Just What I Kneeded

A llama, an Elmslie and DeNovo.

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Viscosupplementation (or rooster comb revisited)

I’ve had a total of seven HA (hyaluronan or hyaluronate) injections in my right knee to help alleviate the effects of the cartilage damage behind my patella and on my lateral tibial plateau. The first was a single Synvisc injection in October 2011. That was followed by a series of three Euflexxa injections in the summer of 2012. The last series was another three Euflexxa injections in June 2013. The series of three injections were administered with a week between each one.

I previously wrote a bit about the injections when I was explaining the road that led me to the DeNovo NT cartilage transplant in September 2012. The injections were initially derived from rooster combs. I find it both odd and fascinating that scientists can develop medical treatments from just about anything.

These HA injections never really helped me; I couldn’t tell a difference at all after getting the injections. They didn’t hurt anything (except for the pain immediately after the injection that lasted only a short while), but they didn’t help. Now, I feel vindicated in my assessment that they were a waste of time and money.

Last June, the AAOS (American Academy of Orthopaedic Surgeons) released an updated clinical practice guideline (CPG) that says, “We cannot recommend using hyaluronic acid (HA) for patients with symptomatic OA of the knee.” Apparently, despite a publication bias toward positive results (meaning that “studies with results that did not support viscosupplementation were less likely to be published than studies with positive results”), the current literature still doesn’t support a recommendation to use HA injections in clinical practice. Very interesting. Unfortunately, this CPG was released at the same time I was getting the last injection, so I didn’t know at the time that literature doesn’t show a “clinically effective response.”

Again, I don’t think the injections I received hurt anything, but I’m glad to know that these things are being monitored and new recommendations are being made, despite potential implications to clinical practice.

Physical Therapy Update

Not much to talk about with physical therapy this week. We added the leg press in again last week, and that’s proved a bit challenging because I sometimes get a shooting pain through the lateral side of my knee. It happens right before I get to full extension. This has also happened twice after I’ve finished in the pool and once, randomly, last Sunday when I was walking through my living room. Not sure what’s up, but I’m being as careful as possible to avoid that ridiculousness while not scaling back too much.

PT suggested that it’s time we spaced our appointments out a little further, stretching them from once a week to once every two weeks. I’m good with this because I’m making such slow progress, we’re not even adding new exercises every week, so this gives me more time to progress between formal sessions. I’ll just need to simultaneously keep myself in line doing only the things I’m “allowed” to do and keep myself motivated to continue the PT exercises despite being bored doing the same things for weeks on end. If you’ve read more than one post on this blog, you’ll know that’s going to be a challenge for me. A big challenge.

Last weekend was the sunniest and warmest that we’ve had yet this year. So that obviously meant I needed to ride my bike. I swear there must be a medical condition in which sunshine makes me do irrational things. Because thirty-six miles later, I finally called it quits for the weekend. That’s approximately 28.9 miles over my PT-imposed weekly limit of 7.5 miles. Whoops! I’m monitoring my recovery this week before I really determine if it was worth it. At the moment, I’m glad that I still have another week and a half to recover before I see PT again. True story.

Thirty-six miles on the bike computer.

See? It’s going to be a challenge.

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Spring is springing

In the spring, at the end of the day, you should smell like dirt.” — Margaret Atwood

You know that saying, “Spring has sprung?” It hasn’t. Not exactly. I suppose that, if you look hard enough between the raindrops, you can see the first tentative tendrils beginning to spring forth. But it’s taking too long! I want to smell like dirt. I know I’m not the only one. These two are pretty excited about the warmer weather, too.

Gypsy Vanner stallion.

He’s a racehorse. A Thoroughbred, if you ask him.

Gypsy Vanner mare.

She’ll not be left behind.

This past weekend provided a tiny hint of what’s to come, and I enjoyed every minute that I could get outside. I went out early on Sunday for a bike ride, but the sun wasn’t out, and it was freaking cold. I lasted only 5 miles before packing it in. My nose was running faster than I was biking.

After the sun came out that afternoon, a friend and I went for a walk on the Monon. It was sunny and warm, the company was fabulous, and we just kind of ambled our way north. I’d no idea how far we’d gone until we finally got to a cross street and looked at the app that was tracking our progress. Over two miles. Whoops! We had to get back to the car, so there was no choice but to trek back the same way. So I logged over 4 miles on the knee; that’s the longest walk I’ve taken since the big surgery in September 2012. I was worried that I’d done something that would cause some nasty repercussions because it was achy and tight by the end of the walk, but I was pleasantly surprised to wake up the next morning and find the knee to be in general working order. Progress! I don’t think it hurt that I’d iced my knee from the inside out with a full cup of Huddles fro yo.

Physical Therapy Update

I told my PT last week that I’m cured. “I don’t need to be able to walk, go up/down stairs, bike, ride… nothing. I’m going to be a couch potato the rest of my life.” Why? Because she was making me do a dumb exercise that I didn’t want to do (by “dumb,” I don’t mean hard exercises; I mean the ones that make me look dumb while doing them). I’m not about doing the dumb exercises in a room full of people. But, as per usual, PT won the battle of wills. I did the exercise.

We didn’t tape my knee last week because it was covered in slime so that my PT could do some soft tissue work. I didn’t think too much of it until the next day when my knee was feeling more swollen, stiff and generally uncomfortable. I did some quick research on the world wide internets and found a place close by that sells similar tape. I slapped it on and felt better inside of 24 hours. Before this experience, I wasn’t entirely sure that the tape really did anything. Now? I still don’t know if it’s the tape or if I just like having a security blanket. Doesn’t really matter because I feel a bit better with it, so I’ll use it.

We’re still working on the IT band. This week brought more stretches and exercises targeted specifically at the hip muscles. Glute medius. Hip flexors. Something like that. I just know where it’s supposed to hurt when I’m done. We added the leg press back in for the first time in a long time. I can do a single-leg press with 150 lbs using my “good” leg. Guess how much I’m allowed to do with my right leg? Twenty-five pounds. Yep. That’s it. And I’m not allowed to move through the whole range of motion; I have to do small presses on either side of my bad ROM. Not that I want to do the full ROM. I totally agree with that part. I bring it up just as a comparison. Because I feel like I should be able to do more at this point…

My PT told me that she was going to give me membership in the “Should Club.” It’s because I keep saying, “I SHOULD be able to do this. I SHOULD be able to do that.” Usually, it’s things that I just want to do. I should be able to bike more than 10 miles without having to suffer consequences. I should be able to stand on my feet for more than an hour. I should be able to sit at my desk for more than 20 minutes before the knee aches. Those sorts of things. My PT apparently doesn’t have much sympathy for my lamentation of self-pity. From now on, I’m going to change my tune… I MUST be able to bike more than 10 miles. I MUST be able to stand on my feet for more than an hour. I’ll let you know if she’s more sympathetic to my new tune.

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To the old dude in lane 7

Stop. Just stop. You’re a menace to society. There are rules of etiquette that must be followed when you’re in public. Especially when there are impressionable young people around. Like me. (Though I’m not that young, nor really all that impressionable.)

Let’s review some of the most basic rules of how to properly conduct yourself in a public pool.

1. Speedos are not ok unless you look like Ryan Gosling in Crazy Stupid Love. Yeah. It’s true. (See the pic below for reference, if you’re unfamiliar. Ladies, you’re welcome.)

Ryan Gosling.

My future husband. (Pic from Warner Bros.)

2. As an extension to Rule #1, it’s not ok to go swimming in public in a pair of tighty whities. I don’t care if they’re an odd shade of grey. Underwear is underwear, not swimwear. And I don’t want to be confronted with your junk when you get out of the pool.

3. Ask if it’s ok to share the lane before you flop in and smack the person who’s already in the lane with a ferocious wave of water as they’re trying to maneuver a turn.

4. When you’re sharing a lane, stay on YOUR side of the lane. Don’t swim down the middle of the lane where you thigh bump the person sharing the lane. (Yeah. That happened. I felt dirty.)

There really aren’t that many other rules. Except for the universal “don’t pee in the water.” (Apparently, it’s a health hazard, not just gross.) Next time I see you, old dude in lane 7, you better be abiding by the rules. Otherwise, I might drown you.

Physical Therapy Update

Last week was a little tougher than the previous three weeks or so. I had an “incident” at the pool the week before where I couldn’t straighten my leg, and I was pretty sore after the  PT session that followed. In a shining moment of stupidity, I decided that I was going to go on a ride even though I was already hurting. I went 15 miles. I didn’t think it was too bad at first, but it took me a lot longer to recover than the previous three rides. I should not have gotten on the bike when I was already in pain. Noted. But it was so beautiful outside! After the winter we’ve had, the nice weather makes me do impetuous things.

By the time I saw PT this week, I was recovered from the pool incident and biking, and I was able to tell her that much of the pain at rest has dissipated (where “at rest” means when I’m able to have my leg elevated and straight; just simply sitting in a chair with my knee bent still hurts). PT said that no pain at rest is worth having the surgery. Nice to have some relatively objective validation.

We’re working on my IT band now. PT worked me over pretty good in therapy, and I walked out of there for the first time without my knee being the thing that hurt the worst. I knew exactly where my IT band was for two days following the appointment. PT said I’d probably be a “little sore,” and she wasn’t kidding. At home, I’m working on stretching the IT band and working out some of the knots. I’ve been doing foam rolling several times a week, but I’ve kicked it up a notch over the last couple of days. Last night, my thigh was radiating heat after my date with the foam roll. I had to ice the thing down.

In related news, PT has really restricted my bike mileage per week. She gave me a fairly astute lecture (I hate astute lectures because I find it difficult to argue with them) and convinced me to take it easy on the bike because she thinks that’s what’s causing the IT band issues. Way to harsh my mellow, PT.

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Much work to be done

“The price of success is hard work, dedication to the job at hand, and the determination that whether we win or lose, we have applied the best of ourselves to the task at hand.” -Vince Lombardi

I have a lot of work to do. Two weeks into the new year, I had a third knee surgery to address some lingering issues after the DeNovo NT cartilage graft in September 2012. Today marks 10 weeks since the surgery, and I’ve made a lot of progress, but there is still such a long way to go. Much work to be done with that (more on that later in this post), but there is also so much to be done in general. In life.

Spring officially arrived last week, and I feel a new urgency to make things happen. On the first full day of spring, it was nearly 70 degrees and sunny, so that obviously meant I had to go cycling. I went on the longest ride I’ve done in six or seven months. It was only 15.1 miles, but it felt like such an accomplishment. Luckily, the aftermath wasn’t much different from the 10-mile rides I’ve done recently (plus, my knee goes numb about mile five or six, so the pain on the bike isn’t that bad). Progress there means I’m looking at riding in Indiana’s Tour de Cure at the end of June. It’s good to have goals, and I think this one is my first bike goal for the year. Don’t tell PT. Cycling is still not on my list of approved activities, and she frowns at me every time I admit to a ride.

We have our quarterly “work day” at the farm this weekend where we trim nails on the llamas/sheep/goats and give them their dewormer medicine. With nearly 100 llamas, it takes an entire day and wears a body out. I’m just happy that I can participate again this time because I had to sit out a couple of times last year. My sister does the nails and shots because I refuse to give shots; I don’t want to mess it up and leave them with an abscess. My job is to run the animals from their pens (spread out all over the farm) up to the “middle barn” to get them weighed and then to the “Main Barn” to have their nails done. Then I have to run them back out and bring in the next group. As you can imagine, it’s a lot of stress on my knee, especially when I have to chase down the more reluctant members of the herd who refuse to come inside the barn where it’s easier to catch them. Smart is probably a better adjective than reluctant.

Soon, we’ll begin the process of shearing the llamas and sheep. Thankfully, we don’t shear the sheep ourselves anymore. I did that for two years, and then I threw in the towel because it’s extremely hard, physical labor; you have to throw the sheep over on its back and then move it around as you shear the different body parts. As if that weren’t hard enough, I accidentally cut one of the older ewes one year, and it scared me. She was fine, but the cut was severe, and I decided to never shear sheep again. Leave that one to the professionals.

I do shear some of the llamas. My sister shears a bunch because she lives in the same city, where I have to drive a couple of hours to help on weekends. I love shearing the llamas. There’s something satisfactory about seeing the wool come peeling off the animal (partly because once that’s done, we don’t have to groom the shorn portion). I’ll have to remember to take a camera with me this year.

I also need to get the horses cleaned up and ready to go after the long winter we’ve had this year. Baths and braids are coming in the near future. It’s kind of depressing because we haven’t even hit the muddy part of the year. There’s more dirt coming. Yuck. I hate the muddy part of the year.

Picture of Gypsy Vanner horse.

What a dirty girl.

 So much work to be done.

Physical Therapy Update

Last week at physical therapy was a bit… dull. Dull, but also painful and slightly frustrating. We didn’t do any of the “fun” exercises and instead focused on the small exercises that are intended to help my muscles work properly to get the kneecap to track properly when I’m up and going. I don’t know that it’s worth discussing here because it was a lot of my PT holding my kneecap in place and poking me to get certain muscles working correctly. I only added one balance exercise to my home routine. Nothing too exciting. Perhaps I’ll have more to report after this week’s session.

The session was slightly depressing as well because my PT said it could take up to a year to get everything in working order. And that’s if I pay close attention and keep on top of my exercises and recovery. Aaaaaahhhhh! Another year?! Not sure I have the stamina for that. But I’m assuming that the year will continue to get better, and I’ll be able to add more and more things to the list of approved activities (and then I can stop having to shamefully confess to doing things I’m not supposed to do).

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“You don’t run the show.”

PT has now started quoting episodes of Cops to me. Which I find hilarious. One that she admits to watching the show. Two that she finds it quotable. Not so hilarious when she’s quoting it to basically tell me to shut up and get my exercises done when I’m whining about not wanting to do something. Cuz I don’t run the show. She does.

The Fitter. Or, more specifically, the Pro Fitter 3D Cross Trainer. It’s my new nemesis. I’ve secretly been envious of the people I saw on this machine; I’ve wanted to play on it since the first time I saw it at rehab a year ago. But alas. It seemed like it was never meant to be. Until last week! When I saw PT go over and start setting this thing up, I was secretly oh so excited–internally elated. Then I got on the damn thing. It can be used for a variety of exercises, but the one I was supposed to do–the one I’d thought looked like so much fun–is a side-to-side motion that probably helps skiers. PT thought it might be ok for me since I wouldn’t be putting too much weight on the bent knee. Except, I don’t have the strength necessary to smoothly glide back and forth. Or the grace to make it look easy. In short, I feel like an idiot when I’m on it. So much for my idea that it was something fun to do.

New exercises this week include:

Balancing on one leg with eyes closed. (I hear you wondering how this can possibly be an exercise for PT. Why don’t you go stand on a foam mat or pillow and try to balance on one leg with your eyes closed. Get back to me when you realize it’s actually quite difficult.)

Single leg ball toss. (This is literally balancing on one leg and tossing a 6-lb medicine ball in the air and catching it. This one is not as hard as simply balancing with my eyes closed.)

Single leg ball toss while in a half hip hinge position. (This is just like the previous exercise, except I’m leaning forward–bent at the hip–with one leg straight out behind me while tossing the ball. I look ridiculous, I’m sure.)

High steps with weight. Sideways.

Ridiculous leg lift. (This is not what I’m doing, but I found this and thought it was humorous. I might start doing this so I, too, can have a sexy butt. What I’m doing now, though, is leaning on a table and raising one leg straight out to the side as high as I can go and then do small leg lifts. I am not exactly flexible, so I can’t get my leg all that high. I laughed when I realized my limit, but my PT didn’t laugh. She just grabbed my ankle and pulled my leg up higher.)

I was so worn out after my PT session last week. Worn out and sore. I told my sister that my hips hurt so bad, it felt like I’d given birth. But the exciting part is that I can get that worn out without angering my knee so much I can’t function. That’s been a long time coming.


So you’ve had a knee replacement

I don’t often wear shorts in public, but when I do, random people like to ask about or comment on my knee. The latest one was just a simple statement, “So you’ve had a knee replacement.”

Actually, no. I’ve not had my knee replaced. I’m way cooler than that. I had cadaver cartilage stuffed in behind my patella. My traumatized, ruined cartilage replaced by the biological parts of another human. It still amazes me to this day how the DeNovo NT transplant works. As if that wasn’t enough, I then had a tibial tubercle transfer; this is where the surgeon cuts through the tibial tubercle (where the patellar tendon attaches to the tibia), moves it over a bit and screws it back in place. Again, way cooler than a “simple” replacement.

Once before I told someone that I’d had an adamantium knee put in. But only awesome people would get that reference, and this person wasn’t awesome enough to know that’s what Wolverine’s skeleton is made of.

Knee sixteen days after surgery.

“There is something beautiful about all scars of whatever nature. A scar means the hurt is over, the wound is closed and healed, done with.” -Harry Crews

DeNovo NT Update

Now that I have my head back in the game and my knee behaving once again, I’ve made some strides in PT. Last Thursday, for the first time ever, my patella tracked straight when I engaged my quads while sitting on the table with a straight leg. Not really a huge deal, but kind of a huge deal. It’s a start.

After taking three weeks to control pain, swelling and heat in the knee with every tool and technique imaginable, I’ve been able to slowly start adding some exercises back in to my routine that actually make me sweat. And it feels so good.

I’ve started swimming 5 days/week for 30-60 minutes. I do this in the morning and the PT exercises in the evening. The basic PT routine is below.

Bike 5-10 mins at moderate resistance OR elliptical for 5-10 mins at low resistance for warm up.

Bosu ball exercises include:

  • Single-leg balance
  • Forward/backward tilt
  • Side-to-side tilt
  • Hip abduction
  • Single-leg hip hinge
  • Deadlifts

Y slides holding a 90° bend (I wish I could find a video of these because they’re pretty tough to do. PT commented before that not too many of her clients could pull these off.)

Y slides with small ROM (To protect myself from pain, I keep this movement to no more than 30° of bend.)

Single-leg deadlifts with 25 lb kettlebell

Cable column, 4 ways (Here’s a video of the hip abduction, so you’ll have to imagine it in the other three directions.)

Mountain climbers (This is a new one this week. Here’s a video. I look dead sexy doing these in the gym–more dead than sexy.)

Reverse plank on bench with leg lifts (Another new one.)

Walk out to plank with leg lifts (One more new one.)

Seated march on stability ball with 6-second hold with each raise (Here’s a video that’s close to what I do. I don’t do the hand part, and I get yelled at if someone catches me touching the ball for balance.)

Bridges on stability ball (Here’s a video wherein the trainer says “booty” several times. Now imagine me doing this on one of the tables in the therapy room with, like, 23 other people in there. I feel like I’m on display, and I really hate it. PT says they’re just impressed with my mad skills, but I don’t believe her.)

Hamstring curls on stability ball (Here’s a short video. Sorry for the loud, annoying music.)

After I’m done with each session, I ice and then ice some more. Sometimes, I use my shock box on a TENS setting. I also massage my knee in several different ways to both help with the swelling and desensitization. Once about every other day, I still prop my leg on the wall, at almost 90°, for 30 minutes to help with the swelling as well.

So far, so good. Last week was a good week, and it’s been at least two weeks since I had the bad swelling. Nor has the knee gotten hot in the last two weeks. All good progress.

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100 is about 70 too many

At our regularly scheduled session last week, my PT said that swimming might not be a bad idea. I’d swum laps the weekend prior in a thinly veiled thumbing of my nose at “the man.” But it wasn’t all bad because I discovered that swimming freestyle laps didn’t cause any of the sharp pain. Likely because I’m not bearing weight, and my leg is kept relatively straight. Doesn’t matter why though; PT said it would be good to try out.

I don’t particularly like formal swimming. I like floating way better. The last time I tried to add swimming to my PT routine, per my surgeon’s suggestion about nine months ago, I didn’t make it much further than buying new goggles and practicing my fish face. I think I made it to the pool a total of about three times.

Swim goggles and a fish face.

That I practiced my best fish face is not as weird as taking and then posting a selfie while doing so… I get that.

This time, though, there’s little else I can do, so I’ve a new commitment. A serious one. I’ve been in the pool four of the last six days–two of those have required my getting my butt out of bed at 4:30 in the MORNING to hit the pool by 5. This way, I can get in the laps and still have time to shower and ice/use the TENS before heading in to work. But oh does it make for a long day and grumpy me.

On Sunday, I had a little more time in the pool and thought it would be a brilliant idea to try some single-leg squats on my right (bad) leg while in chest-deep water. I thought this because PT has had me doing single-leg squats on my left (good) leg while holding most of the weight off my right (only doing the motions). So I started doing 10 squats after every other lap (one lap = 2 lengths of the pool). They didn’t hurt too much when I was doing them, so I just kept doing them after every other lap.

Later that night, I was trying to do my prescribed exercises, and I had a considerably more pain than usual. The prescribed exercises don’t generally elicit a pain response; that’s why I do those. But that night was kind of awful. It took me longer than it should have to figure out it was those squats in the pool that caused the problem. I did 100-ish (probably more) when I should have started with maybe 30-ish. Something much more reasonable. But I didn’t think it was even really doing anything because of the way it didn’t hurt in the pool. Wrong. I’m wrong a lot about the things I can/cannot do. Sometimes I’m willfully idiotic about it. Other times I just don’t think. This was one of those times. Good news is that I’ve modified, and my PT didn’t even need to tell me what to do. So at least I can follow up an idiotic decision with a responsible one. #winning


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