Wednesday, May 5, 2010

Sting is the King of Pain; I am the King of Physical Therapy

Today -- God willing -- is my last day of this current round of physical therapy I've been going through to shore up my cranky knees.

I'm happy about that -- only because PT, while it is a very useful tool for the purposes of educating yourself about your personal infrastructure -- is also, well, to be blunt, painful.

I'll be done with it at around 11 o'clock this morning ... but I won't be done with it forever. That much I can pretty much guarantee. The arthritis that invaded my knees a decade ago (it was the summer of 2000 when the first bit of cartilage in my left knee gave way) only gets worse. I've had two partial (clinically called unicompartmental) knee replacements, in which the most damaged part of joint was reconstructed while the healthy parts were left intact, but that didn't stave off the problem forever.

Arthritis is relentless. I takes its time, and -- often -- lulls you into thinking that, "well, if doesn't get worse than this, I'll be OK."

But it always gets worse than this.

I can't imagine what I'd be like if I hadn't had a gastric bypass last October and lost 110 pounds. All I know is that one day this past February, on an unseasonably warm day, I went walking down the beach. It was a three-mile jaunt up and down the Nahant Beach causeway, and on the way back, I decided to walk in the sand.

Bad move. The lack of support caused me to change my gait (I'm learning how important one's gait is when walking), and it irritated the delicate balance in my knees that keeps them from being too much of an impediment.

It was also time for my once-a-year Cortisone shots, too. I hate them, even though they help alleviate the more intense pain in my knees. My reacts badly to Cortisone. Every time I get a shot, I end up with about a three-day headache, and I'm hot enough to catch fire.

I had the same problem when I got bronchitis a few years back and my doctor prescribed Prednisone. I thought I was going to explode out of my skin.

I got the shots, and with them came the recommendation that I get injected with Synvisc, which -- just as it sounds -- is a synthetic compound that acts as the same type of sponge in your knee joint as cartilage.

Your cartilage's main function is to absorb shock. If you're driving in a car with bad shock absorbers, and you go over a bump, it can -- if you're going fast enough -- knock you right out of your seat. Similarly, if you do a lot of walking, and your cartilages are starting to wear down, the two main bones that join to form your knee (that would be the femur and tibia) become adversely affected. Soon enough, with more erosion, you get the bone-on-bone syndrome, and, when that happens, the bones start to chip too. Eventually, if it gets bad enough, the jagged ends of the affected bones can lock into each other.

That's generally when it's time for a prosthetic device, and you get a knee replacement.

Ask me any question about the knee. Anything. I know it. It's like nutrition. There isn't a damn thing I don't know about nutrition ... except how to apply the knowledge into something approaching useful.

Ask me about the Illiotibial band. I'll explain it anyway. The IT Band is a tendon that runs from the pelvic bone in you hip to the outside of the knee. It helps stabilize the knee for all manners of impact activity, all the way down to simple walking.

If the IT Band gets irritated, even a little, it results in very, very uncomfortable knee pain. And the reason I know all this is because after partial knee replacement No. 2, the IT Band came back tight and it took me an extra month of rehab to stretch it out to the point where I could even walk!

Anyway, after this round of Cortisone shots, I asked whether I could see Tom Cookson, who is probably the best of all the ones I've worked with, for some quickie physical therapy. And here we are.

Like most 57-year-olds, I confine the bulk of my physical fitness activity to walking (not strolling, mind you ... actual brisk raise-your-heart-rate walking), and consider myself an athlete for doing it.

Once in a great while, I'll go on the elliptical cross trainer and do 45 minute (sometimes more) on that. And when I get off, and realize I haven't died, that's when I start comparing myself to Bo Jackson.

This past Sunday was the Greater Boston Walk for Hunger -- an event I haven't completed since 1986. Something always seems to derail me. And for the last 10 years, except for brief attempt in 2007, I didn't even participate.

My goal this year was to get from the starting point (Boston Common South) to Boston College -- which is, roughly, five and a half miles out of the 20-mile course. I thought that from where I'd come from -- which was basically walk 10 minutes with a cane and sit for two -- five and a half, non-stop, would be terrific.

Once the weight started coming off, I started walking for real. No breaks. No cane. Just walking. Even with the Cortisone booster, the knees took an awful beating. But I wanted to do this, so I just kept walking ... faster and faster, longer and longer.

Every third or fourth day, I had to stop, ice my knees about five times a day, put Biofreeze all over myself, and exercise some patience. And it worked. A day off would do wonders, and I'd be back at it the next day.

Finally, though, about a week and a half before the race, the damn things just gave out on me. I had to just shut it down for four straight days. And there's one thing I've learned about exercise: you get into a routine, and when you fall out of it, you're lost.

Not walking just threw me off all around. I didn't eat as disciplined as I'd been eating (bad for gastric bypass patients), didn't sleep as well, couldn't concentrate on my job as much, became more irritable ... I was the official Mr. Hyde of the Krause family.

Right before the knee gave way, I'd done a particularly grueling stretch of walking, averaging about five to six miles day -- through Boston -- ambitious jaunts that took me pretty much all over the city. No wonder my knees gave out on me.

Anyway, Sunday game, and I walked six miles and some change ... from the common, past Boston College, and almost to Newton Centre. I could have gone more (which made me happy), but didn't want to risk it. I'm glad, too, because about a half hour after I'd stopped walking, I could barely get up out of a chair.

I need to exercise. And when the weather's nice, I like to walk. I don't want to be indoors. I don't even like to be indoors in the dead of winter. I'd rather pile on some extra layers, and face the elements.

About the only time I'm happy to exercise indoors, actually, is in the searing summer heat and humidity, when any kind of physical activity is tantamount to suicide. Those days are coming.

But at the same time, I don't like not being able to straighten out my legs either ... and don't enjoy waking up at 3 a.m., in pain, because my leg is in some kind of twisted position and it has irritated my knee. So there has to be a happy medium.

So, I think I'll just have to do more low-impact, non-knee damaging exercising (like swimming). Now that I've passed the test I laid out for myself, I can let this thing heal right (and maybe take the doc up on those Synvisc injections).

I'm kind of tired of being the King of Rehab.

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