How I spent my summer (4.5 months post-op)

Time has an interesting property of passing way to quickly.  My dear reader (for perhaps there's one or two remaining), I have fallen into the trap of procrastination to the point where writing a new post became an endeavor next to impossible.  Believe me when I say that in the past months I have often thought about writing a new post, but so many things have accumulated that it seemed I would have to write a small book to catch up.

Finally, I decided to bite the bullet and just do it.  My recovery is not yet close to being complete and so perhaps my challenges are still of some interest.  So first, let me catch you up on what has happened over the summer.

July: three months Post-Op and Strength Test

Back in July I had another follow up with the surgeon and a Biodex test to figure out how much strength I had accumulated in the leg.  It was an unpleasant experience - I had to kick my knee up as fast as possible with weights while sitting down with my waist and legs tied down.  The machine measures the strength of the kick as compared to the healthy leg.  This is a movement that I was not supposed to do in any of my exercises, so the test was painful and I knew I wasn't doing well.  The results confirmed it: I was significantly weaker in the right leg than in the left and needed to do a lot more work.  To say I was upset is to say nothing at all, but its all in the past now.  I have done what I could to step up my exercises, and can only hope that the next test, which is scheduled for October will go better.

After the test I visited my physiotherapist who told me that the strength would still take time to come back, and that the most important part was to regain the range of motion (which I already did).  She gave me more exercises which I am still doing at the gym a few times every week.

August: 4 months post-op 

In the past 2 months I have been making an effort to step up my exercise routine.  At the follow-up Dr. Zarnett told me I could start jogging with the brace.  I pushed myself through some considerable pain in the knee to build up the strength with one-legged squats, lunges, and leg presses.  I also stepped up my cardio (biking or eliptical for up to 25 min).

September 3 (today)

Nowadays the knee feels much more stable.  There is still pain, especially after weight exercises, but it is rarely sharp.  I sometimes ice at the end of the day, but I haven't needed painkillers to manage it.  I can do little jumps, and stretch and bend in almost every direction.

Here is a brief round up of the exercises I can do today:

• Jog with brace at 4.5 mph for 5 min
• Bike outside for 20 km on a flat path
• Biking or eliptical indoors for 25 min (level 12-14)
• Lunges in different directions
• One legged squats
• One-leg press at 70 lb

Last but not least, I won't make any promises this time around but it really is my intention to keep writing regular updates here.  Winter is coming, and we all know what that means.

2 months post-op check point

My procrastination has officially reached epic proportions.  I have abandoned weekly retrospectives without formally saying I would do so, and I didn't follow through on my promise to do a large-scale retro on how things have been going since surgery.  This lack of discipline is abominable, and is not likely to improve very much in the coming weeks.  But it has been two months since the surgery, and so the least I can do is write an update on how things are going now.

I had a follow up with doctor Zarnett last week as well, at which he told me that the knee looks good, but I need to be doing more to increase the muscle strength.  I have been exercising, but have found it challenging to increase the intensity, and so I have been feeling weaker and somewhat stuck.  I've been trying to get more motivated to go to the gym, which also hasn't been easy with the arrival of the gorgeous summer weather.

How's the knee feeling?

Compared to a month ago, I have more stamina, and can walk more and sit in the same position longer.  Having learned my lesson earlier, I avoid long distance walking or uneven terrain.  I can sit cross-legged for a bit as well, and even find that it feels good to stretch the knee by dropping it sideways.  There is less numbness, and almost no swelling.  The knee looks almost normal, although the right (operative) leg is still somewhat smaller than the left one.  There is still lots of tension on the outside of the knee and in the patella area.  I still find it hard to straighten the leg from a bent knee.  In the last week I have been feeling more pain which is probably partially due to the fact that I slacked off for a few days and then did two pretty intense workouts in a row. 
The incisions are looking very good - one of the small scoping ones has almost become invisible, and the long one is also fading.  There is still a small hard spot in the very bottom where a piece of stitch is likely causing trouble, but it doesn't seem to be trying to come out anymore.  Dr. Zarnett said it will eventually dissolve altogether.  The whole incision is fully closed and healed.

What am I able to do?

I exercise 3-4 times a week.  At each session I do some combination of half-squats and lunges, one-legged dead lifts, step downs and step ups, hamstring exercises, leg presses, use the cable machine to do hip abductions and adductions as well as to workout the glutes and the quads with about 10-15 lb weights.  I also do cardio on the eliptical and the stationary bike.  Believe it or not, this is the minimum amount of exercising I need to be doing.  I should be doing a lot more.
In terms of day to day activities, I can do almost anything that doesn't involve heavy lifting, squatting, or stepping up with the full weight on one leg.  I have been catching myself trying to skip, or quickening my step almost to running without much regard for the knee.  This feels good, but I still don't have an ok to actually go jogging or to skip.
I can't really squat or kneel yet either.

What's next?

Since the frequency of my physio has now been reduced to once every three weeks, I am facing the challenge I was weary of from the get go.  As evident from my perpetual procrastination in updating this blog, I am not the most disciplined person, and this shows in my recovery as well.  I worked very hard in the beginning and reached a certain level, but have now plateaued and need to get unstuck.
I am still formulating the plan to deal with this situation, and I will write an update on some ideas I will try in the next few days.
I also need to schedule a strength test with Dr. Zarnett's team in the next 4-6 weeks which give me a good deadline to work towards.   And the ultimate goal should not be forgotten: winter is less than 6 months away and I need to get in tip top shape for skiing by then. 

No pain, no gain? (6.5 weeks)

Summer finally came to Toronto, and I have been busier than a bumble bee with working, rehab, exercising, barbecuing, and otherwise enjoying life.  Can I be blamed for missing an update or two?   With some delay, here is then a comprehensive update on my progress.

Walking

Its been almost a month since I wrote about ambulating in Walking the talk shortly after I ditched the crutches and was working on loosing the limp.  It was challenging and sometimes painful, but the limp did go away after another week or so, and I was also able to walk greater distances without the leg numbing up.  When I say "greater distances" I don't mean miles and miles across the knolls and ridges - no, more like a couple of blocks from my house.

Before the surgery I installed Moves on my phone to track my daily walking.  Thanks to that nifty piece of technology I figured out that in general I walk every day:

• less than 1000 steps (0.5 km) just to go to my car and office
• around 2500 steps (2 km) if I add a short stroll in the neighborhood
• 4000-5000 steps (3.5-4 km) during a longer weekend walk in the park

The longer walks were getting manageable and all was well and good, until this happened last week:

At first I was like "Whoa!!! I can't believe I walked a whole 8 km, just 5 weeks after surgery while still spitting stiches." The next day, however, was more like "Wait... Ouch... It hurts! and not in a nice post-exercise way."  Turned out that despite the gym workouts, something about walking across uneven surfaces is inherently knee-intensive and these 9901 steps fatigued mine so much that I had to take two days off exercising to let it heal.

On top of that, as if to drive the point home, the knee developed a new attraction called Bursitis - inflammation of the bursa, a small fluid filled sac that prevents friction in the joint.  This new joy, that I likely got by bumping into something, pushes on the already over-strained tendons making walking more uncomfortable.  The physiotherapist says its not dangerous and will eventually go away on its own.  Oh, and yes, I am well on track to becoming an expert on knee anatomy.

This did not deter me from walking, but I do try to take it a bit easier for the time being.  Here's what my history of walking looks like since the beginning of May:

Exercising

The doc told me to be at the gym four times a week and gave me the green light to use almost any machine for glutes, hamstrings, calves.  Karla also showed me how I could do the same using cable machine or the exercise ball.  With some variation, my typical leg routine consists of about 80% of the following:

• Step downs (15x3)
• Step ups (15x3)
• Squats (half way) (20x2)
• Glute bridges 
• One-legged dead-lifts with 10 lb weight (10-15x3)
• Calf raises (10x3)
• Hip abductions, adductions, glute and hamstring swings with cable machine (10x3 each)
• Rolling the exercise ball with one leg (for hamstring) (15x3)
• A medley of stretches

I do this set 3 times a week.  I also have been doing 15-20 min of stationary biking once or twice a week for cardio.

Motion and Pain

I still experience some pain when I tire out the knee with walking or exercising, or when it gets tense after being in the same position for a while.  Being immobile for long periods of time is becoming easier, but sometimes will cause tension.  It makes driving unpleasant, especially, when I get stuck in traffic.  Stretching or biking helps loosen up the tendons and alleviate some discomfort.

I have been very carefully testing whether I can put pressure on the patella by kneeling on it lightly.  It is still sore and numb, so I can't kneel fully (i.e. won't be able to propose to anyone just now), but it is getting less unpleasant gradually.  
I can also drop the knee sideways more and hold it for a few seconds (sitting in a cross-legged position).  And I can sit with my legs crossed on a chair without any discomfort, though only with the operative leg on top.
Its still early to really judge this, but I think I feel more stability in the joint.  There is less discomfort in other parts of the leg, hopefully meaning that they don't need to compensate for the knee as much.
My range of motion is pretty much back to normal, with some pain remaining at the extremes that I will work through eventually.

Incision

... still spitting stitches, eh.  Outside of that, its healing nicely, and I think the scar will be really small.


This update has been brought to you by warm late May weather. Transmitting directly from the balcony, I wish everyone a great week and healthy knees.

Week 5 Retrospective

I'm becoming a serial procrastinator - its almost end of week 6 and I just got around to doing week 5 retro.  But I'm still doing it, so I get brownie points anyway.  I haven't been slacking, just having too much fun over the long weekend.  Well, on with it now.

At the last retro I said that I would include some upper body exercises in my workouts.  This did happen, once.  I did some machines and weights at the gym for the arms, back and chest.  I also said that I would keep the exercise records in one place, and I did.  They are all in Evernote.  And, finally, I was going to keep up with my exercises, and I also did that, having done the full routine four times last week.  So, I'm three for three on the action items!  Good for me.  I will be having a gluten-free cookie later to celebrate.

For week 5 retro I decided to come back to the simplest format of went well/could be better (read: I didn't have time to think of something more exciting).  So, here it is:

Went well

• Good news at the follow up with Dr. Zarnett
• Doing all exercises
• Doing an upper body workout
• Can walk a lot more
• Flexion and range of motion improving
• Don't get as tired anymore
• Housework is under control
• Part of stitch came out
• Going to bed/getting up early
• Stretching/breathing exercises in the morning

Could be better

• Still have inflamation on the incision
• Scar is itchy sometimes
• Can't wear skinny jeans
• Don't have enough time/energy to get big chores done
• Not doing enough cardio
• Procrastinating on retros

Action items

• Plan to get 1-2 big items done during the week
• Do eliptical/bike for cardio
• Do next retro on time

Because today is already Wednesday of week 6, I think there is a good chance that I will procrastinate on this week's retro as well.  To mitigate that I've decided to do a different retro at the end of the week: instead of going over the past 7 days I will be reviewing the whole time period since I had the surgery.  I will also do that in a different format to make things more interesting and dig deeper.  

Before then I'll write another post on my progress, the exercises I've been doing, and the latest improvements.

That's it for this retro, a great rest of the week to all, and ciao.

2nd Post-Op Follow up (4.5 weeks)

I had another follow up with Dr. Zarnett on Wednesday, and he told me that everything is going really well.  Rather counter-intuitively, this means that I should be at the gym at least four times a week, doing a ton of new exercises.  I'm planning to have killer glutes by the end of this process.

  

The inflammation in the scar is spitting a stitch knot that didn't dissolve.  The doctor said its pretty normal, and will clear up by itself eventually.  No special treatment needed.  For now that thing still looks medieval, not to mention that it is preventing me from taking scar-selfies that would show off how well the incision is healing.  It was very painful in the beginning of the week as the abscess was growing, then it opened up relieving the pressure a bit, and now its just annoying that it won't heal completely.  I think its trying to get me to sponsor Polysporin and bandaids manufacturers.  

Overall, it was an uneventful follow up that could otherwise be described as "no news is good news".  The next follow up is in a month. 

I suppose it gets a bit boring if all I talk about here is how well things are going, but I honestly don't have any bad news.  Except for traffic: it always drives me insane.

Week 4 Retrospective

Last week I said I would get better organized so I don't get so tired by end of day, and keep up the exercises.  I got a good head start in the beginning of the week by cleaning up and getting some food ready for the week with my mom's help.  During the week I did a little housework every day to keep my place clean and to make sure I have enough healthy food.  I went to the gym to work out, where I used the cable machine to do the leg exercises and biked for a bit of cardio.  And so I'm 2 for 2 on my action items from the third week! Yey, me.

For week 4 retro I decided to change it up a little.  Doing retros the same way every time gets boring quickly, and there is a danger of going through the motions without thinking about the substance.  So, instead of the previous "Went well - Could be better" format, this time around I thought about what made me glad, sad, or mad. Not like dishes throwing mad, more like "argh, wtf" mad.  I'm also going to add "thankful for" category.  I know, I know, I'm sounding life-coachy again, but it does make things more fun, I swear!

Glad :)

• Can walk longer distances
• Can bike longer
• Don't get as tired
• Exercises getting easier
• Leg muscle showing
• Stretching and breathing exercises in the morning
• Its getting warmer outside!
• Might be able to bike outdoors soon
• Moved up follow up with Dr. Zarnett

Sad :(

• Incision not fully healed
• Can't go swimming yet
• This blog has no comments
• More pain elsewhere
• Not doing any upper body exercises
• Exercise records aren't organized

Mad (grrr)

• Leg cramps
• Stitch coming out (yuk)
• Housework is tiresome and boring
• Traffic still sucks

Thanks

• My parents!
• My friends who call/write to ask how I'm doing
• Coworkers are very supportive

Action Items:

• Do some stretching every morning
• Start doing upper body workouts
• Keep exercises records in one place

Overall, my progress is still good - my flexion is getting close to the pre-op levels, I can feel increasing strength in the leg, going up and down stairs is becoming easier, etc.  The only hiccup is the part of the incision that seems to be "spitting" a stitch that my body seems to have refused to let dissolve.  Its pretty painful, not to mention unpleasant, and its not letting the incision to heal properly. I'm told this is a relatively regular occurrence, but I moved up my follow up with the surgeon to get it checked out.  

Week 3 Retrospective

I seem to have run into one of the classical retrospective problems: my action items aren't getting done despite being clear and fairly manageable.  I was thinking a lot about my long term goals this week, but the dog ate my homework I never actually defined them.  I think partially I'm ok with not having longer term goals set in stone for now, because I feel that I am on track or even ahead of schedule.  I also get lots of feedback about my progress at physio every week.  However, I'm guessing it will become more of a problem later on when I have fewer sessions, and will need to keep track on my own.  I will drop this action item for now and will revisit it later.
I did concentrate on stretching more, which was the second action item.  So I'm one for two on action items again this week.  With that said, here's week 3 retro:

Went well:

• Almost no limp
• Doing exercises every day
• Back to work
• Driving is ok
• More range of motion
• Muscles coming back
• Lots of feedback from physio
• Flexion is ahead of schedule

Could be better:

• Traffic sucks
• Small infection/irritation
• Getting tired quickly

Action Items:

• Get better organized so I don't get so tired by end of day
• Keep up the exercises

This week I was getting swamped with chores at home.  I kinda like home made food, and I don't like living in a pigsty, so at least a minimal amount of food shopping, cooking and cleaning has to be done to make that happen.  My mom helped me with cooking on Saturday, so food is covered for a little while.  Also, next week I will try to organize things a bit better (like getting my lunches ready the night before, packing my gym stuff ahead of time, sweeping and dusting a bit during the week).  

Nothing to say goodbye to this week, even the limp is still with me if I walk long enough.  But I'd like to welcome back my super-cool Donjoy brace which I now wear to do squats and some other exercises.  It accompanied me on a walk on some uneven terrain today, and it reminds me that I will soon be able to do light hiking, and I will one day ski again.  

Don't we look good together?