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.