Just What I Kneeded

A llama, an Elmslie and DeNovo.


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Today marks two years–twenty-four months–since my DeNovo NT cartilage graft and tibial tubercle transfer (the Elmslie-Trillat, to be exact).

I thought I might write something to mark the occasion, but… I’m not sure that I have much to say. As you know, if you’ve read this blog at all, the last two years have been full of ups and downs, but there have been mainly ups the last few months. I’m continuing to slowly improve, at least as far as my ability to build strength. The pain shifts around a bit–hurts more some days and less others. I captured most of what’s going on in a fairly recent post about my positive progress. I’ve been able to do much more this year than I even hoped this time last year.

I suspect that, if things continue to go well, this date will come and go next year without a second thought. That’s the goal anyway. To put it all behind me.

I think the best update I can give right now is that I’ve been spending more and more time with the horses. They’ve been sadly neglected (as in they’ve been running around like fools free on pasture) this summer because there has been so much work to do with the llamas. But their show season is almost over, and I’ve had more time to work with the horses. There’s a TON of work to be done, but we have to start somewhere. So I started with a spa day for Pie.

Pie.

Pie after her first bath (took about five hours to do all the grooming and bathing). I fear she’s gotten stained this summer because she didn’t come out exactly white.

After she had her pampering, I decided it was time to try to ride. I haven’t been up on the horses since about this time last year, and it hadn’t gone well, so I was a little worried. But it went amazingly well! I was able to not only ride, but post the trot. That means I was able to pivot up/down through my knees while Pie trotted in slow circles. It wasn’t pain free, but I could do it. So exciting! I think this proves that I’ve been able to build back some of the strength in my leg because I could barely ride a walk last fall. I thought maybe the first time was a fluke, but I’ve now been on four rides, and each one has been fairly good. Lots of taping, elevating/icing and Celebrex, but I CAN RIDE.


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Rare bird

A few weeks back, I had X-rays taken of my knees and legs. Don’t worry; there have been no new symptoms or a worsening of symptoms. I’m still in a pretty good place. In fact, I’m doing the best I’ve been doing in the two years since surgery. I’m just trying to work out why I still have so much pain doing certain activities, especially since some of the activities cannot be avoided or are actually kind of important parts of life. I can’t avoid stairs all the time, nor can I (unfortunately) avoid vacuuming my living room.

Good news is that my knees look ok from a radiographic standpoint; there’s no compartmental arthritis that has caused joint space narrowing or anything like that. Not so good news is that I’ve been subconsciously favoring my “bad” leg for so long, there are radiographic changes in my right tibia. The doc pointed to the X-ray showing my legs side-by-side and showed me the difference, which was pretty easy to see.

The left leg is normal (an opaque, whitish color on the image). The right leg shows radiolucency (dark bone when it should be whitish).

The doc indicated this is because I’ve favored/protected it for so long because of the pain that the stresses aren’t enough to keep the normal metabolic process going. You need to stress a bone to make it strong. Mine looks weak on film.

I was surprised to see that there were radiographic changes; I wasn’t aware that was something that could happen in my case, though I guess it makes sense. I think it also validates that the knee hurts. Duh. My brain likes to protect the things that hurt, so my body adapts new ways of doing things. I’ve talked about the incorrect movement patterns and the way I walk with my foot curled in at length. None of it is something I consciously do. At least not anymore, if it ever was conscious.

Side note. After I heard this, I started doing research… as usual. According to the Department of Radiology at the University of Washington, a person must lose 30-50% of bone mass before it shows up on a plain X-ray. That sounds great. Just great.

After looking at the X-rays, I’m pretty much sitting there just staring at the doc. I wasn’t exactly sure what he was telling me. I mean, I understood his words, but I didn’t understand what it meant. He said “you’re only as strong as your weakest leg,” so we still need to work on that a bit. Build back the strength. But first, he wanted me to work on ROM… again.

I was measured at only four degrees off of extension and had full flexion, so it didn’t sound like much of a big deal to me. Regardless, I was told to do nothing but work on getting full extension back. I was given three stretching exercises to do five times a day for two weeks. I was also told to do no more walking than absolutely necessary; I could continue with the bike and swimming but had to limit walking. You know that means no more Challenge Route.

I was a stellar patient (I can’t often say that since I frequently take things into my own hands), and I walked back in to the clinic after two weeks of stretching and had regained full ROM. That it had been accomplished without an exacerbation of symptoms was great.

I was really taken by surprise with the next steps. I had to build strength, but first I had to be tested so they had a baseline. I didn’t realize right away that this meant testing with the big, scary machines that I’d always been told would hurt too much to use for my case. Holy chipotle.

I was tested on both legs doing both leg extensions (ouch!) and leg presses (not as much ouch). Turns out, I am exactly equally deficient in all four ways they tested. Seventeen percent across the board. I was told that’s pretty uncommon. Most people are deficient in one or two areas, but few are equally deficient across the board. I’m no longer surprised when I hear things like this. I can’t tell you how many times my doc or my PT has said I don’t follow the book or I’m not like most people in how I move/compensate/function. This latest rarity apparently makes me the “poster child for a deconditioned knee.”

All of that to say… I guess I’m back in PT. Sort of. I’ve been given two exercises to do at home that are intended to help build strength until I go in again in about four weeks. At that point, my strength will be tested again. Joy of joys.

I have so many questions right now. How can the strength test be accurate when it hurts so much to do leg extensions in the first place? How are two simple exercises with relatively low weights going to make up for a 17% deficit in four weeks? I wish I’d thought more quickly and had these answered while in the clinic. I think I was so floored by the fact that I had to do strength testing that I couldn’t think of much else.


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O summer, where art thou?

How did it get so late so soon? It’s night before it’s afternoon. December is here before its June. My goodness how the time has flewn. How did it get so late so soon? -Dr. Seuss

The days are getting shorter. It’s already the ninth of September. Labor Day came and went. The chill is back in the morning air. The cicadas are buzzing. All signs that summer is not long for this world. Fall will officially be upon us in less than two weeks.

Summer came and went this year like a flash flood. I’ve barely had time to enjoy the longer days, the sunshine and the general wonderful-ness of summer.

Mowgli.

Mowgli and I share the same opinion when it comes to the suggestion that winter is on its way.

Winter was so brutal this year, summer was slow to make an appearance. It was March/April before I was outside on the bike; last year, I was riding outside in January. I’ve cut back quite a bit on the cycling for the last two months as I’ve done more swimming, and now I’m desperate to fit in more rides before it’s too cold or it’s dark before I get off work. I need more time!

Don’t get me wrong. Fall is, was and will likely always be my favorite season of the year. Just the smells of fall make it the best season, but then if you acknowledge the bonfires, the hayrides, long rides through trees of red and gold, football, the pumpkins and the crispness in the air, there is just no other season that comes close to Autumn. But this year, I don’t want it to come quite so soon.


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Three Point Oh

When I was in the pool last night, I just couldn’t stop. I was swimming laps in the outdoor pool because the indoor lap pool has been closed for the last few weeks for routine maintenance and painting. The night was sunny and warm. The triathletes swimming laps with me were welcoming and encouraging. The laughter and fun the kids were having in the big pool outside the lap lanes made me smile. I didn’t want to stop.

I swam three miles without stopping. That’s not entirely true. I did stop a few times long enough to put on or take off my fins. I use those to continue building strength in my right leg. I’d never had any desire to swim that far or that long. The longest I swim is 1.5 miles, and most days are closer to 1.25 miles. Last night was different, and I kept going.

I’m pretty excited about it. (In large part because there seem to be no repercussions today–no increased knee pain, no muscle soreness, no nothing.) I sometimes have moments like last night when I’m amazed at what I can do, and I’m reminded that I’m capable of more than I realize much of the time. I think we all are.

This basically means I’m one-third Ironman. The swim portion for the Ironman triathlon is 2.4 miles. I went way past that. Now I just need to add in a marathon and a 112-mile bike ride. Look for me in Kona in 2017. I kid! I kid. I’d never be able to do the run, and I’d need to cut considerable time off my swim. So look for me looking for relay partners to do the Ironman 70.3 in Muncie, Indiana. It’s right up the road, and we have plenty of time to prepare!


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Confetti

When this video hit YouTube years ago, it spawned in me a love for a group called OK Go. Good music and quirky, fun band members are a pretty enticing combo.

Last night, I attended one of their concerts for the first time at the Old National Centre on Mass Ave in downtown Indy. Best concert I’ve seen since I saw Cher a few years ago (actually, I’ve been to two of her concerts; don’t judge). It was nothing short of amazing. I think the best part was the ad-libbing of the lead singer and his bestie during a short technical snafu–they perfectly performed a small part from Les Misérables. It was hilarious, but oh so good. I’m fairly certain the two of them spend an inordinate amount of their free time acting out musicals. They met at art camp, so it makes sense.

Damian Kulash of OK Go at the Old National Centre..

Standard crappy concert pic taken on a phone.

As you might imagine it would be if you’ve watched any of their videos, the show was packed with techno “stuff.” Sorry I can’t be more descriptive, but there was a lot packed in there. Screens in front, screens in back, flashing lights, crazy camera work, audience participation and confetti. SO MUCH CONFETTI! Confetti cannons were going off about every other song. Maybe more. I got a text this morning from one of my friends who was with me, “When I got undressed last night, confetti fell out of my clothes. Can’t say that about every night.”

At one point, the lead singer (Damian Kulash) asked the audience if they had questions. In classy Indy style, the first person to shout out yelled, “Show me your titties!” Geez, Indy. (There were no tops thrown off.) Thankfully, the next person asked some in-depth question about their stance on net neutrality. That helped save our rep a bit. Good thing, too, since the show was being streamed live on Yahoo! last night.

The audience was about as an eclectic a mix as Cher’s audience. There were kids under the age of 10 and grandparents. There were hipsters and jocks. There were ridiculously styled women and a few who looked like they rolled out of bed. The crowd was pretty awesome–lots of energy and really into the band.

My only disappointment is that there were no treadmills.


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Extinguished

O Captain! my Captain! rise up and hear the bells;
Rise up–for you the flag is flung–for you the bugle trills.
-Walt Whitman

When my social media started blowing up last night with the news of the apparent suicide of Robin Williams, I was sad that another creative bright light had gone out. I didn’t always think Robin Williams was funny; he was often crass and, at times, seemingly unhinged. But he lived a life that showed us you don’t have to color inside the lines. Differences are to be embraced and celebrated. There is beauty in simplicity. Inspiration can be found… anywhere.

I grew up watching Williams’ films like millions of other people in their 20s and 30s. So many were profound the first time I saw them. In my angst-y teen years, I found a hero in John Keating who urged us to seize the day. In Sean Maguire, I found a tempered soul who challenged and inspired me (not Matt Damon) to stop being afraid to live a better life outside the boundaries of what I’d known.

Then there are the movies for which he is perhaps most well known–the movies that brought riotous laughter and those that made us let go a little bit as we used our imaginations. He made us delight in the absurd. I’m sure future generations will continue to be entertained by the legacy that Williams left, by the laughter and joy he provided so selflessly.

I feel for his family now. Everywhere they look in the coming days, they are going to be sharply reminded of their loss. And it really is their loss to mourn, not ours. I think, perhaps, the best tribute we can pay is to reach out to those around us who are suffering through depression, loneliness or other mental illness and simply let them know we’re there.


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I joined a support group

It was not intentional, I assure you. I didn’t have a choice in the matter.

At my last appointment with my OS, I was given a prescription for Celebrex. Within three days (and about 30 days before I even actually managed to get the actual prescription), I received a letter in the mail from the pharmacy.

“Dear Laura,

Thank you for filling your prescription for Celebrex at blah blah blah and taking this step toward managing your condition.

As your pharmacists, we are committed to helping you manage your condition, so we would like to welcome you to the blah blah blah Support Program. This complimentary service has been developed to make sure you have the information and advice you need to take your medications safely and effectively…”

The letter goes on, but that’s the crux of it. First, let me say that I appreciate that there is a support program like this. I’m not bashing that at all; I truly think it’s phenomenal that support programs like this are offered to patients. What concerns me is why I’m getting a letter like this now. What the hell is in Celebrex that makes it more dangerous than all the heavy-duty narcotics I was prescribed last year? Why is Celebrex more concerning than morphine or Dilaudid or Nucynta (all Schedule II controlled substances)? On a side note, cocaine and meth are also Schedule II drugs. I feel like maybe I was playing with fire last year.

The letter was helpfully accompanied by the biggest drug insert I’ve ever encountered, and I’ve seen more than a few. The sheer size of it was impressive. The pic below is only one side; both sides were stuffed to the margins with tiny print and super easy to understand (<— that’s sarcasm) chemical diagrams of the Celebrex molecule(s). Is it more than one molecule? I forget an awful lot for someone who earned an associate degree in Chemical Methods (it was really just kind of tacked on as part of my bachelors program, so it’s not like I was ever an expert).

Celebrex insert.

Who actually reads this?

I’ve digressed now. As per usual. Back to the point. I should obviously be scared of Celebrex. If you google it, you’ll find all kinds of horror stories. Even the Celebrex site itself calls out warnings for cardiovascular risk, skin reactions and GI upset (like bleeding ulcers). It’s carefully pointed out that all NSAIDS carry similar risks, but I’ve never been inducted into a support program for any of the other prescriptions, so I’m not so sure about that.

I’ve been taking it for a little over a week now, and I’m still alive. I haven’t yet really noticed any side effects. (Knock on wood! I don’t want to jinx myself.) So far, it’s much more innocuous than some of the narcotics I tried to take. I’ll let you know, though, if I succumb to the side effects.

p.s. I also haven’t noticed much in the way of benefit, but my OS wasn’t exactly optimistic when he prescribed it, so I’m not totally surprised.

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