Just What I Kneeded

A llama, an Elmslie and DeNovo.


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Suck it up, Buttercup (part deux)

I explained in the last post that a new MRI clearly showed patellar tendinopathy (degenerative process in the patellar tendon). This post will explain what we plan to do about it (I mean “we” as in “my healthcare team and I,” not in a royal sense).

I have a lot of pain right straight through the front of my knee during a specific ROM (have since about four months after the big surgery), and I thought perhaps that was the scarred fat pad because it feels like there is something physically in there that my knee has to work around (I’ve described it like someone jammed their finger into my knee right below the patella and now the knee has to bend around it; it’s weird). Doc said he doesn’t think it’s the fat pad; he thinks that the tendon is so thickened, it’s catching/rubbing during ROM.

I was inadvertently making the problem worse over the last couple of months. I knew the pain had increased, but I didn’t yet know for sure that the pain was coming from the patellar tendon. I was doing leg extensions with increasing weight/pain, and some nights, it was all I could do to get through the leg extensions. I had to turn my headphones all the way up to help take my mind off the actual exercise, and I’d occasionally sit in the gym literally talking myself into doing the sets. I might go deaf because of a knee issue, but, by gum, I’m going to do the exercises I’m told to do. I’m sure I looked and sounded like a crazy person talking to myself and singing along to my tunes.

I knew I had a problem when the knee started hurting in the pool, but I didn’t stop because the PT had told me that I should push through the pain. I’d worked the knee into such a tizzy that, by the time I had the MRI, I was having all kinds of trouble going up/down stairs again. The pain was so bad, I would throw my leg out from the hip to get it bend enough to go down the stairs. Not good.

I was not a fan of the new PT for a number of reasons. I think a lot of the issues stemmed from his inexperience. He had a specific protocol for a specific diagnosis, and he couldn’t tailor it to a specific patient’s needs. I had to make a quick decision when the doc said to continue with PT for the patellar tendon issue, so I decided to go back to my previous PT (the awesome one who has helped immensely over the past year). It’s a bit odd since she’s in a different clinic, but I trust her and value her guidance.

I met with my previous PT last week, and she showed me a few things to do to see if the tendon will respond favorably. She also did ultrasound while in the office (we’re not sure it will work, but it shouldn’t hurt). I’m supposed to do some at-home work to see if I can reconfigure the scar tissue in my knee and to see if I can stretch the quad to allow my kneecap to drop down into a more normal position (we know from the exam and a previous MRI that I have patella alta). In addition to these things, I will do eccentric exercises to load the tendon in a protected manner. We didn’t specifically talk about squats on a decline board, but quite a bit of the research I’ve read in the last couple of weeks shows decline squats are something that works for patellar tendon issues. Like with everything else, there are also detractors who don’t think decline squats are the way to go (so confusing!), so I’m unsure whether or not I will do those. I will, however, go back to the leg extension machine and use it in a slightly different way. I’m only using 30 lbs (so lower weight), and I use two legs to push it up and then lower it with just one very slowly. I still freaking hate this machine.

We’ll see if all of this helps a tendon that first showed signs of a problem on the MRI in May 2013. That’s 19 months that have gone by without directly addressing this issue, though we did work around it because I’ve always been sore there. In some ways, like the single-leg extensions I’ve been doing, we’ve probably made the issue worse. Seems like it’s going to be a lot of slow work, but I am glad there is something specific to address.

The good news is that, through all of this, the lateral portion of my knee that had caused such pain in the past has not been affected. At some point during the summer/fall, that particular pain largely dissipated (I’m willfully ignoring that there might be a connection to the fact that I was swimming so much, I stopped biking very much at all), and it hasn’t returned. Let me be clear. There is “pain” there, but it’s minimal and totally manageable. That really just leaves the big pain through the front of my knee. I feel like there’s nothing I won’t be able to do, if we can improve that pain. Well, nothing other than running and other high-impact activities. But the doc indicated he sees no reason I can’t ride, as long as I can manage the pain. Exciting!


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Suck it up, Buttercup

It’s been nearly three months since I updated on the knee. It’s about time I bring y’all up to speed. Much has happened.

I wrote in September that I’d had an x-ray, been diagnosed with some bone loss and a “deconditioned” knee. Then I started another round of PT that began with regaining ROM followed by strength building. (This was a new doc and a new PT. I’d given up trying to get my surgeon to own that he’d fixed the cartilage problem as best as it’s ever going to be fixed–a good thing– but that there was something else that needed to be addressed. He just seemed to be focused on the cartilage.)

We started with single-leg extensions with a 5-lb ankle weight and single-leg press with 60 lbs. Those low weights were all I could do without eliciting significant pain, even though the strength test indicated I could do much more (but there was pain with the test). I worked up to 30 lbs on the leg extension and 90 lbs on the leg press in the first four weeks. I thought I was doing pretty well, despite increasing pain.

After the second round of strength testing (four weeks after starting the exercises), I was told that I should push harder to add weight and that I should push through the pain to do so. Ok. Bring it on!

In the next four weeks, I added another 60 lbs to the single-leg press (150 lbs total) and another 10 lbs to the single-leg extension (40 lbs total). At some point during this round, my knee started hurting when I was in the pool–even a simple flutter kick elicited pain. I’d never had much pain while in the pool, so I should have called it off at that point. But hindsight is 20/20, and I had a PT encouraging me to push through all the pain (suck it up!).

After the third round of strength testing showed that my numbers on BOTH legs were decreasing for the leg extension (because pain!), we decided it was time for another chat with the doc. I was, once again, not following the normal pattern of progression.

Doc said I was trying too hard to get the strength back (that’s going against what his PT said, but whatevs). I asked very specifically if we were sure that it’s the cartilage causing the problem. My thought has been for a very long time now that there is an issue with the patellar tendon; I’d even discussed it with my surgeon seven months ago, but he didn’t agree after a cursory exam. New doc said he would be disappointed if there was something else wrong with the knee (me, too!) but that he wanted to send me for an MRI to make sure since my last imaging studies (MRI, bone scan and CT arthrogram) were done 18 months ago.

New MRI taken a month ago showed a number of things. Cartilage fissures and subchondral cysts on the weight-bearing surface of the lateral tibial plateau were unchanged. There is a new fissure on the mid medial side of the lateral tibial plateau that is already more than 50%. There was a lot of info about the cartilage behind my kneecap–there’s thinning in a few areas under there, but largely unchanged since the last scan (all indications the graft is doing ok). There is arthrofibrosis or a joint body in the intracondylar notch near the tibial insertion of the ACL. There is scarring of the infrapatellar fat pad (Hoffa’s fat pad). And, wait for it… patellar tendinopathy.

I met with the doc after the MRI. I was concerned about the new cartilage fissure. I don’t think there’s pain from it because I couldn’t have said there was a new fissure or any other new problem on the lateral tibial plateau. But I was worried that there was a new fissure even though I’ve only been doing PT and low-impact activities for the last 18 months. He indicated that the degenerative process has started in the cartilage, and there’s just not a whole lot that can be done to stop it. I’m not going to make the problem worse, but I can hasten the process if I do high-impact activities like running. Good thing I’m not a runner.

We talked at length about the patellar tendon. He said it’s not an inflammatory problem (it’s a degenerative problem), but he thinks it’s worth pursuing PT geared specifically at addressing the tendon. He said surgery is not on the table because the degeneration is so widespread. If I were, say, a basketball player with a focal defect, he could go in and cut it out. The tendon would heal. I don’t have a focal spot that’s bad; it’s all bad. I’m glad we’re not talking about another surgery, but I’m not happy that there is such widespread damage in the tendon. I don’t want to dwell on it, but I wonder if the damage would be so bad if we’d addressed this specific issue when I first asked about it.

I’ll write more about what we’ll do for the patellar tendinopathy in another post.


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My thanksgiving is perpetual

“I am grateful for what I am and have. My thanksgiving is perpetual. It is surprising how contented one can be with nothing definite – only a sense of existence.” — Henry David Thoreau

Thoreau perfectly sums up how I feel about this time of year. While it’s nice to have a day to sit down and give thanks, I’m grateful for the blessings in my life every single day of the year.

1. I’m thankful that I get to be an aunt. It’s the best job in the entire world. I get to spend time with some wonderful kids and then send them home to their parents when I get bored/tired. Just keeping it real here.

2. I’m thankful that I have my health. Working in an environment like I do, I get nearly daily reminders that health is not to be taken for granted.

3. I’m thankful that I have some of the best friends one could find in a lifetime. They keep me grounded; they keep me laughing; and they keep me inspired. Today, two of them fed me BBQ’d turkey and from-scratch bacon stuffing. Delicious.

4. I’m thankful that this–the fourth year–has been the best, most productive year of my knee journey. I’m still seeing improvements, and that keeps me going to continue to find things that will help control pain and help me gain strength. I’m indebted to a number of people who have helped me on this journey, both from my personal life and from the healthcare side, and more thankful for them than most of them will ever know.

5. This year, as I was last Thanksgiving, I am thankful for Ryan Gosling. Who isn’t, really?

6. I’m also thankful for mashed potatoes (only the real kind, not the box kind), fro yo, cupcakes and old fashioned sugar cream pie (which I recently found out is Indiana’s state pie–who knew we’ve had an official state pie since 2009?).

7. I’m thankful for all the four-legged beasts in my life. I love that I get to spend time on the farm and breathe in the fresh air. On a related note, I’m thankful for any minute that I can spend outdoors. Even though it’s been in the 30s here, I’ve still been hiking at my favorite park. There’s nothing quite like gulping in fresh air, no matter how frigid it is.

There are many, many other things on my list, but I don’t need to write them all down here. Besides, if I did, I wouldn’t get this posted on Thanksgiving. #procrastinator


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A nice little side effect

Over the last month or so, I’ve had a couple different appointments where my blood pressure was taken. I’ve always had what I like to call “robust” blood pressure. It’s not high, but it’s certainly not low. It typically sits right in the middle of normal. On rare occasions, when I’m stressed out or worried about the appointment beforehand*, my blood pressure will read on the high end of normal.

Then I started swimming.

My blood pressure has consistently read at the very lowest end of normal. Actually, one reading was well below normal.

This makes up for the fact that I gained a couple pounds after I started swimming. I’m pleasantly surprised by this development, but I’m curious, too. I’ve always been active, so what is the difference with swimming? Why does it make a bigger difference than the biking I was doing? Is it because I have quite a bit of time to myself to think and meditate on my day? That might be part of it. I’m more in tune with my mind because I’m not distracted by my headphones, which are ever present when I engage in other forms of exercise. I’m not sure, but I believe I will keep up the swimming. Partly because of this… partly because I love to people watch at the pool.

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*I have a touch of “white coat syndrome.” No matter what this blog may have you believe, I absolutely hate going to the doctor’s office. Hate. It. I tend to get really worked up about it. I don’t think I went to the doctor once in the time I graduated from high school all the way through my 20’s. Then along came the knee, and now I’ve been to so many appointments with various doctors, I can’t keep track.


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A llama

Llama.

He’s so cute, I just want to smoosh his cheeks.

This is Normandy.

He was born on D Day. Hence the name.

My schedule has been insane lately, and I haven’t had time to write a post this week. I thought instead I’d share a sweet pic of a sweet little llama. He was about six months old in this pic. Now, he’s four years old and thinks the world owes him–he’s quite full of himself. He was one of the last two babies I bred, and I unfortunately broke my leg shortly before he was born. He never got the training I did with my others, and I’ve never shown him. He did spend one year in 4-H, so he has been halter trained and had some performance training. But he pretty just hangs out in the pasture, beating up all the old guys.


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Gypsy portrait

This is Stryker. He’s a seven-year-old Gypsy Vanner stallion. We joke about changing his name to Ferdinand because he is extremely (sometimes infuriatingly) laid back. Just like Ferdinand from the children’s story–the bull that would rather smell flowers than engage in the bull fights.

Gypsy Vanner stallion.

Someone should have scrubbed the mud off his face before snapping his picture.

I spent some quality time with Ferdinand this past weekend. We’re working on his ground training. He’s a big baby about, oh, pretty much everything. He likes to pretend that he’s not bigger than anything else on the farm and gets scared when he sees inanimate objects. It’s not his fault. He hasn’t gotten all the proper training. He’s been professionally trained under saddle and in a cart, but he hasn’t really gone too many places off the farm to learn that the world is not a scary place. It’s the lack of experience that shows up from time to time, and we’re working on that.

I tied three pie pans together with some twine–makes an awesome racket. The neighbors were probably, like, what the hell?! The lesson was brief, but it was a good lesson. It ended when I could rattle the pans on either side without him moving his feet and when he’d walk with me while I was rattling the pans. He was still tense, but it was his first lesson with the pans, so I think it went very well. He has no idea what’s coming because this was just the first in a long line of lessons I have planned for him. He’ll be “bomb-proof” eventually whether he knows it or not.

This ground work gives me something to do while I build strength and confidence in my ability to ride again.


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Random camera pictures

I take way too many pictures with my phone. Half of them are just extra shots taken in quick succession so I can capture the action. You’d need a magnifying glass to pick out the differences in some. I then go back through and delete pictures like crazy because no one needs three shots of the same image, and let’s be honest, I don’t really need most of the pictures I’ve taken. They’re not anything that I’d print out and hang on the wall. But I thought I’d share a few here. For no reason.

Re-paved road in park.

Who knew new pavement was so awesome?

This picture is über exciting. That’s new pavement on the main road in my favorite park. It’s so smooth! And so fast!

Deer in the park.

Deer.

I always have my phone with me on my rides, and I managed to snap this as I breezed by some of the deer in my favorite park. You can’t stop completely to take the pic because then they get all suspicious and run away, so this is the best it gets when I’m on my bike.

Barn cat named Tarzan.

Tarzan. The (not so) wild man.

This little dude is Tarzan. He and his three siblings (Moxie, Batman and Tiny) were born early this spring in the horse barn. I was doing chores one weekend morning, and I heard what I thought was one of the barn swallows screeching. On further inspection, I figured out that a stray cat had given birth to a litter of kittens in the back of the hay stack on the floor of the barn. Tarzan was so named because he was absolutely wild when he first started venturing out into the world. We couldn’t get close to him, but we could pet and play with his siblings. That’s all changed, and he’s now the most ridiculous of the bunch. He comes to you immediately when you enter the barn, and you spend the entire time in the barn tripping over him. His purr is the loudest I’ve ever heard. As you can see, he likes to take selfies.

Llama in front of fence.

Studly.

The most important thing about this picture is not the gorgeous llama. It’s the equally gorgeous fence behind him. Look at how straight it is! I built that damn fence with my bare hands.

Nephew on the playground rock wall.

Little monkey.

This little monkey is my five-year-old ‘phew. If anyone asks, he’s not my favorite. I love my niece and all my ‘phews equally. For the most part. He’s the only kid on this planet that has made me pause longer than 10 seconds and think that maybe I need to have my own kids some day. He gives super ultra mega hugs of doom. What is a mega hug of doom you ask? Well, he runs to the other side of the room and then runs full speed right into you and tries to squeeze you to death. Depending in whether he catches you standing or sitting, he’s fairly successful in squeezing the breath out of you.

Girl on a horse.

The niece riding Pie.

I took the niece and the ‘phew to the farm a few weeks ago, and my niece rode Pie for the very first time. I think she might be hooked. The ‘phew wasn’t quite convinced he wanted to get on Pie, but he was really excited about taking pictures of his sister from the other side of the fence. This is one of the 57 masterpieces he took that day. What bothers me most about this picture is that my niece is only 7, and her feet almost fit into the stirrups that were set for me.

That’s it for now.

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