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Simple Joy of Walking

A couple of days ago, I had the first of three Euflexxa injections in my right knee.  The goal is that the substance will replace at least some of the natural material that provides a cushion between some of the bones in my knee joint.  On one side of the knee, that natural material is pretty much gone and the bones above and below are “kissing”.  I’m scheduled for two additional shots, administered at one week intervals.  Getting the injections doesn’t cause pain; maybe just a twinge of discomfort after the topical numbing spray wears off.  The post-shot care calls for icing the knee several times a day for a couple of days and restricted activity.

So, I did only minor walking and no Tai Chi.  Today, since it was now a full 48 hours post-shot, I wanted to walk a little further than I have been, mostly for the benefit of my dogs.  The twice-daily walks are as important to their well-being as they are to mine.

I’m happy to say that the walk was one of the most comfortable ones I’ve enjoyed in the last month.  I believe I’ve mentioned that, in addition to the chronic knee pain, I’ve also been suffering a bout of plantar fasciitis in my left foot.  Right knee, left foot — yep, walking has been a chore when every step hurts.

I hate to complain.  When I do, I think of all of the military veterans who have suffered devastating injuries in the war and are now home having lost limbs, among other things.  Sure, my left heel and my right knee hurt, but hey, at least I have a left heel and a right knee.  Every Monday night, I’m inspired by veteran Noah Galloway and his presence and performances on Dancing With the Stars.   One of his legs was amputated above the knee.  One of his arms was amputated above the elbow.   If he can train, practice and perform with those challenges, I can certainly walk without whining.

Before I had weight loss surgery, I could barely walk a long block without breathing heavy.  Stairs made my heart pound.  If I had to walk too much or otherwise be on my feet for significant periods in a day, I’d need ice packs and 800 mgs of Ibuprofen to recover at night.  Even when I stretched out in bed, my legs sometimes jerked or trembled from the trauma of simple activity.

After the surgery, the doctor said get up and walk.  I was on my feet and trundling down the hall a couple of hours after I got out of the recovery room.  Yes, I was accompanied by a nurse the first few trips, and I had to roll my IV pole along with me, but I did it.  Maybe not far, but it was a start.  Every walk I took over the next day or so in the hospital, I made sure to go a little further.

Once I got home, I walked a little each day of my recovery and, gradually, added steps.  That was the foundation to which I added more distance over time.

More than the physical activity, I grew to enjoy the pleasure of taking a walk.  It’s not just the surroundings, or the simplicity of the exercise.  I began to revel in the simply enjoying that I was capable of walking at all, compounded by going any distance and, in some cases, pushing myself in the occasional 5K event.

There are other exercises that I enjoy.  I loved Zumba when I did it, but needed to give it up because of the risk of really messing up my knee more than its existing arthritic condition.  I love riding my bike, too.  I also derive great pleasure and peace from regularly practicing my Tai Chi.

But there is something so complete, so wonderful, about walking.  I didn’t realize how much I missed being able to do so comfortably until today, when my knee felt better and I’ve also resolved most of the heel pain of the plantar fasciitis.

In marketing terms, I’d say that I get a great return on the investment of my time and effort when I walk.

In regular terms, I’ll just revel in the feeling of simple joy.

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Day by Day

It’s Day 8 of the Lean-Green-Clean effort.  So far so good, mostly.  I’m still refraining from chocolate, refined sugar, junk carbs like white bread or potatoes, cakes, cookies, etc.  I’m eating more vegetables, fruits, and lean proteins.  My body feels great.  I lost seven pounds in the first week.  My head and heart are serene and happy.  My spirit is encouraged by my ability to stay on the program.

I won’t pretend it’s been easy all of the time.  Some nights I need to guard against the compulsive behavior, even if the extra food I’m tempted to reach for is something healthy from my plan.  The behavior is as much of a risk to me as the actual food items.

Cravings pop up from time to time.  It’s always important for me to analyze whether the craving is real — a physical desire for a type of food (salty, sweet, crunchy, whatever), for a specific food, or if it’s a mental/emotional craving.

I’d put together a lean, healthier version of a meat loaf to bake for dinner tonight.  Lean ground meat augmented with chopped peppers and onions and spinach.  Driving home from a doctor’s appointment, I thought about that protein and started thinking about how I’d always served it with mashed potatoes and gravy.  All of a sudden, the broccoli I’d planned to steam as a side dish had zero appeal and I started craving creamy mashed potatoes, darn it.

It wasn’t a physical “want” but a mental and somewhat emotional or associative desire.  Potatoes stayed in my mind while I ran some errands and then inspiration struck.  I could buy some cauliflower and mash that instead which would keep me on the low-carb/more veggie path but, hopefully, satisfy the craving.  I made the conscious choice to allow myself this substitution from the broccoli and drove to the supermarket to get the cauliflower.

Once I was in the store, I started thinking about chocolate.  Rich, dark, chocolate.  Not a lot, just a single piece.  It won’t hurt, my eating disorder said to me.  You’ve been so good and on point, it cajoled.  Go ahead.  Really.  It’s okay.

In the short line at the checkout, I went so far as picking up a bar and then putting it back.  “I never liked chocolate with cherries in it,” I said to myself.  Right before the employee started scanning my other purchases, I picked up another bar – one which I darn well knew I loved.  You can bring this home and trust yourself to only eat a square of it, my disease assured me.

My disease lies.  Oddly enough, it was that lie that snapped me out of the compulsion.  I put back the chocolate bar and finished my purchase, then immediately left the store.

Sometimes recovery isn’t achieved day by day, it’s minute by minute.  Definitely choice by choice.  Today, I prevailed.  By the way, the healthy meatloaf and mashed cauliflower were delicious.

In other news, I restarted treatment for my bad knee.  The orthopedic doctor injected me with Euflexxa, a hyaluronic acid product, to hopefully restore some cushion in my knee joint.  Getting the shot honestly isn’t that big a deal.  He numbs my knee with an icy spray first so I don’t even feel the “pinch” of the needle going into my leg.  (The two inch long, somewhat thick needle, I might add, with a nod to my toughness. :-).)  It’s a little sore tonight but I’ve complied with the instructions to rest and ice it for 20 minutes at a time for five or six times.  I’m on restricted activity for 48 hours which, unfortunately, means I can’t do Tai Chi for a couple of days, but I’ll be back on it by Friday.

It’s all worth it if the full course of treatment improves my overall knee condition, reduces the pain, and helps me maintain a strong level of activity.

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Internet Diagnosis

You really can find answers for anything on the internet.  The answers aren’t always right.  In fact, I’ve come to believe that misinformation, rumors and frauds zoom around the web at a rate only slightly slower than the speed of light.

It’s hard to sift out the legitimate information from the crap.  That’s why I tend to not run to medical sites on the ‘net to diagnose ailments.   Now, once I have a diagnosis, I find it useful to use some respected websites to provide additional information, but I’ve learned not to go on a site and list my symptoms.  The last time I did that, I came up with multiple possibilities, with one sounding more dire than the next.

Those caveats aside, my leg continued to bother me today with a pain that’s unfamiliar.  I’m used to my usual knee pain.  (SO looking forward to the new year when I will continue those injections.)  This pain isn’t the same feeling, it doesn’t come from the same location, and it’s at its worst when I’ve been sitting or lying down for a while.  Seriously, I get out of bed or stand up from my desk chair and I am downright hobbled for the first several steps.

It reminds me of when I suffered plantar fasciitis.  If I got out of bed in the middle of the night, or first thing in the morning, my foot hurt and was tight beyond belief.  I learned to stretch and flex my foot before I got up and then was taught some other stretches to use during the day.

Once this behavior comparison came up in my head, I decided to do a broad Google search for  “pain behind the knee”.  I located a couple different suggestions for what could be causing the condition.  Not being a doctor, I couldn’t determine which, if any, actually applied to me.  However, one site gave me some great suggestions.  I watched the video on where and how to press my thumbs into the muscles behind the knee going toward the upper calf.  The guy talked about how the two muscles back there often get tight, particularly after sitting for a while but that a little massage work can often loosen them up.

Since he wasn’t advocating that I get a nice, sharp kitchen knife and attempt to follow along with some DIY surgery, I figured I was safe giving my muscles a little rubdown.  Specifically a push-pull-release action.

Much to my surprise and delight, the approach worked!  About a minute of working my thumbs into and around the muscles behind my knee significantly loosened them and allowed me to work without such a stiff, painful limp.

About an hour after I first tried this, I had again been sitting at my desk.  This time, before I stood up and attempted to walk, I did some muscle massage.  Again, it loosened up things and walking was much more comfortable.  I’m sold to the point that when I get up in the middle of the night or first thing in the morning, I’m going to put my thumbs to work on releasing those muscles before I even attempt to get out of bed.

I might still not have a diagnosis – Internet or otherwise – but for now I appear to have a useful treatment plan.

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A Beautiful Day

I didn’t let any grass grow under my feet — or under my knee.  Having made the decision to get my knee medically evaluated, I went into action.  Specifically, I wanted someone who would not make surgery the first or only option — unless it really was the only option.  Friends recommended a couple of orthopedic/sports medicine specialists.  I checked each of them out online.   One in particular jumped out at me as meeting my criteria.  As an extra bonus, he trained with the specialists who treat the Philadelphia Eagles — my favorite football team.

It was meant to be.  I was fortunate enough to get an appointment today.  After some football chat, the physical exam and three x-ray views, I got the low-down.  In summary, there’s significant erosion on the medial side of my knee because of osteoarthritis.  It’s created something called a kissing lesion.  The doctor still wants me to have an MRI to check for any meniscus involvement, but he strongly believes we can take a non-surgical approach to reducing the pain I experience.  Honestly, the condition of my knee doesn’t physically prevent me from being active.  It’s the pain that interferes.  Being active is the best thing that I can do for my joints so reduction of pain and discomfort will further aid that effort.

Today he injected my knee with a novocaine-steroid mixture to reduce the chronic inflammation in the knee joint.  Tomorrow I start a six day course of oral steroid medication in diminishing doses.  In a few weeks, I’ll go for three injections of  a hyaluronic acid (HA) product over three weeks.  HA is found naturally in the body and serves to lubricate, cushion and protect the joints, but it thins out in older patients with osteoarthritis.

I’m familiar with HA products for a lot of uses.  I already use a serum morning and night as a facial hydrater.  It’s great stuff.  Now it will help my knee.  No surgery at this point.  Projected reduction in pain and increase in function.  I’m feeling pretty terrific all around.

This leads me to the topic most on my mind for tonight’s blog post.  Recently, I learned from a friend that her husband’s cancer, which he has bravely fought for a long time, is, indeed terminal.   They have a good amount of time left, but they’ve had to face reality.  Right now, she’s angry, frightened, and incredibly sad — all to be expected.  They need to find out how they’re going to go on from here as a family.  I truly hope that they are able to find a way to not let the news steal their remaining joy.  I hope they’ll live to the fullest and not get overwhelmed by the thought that he’s dying.

We didn’t have that chance with my mom.  Once she got diagnosed, things went downhill and got super complicated really fast.  We were fighting, fighting, fighting the cancer and her other conditions and it never feels like we got a break where we could live and find some joy, or at least enjoy a few days here and there.  It just sucked.

The other day, someone on Facebook shared a meme that was connected to appreciating each day and feeling gratitude.  It so resonated with me for a number of reasons, including my friend’s news.  To paraphrase, the meme suggested that if we can, we should begin each day with the thought that this will be a beautiful day.  Then, at some point we should take time to think and say, “This is a beautiful day.”  Before we go to sleep at night, we remind ourselves that it was, indeed, a beautiful day, one to be grateful for.

If we do this regularly, we will compile many, many beautiful days, and at the end, we’ll be able to look back and know that we enjoyed a beautiful life.

It’s almost the end of my day.  While I type, my leg is propped up with an ice pack on the knee, as per the doctor’s orders post-injection.

It wasn’t a perfect day by any means, but it was, definitely a beautiful one.

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About My Knee

I haven’t exercised much this week.  Starting Monday, every morning when I woke up, my right knee – the problem one –  really ached and was particularly stiff.  In Tai Chi class on Wednesday night and yesterday morning as well as whenever I practiced, that knee clicked and felt much weaker than I’m used to, which hampered my ability to balance on it one-legged for some of the moves.  I had to use a “prop” foot much more often.

A couple of days, the pain was enough that I took some o-t-c relief.  I also massaged in arnica gel a couple of times each day.

I thought about it long and logically and decided that my knee was telling me to give it some time off for good behavior.  As much as doing so kicks me into the mental stew of, “You’re being lazy.  Don’t fall out of the exercise habit.  This is wrongwrongwrong.” I focused on the wiser, less judgmental voice that said, “You’ve done a lot over the last few weeks.  If you keep pushing you could really injure yourself and that will suck even more.”

So, except for shorter walks with the dogs a couple of times a day and the Tai Chi, I took it easy.  (Sadly, it’s been too windy to go for long bike rides.)  I didn’t hit the cardio work with the squats, jogging in place and other impact moves.  Today, Sunday, is the best that my knee has felt all week.  This indicates that I made the right decision.

The fact that I experienced this week at all really made me think about the knee overall.  I’ve come to believe that it’s time for me to have it professionally evaluated by a doctor.  My boss/friend suggested I consult the town acupuncturist, which could be a treatment option.  I’m open to alternative therapies.  However, I think I really ought to have it examined by a medical expert first.  I honestly don’t know if the problem is from arthritis, lack of cartilage, a combination of problems, or something else all together.

I don’t think the problem is serious enough to warrant surgery, but that’s my uninformed, not-grounded-in-medical-knowledge guess.  I honestly don’t know.   Maybe the answer is as simple as some physical therapy, or a brace for added support.  Maybe the problem is something more serious.  The maybes are endless.  The only thing for sure is that I won’t know until it’s checked.

I discussed this with my sister-in-law who is a nurse practitioner.  She agrees that it’s time to get it looked at.

In the meantime, I don’t believe that I need to give up exercise, but I need to be more careful about the level of impact in the exercising that I do.  Perhaps I also need to maintain balance and not overload myself with too much in too short a period of time.  I have another 5K walk coming up in a couple of weeks, which should be fine, as long as I don’t overdo it in the days right before and right after.  Some mindful moderation is in order, I believe.

This is another way to take care of myself.  Rather than ignore the problem and soldiering through, taking extra care now will, hopefully, prevent a serious injury down the line.

 

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Keep Calm and Be Well

I was going to continue the idea started by Hope in the comments and go with Keep Calm and Eat Kale as a title. Then I decided that Eat Well was more universal.

That realization yesterday that these slow months of remaining weight loss have been necessary in order for me to build lasting recovery has done me a world of good. It’s like my emotions can stop fighting each other, or my emotions and my mind can quit blaming each other — or something. Today I’ve been extremely calm and matter-of-fact about eating, food, and the weight I still want to lose. It’s no surprise to me that I haven’t had to struggle to stay on the food plan either. No white-knuckle abstinence today, thank goodness. Lack of obsession over food, absence of compulsions all further advance the calmness. There is a lot to be said for serenity.

I had another realization over the weekend. More accurately, I finally accepted something that I realized a while ago. Yes, I am incredibly more fit and much more physically active than ever in my life. However, I also need to be aware of some limitations. Remember when I talked about not needing to take over-the-counter pain meds very often anymore when I used to take them a couple of times every day? That continues as long as I respect my body, specifically my right knee, and not push it further than it’s good for it to go.

The Saturday of the 5K walk, I logged more than 16,000 steps. That evening, my knee throbbed a lot and I finally took some ibuprofen tablets so that I could sleep. All week long I stayed in the 10-12K steps range with walking and some bike riding. Occasionally my knee got stiff or twinged, but at no time was it really bad, nor did it interfere with my life. This past Saturday, I topped out at close to 16K steps all with walking, no bike riding. I also pushed my intensity on the treadmill that night.

Small wonder that when I tried to sleep, my knee really hurt. Unfortunately, I didn’t have any ibuprofen with me at the hotel. I did my best to adjust, cushioned my knee with a pillow, got some ice for a while. Eventually, I fell asleep but discomfort woke me up a couple of times before the throbbing eased.

Yesterday with the long drive home, I didn’t reach the usual 10,000 steps. Mentally and emotionally, I need to remind myself that taking a day off is not only okay, it’s a good suggestion. Today, I am back on track, beginning with a 40 minute walk before sunrise.

I’ve been trying to gradually raise my step level to average 15,000 steps every day. Now I get that this is an unrealistic goal at this point. It is one thing to encourage myself to work out and make sure that I don’t get lazy and complacent. It is another thing to push myself to the point of pain. If I do that too often, I risk truly messing myself up which could make it so that I can’t keep up with my fitness regimen at all. That’s a worst case scenario that I want no part of. So, I’m going to continue with my average of between 10K-12K steps per day and make sure that I ride my bike as much as possible, which greatly reduces the impact on my knee. With this approach and my Tai Chi, I can continue improving my physical condition and remain fit.

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