fitness · Seasonal sadness · self care · training

Checking in one month after knee replacement: Sam is gearing up for a winter of rehab

They tell you that recovery from total knee replacement is a long haul of physio and rehab.

I’m here to say it’s just dawning on me how true that is. It’s not that I didn’t believe it before. I did. But now I’m feeling it too. That knowledge is real in a way that it wasn’t before.

There were big gains in weeks one, two, and three. Not so much this week. This week I might have overdone it. Too many tiny walks? Too much mobility work? Possibly going to a Tafelmusik concert in Toronto might have been too much. But the music was beautiful and I had a lovely visit with my daughter so that was all good.

Handel’s London, Experience the energy of baroque London, a lively metropolis where musical influences intersect.

I had hoped to report that I could turn the pedals over on my bike my now, but I can’t, yet. And yes, I know there are no fixed timelines for these things and that people regain mobility as different rates. Still, in my head it seemed reasonable to be back on the trainer in a month and I’m not there yet. I mean, I’m there, but I’m not making full rotations of the pedals just yet.

Weirdly, I am so close when I do it backwards. Weirdly backwards everything is easier. I’ve been doing walking backwards without crutches drills for physio and I don’t limp walking backwards.

Why is pedaling backwards easier? Here is one explanation:

“Pedaling backwards after knee surgery is often easier because of the hamstring activation. When you pedal an exercise bike forward the quadriceps is likely more active and the hamstring is likely less active. By pedaling backward after knee replacement surgery your hamstring is pulling the lower leg back which often improves knee flexion.”

YouTube video about starting on a recumbent bike after knee replacement

The other hard thing is simply pain. I’m surprised that a month out things still hurt this much. I take pain relief medication regularly, not the narcotic stuff–the narcotic pain meds ended more than a week ago. But I’m still waking at night with pain some of the time and by end of the day things hurt a lot.

It’s also fall of course, not my favorite season, and I’ve been brainstorming ways of coping given that my options are somewhat limited this year. My friend Todd is similarly scheming and I’m enjoying reading about his plans even if I’m jealous that they include running.

What am I up to that’s positive?

🍁Well, I’m seeing more of friends and family. I’m out and about more than I was.

🍁Today I get to start driving again. Cars aren’t my favorite things but it will be nice to be independently mobile.

🍁I’ve joined a new gym that has aquafit classes and I’m looking forward to that over the winter. Aquafit isn’t my favorite thing but it’s a thing my healing knee can do once the incision heals fully . And I do love being in the water.

🍁This week the blog’s Catherine Womack comes to visit. She’s giving a talk at Guelph’s Philosophy department called “Epidemiology Food Fight: a fat feminist takes on values in nutrition science.” That’s October 6th, 430 pm.

🍁I’ve dug out my light alarm clock.

🍁I’m very happy to be planning my return to work. I miss the university. I love fall semester even though I’m not a fan of fall overall.

🍁I’m thinking I might start my November gratitude practise early this year and make it a fall thing, beginning October 1. Gratitude is good in its own right and it makes me feel better. Right now I’m thankful that I got to have knee replacement surgery and that I have lots of support through the healing process.

Bright red and orange leaves

fitness · injury

Sam’s sad knee saga: A struggling system meets the pandemic

I’ve been seeing physiotherapists and sports medicine doctors about knee pain and function since my mid forties. I’m 57 now. It’s been a while.

Advanced knee osteoarthritis has ended my time as a soccer player first, then running, then CrossFit, then cross country skiing, and then Aikido. My sports world has narrowed considerably. I still lift weights and do yoga and ride my bike, but I can only walk short distances and I’m in pain a lot of the time. Lately it’s started to affect my sleep. Wordle helps. Thanks Wordle.

Years of physio, injections, canes, and braces later, in 2018, a sports medicine doctor recommended me for total knee replacement and referred me to an orthopedic surgeon. It was time.

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.



In August 2019 I went into the hospital and met with the surgeon and his assistant and talked about what the surgery involved, how much recovery I would need etc. Since then pretty much radio silence. There was the usual wait. In Canada it’s a year to 18 months depending on where you live. But then there was the pandemic.

Some friends had knee surgery during the pandemic. Why them and not me? I’m not sure. One had both knees replaced at the same time and while that sounds brutal it has a kind of economy of scale and risk that sounds attractive. Would I be eligible for double knee replacement? I have no idea.

Last summer in 2021 I reached out to the referring physician to check in. I started to have those kind of worries that arise in this sort of situation. Could they have the wrong number? Maybe they lost my file?

The sports doctor has a memorable name. It’s one of those names you can’t quite believe isn’t a joke. It’s “Getgood.” He’s Dr. Getgood at the Fowler Kennedy Clinic in London, Ontario. New xrays determined that now both knees need replacing. They can’t do any more injections because in case I do get called in for surgery that would make surgery not an option. You need to wait months between last injection and surgery.

The clinic said that the hospital kept operating on young athletes throughout the pandemic, less worries about covid I guess. Once things opened up again, there were hundreds of seniors with zero mobility who needed joint replacement. And I see why they need surgery before me. Still, being stuck in the middle and waiting isn’t much fun.

So here I am. As covid continues, the surgical backlog grows. American friends are puzzled. People keep think I’m putting off the surgery because I’m nervous. Not true. I mean, yes I’m very nervous but that’s not the issue.

I’m just waiting.

I’m learning about how waitlists are maintained.

I’m learning about Quebec’s two tier system.

I’m finding the opacity of the system frustrating. I’d like to know where am I on the current surgeon’s waiting list. I’d like to know what the criteria are. I feel like I could make better decisions about my life if I had more information.

Friends suggest I change waiting lists, change hospitals but I’m not sure. Does that mean I go back to the end of the line? Can you be on multiple surgeons’ waitlists? None of this is clear to me.

Through my family’s varied health crises, and we’ve had some dramatic ones, I’ve been proud of the Canadian health care system. But I’m not happy and I’m not proud of where we are right now.

Listen to this episode of The Current if you want to hear more.

“There are thousands of Canadians whose surgeries have been postponed because of the strain COVID-19 is putting on health-care. Matt Galloway talks about addressing this health-care issue, with Dr. Jean-François Joncas, an orthopedic surgeon and president of the Association d’orthopédie du Québec; and Dr. Danielle Martin, a family doctor and the chair of family and community medicine at the University of Toronto.”

At the moment I’m on an airplane. My first flight since the pandemic began. There’s a lot of standing and walking in airports. I’m starting to consider the mobile cart to the gate. I’m staying in the conference hotel to avoid walking too much and I’m telling friends who I’ll see here that I need to eat in or near the conference hotel or take taxis.

Update: It’s very pretty here and I’ve walked a fair bit so far.

Vancouver in bloom

There’s also a 24 hour Peloton Studio at the hotel and bike rental nearby. Don’t worry. I’ll keep moving on two wheels. There’s also a pool, a hot tub, and yoga. I’m a naturally cheerful, optimistic person but if you get the sense that this is starting to wear on me, you’d be right.

Dressed for travel 2022 style

The early mornings are nice here too.

Boats, water, and grey sky with sun just starting to rise
fitness · injury · walking

Sam, the slow walker

If you are hiking in a group and waiting for slower people to catch up, don’t start walking again when they do catch up, because then you got a rest and they didn’t. I think about this tip a lot, in many different contexts.

Thanks to severe osteoarthritis in both knees, I’ve become a slow walker. See here and here and here.

I feel pretty good that I am still walking and I’ve read lots about the benefits of walking even though it hurts. But I’m not walking very far or very quickly these days.

Cheddar is very patient and seems to easily adjust to whatever speed I want to walk.

Walking with Cheddar

I’m glad my friends who walk with me–hey Kim!–are patient.

On the bike, I’m sometimes the faster one and this same lesson about waiting for slower people is true there too. When waiting for slower riders at the top of the hill, never just take off when they get there. Sometimes cyclists play a game called “no rest for the wicked” where first to the top have to ride back down and ride up again with the slower riders. As a slower rider, on hills, that feels ok with some people, some of the time. I talk more about this here.

When I’m walking and people get ahead, I’m happy if they walk back to me and I’m also happy if they wait. The only bad combo is waiting and then taking off again the minute I get there. That’s lonely and it would be less pressure all round just to walk by myself.

Walked home from work!

Recently my knees have been feeling a little less painful. I’ve even been able to walk home from work and I’ve been enjoying walking alone in a way I haven’t before. It’s a nice mental break between work and home (the bike ride is too fast to count as a real break) and I like getting to have complete control of the pace without worrying about other people.

fitness · monthly check in

Sam’s monthly check-in: February’s ups and downs

First, the February good news. I’m counting down the days to spring. I’m loving the added evening light. There are days when it’s clear spring is happening soon.

It’s 23 days to spring and this is a photo of pink buds with green grass and a bright blue sky.

Also, February contains Valentine’s Day. And that’s a good thing.

Happy Valentine’s bitmoji

The rest of February is a mixed bag of feelings.

With my knee surgery within the year, I’ve been trying to push myself. I want to be in the best shape possible before it’s all knee rehab all the time. I’ve been watching another athletic friend go through the work that’s required in recovery and that was her goal. Go into surgery in fighting form. (Go Patty!) That’s my focus for the year.

My knee and knee surgery isn’t really bad or good. It just is.

But it’s also a challenge in that there a lot of things I just can’t do. Have I mentioned how much I miss running? Aikido? Soccer? CrossFit? Blerg. Yawn.

Here’s a green belt Aikido selfie from four years ago.

Aikido Sam selfie in dojo washroom mirror

But focusing on what I can do…

Mostly it’s strength training, yoga, and Zwift these days with the odd dog walk thrown in for good measure. There’s also a lot of tedious knee physio. That’s not a bad combo but by temperament I’m a Jill of All Sports.

Home yoga with Cheddar

It’s also a lot of balancing. Workout hard, let my knee recover. Gentle exercise, hard thing, rest. Repeat. I’m edgy about it. I want to bite peoples’ heads off when they say, listen to your body. (Sorry friends!) Our bodies don’t have singular messages. They don’t speak with one voice. My heart and lungs want to push harder. My knee says slow down. My strong core is ready for anything but again the knee doesn’t like quick, unexpected movements on unstable ground. Okay, so maybe I should just listen to my knee since that’s my focus for the year. But my knee isn’t always the most helpful voice. My knee says, nothing hurts on the sofa. Grab a book! We can wait for surgery with a backlog of unread fiction and pots of tea. Lots of Netflix to catch up on.

But I’m with Cate about the importance of movement. I’ve written before about life as a shark. Keep moving. Keep quiet knee. My brain knows what’s best.

Also, for the first time since this whole knee falling apart thing began I’m self conscious exercising in public. I’m noticing my incapacity more and feeling embarrassed. I shouldn’t have that attitude. I wouldn’t have it if others had the same disability. And then I get angry at myself for being so self-judgey. That’s not a very good mood cycle.

When I do Modo Yoga in the studio now I’m very conscious of my limitations. There are things I just can’t do no matter how modified. That’s you, hero pose. I can manage tree and eagle with my right leg as the sole leg but not the left. I imagine I can see people looking and wondering what’s up.

This month I went to my favorite lunch hour fitness class at work, the full hour TRX class plus a “playground” add on that’s like calisthenics. The regular instructor was away and instead we did a Tabata style thing with circuits and partners and there were a couple of things–like sprinting for 40 seconds and jumping jacks for 40 seconds–that I just couldn’t do. I felt rotten and I nearly left the class. Instead, I told the instructor about my knee and I did planks instead. I’m glad I stayed even though my abs are sore.

As you can tell even my mood has taken a hit. I’ve become crankypants Sam. This is not normal for me. My mellow disposition is somewhat legendary. It’s part of what makes me a good academic leader. I’m hard to ruffle and cheerful and generous by nature. I don’t work at it. It’s how I wake up. It’s who I am. But I’ve been realizing lately that it takes a certain amount of exercise to keep me that way. As other people have been counting up to some really big numbers in the 220 in 2020 group, I’m having to workout less than usual to keep up with knee issues and recovery.

Also, it’s been extra busy at work. If January feels like it lasted forever, February is the month that flew by.

Also, unlike January when I did a lot of riding, February has been all indoor riding. I think that’s been part of the mood issue. My plan is to get back on my bike and make some plans for summer riding.

So Sarah and I got out for some fat bike riding on the weekend. That was fun!

Fat biking in six photos

Sarah, Joh, and I have registered for the Ride for Heart. It’s 75 km pretty early in the season. We’re really looking forward to it.

You can cheer me up by sponsoring me here.

aging · athletes · cycling · injury

Bonus mini blog post: Sam sees some hope when it comes to her knee and riding a bike

I know many of you have been following the saga of my knee with interest and concern. I feel like I’ve got a whole community watching out for me and wishing me well and cheering me on.

Tonight something really good happened.

Here’s what I posted on Facebook.

Feeling hopeful. Really hopeful. First time on the spin bike without any pain when pedaling while standing. No pain while using big gears either. Phew. There’s hope.

The last time I went to a spin class I could spin in easy gears well enough but it hurt to put resistance on and it hurt to stand. So I didn’t do those things.

But today, nothing. It felt fine. I kept stopping, expecting it to hurt but nothing. I did sprints. I did hills. I did max wattage drills. All felt good. Well, except for the getting sweaty and out of breath part.

It was only a 45 minute class, not the 90 I’ve usually been doing over the winter but I walked home after feeling happy and strong.

And actually I felt so good I stuck around for the 30 minute core workout after.

Yay! There’s hope.

fitness

Update: Sam’s extremely cheesed off medial meniscus!

Gray349.pngI’m just back from the Fowler Kennedy Sports Medicine Clinic.

They say I have an angry medial meniscus. That’s their technical diagnosis.

What’s that body part anyway? Wikipedia says, “The medial meniscus is a fibrocartilage semicircular band that spans the knee joint medially, located between the medial condyle of the femur and the medial condyle of the tibia.[1] It is also referred to as the internal semilunar fibrocartilage. The medial meniscus has more of a crescent shape while the lateral meniscus is more circular. The anterior aspects of both menisci are connected by the transverse ligament. It is a common site of injury, especially if the knee is twisted.”

The first goal is to get the inflammation down. So that means a lot of ice, not much walking, no stairs. Possibly it means crutches. We’ll see. Today we did lots of icing and moving the knee gently. There was also some ultrasounding. I’ve got frequent physio exercises to do. The good news is that I do get to ride my bike on the trainer. With no tension but 10 minutes, twice a day, to start. There’s also foam rolling in my future. Wish me luck!