold our house so Aaron was there for a good part of the week directing the movers: what goes to our apartment, what goes to the storage unit, etc. I stayed here because I am only allowed a couple days this semester for doctors appointments and in case I get sick.

Aaron also attempted to dig up one of the St. Joseph statues we've had buried in the yard since last June. For those of you that don't know, burying one of them in the yard of your home is supposed to help sell your house faster. You bury the statue head-first into the ground, facing the street (some say pointing to the house works as well). Once you sell the place, you are supposed to dig up the statue and put it in a place of honor in the new home. If the statue is left in the ground after the house is sold, the house is supposed to continually change owners.

For extra help, we buried two statues. One of them was placed under the For Sale sign which is now gone so there is no way to locate it. The other was in the flower beds in the back yard. Mind you, this was February in Michigan, so when Aaron went to dig him up, the ground was frozen solid. Aaron was determined though and he spent about 4 hours dig and dumping hot water into the hole to soften the ground. The movers thought he was digging up a dead body. Finally, St. Joseph was ressurrected. In the process, he lost his arms and his workbench. He is now sitting on a shelf in the apartment. After all that work, Aaron decided that he wasn't even going to attempt looking for the other statue.

Another new event is that I had my first run since my surgery. It was time. I had thought about calling my doctor and asking him if I was okay. He'd probably say let's wait in see when you come for your appointment in a week. I felt ready and everything that I have read research-wise states that it is safe for me to begin. I have nearly equal strength in both legs, full range of motion, no swelling. I still have a bit of scar tissue in my knee that makes it a bit stiff at times and that has been my only concern. I found a return to running protocol that lasts 8 weeks and gradually moves you up to 30 minutes of running. You start with 5. I warmed up on the bike and stretched and then got on a treadmill. I was scared. First thing, I don't usually run on treadmills. I will run outdoors unless it is below 0 degrees, the roads are a complete sheet of ice or under more than 8 inches of snow. Even though winters in Michigan are rough, there are usually only a handful of days when I am unwilling to go outside to run. The other reason is the fear that my knee wasn't ready and that it would hurt. I have been told that the first run after an acl reconstruction is the worst. Some people do just fine. Others feel like they'll never be able to run well again. My run was kind of in the middle. Those 5 minutes felt like an eternity. My left leg didn't want to keep up with the right and I kept shifting a lot of my weight over to my good leg. It didn't exactly hurt to run. It felt odd though. Like my bones weren't used to the jarring. It got easier towards the end of the run and everything felt a little smoother. That evening my lower leg ached a little bit. I iced the knee even though it really didn't need it. It didn't swell up and nothing broke. Next run is on Tuesday. Another 5 minutes.

Ready to Run

Sitting on the trainer: Beans decided to jump up on me during a cycling session. Luckily, I was cooling down at this point.

Reasons I need to get back to running:

1. Sparta has too much energy and won't listen to me anymore. I need to take her down a few notches.

2. P.T. clinicals are stressful and nothing beats stress for my like a good run.

3. I have done so much lifting this winter that my body looks more like that of a bodybuilder than a triathlete.

4. Running doesn't require me to have to go to the gym (at least usually), I can leave from my front door.

5. I have races that I want to do this summer (Enough said!)

6. There is nothing like that new running shoe smell.

I'm definitely a little stir-crazy right now. The weather has been unusually mild here in Michigan for February. Most of the snow and ice disappeared last week with the 60 degree(!!!) temperatures. I am SO ready to get back to running. In fact, I'm finding it difficult to keep my feet stuck to the ground. When I'm walking (in the evening, for instance, when I'm walking to the gym and it's dark and no one can see) I find myself sometimes trying to break into a job. Rather it is a cross between a hop and a race walking shuffle. Most of my antics though have been taking place in the pool where I can hop around all I want because it isn't placing any pressure on my joints. I've been just goofing around so far but I am planning on starting some serious pool running next week because I am tired of the stupid elliptical machine.

I probably could start running now. I'm 5 months out of surgery. However, I do still have some stiffness and a slight amount (almost unrecognizable) swelling in my knee. Another month and that should be all gone. I also haven't gotten the okay from my doctor to do it and he told me in the beginning- 6 months. I plan on running for a long time on this knee so if it needs another month, that is what it gets. I'm looking long term at this situation. So it is a countdown right now to March 16 when I see him again.

I'm just feeling so much better. I can kneel and sit on my heels now. Joan, my clinical instructor, gave me the idea to sit with a towel underneath my knees in order to gap the knee joint a little more and stretch out the scar tissue.

(Seated Warrior Pose, I believe it's called)

I feel that I official have a herd of cats. This weekend, we are watching the cat of one of Aaron's coworkers. We originally found Oliver at a park last year but Aaron did not want another cat at the time (notice that I said Aaron) and we gave him away. He has turned out to be a very friendly and gets along really well with the rest of the brood. Sparta, a herding dog herself, takes her duties seriously of finding each and everyone one of them and nudges them out from under the bed or out from behind the furniture.

The one and only Oliver (glaring at Sparta)

Aaron's Birthday, Old Videos And Mookie

Flu season is in full swing! The fluctuating weather conditions here in Michigan have probably been partly to blame. This past week people were dropping like flies: first someone from the Speech Therapy, next one of the OTs. Last week one of the other PTs was ill for a couple days and Aaron and my dad were also ill. So it was not surprising that I woke up this morning tired and achy. At first I thought I had just this pulled muscle in my back (from lifting a patient on Friday) but as the day has gone on, the aches have shifted. Usually when I get sick, I get aches starting in my neck and they progress down my body as my illness progresses. But a long soak in a hot tub, plenty of water and a good night's sleep and I should be as good as new.

Yesterday, we celebrated my husband's 30th birthday. His family came over and we all went out to dinner. His mom brought over a red velvet birthday cake.

His brother, Justin, told us about the Shack In the Woods videos that are now on You Tube. This was a series that a group of friends, including Aaron and Justin, performed in while they were in college. We spent some time watching them. I'm posting the link to one of them here:

http://www.youtube.com/watch?v=BhwG6zLq4S4

This was before Aaron was in the military so he reminisced a little about his sideburns. This particular video ended with the guys getting taken down by the Mount Pleasant police. The taping occurred shortly after the Columbine shooting. Someone saw these guys all dressed in black and carrying guns and freaked out and called the police. So their day ended with them being handcuffed face down on the ground. I had heard the back story to this before but last night was the first time that I got to see the video. Aaron actually has two parts in this film: one has Captain Eugene and the second as the soldier with his face hidden behind the gun.

After they left, I discovered "Mookie". He is Aaron's ewok from when he was a kid. Mookie looks a little rough. He's had a bath and a haircut in his time. Aaron and Justin pass this little guy from each others places. It has been a while but Mookie finally made it back to us. I discovered it in my medicine cabinet when I was getting ready for bed.

Sparta + Shoes = BAD

For those of you who don't know, there are three Friday the 13ths this year. Today, in March, and one in November.

If I was a superstitious person, I'd take today (Friday the 13th) as an omen for how my racing season is going to go. I woke up this morning to find pieces of one of my running shoes strewn around the living room. I couldn't find the laces. This was surprising because she hasn't destroyed a shoe since I first got her 1 and 1/2 years ago!

I think she might have been upset because Aaron shut her out of the bedroom last night. Apparently, she was hacking up something and he couldn't sleep. Why she didn't go after his shoes, I don't know.

Still, it made me a little sad looking at my torn up shoes. I have realized that I haven't ran in 6 months and I'm still not sure when I'll be able to start. I am almost 5 months post-surgery. My doctor didn't want me running before 6 for various reasons: mainly, the hamstring graft is a bit weaker than the patellar tendon. My concern is the remaining stiffness in my knee. I still have to work to bend it although it doesn't take nearly as long as it did a month ago. I was told that before I started running that I need motion equal to what I have on my non-affected side. That means nice, easy motion. When that is going to come, who knows.

It has me a little bummed. Running is the final piece that I need back in order to race triathlon this summer. The longer it takes for me to start running, the later that I can start racing. So now that we had a break in the cold weather, I am getting impatient to get started. I want to start running with my dog again! And shopping for new running shoes!!!

On a happier note, I'm getting my rhythm back in the pool. I've had two great swim workouts this week and I feel like I am getting faster and my endurance is improving.

A New Place To Play!!!

This week I found out that as an intern I could get an employee membership for the hospital's wellness center. I didn't even know that this place existed in the little town of Chelsea. It's super nice. The weight room is enormous and has about everything that an athlete (and PT) would want. There is a spinning room, aerobics studio, and a little corner with all sorts of balls and mats for doing ab and core workouts. It also has two pools, one for laps and a warmer one for aerobics. I was in absolute heaven when I saw the locker rooms with the towel heaters, spa, sauna and steam room. I think I could live here.

The best part is that I pass it everyday both to and from work. I started using it for lap swimming this week and I next week I plan on doing some weight training as well. My schedule is becoming pretty regular now that I have the same work hours everyday:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Bike Bike Bike Bike Bike Bike Bike

Weights Swim Weights Swim Weights Swim

Currently I am doing lots of riding on the trainer. It drives me crazy to ride inside but I'm getting used to it. I've started having my morning coffee with my ride so by the time I'm done I'm really wired. I've discovered that a combination of riding and bending of my knee is the morning really helps it to loosen up. I'm also working on bending it each evening. The sooner the stiffness goes away, the sooner I can start running.

It's All In The Family

This weekend I went to visit my dad. Almost 2 weeks ago I got a call from him telling me that he had fallen at work and injured his left knee. After a lot of questioning, I deduced that it was most likely a meniscal tear (cardilage tear) in his left knee. Apparently, he was reaching for his coffee and just twisted it. There was a fair amount of pain and a lot of clicking along the joint. I emailed him some exercises and told him that I would come up in a week to look at it. Most likely, a surgeon might just go in and remove the loose piece if it kept bothering him.



Fast forward another week...



I gave him another call to see how he was doing. Turns out, he was laid up on the couch after just getting his knee scoped. It turned out that he went to a surgoen the following Monday after his injury (almost 1 week later) and the doctor told him that he could send him for an MRI but the cardilage flap was so visible even underneath the skin that he might as well just schedule him to have it taken out.



He then asked my dad: When would you like to have it done?



My dad responded: How about tonight? It didn't happen quite that soon but 2 days later he had surgery.



Now I know where I get my level of patience from. After my injury, I was the same. I wanted my knee fixed right away. (And I would have had it, if the doctor wasn't out of town).



Anyway, I went to see him on Saturday and he is doing really well. There is still a fair amount of swelling but that will go down. His strength his normal and his motion is pretty good for being only 3 days out. I expect him to be back to his normal activities in about a month.

What a Week!

The knee seems to be doing a little bit better this week. I was going down the stairs at the gym this evening and it seems to be bending a lot easier. I can actually go down the stairs without holding on the railing. The morning was a little tougher but it always seems to loosen up by the evening.

This has been a crazy week so far. I started my last internship this week and I think... it's going to be okay. My clinical instructor, Joan, is great. She is this perky little lady who has been at the hospital for 20 years so she knows the place backward and forwards. I have the feeling that I am going to get a very well rounded experience here. It will be a mix of inpatient, outpatient, neuro and orthopedic cases. I'm fine with the orthopedic stuff. Not so sure about the neuro. The BIG difference between this internship and my last one is the health of the patients. Most are quite old and a lot have recently had surgery. I watched one lady barf today. Morphine is nobody's friend.

I've been run the wringer as far as the amount of health-related documentation that I have to provide. All the other places have simply assumed that I'm up to par. This place wants to see ALL of it. They also wouldn't just take my word that I had chickenpox. Apparently, it is actually a state law that you provide documentation of having had either the disease or the vaccine (but this is the only place that follows it). I had it when I was 8 and I don't even think that I even went to the doctor for it. My sister caught it before me so when I came down with it, it wasn't even a surprise. So last night I had to skip my swim workout to go to a clinic and pay 70 dollars for a blood test to prove that I have the antibodies. If it isn't the school, then it's something else that keeps sucking me dry.

I'm also having a difficult time just getting to the hospital. I have been there three days and have gotten lost a total of 5 times (2 coming and 3 going). I was so proud of myself because I thought I was on my way this evening. Then I realized that I was going west on 94 instead of east toward Ann Arbor. I realized this only after I had gone about 9 miles out of my way.

If there are any bonuses for this clinical internship are the hours. I don't have to be in until 8:30 and I'm out between 5 and 5:30. This gives me plenty of time to work out both in the mornings and the evenings. Now, maybe I can start getting some decent swim workouts in. I'm expecting this week to continue to be a difficult one for workouts but I should be in a better routine for next week and then I'll at least be getting in regular trainer rides and swims (in addition to huge amount of lifting that I am still doing).

Smelly Cat

I week ago I blogged about my new cat, Beans. It turns out that his name is completely appropriate. Beans is not the freshest smelling animal. It has calmed down a little since we got him but he simply smells like poo. Maybe it was the food he was eating or maybe he is just a gassy little beast. Other than that little aspect, I love him.

Amanda (his previous owner) was right about a few things. The cat demands your undivided attention. Right now his furry little face is merged between my fingers on the keyboard. Not my preferred way to type. And he does have this thing about licking people's heads. Some of his more endearing traits are that he purrs all the time and he has become a wonderful playmate for my other grey cat. I had to get him a collar though because except for eye color and a slight difference in size, the two are nearly identical. It was driving me nuts.

Tomorrow I begin my last clinical in Chelsea. I am hoping that my schedule is a little more forgiving to my training. My goal is to start getting to the pool more than once a week.

Recovery Weekend

This weekend is Jill's Recovery Weekend. I do have some training scheduled: an afternoon swim today and a 1.5 hour ride tomorrow on the trainer. But mostly this weekend is about mental and physical rejuvenation after the past 4 months of school-training, rehabiliation and lots of paperwork.

This week has been a tough one. I finished up my clinical internship on Friday at Medsport. I had a lot of mixed feelings about it. In fact, I'm pretty sad. In one sense, it means that I am now one step closer to finishing school (and to start paying back that mountain of loans). On the other hand, I am going to miss all of my co-workers, the nice facility, my patients and generally the great work atmosphere. (There is always a chance though that I'll end up back there at some point since Aaron and I don't plan on moving to far out of the area after I finish school.) Since my team gets out at noon on Fridays we all went to lunch at a great little restaurant in Ann Arbor called Caseys. Great burgers and fries. The place was packed so you know it's good.

I got a great review by my clinical instructor so now I have to gather up all my paperwork to send in to school before I start my NEXT and FINAL internship on Monday. My knee is very thankful that there are no more 12.5 hour days on my feet. The hardest thing was hitting 4 o'clock in the afternoon when it was starting to get dark and knowing that I still had another 3.5 hours to go.

My doctor was pleased to see that my knee is improving. My quad tone is nearly equal with the right, almost all the swelling is gone and I can generally get my knee bent to 120 degrees. It is still short of my right knee but it is getting better. Last night I was even able to get my heel to my butt several times all by myself. This is by far the best that I have been. I think that there is a very good chance that I'll be able to start running at 6 months post-op.

Now that I am getting more comfortable about the progress of my knee, I can start focusing more time on strenghtening and stretching the rest of my body. I feel like my left leg is the strongest part of me and it is not even at 100%. Aaron got me a massage at a place in town today and it was there that I realized how badly other areas of my body need attention, especially my shoulders. I'm getting far to hunched from all the swimming and aero positioning on the bicycle. I was instructed to start doing a self friction massage at the attachment of the pec muscle on the ribs. I never thought about this but I just tried it. Yep, I'm tight. No wonder my shoulders don't want to go back anymore.

100 Days

I've been doing most of my rides at home on my trainer. The thing finally made it to me about a month ago after being backordered for about 2 months and then taking the long route here by accidently getting sent to Ohio.

In an effort to get my range back to normal as soon as possible (so I can run!) I have decided to do a little game that I did back in my first year in college. At that time, it was to run at least 1 mile a day for 100 days in a row. I think that I topped out at 114 days. This time it will be to cycle at least 15 minutes a day for the next 100 days. I know 15 minutes doesn't sound like much but on some days I work 12.5 hours so getting on the bike is the last thing I want to do when I get home. I'm sure I'll go much longer on most days. I've decided to count these past two days because I got in a couple good rides in. If I am not running by the time I hit 100, then there seriously must be something wrong.

Despite the fact that the weather has been below freezing here (and my leg has felt like a frozen piece of meat) it is still moving relatively well. There only seems to be a small area of scar tissue towards the back of my knee which is keeping me from being able to actively bend it on my own. I can now grab my own foot, a feat not possible since August. Tomorrow I head back to the surgeon for another follow up visit. Hopefully my knee will be loose enough to try to impress him with this added movement.

Dancing With The Dirt

This is a hard time of year for me to be motivated to train. It is especially hard this year. I'm almost 4 months out of surgery. Under ideal conditions, I could start running next week. But until I get the stiffness out of my knee I have to put it off a bit longer.

It's been sad because I keep having a pity party for myself just because I'm not able to run yet. However, I've allowed it to affect my mood and motivation for swimming and cycling as well. These are two things that I can do as much as I would like to but I haven't gotten myself on a regular schedule yet. I'd ideally like to be swimming 3 times a week but I have been having a hard time getting myself to the pool more than once a week. The same with cycling. I need to get myself on the trainer every day to help loosen up my knee. However, recently, I've been tired either from lifting or the clinic and have been letting it slide. So I'm kind of unhappy with myself because I feel like that there is so much more I could be doing at this point that I'm not.

I have another race planned though to help get me motivated to get my knee moving again. My friend, Bree, emailed me this week and asked if I would be interested in running in Dances With Dirt with her team. There are a couple different races but this will be the one in Hell, Michigan in September. I'll be in the 100k relay. Each person of the 5 person team runs 3 legs of about 4 miles each. Now these legs have names like "This Sucks". I've been wanting to do this race for years but have never been able to get a team together. And now I'll be doing it costumed in underwear and a tutu. So now I have extra motivation to not only get my legs in shape for running but also also to handle off-road trails, rocks, water, and mud. It looks like once I'm able to run, I'll be hitting the trails for some training as well!!!

www.danceswithdirt.com

Welcome Beans!

We are soon going to have a new addition to the Putt-Radlinski clan. A new cat named Beans. I don't know much about him except that he is grey and has this thing for dressing up. He currently belongs to Amanda, my brother-in-law's girlfriend, but he is requiring a bit more love and time than she currently has to give. Fortunately, there is no shortage here. He will join a long line of pets that we currently have. Here is the rundown in order of seniority.

Moose

A nearly 7 year old rabbit that I picked up at a petstore in Colorado Springs as a companion to the late Avery (another dwarf rabbit). He likes alfalfa hay and the protection of his cage from predators and family members alike. Very fast (or he used to be). When he was little I gave him the nickname "Soap" because when you tried to catch him he would slip out your hands. And he's white.

Cosie (Cosette)

6 years old, originally a stray from the Humane Society in Colorado Springs. Originally, I thought about getting a kitten but after one look at those sad eyes and I was hooked. She has grown into 17lbs of fur and love. I had no clue when I got her that she had long hair. Cosie is the biggest lap cat whether you are eating dinner, on the computer or just trying to get dressed in the morning. Most mornings she can be found making herself comfortable on my back.

Strider

3 year old male cat. I got him two weeks after I had to put down my last grey cat, Ziggy. I came upon him as I was out riding on the Rail Trail outside of Midland. He and his brother were in a cage with an umbrella stuck in it to protect them from the sun. They were by the side of the trail with a sign that said "Free Kittens: children please ask your parents first" I knew I would get him because 1.) he was grey 2.) he immediately fell asleep in my arms. Strider loves houseplants and I mean LOVES them to death. He killed the unkillable plant we got from my inlaws. The rest of them are just holding on by a thread.

Sparta

Nearly 2 year old cattle dog/shepherd. The one that destroyed my knee. Sparta was another sad-eyed animal that I found at an adoption at Petsmart about a year and a half ago. I was not looking for a dog that day. She was the only one that wasn't jumping around and smelling everything. She was just curled up on the floor with her blanket, not even making eye contact. My have times changed. Sparta has turned into the dog who has to say hi to everyone. I am afraid to let her out at times because she has a tendency to take off after any person/animal she sees.

Sooo... that is the brood. I think that I can safely say that we have a full house. Who needs kids?

Two Wrongs Apparently DO Make A Right!

I've been pretty frustrated with the progress of my knee since surgery. It is still stiff and today the temperature outside was so low today that my knee just ached. I learned a little more about knee injuries (and one more way that my whole injury was care was bungled).

It all started because one of our new patients had a similar injury as mine: ACL, MCL and meniscus... but with a little extra - PCL.

This new information has to do with the MCL. This is the ligament that runs down the medial (inside) part of the knee. Dale was telling me that you only have one chance if you injure your MCL to get it to heal down right. When you get an MCL tear, there is a decent enough blood supply that unless it is really bad, it is normally left to heal on it's own. However, if you're up and around on it too soon - even walking, it may cause it to not heal down as tight and you'll continue to have some laxity around that part of the knee. This is especially true if you have injury to additional ligaments that make the leg more unstable- walking on an unstable leg (such as one without an ACL) will make the MCL likely to heal down even more lax.

Naturally, I found this a bit alarming. I had a fairly significant MCL injury in addition to my ACL rupture. And then I was walking around without crutches for the entire month between injury in surgery. No one immobilized me. The emergency room doctor let me walk (well hobble) out on my own.

It turns out though, the rules don't exactly apply to me. Because I got a stiff knee, I have all this scar tissue that makes it very stable. So it turns out, all the mismanagement of my originally injury has been taken care of by the mismanagement of my post surgical rehab!!! So I guess when people say that everything happens for a reason, they are right.

Case Study Blues

I haven't gotten much done this week because I am trying to finish up my case report for school before the end of my internship. I'm almost done. In fact I am probably 7/8 done with this thing but it seems like the closer I get the less enthusiastic I am about finishing it. Basically, a physical therapy case study is where you follow a patient through their course of therapy and document what you did so that other clinicians can learn from it (if you get it published). I just need to do this in order to graduate. In fact, I need to do two but I won't start the second one until I start my second internship in 2 weeks. So I definitely need to finish this one before then. I gave myself this weekend to finish up the entire rough draft.

It has been a struggle. Several inches of fresh snow has fallen so I have to listen to Sparta whine every 5 minutes because she wants to go outside. The cat has been laying across all my piles of papers (which are carefully organized into "need right now", "may be of some importance later" and "just junk but you never know").

So because I'm so bad about writing papers and tend to procrastinate a lot, I haven't gotten very many workouts in this week. I did make sure that I got my 3 strength workouts in for my leg. Those usually last about 2 hours and end with a bag of ice and some electrotherapy (for swelling). On these days I have been warming up on a bicycle and ending with about 15 minutes on an elliptical. So I'm getting a little bit of everything in, except for swimming. Once my next internship starts I plan on getting to the pool 3-4 times a week. Right now the only time I have is on the weekends and that has been when most of my case study writing has been taking place.

Once my next internship starts I'm also going to have to change up my regular strength workouts. Since I won't have access to the clinic and all its equipment I am going to creative with my workouts. I belong to a gym so I have all the weights and machines that I need. I am thinking about attempting yoga again and now that I have changed the batteries in the Wii Fit board, I am going to use that to work on balance. I don't think that if I hadn't gotten injured I would be thinking so much about all these different aspects of strength. I doubt that a lot of people when they are going to the physical therapist do. Their given an exercise and they do it. They may like it, they may not, but a lot of times people don't question why we give them what we do. This is especially true when it comes to some of the odder exercises. Granted, some are just other ways to work on strength. Others though are meant for neuromuscular training. THe thing that I notice most about my knee is that unlike its counterpart, I don't have a good sense of where my knee is in space. It could be bent 30 degrees or 90 degrees and it still feels pretty much the same. That is one of the issues with this type of injury. You lose a lot of the proprioceptive information that comes from that joint. That is why if you don't rehab it correctly, you're more likely to injure it again. After what I have been through with this stiff knee, the idea terrifies me. I keep telling my CI, Dale, that this was my last knee surgery (surgery total) for me. I never want to have to do this again. He, of course, laughs but I made it 30 years before I had this injury. Now, knowing what I have learned about training, I don't intend on letting something like this happen again.

Okay, time to get back to this case study. If I work consistently I should have this done before 11am today and that will give me time to go to the pool this afternoon.

The Little Things

It's hard to believe that my clinical internship at Medsport is almost over. I have only 2 weeks left there and a lot has changed in the past 4 months. Now I'll have a formal evaluation done by my clinical instructor about my progress through the internship. But there is more growth going on than just what I have learned about treating patients. I've learned a lot about myself. I've learned that the body is remarkable about healing itself when the proper stress is applied. I've learned to be very, very, very patient with . I also learned to push myself beyond my former personal limits of discomfort.

When I started there I was barely walking (and when I did, I limped). My quad was a shriveled mess. I couldn't bend my knee to 90 degrees. I couldn't straighten it completely either.

Today, after work, as I did my usual knee rehab I pondered the following little things:
1) No one has been picking on the way I walk.
2) Just a couple days ago, Ernie (one of the PTs) told me that it was hard to tell which leg was the weaker one because my strength has improved so much.
3) I can leg press 130 lbs on my weak leg.
4) My heel can touch my butt (and I can almost get it there on my own)

One weak area that I currently have is my balance. I started incorporating balance and proprioceptive work into my routine today. It was really hard. I can tell that when I stand, I still must be favoring the left leg. I was doing some single leg squats with a kettlebell and my whole lower leg was on fire. I have gotten very strong from the weights but now I need to carry over that strength to more functional activities. I have to be ready to be able to run out of the water and up a beach and into the transition area barefoot by this summer.

I Tweaked My Knee

Yesterday, I had an experience that was a little scary but at the same time enlightening.

I tweaked my knee.

I was at the clinic demonstrating a new exercise to a patient (who also underwent ACL reconstruction) and I pivoted a little too much. It was a perfectly safe exercise for this stage of the game. It involved holding a medicine ball in both hands while in the squat position. You go from that position to a pivot to one side while you lift the ball into the air on that side. Then back to the squat position and repeat on the other side. It didn't really hurt but it sure felt weird. Almost like an electric shock went through my leg. After that, it was a little sore and swelled up a bit more than usual.

Today, it seemed normal although a little stiff. I did my workout after work today though and it felt fine (in fact better) than it had previously. I explained my experience with Ernie, one of the PTs. We got into this conversation about function and proprioception. Now I knew that you lose a lot of balance as well as strength with an injury such as one to the ACL. Still, I was very surprised about the signals my body was sending when I did something that it wasn't used to. Apparently, training after knee injuries like mine used to involve mainly weight training on machines such as the leg press. What often happened after the athletes went back to competing is that they ended up getting injured again due to the fact that the weight training wasn't carrying over functionally to what they needed to do. I'm lucky in the fact that triathlon is mainly a straight line sport. It doesn't generally require a lot of cutting like in sports such as soccer and football. Still, if I think about most courses, the run courses are sometimes over trails or through sand. The approach from the beach to the transition area is usually soft and uneven and in some cases extend up a mile (as is the case in Grand Haven).

So the plan is to now incorporate more proprioceptive work including single leg squats, single leg balance and really anything that challenges my balance on my left leg.

Goals, Ellipticals and Lots of Stretching

January goal: have full active range of motion by 4 months post-op (January 19)

At the start of this new year, I wrote down a lot of things that I would like to accomplish: get back into shape, graduate, get a job, race another Ironman, etc. I ended up narrowing my list down to one thing: to get strong. Meaning that I am not just going to finish rehabbing my leg, but my entire body as well. I've noticed a lot of changes since I have had to put aside my running shoes. I've had tunnel vision where all I saw was my injured leg. Now my core is weak. I've also neglected to see that my upper body could use some help as well. I don't want to even think about my cardiovascular system either. What a trainwreck.

Of all things, my left leg is still in need of the most attention. The quad is still smaller although it is getting harder to see the difference between the two legs. It at least looks like I have muscle now. The range is steadily getting better. I am working standing and being able to grab my leg behind me to do a quad stretch. Not quite there yet.

Last week I began adding the elliptical machine to my workouts about 3 times a week. I'm up to 15 minutes at a time right now. Oh it hurts. The elliptical machine is more weightbearing than the bike but much less than running. The idea is to work this machine for the next couple months to help guide me back to running. The big issue when I go back to running is not being out of shape cardiovascually, it is that my knees are not going to be used to the impact on the ground. By adding some impact now, I am hoping to lessen the shock when I start running for real. It does feel nice though to get on a machine that simulates running somewhat. Today that's what I pretended to do. I chose a machine facing a large window and I just imagined myself running outside. Today was one of the nicest days we have had in a while. Perfect winter running weather. This would normally be the type of day that I would take the dog out and we would go about 8 miles. You don't get that many days like this on a January in Michigan.

Later on this evening I am going to jump on the bike trainer and ride for a while. This in addition to stretching my leg twice a day has really been helping to get my range back. I can get my knee bent now to about 4 inches from my butt. This is under my own power this time. At the rate I'm going, I think I'll have it all the way soon.