Just What I Kneeded

What happens after a life-altering knee injury?


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Motivation is hard to find sometimes

I am no closer to not resembling a couch potato than I was when I last posted after a 5k in March. I did do the 5k I’d signed up for on April 2. Despite the BLOWING SNOW through the whole race, I actually made my best time yet, but it was also my first road race (read there were no real hills). Regardless, my current strategy of running exactly once a month–at a race–is clearly working.

Not really.

But sort of.

Seriously, who does this? Not smart people, that’s for sure. A friend of mine was incredulous after I told her about the last race, “How do you even do that? Just go out and run  5k?” I think it may simply be my stubborn streak.

I decided after the last race (yes, if you’ve been reading, it’s like the fifth time I decided) that I need a plan. For a variety of reasons, I’ve stopped doing pretty much anything active for the last four months (aforementioned one race a month doesn’t count), and I know I need to get back to it. I feel the need to get back to my PT exercises now more than ever because the knee is aching on days when I do nothing. I think the down time was good for the knee for a while, but even it has had its fill.

I made it my goal this year to do one race per month–12 total. I’ve managed to do the first four by the skin of my teeth. Now, I’m going to plan a bit better. I have the next two races planned–a 5k in May and a quarter marathon trail run in June. I’ve done both distances already this year, so I’m not worried about finishing. I am, however, worried about finishing with an intact knee. I can’t blow it now after all the blood, sweat and tears that I’ve expended rehabbing it over the course of five years.

So… I spent time this past weekend putting together a plan to get back to doing my PT exercises. I also ordered a Bosu ball and helped a friend make me a slant board so that I can do some of my most important exercises at home. Not completely sure why, but actually getting to the gym feels like such a burden right now. But it doesn’t (read shouldn’t) matter because I can do nearly everything from home. I also found a good online yoga practice, so I can start doing yoga at home, too. I’ve done it twice already, and, um… I’ll be easing back in to that. I’ve lost an awful lot of strength while sitting on my butt.

I also ordered a new pair of running shoes. I tried them on in the local running store, and they felt like I was seriously walking on clouds. I couldn’t stop smiling while I was wearing them around the store. But the price was a bit steep for me, especially for a pair of shoes that might not get all that much mileage. I had to leave them in the store. But then I found them online for nearly $50 less. I ordered them immediately, but I have yet to receive them, so we’ll see if that deal was too good to be true…

I hope I’m headed in the right direction. I certainly feel more motivated than I have in a long time. Maybe it’s because spring feels like it might actually arrive this week, and that has me feeling pretty happy.

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Tri, tri again

(Little Miami Triathlon Fall 2015 Recap)

Triathlon montage.

(clockwise from top left) Me and my super awesome tri partner before the race. Icing the knee(s) in the car on the way home. Headband that appropriately says, “This isn’t sweat. It’s liquid awesome.” The kinesiotape configuration that makes a world of difference with swelling. Us post race–we still look pretty good!

Facebook reminded me the other week that it’s been three years since my DeNovo transplant and Elmslie TTT (surgery was on 9/18/12). Three years. I would never have recognized the anniversary if it weren’t for the FB memories that pop up at random. That’s a great thing because it means I don’t worry about the knee quite like I used to the first two years after the surgery.

How to better celebrate another year down than to complete a triathlon?

That’s right. I had no grand ideas that I would be able to COMPETE in the venture. Especially not with everything that’s happened over the last six weeks. Through all of that, I managed to run only once (for about 2 miles), bike three times (for a total of about 30 miles) and kayak twice (for a total of about 18 miles). That was the full extent of my “training” for this triathlon. Well, I do still swim fairly frequently, but perhaps not surprisingly, swimming is not a great training plan for a triathlon that does not include a swim leg.

I thought I’d back out after my dad passed away. I had an understanding partner who didn’t pressure me and said we could try again in 2016. But I decided to go ahead with it because I really needed to focus on something else.

I did the Little Miami Triathlon the first time four years ago. My goal then, too, was simply to finish. I’d broken my leg the year before and had my first knee surgery only five months before the LMT.

This time, I’m about 20 pounds heavier, so that’s not an awesome start. I had also been running quite a bit leading up to the 2011 event and biking 20 miles a couple times a week. In short, I was much better prepared then than I was this year. And it was brutal.

But I finished. And damn did it feel good.

I struggled mightily on the run. I knew it was going to be the tough leg. But there were SO many people out there motivating me–all of us. There were kids with parents manning the water/aid stations, and they would cheer us on. There was one kid kneeling in the middle of the road with both hands flung high in the air, “Motivational high fives! Right here! That one’s for you!” There were people along the route clanging cow bells and cheering us on, “We’re so proud of you! Good job! You’re doing great!” I couldn’t help but smile when I passed one kid dressed up as Captain Jack Sparrow. There were cyclists (not with the race) who flew past us as we ran on the trail toward Killer Hill, “Awesome job!” Other racers would pass me and tell me to keep it up. It’s kind of hard to stop when you’re getting that much awesome support from strangers.

I didn’t do so well on the bike either. At least I can blame a constant headwind for the trouble on the bike; it seemed like it was blowing straight in my face no matter which way I turned. Tons of people passed me on the run, so I felt better when I passed a number of people on the bike. That didn’t stop the negative self talk that started up when I found myself fairly alone on one uphill stretch that went directly into the wind. “Ok, well, you’ve gotten this far. That’s ok. No one will blame you if you stop. Oh, look, that guy got off his bike to walk. That seems like a good idea. No, don’t get off the bike. If you get off the bike, you’ll never get back on. Wait. Josie [my friend/driver] has the car key. If I stop here, I can just call her to pick me up. Where the hell am I? I can’t even give her directions to come scrape my body off the side of the road. Shiiiit. Better keep pedaling.” Like I said, it was brutal.

Last time, when I rounded the final corner and saw that the last little bit of the bike course was all uphill, I started crying/cursing. This time, I was so focused on simply turning the pedals, I didn’t even realize that I was on the last hill until I saw the flags marking the finish line. Holy shit. I was almost there. I had one last surge of energy that put me across the line. My time this year was considerably worse than last time, but I don’t know that I really care. I finished. My friend told me, when I started lamenting the time, to knock it off. She said that doing what I did with virtually no training made me that much more of a badass. I think maybe it just makes me insane, but I’m going with her version.

The one really good part of the race was the canoe. We didn’t do very well in 2011 (in fact, we did so poorly, we had other participants laughing at us). We didn’t want a repeat of that, so we practiced a few times and watched THIS amazing video that was clearly filmed off a VHS tape from the 80’s. The people in it are perfect, mullets and all. It was entertaining to watch them, but more importantly, the video was pretty informative. It helped! We had compliments from other teams about how well we navigated the waters, and we had at least one other team following us because we were doing such a good job picking routes downstream. We passed people! That was pretty cool.

After the race, I crawled across the back seat of my car so that I could prop my leg up. We stopped at the first gas station we saw to buy ice that we then put in a couple plastic sacks and packed both my knees in ice. I stayed that way for the two-hour ride home. I’m happy to say that, while there are parts of me that are very sore, my knee is ok. In fact, it’s responded better than I’d dared hope. There is some residual pain, but it’s completely manageable with the normal measures of ice and elevation.

Which means… I’m looking forward to the HUFF 50k relay in December.


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Holy shit

I sent my PT a progress report last week, and I told her that I really wanted to put “holy shit” in the subject line of the email. I didn’t because I thought it might get flagged as inappropriate, and the email was important. But this is my blog, so I get to title this post whatever I want to title it.

But why the title? Why the email? I’ll tell you why! Because I’ve never made such significant progress in such a short amount of time… ever. I don’t even know that I should be sharing this progress out loud in case it’s a blip or something, but I’m too damn happy to keep it to myself any longer.

The eccentric exercises and the Graston-like (but done with the handle of a reflex hammer and by myself) work that I’ve been doing for the last two-ish months seems to be helping. Like a lot. Over the past two weeks, I’ve been able to do the eccentric phase of the single leg press with 105 lbs with minimal pain. And the eccentric single leg extension with 35 lbs through the ENTIRE ROM with minimal pain. Can we just take a minute to appreciate that last sentence? Not the part about the weight–that’s kind of lame yet–but the part where I’m suddenly able to do a single leg extension through the entire ROM. I have not been able to do that since the initial injury nearly five years ago (five years in March). In fact, I would elicit pain just straightening my leg when in a seated position. It’s not entirely pain free, but it’s a huge improvement.

I do the exercises after I’ve been in the pool, so I completely warmed up. I’m still having lots of trouble on the stairs, but I think it might be because I do those cold. I’m hoping that the improvements in the gym carry over to real life.

So, yeah, 2015 is just full of possibility at this point.


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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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Side effects

I mentioned a while ago that I was taking Celebrex in a last-ditch attempt to find some prescription help for the knee. My OS isn’t a big fan and explained why he doesn’t typically prescribe Celebrex. Then he went on to say that a handful of his patients with cartilage degeneration had found some relief with the medicine, so he thought it might be worth a try since I can’t stomach any of the narcotics that were prescribed, and the injections didn’t work. We plain don’t have other options.

At first, I didn’t think there were any side effects. It was the first medicine that didn’t make me nauseous or otherwise destroy my GI system. (I would much rather deal with daily pain than some of the GI problems caused by the prescription narcotics and NSAIDs that I’ve had in the past.)

I started having weird symptoms over the last three or four weeks. My shins itch like crazy, and there is no rash (which made me think I really was going crazy). I thought maybe the pool water was drying out my skin, and I started slathering on the lotion (“It rubs the lotion on its skin, or it gets the hose again.” Anyone?). I wasn’t convinced that was the problem because I’ve been swimming for more than six months now with no issues, but I didn’t have any other ideas. Then, a little over two weeks ago, I started having extreme dry mouth. At first, I thought I was dehydrated–simply not drinking enough water. The dry mouth persisted for a few days and grew bad enough that I had to try to figure out the problem because drinking 100 oz of water a day wasn’t getting rid of the dry mouth. My tongue was sticking to the roof of my mouth and my teeth, and it was getting raw.

Turns out, both itching and dry mouth are potential side effects of Celebrex. I finished the last of my prescription, so I’m going to wait to get a refill. I’ll see if the itching and dry mouth go away. I might not ever get a refill because I can’t tell for sure that the Celebrex was helping my knee. Even without side effects, there is absolutely no reason to take a drug that’s not helping. We’ll see. In the meantime, I’ll just keep swimming.


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24

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.