Thursday, November 17, 2011

Carticel recovery @ four months

I reached my four month anniversary two weeks ago, and to celebrate, I decided to absolutely abuse my new knee.

(The decision was more like "I've got some business travel to do in Europe. What if I used my spare time to do a walking tour of wherever I happen to be, and count on only needing regular sleep to recover?")

Before further explanation, let me catch up on the last two months: I transitioned from my full-length leg brace (ankle to thigh) to a much smaller unloader brace which I wear only when awake. The smaller brace allows complete freedom of movement, and as I learned, is firstly for protection, not recuperation. (In other words, it is designed to keep you from doing anything stupid, whether intentional or accidental.)

Along with the new brace, I have graduated from mentored physical therapy to a self-guided physical therapy program, also graduating from increasing range of motion to increasing strength. My typical routine is a 5-10 minute cardio warm-up followed by a series of lifts - leg extensions, leg press, hamstring  lifts, and thigh abduction/adduction, finished with a cardio session of 20-30 minutes either stationary cycle or elliptical. (Though typically shorter intervals with the elliptical.)

I alternated every day between the above lifting routine, and aquatic sessions - 15-20 minutes of chest-deep movement exercises and up to a mile of lap swimming. I highly, highly recommend having an aquatic component, btw.

I thought I had a complete approach, but I was reminded at my four-month check in that I need to continue the leg lifts with ankle weights in addition to the gym & pool work.

For the last month or so it has been very exciting to see increases in leg strength. The progress has been obvious just looking at my weight lifts, and by my speed and strength in the pool. Also, by and large, I have been pain-free even during my most aggressive workouts, though plenty of times I have rapidly fallen asleep on my couch following a good workout.

I have also weened myself off of the pain meds, including ibuprofen (Advil), which I'll take 1-2 times per week.

On to my 4-month update:

So, at four months, my doc, Dr. Zaslav, was very happy with my status. No problems, good flexibility and good strength. I won't see him for another 4 months, and in the interim I am allowed to wind down my use of the unloader knee brace, and wind up outdoor cycling - though only on flat ground, and without standing up on the pedals. (I need to wear the brace while cycling or working out any way except swimming.)

The only item of interest at my 4-month check-in is a minor discoloration (bruise-like) on the inside of my knee, roughly corresponding to the site where the carticel was implanted. The discoloration ebbs in intensity, seemingly depending on how intense my use of the knee was that day. The doc didn't know what this might be - he'd never seen this phenomenon before, so we didn't take any action or curtail my workouts. Has anybody else had this discoloration?

Your host @ the Arc de Triomphe in Paris, November, 2011. Can you guess which leg has the brace on?

To celebrate, I flew off to France, Scotland, and London. (OK, it wasn't a celebration so much as a necessary work trip.) I did manage to spend time walking around some of these great places (and I'll post some picture highlights in a subsequent post).

I was fully mindful of my knee health, and always intend to let my knee determine the duration and pace of touring. However, I completely forgot the advice I received post-surgery: always stay ahead of the pain.

I would set off from my hotel with the intention of stopping mid-walk for a stop at a cafe or Starbucks no more than every hour or so. I was pretty faithful to this approach, but inevitably, I'd get tired before I found a cafe, or have to walk a bit further than expected. In retrospect, I should have had the intention of stopping every 45 minutes, but be prepared to go an hour (if it takes 15 more minutes to find a cafe), instead going an hour, and sometimes struggling to an hour and 15 minutes.

I found myself being able to go less and less far between breaks, but typically didn't realize it until my limits were only 10 minutes or three blocks between rests. (At one point, I was down to resting between blocks.)

To make matters worse, my overnight rest cycles were about the same as they had been at home. I should have budgeted an extra hour on touring days.

There was a mild knock-on effect - I found myself lagging in a few of my business meetings. One meeting - scheduled to go two hours - rant to almost 4 hours. I didn't realize it at the time, but I was absolutely pooped by the start of hour 3, and found myself getting a little bit silly in the meetings. Hopefully I didn't make the wrong impression.

The other negative is that once I made it home, I took three days off from my physical therapy routine. Not good, but definitely necessary.

A couple of observations/ideas/advice for Carticel patients:

-Very important: get a good seat on your flights. I scored an exit row seat with plenty of legroom for both long flights. I really didn't have any problems in-flight or post-flight as a result. If I hadn't scored, I probably would have been worse off, and being squeezed into a seat with less legroom would have certainly gotten in my head.

(Incidentally, my doc offered to write a prescription for business class seating, but as a consultant, the price of the trip came right out of my pocket, and I wasn't about to pay $3,500 more to make the trip.)

-Don't underestimate the walking mileage that you'll rack up in the airports. Always, always take the elevator if available - that walk to the gate or bus stop is always longer than you think.

-Consider taxi rides instead of subway/metro travel. I tended to get all-day passes for the metro/Underground, which certainly encouraged me to ride between tour destinations, instead of walking (which was smart), but eventually you'll have subway journeys with long walks to transfer, or plenty of stairs. The taxis are definitely more expensive but an investment in knee health.

-Dial down your touring ambitions and be smarter than me when it comes to knowing your limits. By the time I got back to my hotel room, all I could do was crash for the day or night. I lucked into hotels with good fitness facilities (including in one case a pool), but never did any PT as I was too pooped.

-Do NOT backpack - used wheeled suitcases! The last thing you need as a recovering patient is 25 or 35 more pounds of stress on your knee.

-I am extremely thankful that my trip wasn't a month earlier (month 3). I don't think I could have made it.

My final verdict on the trip will be determined by my strength tests tomorrow, when I'll learn if I grew stronger, or atrophied while traveling. For now, though, it is off to the gym for me!

I hope this update is helpful. As always, please feel free to ask me any questions in the comments section or via email.

No comments:

With my new friends on the Great Wall of China

With my new friends on the Great Wall of China
Click to go to my online photography

World sun clock

Uncommon Man's Creed

"I do not choose to be a common man. It is my right to be uncommon -- if I can. I seek opportunity -- not security. I do not wish to be a kept citizen, humbled and dulled by having the state look after me. I wish to take the calculated risk; to dream and to build, to fail and to succeed. I refuse to barter incentive for a dole, I prefer the challenges of life to the guaranteed existence; the thrill of fulfillment to the stale calm of utopia. I will not trade freedom for beneficence, nor my dignity for a handout. I will never cower before any master, nor bend to any threat. It is my heritage to stand erect, proud, and unafraid, to think and act for myself, to enjoy the benefit of my creations, and to face the world boldly and say, "this I have done." All this is what it means to be an American." -- Anonymous