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 · sleep

Why middle of the night Wordle?

Like the rest of the English speaking world, I’ve been Wordling. And I gather, though it started in English, it’s spread to other languages. I have friends who do the French version, as well as Canuckle, the version with Canadian themed words.

Most days I do Wordle and then Wordle2. I’ve resisted the lure of non word based variants such as Worldle, Nerdle, Heardle, etc. And I don’t do the multiple versions like Dordle or Quordle.

Like many people I share my results on social media, since sharing is part of what the game is all about. The ubiquitous squares offer a glimpse into the way others play the game. That’s a big part of the appeal.

A pretend Wordle board that’s says “Build more safe bike lanes.”

In my case though it’s also alerted friends to the fact that I’m up in the middle of the night. Why? What wakes me? I mean, aside from the state of the world. Mostly though the state of world keeps me up but it doesn’t wake me up.

What wakes me a few times each night is stabbing pain in both knees. I suffer from severe osteoartitis in both knees and the worst pain I experience is in the middle of the night. And then given the state of the world, it can be hard to go back to sleep when there’s war and a global pandemic to worry about.

“Osteoarthritis pain may feel like stiffness, aching, swelling, or throbbing. These symptoms may seem more pronounced at night since osteoarthritis pains can flare during periods of rest.” That’s from What You Need to Know About Throbbing Knee Pain at Night.

I’ve read lots about why the pain is so intense at night but I don’t find the answers satisfying. People say it’s worse because there’s nothing else going on and you notice more. Also, inflammation is worse at night because there is less cortisol. “When you sleep, your body produces less cortisol. While high cortisol levels can lead to heart disease, healthier levels can help your body reduce inflammation.”

Finally, in a really annoying kicker–lack of sleep makes knee pain worse.

There a lot of stories and studies about the connection between disrupted sleep and knee osteoarthritis. See here and here and here.

Apparently it’s a vicious cycle where not getting enough sleep makes your experience of pain worse and then the pain disrupts your sleep. The lack of sleep can also disrupt your ability to get movement in your day and that too makes knee pain worse.

On the knee pain front, I try to remember to take ibuprofen before bed. I arrange pillows in just the right way to hold my knees in the right place.

But back to where this began, Wordle. For getting back to sleep once I’ve been woken up, there are limited options. I need distraction but not doom scrolling options. Enter Wordle. It’s a five minute exercise. I can focus on it. And when I’m done I post my score and go back to sleep.

If you’ve struggled with knee pain at night and you have suggestions, other than Wordle and its many variants, let me know.

There are lots of images like this out there of bright red inflamed joints.

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 is checking in for March (late, because sad)

This post is delayed due to bad knee news and sadness writing about it. I seriously couldn’t even face thinking about it and I certainly didn’t want to write about it. But the news has kind of settled now and I’m doing okay.

Regular readers will know that these monthly check in posts have focused on my knee and getting ready for total knee replacement surgery.

In general, I’m a big fan of Canadian healthcare. I don’t mind waiting for non-urgent care. I’m pretty stoical about most things. But it no longer feels okay to be waiting for knee surgery.

Here’s Sam and her knees and her bike before all the talk of surgery even began. Photo by Ruthless Images.

I saw the sports medicine doctor who first referred me for surgery the other day, for the first time since June 2019. I saw the surgeon in person in August 2019 and we made plans. We talked about December 2020. That was a long time away then but I figured it would give me time to lose weight (recommended for easier recovery) and I could plan to take time off and have an acting dean in place for my medical leave.

Since then, August 2019, radio silence. Nothing. Nada. I emailed a few times. I phoned a few times. I read articles about the hospital in question putting all non-urgent surgery due to Covid. There were, for a time, weekly headlines about the hospital having covid outbreaks on surgical floors and about surgery cancellations.

So just a few weeks ago I gave in and reached out to the referring doctor. They took what seemed like dozens of x-rays of both knees. The diagnosis is unchanged–end stage osteoarthritis in both knees. There’s nothing there–no cartilage–just bone grinding on bone in both knees which feels about as good as that sounds.

The sports medicine doctor asked me what’s changed since we talked about my knees almost two years ago now. Well, the big bad news is that it’s now both knees. It’s no longer clear on some days which is the bad knee. They’re both bad. I used to tag blog posts about this issue Sam’s left knee. Sadly I need a new tag, simply Sam’s knees.

Better is that I’m walking okay. Not very far and not very fast. But I’m walking. I take Cheddar out two or three days a week and we can toddle around for 2 to 3 km without too much pain and suffering. (Don’t worry. He gets lots of walks. Other people walk him too.) And of course, I’m riding my bike lots.

The doctor said I could start again and get on a waitlist somewhere else. But I’m loathe to do that.

He said that the student athletes have been able to get surgeries right through covid. Seniors, however, were put off and now they have a backlog of frail, elderly patients who can’t walk around their house or get groceries. I’m in the middle. I’m not a 19 year old varsity athlete needing ACL reconstruction after injury. I’m not an 80 year old who can’t walk either. I’m just a 56 year old recreational athlete who wants to be able to go on longer walks (and snowshoe, and cross country ski, and skate) and not be in pain everyday.

I want to be able to go and do some of New Zealand’s Great Walks. More urgently, I’d like to be able to walk to work sometimes. I’d like to sleep through the night without knee pain. I’d like to take less ibuprofen.

In the meantime, I’ll be here, doing endless knee physio exercises and riding my bike. There are worse things than delayed surgery that have happened as a result of covid. No one in my house is sick. No one died. Some of us are even partially vaccinated now. As bad as things are in Ontario right now, I see the finish line and even though I’ll be limping over it, I’m excited to have the pandemic’s end in sight.

cardio · fitness · injury

Cardio without knees that work

Last week I wrote about the wonders of walking lots, even if it won’t help you lose weight. At the end of the post I promised to talk about cardio exercises for those of us who can’t walk very much at all. I can manage a dog walk with my knee brace but I’m pretty slow moving and nervous with my seriously arthritic knees. Stairs are okay going up but impossible coming down.

I walk sometimes just for the joy of being outside but it’s not my go-to fitness activity.

A wooded walking trail packed with snow, sunbeams coming through, trees casting shadows. Also, the front end of my dog Cheddar.

But also it’s winter, in Canada, and some of my fitness time these days is in the gym.

My go fitness activities at the gym used to include running on a treadmill and that’s completely out of the question now. So with the help of a personal trainer (hi Meg!) I’ve been exploring some new cardio machines at the gym. Rowing was already on my hit list and I’ve left out cycling altogether. You’ve heard me talk lots about that. Yawn. Sometimes I go to the gym and just do 5 min of each of the following things and then repeat. It’s not a bad routine. Also, these machines are usually free even at the busiest of times. That’s one advantage of not using treadmills, elliptical machines, and the like.

These won’t work for everyone as some of them involve standing.

My gym, the campus fitness center, has all of the following machines:

Hand cycle: You can do both steady state and sprints with these. It’s more work than you might think.

Ski-erg: This was completely new to me and it feels like a pretty good full body workout.

Jacob’s Ladder: I’ve blogged about that before here.

Rope machine

Rowing machine: I’ve spent a lot of time erging, as rowers say. It’s a terrific workout. It’s the thing to me that feels most like the treadmill in that I can do it for awhile and listen to music. I often start my workouts with a 2k warm up and then try to do a speedier 2 k at the end.

There are also non-machine options, like aquafit and swimming, but I’ll leave those for another day.

How about you? What do you recommend for cardio that doesn’t involve knees very much?

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.

219 in 2019 · cycling · fitness

Sam is quickly checking in for December

I think it’s mostly good news really. My knee isn’t worse. I’m walking more. It still hurts a lot but there’s a lot of research that suggests moving anyway is better than not. See here.

I made it! 300 workouts in 2019. The goal was 219 in 2019 but that went by months ago. I thought 300 was too ambitious but by counting physio I did it.

I passed my indoor cycling exam.

I’ve been riding in Zwift lots.

Zwift at the Bike Shed in Guelph

Still waiting for the snow for fat bike riding.

The only bit of bad news is my arthritic toe

cycling · fitness · monthly check in

Sam’s monthly check-in: What’s up, what’s down, the March version

Thing 1. I am really tired. I don’t usually play the “I’m busier than you” game. I love my work.  But March in the academic world is not a fun month. My former Dean used to say, when I was a department chair, that we should never introduce anything new in March.  Faculty will hate it, guaranteed. Also, nothing anyone says in March really counts. Professors have been teaching all year and they’re tired. However, all the faculty also retreat to their research cocoons in April and so there’s some pressure to get projects that require faculty input and involvement finished. Add to that the tension around our provincial government’s budget and cutbacks to universities, we’re all busy, tired, and stressed. I work 12 hour days quite often and then I come home and do this. (Note though, unlike other Deans I don’t work on weekends other than showing up to events and though there’s lots of those they mostly feel fun and celebratory.)

Thing 2. My left knee saga continues: This is neither up nor down. But it’s official. I’m in the queue for partial knee replacement. The wait time is 6-12 months which is good because that’s after the 5 Boro Bike weekend, my Newfoundland bike adventure and likely also after the one day bike rally and the tri-adventure. Priorities. It’s not certain yet that I’ll go through with it. It’s scary stuff but I’m one step closer and I’ll get (yet more) expert advice.

Here’s an image of knees from Unsplash but they aren’t mine.

Image description: Someone’s knees, not mine. The knees are wearing brown cargo pants. A blurry mountain and some trees are in the distance. Photo from Unsplash.

Thing 3. My riding: I kind of hoped to get outside riding more in March but thanks to the weather that didn’t happen. Instead, I bought a monthly membership for unlimited indoor trainer riding at the Bike Shed. I’ve left my bike there with the goal of making it in three times a week. I love it there. I’ve left my bike there and I’ve been Zwift riding around New York City and London, UK.

Screen capture of my recent Zwift ride.

Oh, and Facebook and Google keep reminding me that in Novembers past I was riding outside in March. Thanks, I guess.

accessibility · Aikido · fitness · injury

Aikido Sundays

I recently blogged about my inability to just walk away from Aikido. I still love it. I miss it.  I found myself back on the mat Sunday morning when the opportunity presented itself. Of course, I logged it in the 219 in 2019 group. I wrote, “Most of an Aikido class including some partner techniques, not just basic movements. Still trying to figure out what I can and can’t do with my knee in this condition.”

It’s not like running. I’ll never run again. I can’t. Even if I got new knees, I couldn’t run.

Obviously, I can’t kneel and some of the breakfalls are off limits. But I found I was able to practice some of the falls which made me happy because with the stiff, sore knee I’ve been more worried than usual about falling on the ice this winter.

And the thing is if I met someone with a knee like mine, I would tell them that Aikido is worthwhile. All the things I love about Aikido remain the same as when I wrote about it in 2012.  I love how gentle it is. I love the rhythm and ritual. I love learning to fall. I love the age range and the diversity of the participants. I wish there were a class with modified movements where I wasn’t the only person who couldn’t do all the things.

The question is, can I keep my ego on the shelf and not wish for the knee I used to have? I think maybe I can.

I think, come fall, I’ll visit the Aikido dojos here in Guelph.

#deanslife · accessibility · equality · fitness · injury · racing

Stairs are not Sam’s friends

Image description:
The Girona Cathedral, also known as the Cathedral of Saint Mary of Girona, is a Roman Catholic church located in Girona, Catalonia, Spain. It is the seat of the Roman Catholic Diocese of Girona.
Also, it has lots and lots of steps leading up to it!

Oh, old European cities. I love you. But I hate your stairs. SO MANY STAIRS.

Why do I hate stairs? They hurt my knees. It’s seriously painful even on days when I’m walking pain free. Down is way worse than up. Handrails help. I’m now a person who notices when they’re there and when they’re at the right height. I also sometimes worry that the stairs are making my knees worse.

So I turned to the Internet with my question. Dr. Google, do stairs simply hurt my arthritic knees or do they make things worse? Here’s a good a survey of the relevant literature.

“Stair climbing increases loads on the knee joints. And if we take into consideration the mechanical factor for appearing and progression of degenerative joint disease, it is clear that damage to joint cartilage increases with stair climbing. So reduced loads are beneficial for knee arthrosis.”

“Combination of stairs and weight or better loading and repetition of it is discussed as having some effect of knee joint degeneration. It is calculated that when someone is walking on plain ground he puts about 5 times the body weight or load in every step into the joint. When stairs are used or walking up or down hill the person is loading the knee up to 7 or 10 times the body weight or load according to the speed used. So repetition (circle of loading) – weight (and load) – and inclination of the ground has possibly effect of degenerative knee disease”

“The reasons why patients are advised to avoid them when OA shows up is that stairs are stress raisers, especially descending them. The point is that OA knees regardless the severity,  are often unstable and in these conditions stairs may  induce shear stresses on the cartilage and speed up the degenerative process. “

So I guess I should try to avoid them. I raised the issue at the knee surgery clinic on Monday when I was there for my regular appointment. Their message was clear. “You need to modify your activity. Avoid stairs when you can.”

See you on the escalator/in the elevator!

Though in these old cities there isn’t much choice.

Image description: Yellow brick buildings flanking a narrow walkway of stairs, in the old city of Girona.