November isn’t my favourite month. But all things considered it’s gone okay. I’ve been lifting, biking, and swimming and my knee pain hasn’t been holding me back. I’ve been finding minutes of brightness in the dark. We even put lights on the house early.
My new job doesn’t let me hide away in the dark in the winter evenings as much as a regular faculty position and all things considered that’s a good thing. There are art gallery openings, music shows, theatre performances, and book launches. There may be a few too many evening dinners with campus visitors but mostly I’m enjoying it.
I’m also organizing events with friends. Sarah and I hosted a cookie party. Bring your own cookies and share! It wasn’t one of those “bake dozens of cookies and swap” parties. They’re too stressful. This was just “bring cookies and eat cookies.” We had a great time.
On the fitness front, I’ve been spending time in the gym with Meg, a U of G personal trainer and taking some classes like Aquafit and Bike Yoga. I’m also walking the dog lots and I’ve started a bike streak. It’s not perfect but it’s not that bad either.
Weight wise, I’m still losing weight slowly, tracking calories on my fitness pal. My knee feels better so I’m going to keep at it.
Best of all, November is almost over and I kick off the holiday season Saturday with this wonderful concert that my daughter Mallory sings in. She’s also moving December 1 so it’s a big weekend ahead!
Google Fit upped my targets! It was 60 active minutes a day and now it’s 85. I’m making it most days between biking, swimming, and walking between meetings and walking the dog.
Swimming lessons were fun. I wish there were a larger group I could join for beginners who want to start lane swimming. I like it but I’m not good on my own.
And I’m still riding to work.
I’m tracking food and being purposeful about food choices, aiming to lose weight and minimize knee pain. I am seeing the doctor who is helping me this afternoon in fact.
What’s down?
Well, it’s November very soon. Brrrr. Also, dark. And I need a plan for that month. Something ambitious and fun that makes November feel less bleak. Suggestions welcome!
I don’t know if it’s up or down, but I’m still considering surgical options for my knee. Now it’s partial knee replacement that’s on the table.
I’m reading, “Return to sports and recreational activity after unicompartmental knee arthroplasty.” Naal FD, Fischer M, Preuss A, Goldhahn J, von Knoch F, Preiss S, et al. Am J Sports Med, 2007 Oct;35(10):1688-95.
Photos below are from The Art of the Bicycle at the Museum of Science and Industry in Chicago. October also included a visit to Jeff’s boat in Chicago and Sarah and Jeff I visited the museum. You can read Jeff’s blog post too about our little river loop trip.
Bright red maple leaves against a blue sky. Photo by Unsplash.
What’s up…
Here’s the fun, easy thing. I’ve started swimming lessons and I’m excited about that. I love learning new things though I feel like I have been learning to swim my whole life! And maybe that’s okay. We’re working (so far) on breathing and kicking. I feel like I am learning lots, I’m not hopeless, and I feel like someday I might be able swim lengths of the pool again. The lessons are semi-private and the other student is a 4th year undergrad, an international student, hoping to learn to swim strokes. The instructor is also a senior undergrad and we’re all having fun. The lessons are short–30 minutes–but twice weekly and I can come early and stick around after for extra time in the pool. This weekend I’m shopping for a second fitness-y, swimming pool type bathing suit and new goggles. Woohoo!
Here’s the thing that’s hard to talk about, doctors and weight loss. I met with a family doctor with some experience/expertise in the area of weight loss. Why? Well, less knee pain is the short answer. But also better surgical outcomes and quicker recovery if I go that route. I also stand a better chance of avoiding knee surgery until the inevitable knee replacement many years down the road. I know doctors recommend weight loss for everything but in this case–I’ve read a bunch of the journal literature–I think they’re right.
So in my case I’m not being extra active in order to lose weight. I’m trying to lose weight to preserve my level of activity. There’s nothing magical on offer. The best diet is the one you can live with. I knew that going in. Weight loss is tough. Read Everything You Know About Obesity is Wrong if you want to know how tough. But with my active lifestyle which I love up for grabs, I have to try. The odds aren’t great. I know that. Given my size and the knee problems, I qualify for weight loss surgery. I declined. I also qualify for appetite suppressing medication. Again, for now, I declined. I might try it later. Instead I’m using MyFitnessPal and tracking all the things, trying to find a lower calorie life I can live with. I like this, from Yoni Freedhoff,
Now, you should know that I too have a weight-loss agenda. It’s fairly easy to describe. In a nutshell, I don’t believe that there’s one right diet to suit everyone. In my clinical practice, as well as in my book, I embrace the fact that there are dozens, if not hundreds, of factors that influence an individual’s chances of long-term success. Low fat, low carb, keto, paleo, intermittent fasting, vegan, Mediterranean, meal replacement, whatever – there are success stories out there with each and every diet that exists.
While I’ve seen proof of this in my own clinical practice, you don’t have to take my word for it. Instead, look no further than the National Weight Control Registry for evidence that, when it comes to successfully keeping weight off long term, everyone’s different. The massive database established in the 1990s tracks why and how over 10,000 people have managed to keep an average loss of 67 pounds off for over five years. And there, as I’ve described, there isn’t one answer.
The one thing successful dieters have in common is that they reduce their calories on their new diets and like their lives and diets enough while on it to sustain its adoption for good. So, while it’s true that you might be able to lose more weight, or to lose weight faster, with one diet versus another, unless you keep living with it forever, that weight’s coming back when you head back to the life and diet that you actually liked before you lost.
To put it even more succinctly: If you promote the notion that there’s one right way to lose weight or live healthfully, you’re part of the problem. The more weight you’d like to permanently lose, the more of your life you’ll need to permanently change. And, when it comes to something as pleasurable as food, merely tolerable lives just aren’t good enough. What’s best for you is undoubtedly worst for someone else.
I reviewed his book, The Diet Fix, here. I’m seeing a family doctor, Aric Sudicky who as part of his training did a placement with Yoni Freedhoff.
At no point have I felt like I’m not believed about what I eat and my current level of activity.
Where am I? I started at 240 lbs for my all time winter high and I’m down to 225. I’d like to get down to 175, which is still solidly in the ‘overweight’ category for my height. But I’m pretty muscular and the normal range 121-158 lbs are weights I haven’t seen since elementary school me! I’ve been keeping my weight loss updates to the monthly check-ins, complete with content warnings. Tracy and I are pretty committed to keeping weight loss talk to a minimum. But I’ve been writing about it at all because it’s very closely tied to my desire to stay active.
Two different knee surgeons say that no matter what I’ll never run again and though weight didn’t cause that (lots of skinny people have osteoarthritis–it’s not caused by my size) if I want to keep walking, hiking etc I need to lose weight. You can read about my left knee here. You can read more about it here.
Given that it’s tied to me having an active future, I feel like I want to write about it. The content warnings should help people avoid it, I hope.
Why is it so hard to write about weight loss? Why?
I know what’s hard about it for me. For years I’ve been happy and active at a larger size, sharing the message that you don’t need to be thin to be fit. I’m not throwing that message out now this larger body isn’t serving me so well. There are so many imperatives to lose weight. See Wishing for weight loss. Looks, caring about pay and teaching evaluations even, and so many medical arguments that aren’t true. So many reasons I reject. But then there is this one, pain. It’s awful and urgent and I want it to stop.
Sam’s bitmoji (a white woman with blond short hair and glasses and lipstick) wearing a purple sleeveless tank top, with arms spread wide saying, “I got this.”
What’s up: I feel like I’m making progress with my knee. In a way I’m not sure why. Sometimes I think I might just be getting used to the new limits on my life but I don’t think that’s it. I think it actually hurts less. And that’s good news. I’m still working on it lots (physio!) but I’m also getting outside, riding my bike, going on long hikes and feeling okay about things.
I’m following the very strong recommendation of several knee surgeons that I lose weight and I’m actually seeing a doctor for an evidence based approach to weight loss. He’s a young guy, from a fitness background first before medical school, and he follows the approach of Yoni Freedhoff whose book I reviewed here. There’s no magic to it. I’m using My Fitness Pal and tracking all the things. I’ve lost some weight. Lots more to go. I know the real trick will be keeping it off if I want to be a weight loss unicorn. I’m going to see if I rebrand, in my own mind at least, constant vigilance as paying attention. And it’s good that I don’t mind tracking things.
Other than that I’m lifting weights at the gym, sometimes alone, sometimes with a personal trainer who is helping with knee rehab (hi Meg!) and sometimes with my son Miles who is going to university here this year. I’m also going on longer, hillier dog hikes being careful to remember my knee brace.
Also, on the upside of life, Sarah and I have been Snipe racing. We didn’t capsize, drown, or crash into any other boats. Yes, we were last but we kept the other boats in sight and stayed a safe distance behind as we learn to sail. Learning through racing. It’s a thing. See Sam and Sarah’s first night of snipe racing!
What’s down: I want to ride my bike! But when? Where? With whom? ARGH! I hate riding on my own but I have a horrible schedule. And now with losing the evening light opportunities are pretty much limited to weekends. I think I’ll plan a birthday bike ride for Saturday, September 1st. (My birthday is actually the day before but that’ll be a night for a family BBQ in the backyard and cake.) 54 km for 54 years?
Saw the surgeon and his team on Monday. I’ve been crying on and off since.
The easy bits are that I got another shot of synvisc under my kneecap. What is it and what’s it for? “SYNVISC is a viscosupplement injection that supplements the fluid in your knee to help lubricate and cushion the joint. SYNVISC is for people with knee osteoarthritis who have not received enough pain relief from diet, exercise and over-the-counter pain medication.”
I’m also still wearing the knee brace and it’s helping on days when I’m on my feet a lot. I spent the weekend in New York and even though I took the subway more than usual and hopped in a few taxis for good measure, I still got 13,000 steps in on Sunday including a walk through Central Park. Thanks knee brace. I did some shopping for more leggings for under the brace and for short skirts and dresses to wear over the leggings. The brace presents some fashion challenges and I’m warmer than usual with black leggings on no matter what.
Image description: A photo of Sam just outside Central Park. I’m wearing black leggings, sandals, a sleeveless black jumper and a purse over my shoulder. Also, a knee brace. I’m smiling and the sun is shining.
I’m still going to physio and doing lots of knee-supporting exercises.
I still meet the conditions for knee replacement surgery (in both knees actually though only the left hurts) but neither of the surgeons I saw recommend it. I’m too young and I’m too active. The surgeons made me laugh, which is something, given the general message they had to deliver.
They said they like to make people happy. The person they make the most happy through knee replacement is somebody who arrives in their office, sad and older. Someone who just wants to walk to the grocery store without pain, the kind of person who says they want to lead a normal life, get a decent night’s sleep, and not suffer all the time. Knee replacement apparently makes that person very happy but they said for someone like me it wouldn’t make me happy.
Why not? Because I want to regain function and their line on knee replacement is that you shouldn’t do it to regain function, you should do it to lose pain. Also, knee replacements don’t last very long maybe 20 years and I’m young. I want to do things like ride my bike and some patients after knee replacement have difficulty bike riding because they don’t have the full range of motion back necessary for riding a bike.
So, no.
Instead they discussed a different surgery called high tibial osteotomy. That surgery involves breaking bones and resetting them so I have a bigger gap in my knee cap on the side that’s in a lot of pain. It’s a good sign that the brace helps because this does surgically what the brace does mechanically. But it’s not a permanent fix. There’s a chance the other side of my knee will become painful as arthritis advances. So it’s good for 2-10 years maybe. Also, it’s big deal surgery. Like knee replacement it’s months and months of recovery. I’d trade off 10 years of active living without pain for six months painful time consuming recovery but I’m not sure about 2 years. There are no magic globes I can peer in to see the future.
I’m trying to decide. See them again in three months.
But the other depressing piece of news from the surgeons was the strong recommendation of weight loss, both as a way of avoiding surgery and as essential to recovering from it. Either way I should lose a lot of weight. It will definitely, they say, help with pain relief. The pain is all about weight bearing. That’s why downstairs is harder than up. It’s all about force on the kneecap. And as far as motivation goes this is pretty horrible pain. Like pain that makes hard to think about other things.
Now as I’ve said before I wish that it were the case that medical reasons for weight loss changed the facts. But that’s not so. Your body doesn’t care how good, how “pure” your motivation is. It’s still tough. It’s tough losing weight and tough keeping it off.
I don’t have any choice but to try. The worse case scenario is that I lose it, gain it back, and more and need knee replacement surgery. But that’s the same worst case scenario I face now. I’ve lost significant amounts of weight in my life, 70 lbs in grad school, 60 when I turned 40. The trick, the hard part, is keeping it off. This time, if I actually lose weight, I’ll be unicorn training, learning the habits of people who actually keep weight off.
Don’t worry. This won’t become a weight loss blog. Likely I’ll save any angst, any updates, to my monthly check in posts. I’ll also add content warnings.
I thought about leaving blogging but making this pain manageable and movement possible is a big part of my life right now. And I’m very much still a fit, feminist just one who is coping with injury and aging and hoping to keep in moving.
It can be tricky moving around in a small boat in ways that don’t hurt my knee but I’m learning how to do it. I haven’t raced a small sailboat ever. All of my sailboat racing experience is on relatively big boats so this is new to me. With all the knee misery, see above, it’s good to have something new to focus on. It’s fun and exciting and lots to learn.
I’m on track to complete 218 in 2018. I’m at 93 workouts. In order to be on track to workout 218 times in 2018 I should hit 109 by July 1. That’s 16 more workouts in June. I think I’ve got this. Here’s what 93 looked like when I logged it on our Facebook page: “One hour personal training. Tough. I whined. Trainer said, “Guess your email asking for an easy workout went into my spam folder.””
With the knee brace on I can walk some serious distances pain free. The other day I logged more than 10 km! I was sore the next day but still.
In June I’m speaking on a panel about women and bike riding. It’s the second London Celebrates Cycling Speakers’ Series from 7-9 pm on Wednesday, June 13 at TAP Centre for Creativity (formerly the Arts Project), 203 Dundas St, London, ON N6A 1G4.
For the first time since knee injury I’m deadlifting again. Not big weights but enough for now. I feel strong and confident. I know how to do this.
What’s down?
I’m moving houses at the end of June bringing together stuff from a storage locker, our London house, and the Guelph university family housing townhouse. I’m nervous about making it all fit. It’s not bad news. It’s just stressful.
Bike riding is a thing I love that I’m hardly getting to do at all. Too busy. I was last on my road bike more than a month ago. It’s sad.
Weight loss is something I said I wouldn’t talk much about at all. I’m trying, as part of trying to avoid knee replacement strategy, to lose some weight. I can officially now report it’s not any easier when you need to do it for medical reasons. Your body doesn’t care about motives.
May! Finally warm weather. The best thing about May is riding my bike. It was 50 km the first week and 60 km the next . Weekdays I’ve been exploring my new home, Guelph, after work and running errands on bike. That’s what’s up. It feels great.
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Not so much “up” is my left knee. It doesn’t feel great.
I met with the knee surgeon again. Total knee replacement still looks far away. At least I hope so. See 9 Things No One Ever tells You About Getting a Knee Replacement for details. We’re still seeing how things go with the goo injections and the brace.
I’m wearing the brace for walking. I’m doing physio still. And I’m riding my bike. That’s all good.
The surgeon and his team are busy telling me that all the activity I’ve done isn’t responsible for my knee osteoarthritis. They do also tell me never to even say the word “running” again. Fine. See Sam struggles not to run, ever!
But they do say I’d be in less pain if I lost weight. More seriously they say that losing weight would help me put off total knee replacement. That’s big.
But if you think you must lose those extra pounds before a knee or hip replacement, think again, as researchers with UMass Medical School found long-term relief from joint replacement surgery was almost the same in obese and non-obese patients.
“The conventional wisdom is that the lower your body weight, the lower your body mass index, the better you will do in joint replacements, and there has been an increasing push to say that if you are obese you should not have joint replacement – either knee or hip replacement,” Dr. David C. Ayers, chairman of orthopedics and chairman and professor of orthopedics and physical rehabilitation at UMass Medical School, said Thursday.
Dr. Ayers is the co-author of a study reporting the findings published last month in the Journal of Bone and Joint Surgery.
“What this study shows is that people who are overweight and are obese get the same type of pain relief and improved function that non-obese patients do,” he said.
Surprise! Fat people are people. Fat bodies are bodies. And knee pain hurts a lot no matter what your size.
The old wisdom sounds just like, “You’re fat so must pay the price! Suffer! No knee replacement for you!” Doctors can be jerks.
But in my case we’re not talking about weight loss before surgery. The issue is weight loss to put off the necessity of joint replacement. Total knee replacement is worth avoiding. Right now knee replacements last 20 years max. So if all goes well, I might need a second one. It’s big painful surgery with a very lengthy recovery time. I don’t want to do it twice.
See here. Point 1: “For many, weight loss is a basic but crucial way to help avoid knee surgery. Shedding just 15 pounds can cut knee pain in half. And should you need arthritis knee surgery later, you’ll decrease your risk of complications and reduce strain on your knees, which will make your rehabilitation go more smoothly.”
So, what to do?
I’m reading a lot about knee pain and weight. No surprise there!
But I’m also researching weight loss for medical reasons. Maybe like me you thought that weight loss is hard but once you’re told you need to lose weight for medical reasons, you just do it.
I’m here to tell you the sad news that it’s not so simple. Your body doesn’t care what your motivation is. It’s not like it ignores the diets for beauty’s sake and pays attention to the diets for urgent health reasons.
I think when I was younger I even thought it would be good to have a medical reason to lose weight because then you’d be serious about it and just do it. I could be a feminist and be skinny because I was dieting for health reasons. Bah.
Now I have very good reasons, I’m being serious about it, and I’m still struggling.
Tracy and I were chatting today about whether it ever makes sense to talk about weight and weight loss on the blog. It’s not something we talk about much. It’s a blog about fitness not weight and shape and we’re very keen to distinguish these things. In this case though weight loss isn’t a goal that I want to result from my fitness efforts. Weight loss may be necessary to keep me active.
We’re all about staying fit and strong in midlife and beyond. That’s the overarching message of our book. But given my knee and the state it’s in, staying active may mean losing weight. I’m trying. I won’t post much about my successes and failures. I know that’s too much for those of you with histories of disordered eating. Even though I’m one of the larger bloggers here, that’s not me. I like food and my relationship with it. But I also feel the need to be honest on the blog about what’s up with me fitness wise.
Have you had or contemplated having knee replacement? Have you struggled with medical reasons to lose weight? Tell me your story
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Also, hello May, I’m tentatively making plans. There are plans afoot for bike/boat holidays, for canoe/camping trips, for long bike rides. I love the summer and I’m going to enjoy it.
I’m riding my bike outside. Yes, it’s still wintery and windy but for commuting at least, I’m good to go.
We bought a house in Guelph!
I’ve got a new personal trainer who has lots of tricks up her sleeve for leg work that doesn’t involve my knees. I’m getting stronger and that’s great.
First week of April, I got my custom knee brace so longer dog hikes are back on the summer menu.
Wake up Cheddar!
And Tracy and I are gearing up for the book launches in London and in Guelph.
What’s down?
Well, I’ve spent lots of time indoors getting the London house ready to sell. There’s been very little time for recreational bike riding.
My new house is so close to school that bike commuting doesn’t really make sense. I’m not quite sure what to do about that other than taking the long way to work. Or getting up early, riding, and then heading into the office. I’ll work it out, I’m sure.
It’s also been cold and wet and sometimes snowy. Brrrrr!
In the middling category, I was fitted for a custom unloading knee brace. See here for a knee update. I considered flashy red but in the end went with matt charcoal. I’ll actually start wearing it in April and I’ll report back then.
An X-ray showing osteoarthritis of the knee. Getty Images
Knee brace. Bulky but if it helps with pain and lets me hike again, I’ll wear it.
In the bad news dept I’m still driving back and forth to London each week getting the house ready to sell and then looking at houses in Guelph. It’s not really bad news, just hard to get time in for exercise these days. But it’ll be short lived. House goes on the market here in just three weeks. I’m really looking forward to riding my bike in Guelph.
In the meantime I’m still doing lots of knee physio and personal training.
That little taste of riding in French Polynesia has me anxious to get my bike out and start riding.
My next planned thing after that is the one day version of the bike rally.
On July 29, 2018 I will be cycling 108km in the very first PWA’s Friends For Life Bike Rally from Toronto to Port Hope to raise money and awareness for the Toronto People With AIDS Foundation (PWA).
PWA provides practical support programs and services to people in Toronto living with HIV/AIDS. The Bike Rally is their annual sustaining fundraiser and critical to the agency. Find out more about PWA by visiting their website at www.pwatoronto.org. I’m going to need all the support I can get to reach my fundraising goal and I hope I can count on you. Make a secure online donation using your credit card by clicking on the link to my personal fundraising page below:https://secure.e2rm.com/registrant/FundraisingPage.aspx?registrationID=3883724&langPref=en-CA
Thanks for listening!
A pretty white bike against a yellow wall with a wooden basket and flowers. Thanks Unsplash.
I’m very happy to have a plan for my knee. I’ve had my first monovisc injection. Felt weird but it seems to be helping. I’m continuing physio. And I’m getting a custom unloading knee brace, being fitted March 2.
I’m trying to come to terms with the upshot of all this knee news. No Pride Run this year? Okay. No Pride Run ever? I’m bursting into tears. No more Aikido ever? That also makes me super sad. Of course, then I feel like a baby given how much worse others have it. You know this cycle, I’m sure.
It’s okay to have big feelings. It’s okay to be sad. I know.
Just because others have it worse that doesn’t my situation go away. It’s still sad. It’s still real.
What might help take my mind off all the sad things? A cruise! I’m going on a cruise in the South Pacific with my sister-in-law Susan who blogs here from time to time. She has her own big health news to deal with and I’m sure we’ll talk lots. I’m looking forward to that. But we’ll also snorkel, and drink fruity drinks by the poolside, and look at beautiful islands. Why hello Bora Bora!
I’ve never gone south in the winter before except to ride my bike. And Arizona, while a lovely temperature for bike riding, isn’t exactly steamy and warm. I’m excited. With the new big job, I’m ready to get away and relax.
Before the big trip, I’ve got a work trip to Vancouver. I’m going to fundraising school for academic leaders.
The upshot of all this busy travel is that there’ll be no personal training in February though I’m sure there’s a weight room and a swimming pool on the boat. I’m looking forward to giving pool running and maybe aquafit a try.
When I come back my March focus will be selling my house in London and buying one in Guelph.
Bye bye beautiful old London house!
People keep telling me that moving is one of the most stressful events in life, right after the death of a spouse. Turns out though that that’s not true. When it comes to stressful life events buying and selling houses and moving doesn’t even make the top 20. See here. But it is a lot of work.
And then April is the publication of our book and a lot of launch related activity. I’m gearing up.
So much going on! [Drawing of a purple rabbit on a small brown boat on water. The rabbit says “I will learn to navigate this new part of my life.” in a pink speech bubble.] By EMM, not Emma.
