NO MORE GRAVEYARD!!!!!!!!!!!!!!!!!!!!

I've been working the graveyard shift for the last month and a half. The schedule was forced on me by my soon to be former employer i.e. the job from hell. This was not only the worst schedule I've ever had, but hands down the most unprofessional, aggravating, disorganized, pointless and generally screwed up in almost every conceivable way job I have EVER had.

The good news is that in 5 days... IT'S OVER!!!!!!!!

It's time to start rebuilding my life into some semblance of normality and happiness.

Road To Recovery: Mile 12

The foot / ankle pain has been a real, well...pain. It's been getting a little better lately. My physical therapist had a few approaches including ultra-sound and very painful massage treatments. The best suggestion he had so far has surprisingly been Epsom salts! I kind of scoffed at it when he mentioned it, but soaking my foot in hot water with a couple of cups of Epsom salts has actually reduced my overall pain. The foot still isn't 100%, but it does seem to be improving somewhat at least. I visited my friend / chiropractor Tarek and he gave me a couple of good stretches / exercises to try, as well as an acupuncture treatment with some electro stimulation mixed in.

I'm definitely limping less, which is my current goal. If everything continues to improve, I think I can actually start to move to my next, and most important goal of all. GETTING BACK ON MY BIKE!!!!!!!

Road To Recovery: Mile 10

I started physical therapy about a week ago with Dr. Aman Abye. His office is in the Miracle Mile area, which is extremely convenient. He was already familiar with the Microfracture procedure, and seems to know his stuff in general. I was able to get a referal through the ever-useful PAA message board. So here's' where I'm at as of now...

The crutches are history. The cane is being used sparingly. My leg is feeling stronger and the knee is feeling, dare I say, great right about now. Naturally, my ever aging, traitor of a body had to throw something else into the mix! My ankle / foot having been hurting pretty bad for the past couple of weeks as I transition to walking again. Dr. Abye and I seem to think it's due to lack of use while I was on the crutches, combined with some unconscious compensation I was doing once I began ditching them altogether. I've been icing / elevating the ankle and taking some ibuprofen once again. It seems a little better, but is still pretty troubling. Hopefully it will improve soon, so I can focus on my knee and not have to worry about other body parts starting a rebellion.

My next goal: LOSING THE GIMPY LIMP!!!

Once Again, It's Time For The "Cane"

I'm having a flashback to October of 2005. I was in the middle of Cork, Ireland, desperately looking for a cane. It was a couple of days after the Dublin Marathon and plantar fascitis in my right foot was the pain du jour. It had started acting up as soon as arrived in town, about a day before the race. The arch and heel started feeling a bit painful when I put weight on them, and I was concerned. But I was damned if I was going to back down after I had raised $2500, trained for 6 months and flew halfway across the world to do this.

I had also just come out of the most heart-wrenching, maddening, life changing and generally fucked up relationships of my life, and guess who my roommate was going to be for the first few nights? The ex-girlfriend in question! It was yet another example of an extremely damaging and mistake laden period in my life that I still have oh...let's say just a wee bit of bitterness about. But I digress...

So basically just I sucked it up and ran anyway. After mile 2, I knew that this was really going to suck. The pain continued with every stabbing footstep, and increased exponentially with every mile. I had decided to take ibuprofen during the run to help with the pain. I'm not sure that it helped any, although it's possible that it's the reason I finished at all. Of course, it it's also a terrible idea to take anything that thins blood and masks pain before a 26.2 mile run / walk, but what can I say, we all make stupid decisions, right? Right.

Yes, I finished, and yes I was in excruciating pain during and after the race. It did feel great to finish after all that hard work and emotional strife. And I had another week in Ireland, free to roam the countryside with only my ex-girlfriend and my horribly painful foot to slow me down. Great!

After renting a car and driving down to Cork, my first order of business was to purchase a cane to make my hobbling somewhat less...hobbly? It was already getting a little late and I didn't much feel like sightseeing, despite the fact that virtually all of Ireland is amazingly beautiful, and looks remarkably similar to all the postcards. There was still plenty more countryside to see, and unfortunately, probably mainly due to my emotional and physical state, I was thinking Cork kind of blew. I limped around the city for about an hour, trying to find what I thought would be a relatively common item. I asked several of the normally helpful Irish people where I might procure such an item, only to be confronted with a mixture of blank stares and misdirection. It was cold, wet and damp out. I was hurtin.' I needed to get a cane, get to bed, and then get the fuck out of Cork and away from my damn ex as soon as possible. Finally I made my way to the local chemist (pharmacy) and finally someone said, "oh, you mean...a walking stick?"

YES!! YES, A WALKING STICK!!! THAT'S WHAT I NEED!!!!!!

So lesson learned, in Ireland they don't call them canes. They are walking sticks, or they are Shillelaghs. And to me it was my ticket to more mobility so I could get where I needed to go. Out of CORK!! The next day I hopped on a bus for Galway and had one of the best weeks of my life "a rovin' a rovin' a rovin' I'll go" across the Irish countryside. One highlight was hobbling atop the Cliffs of Moher. Hands down the most beautiful piece of earth I've set my eyes on so far. And I wouldn't have been able to do it without my new walking stick.

So now, as I attempt to ditch these damned crutches, but still need some more mobility, I'm dusting off my old friend and calling on him once again. I just hope it's the last time I'll need him for a very long time.

Road To Recovery: Mile 6

I went to see Dr. Mandelbaum for my 6 week post-op checkup yesterday. He seems to think everything is coming along fine. I still have some swelling, but he said that it looked normal. The big news is that he officially gave me the OK to ditch the crutches!! That would be bigger news if I could actually do without them right now. Unfortunately, my right leg is so atrophied that walking without assistance is a joke. I am trying to start using only one crutch though, and although it's difficult, I can pull it off for short distances. The best part of this is that I can actually pick something up and carry it from one place to another!!! WOW!! It's the simple things in life, really.

It's time to start official physical therapy now as well, so I'm trying to set up some appointments now. One thing that I'm hoping will go away is a weird combination of pain and numbness in my right foot. I'm hoping that it's just the result of it not bearing weight for 6 weeks. In the meantime, it sucks!!!

Something Bike Related For a Change

OK, enough knee updates. When (if) I get back on the bike someday, I found a couple of cool emergency flat fixes I could use on one of my favorite sites, Lifehacker. The two that it mentions are using a sunglasses cord and a stuffing a bunch of leaves in your tire! It sound like these might a actually work in a pinch. Crazy!

Road To Recovery: Mile 3-4

Things have stayed pretty much the same for the last week or so. Improvement continues to come v e r y slowly. Not only that, but it fluctuates as well. Meaning that I continue to have mentally and physically discouraging days, followed by the occasional day when I actually feel "better." The beginning of week 4 had me feeling pretty discouraged. No real improvement that I could feel. The last 2 days have been better, with some slight increase in my range of motion, and a tiny bit less overall pain and stiffness. I'm up to about 40 minutes on the indoor bike trainer. I might start to break the sessions up so I'm not on it for such long increments. Not only is it boring, but it's painful. Not to my knee, mind you. Let's just say that certain other parts of my anatomy suffer after sitting on a hard racing saddle for 40 minutes without being able to stand up on the pedals at all. I even started rockin the chamois pants to help out with that.

So still a long way to go, but feeling somewhat OK going in to this weekend. Coming up on 2 weeks until crutch liberation day!

Road To Recovery: Mile 2 or "..quick like a band-aid."

Monday marked the 2 week mile marker. That means that yesterday I got to remove the weird plastic strip and bandages that were covering my incisions. I was kind of thinking it would hurt a little, so I was asking Tamara if she should do it quick like a band aid. Well, it turns out that it didn't really matter because it didn't hurt at all. Now that it's gone, my knee feels slightly less weird, and I have a better idea of how it looks visually. It's still pretty sowllen, but it does seem to slowly get better over time. Other than that, there are just two tiny marks where the incisions were made for the arthroscopy.

My range of motion is still not great. I can't bend it more than a bout 90 degrees. There's still some pain, but lately nothing too bad. I'm up to 20 minutes on the bike trainer and I've been driving to work every day this week so far.

The hardest time is the mornings. My knee always starts out stiff, my hands and arms are sore from the crutches and I just want to lay in bed all day. I'm starting to hate the crutches a lot. But I've still got another month on them, so I'd better just deal with it.

Burnin' Up The Pavement

Actually...more like driving like a grandmother. I drove to work today!!! This was one of my first short term rehab goals and I was able to make it happen!! And yes, I'm rockin' the temporary handicap placard. Which is particularly awesome because the parking situation at work is...somewhat less than awesome. As in, there are something like 5 spaces for the whole building. Now I can use one of the two conveniently located handicap spots right by the front door. And even though I'm not technically supposed to, I'm leaving the placard dangling from my rear view while I drive as a courtesy to other drivers. It means "Please go around," or something slightly less polite than that.

This is all because the knee is feeling better after a weekend of basically just sitting on my ass, icing and elevating. Even the bike trainer sessions are getting a little easier. I'm up to 18 minutes now. 20 minutes, here I come.

Slowly But Surely?

Wow, rehab is slow as heck. I think I'm making snail like progress though. The knee feels a tiny bit more flexible than it did a week ago. I'm up to 15 minutes on the bike trainer now, and adding an additional minute every day as instructed. It still feels pretty stiff though. And Mr. Pain is still in the house. My short term goal is to able to drive again by the beginning of next week. The way it feels now, I'm not really confident that will happen, but I'm setting it as a goal nonetheless. People are right when they say a huge part of this rehab is mental. I've had mood swings galore. One minute I'm super depressed and feeling like mondo crapola, and the next I'm far more upbeat than I should be for a temporary gimp. Gotta stay positive!

I found one of the better outlines of the whole microfracture process here today. It covers types of cartilage, the procedure itself, and rehab. It even has neat pictures so you can play along at home!

Road To Recovery: Mile 2 or "This Wasn't In The Brochure"

Week two has been...interesting. So I was right about the pain coming two days post microfracture surgery. On Wednesday, after the hardcore local anesthetic they gave me for the surgery wore off, ol' mr. painy started a' creepin ' in. I'm supposed to do some exercises 4 times a day. Leg lifts, quad stretches and my personal favorite KNEE BENDS!!! Because nothing feels better after knee surgery than trying to bend it as far as you can ten times in a row! So yeah, that hurts. Not to mention the fact that because I started my current job a mere 2 1/2 months ago, I don't get sick days. So it was back to work on Wednesday as well!

After doing a lot of digging on the web, it sounds like it's relatively normal to have this amount of pain and stiffness only a week out of surgery. Especially since the legion was on the medial femoral condoyle. In other words, on a weight bearing area. My gripe is that my doctor didn't really mentally prepare me for the struggle I have ahead of me. He made it sound like a pretty routine procedure. In, out and back to work. No problem! It has definitely not been that easy, and I know this is only the first mile on the road to recovery. But I suppose that regardless of what he told me, I would have chosen to do this anyway, and the result would be the same. And ultimately, all I really care about is whether or not the surgery is a success or not. Dr. Mandelbaum has a stellar reputation as a preeminent orthopedist, and is the team doctor for the U.S. Soccer Team and Pepperdine as well. I think that might explain why there's a sign in his waiting room that says wait times may be 1 1/2 to 2 hours, and everyone (including me) is willing to put up with that anyway!

My best friend this past week has been the Game Ready "Control Unit" ice machine I mentioned in my last post. It's so much easier than trading out ice packs and trying to compress with straps and bands and such. It really provided a lot of soothing icy comfort when the knee was at it's worst. Unfortunately, it costs $30 a day to rent! And insurance covers $0 of that! So alas, Mr. Icey had to go back home yesterday, and my other friend Mr. Peas will take over from here.

Needless to say, working in my current state has sucked pretty royally. I work in a shared space, so it's hard to keep my leg elevated and iced. Luckily my girlfriend got me a little plastic stool so I can at least elevate it somewhat, and use the ol' peas to ice. So at least it's somewhat workable so far. She has been amazing throughout his process. I really can't imagine going through this without her. My mom has been a great help as well. Having that support is priceless.

Another part of my rehab is to ride a stationary bike for 10 minutes a day, and gradually increase my time. I didn't have a stationary bike or a trainer, but luckily I was able to get one for really cheap from a fellow PAA member. It's an old Lemond wind indoor trainer, and so far it works just fine, especially since I'm not putting any resistance on the rear wheel at all.

So with a deep sense of irony, I've been climbing on to my road bike and groaning and sweating through 10 minutes of hell for the last few days. I must say that it has been getting a little better each time. But it still always hurts in the beginning. Oh well, at least I'm back on my bike (sort of)!

Road To Recovery: Mile 1

On Monday I underwent arthroscopic knee surgery, including a procedure called "Microfracture." Basically there was a legion or "defect" on the articular cartilage (the cartilage that covers your bones) of my femur. This was caused by my cycling "incident" on the century last year. Basically, the surgery involves poking tiny holes in my femur causing it to release marrow / stem cells / collagen etc. to form a blood clot. This eventually hardens and replaces the damaged cartilage with new stuff. Unfortunately, the new stuff (fibro-cartilage) isn't as good as the stuff I was born with (hyalin cartilage). But, it's better than nothing, and hopefully it will remain in place for a long time.


The big "NO" on my left leg above is to let the surgeon know which knee to fix. And yes, underneath the bandages of my right leg, there is indeed a big "YES" written on it. Kind of hilarious, and yet...I'm glad they put it there. You never can be too sure, can you?

So far, no major pain, although the numbness from the drugs administered yesterday haven't fully worn off. I've got a full bottle of vicodin standing by for when the pain comes. I have a feeling it will tonight.



The contraption above is an "ice machine" that pumps icy cold water and air pressure into a sleeve wrapped around my leg. I'm supposed to use it as much as humanly possible, except when I got to bed. I have to say that it's pretty awesome. A lot more effective than my old friend "bag o' peas." I'll be using him at work though. I don't want to lug the ice beast to work, especially not while confined to the crutches that I must stay on for the next 6 weeks. Those are TONS of fun!

Nervous As Heck

Tomorrow is the big day. Well potentially one of the big days depending on the MRI results. I'm extremely nervous and eager to hear the results. Needless to day, a lot hinges on this (no pun intended). These are the times when I ask God or "The Fates" or The Universe or who or whatever might be listening to please hook me up with a win. Kind of hippocritical considering I'm not currently a member of any religious club. What can I say, it never hurts to try.

So sending up, or out, or around lots of positive vibies and if you're reading this, please do the same. Thanks.

MRI'D

So I finally got an MRI last week. After all these months (almost a year actually) of trial and pretty much all error, hopefully I'll actually be able to literally get a picture of what's going on with my knee.

The visit with Dr.. Mandelbaum went much as expected. A mountain of paperwork, waiting followed by a quick series of questions from his assistant, followed by an extremely quick round of questions and examination by the doc himself. I didn't anticipate anything more than that. As the doc said, It's kind of pointless to speculate until we get an MRI.

Luckily I was able to come back the same evening for the MRI. They told me I could bring an iPod and they could play it through the speakers while get scanned. So I went home and made an MRI playlist with some classical / country / post-rock favorites. I sat there for about a half hour while the machine made a lot of weird clicking and whirring noises to go along with my self-made soundtrack.

I go back to see Dr. Mandelbaum on Tuesday and hopefully we'll have some results that will actually point me towards finally healing. This is going to be such a long week. Once again, I'm desperately wishing I had a Fast Forward button for life. If the MRI shows us nothing, I will be beyond dissapointed. That will mean that I'm in the exact same place I've always been. Guessing. More physical therapy. More mixed and inconclusive results. No thanks, I'll pass.

It's Bad Luck to Be Superstitious

Sometimes I like to kid myself into thinking that I'm not a superstitious person, when in reality I probably knock on wood more than your average woodpecker. So at the self-perceived risk of jinxing myself, I kind of almost want to say that my knee has been feeling better lately.

Now, I have to be extremely cautious about even thinking this for multiple reasons:

1.RE-INJURY!!!!

The last time I got it in my thick skull that my knee was feeling decent was a few weeks after my initial injury. So what did I do? Get back on my bike and ride full out, of course!! And what was the result? RE-INJURY!!! Which I am sure has massively prolonged this whole craptastic experience sometimes charmingly referred to as re-hab.

2. PAIN FLUCTUATION

That's a somewhat technical sounding way of saying that one day the ol' knee might tell me he's doing pretty OK! Later that day?? Uh...turns out, not so much. Good days and bad days?? Hah! How about OK hours and downright miserable ones. Knee shenanigans abound!

3. JINX!!!!

I'm superstitious, remember?

That being said, I think that maybe...possibly...please??...some of the things that I've been doing, may have contributed to some positive results.

So here are the winners...for now:

1. FOAM ROLLER

Purchased on the advice of the chiropractor I saw awhile back, the foam roller has turned out to be quite a useful tool. I kind played with it a little for awhile, not using it to it's full potential, and subsequently blew it off. Then I stumbled on a part of my inner thigh, right around my VMO, that seemed to trigger pain right in the spot where it always hurts the most (inner or medial side of right knee). Some refer to this as a trigger point, and it turns out there is a whole part of "medicine" revolving around myofascial release and trigger points. The more I roll out this part of my leg on the roller (which hurts like bejesus at first, but gets easier if you stick with it) the better my knee would gradually feel! I also found some additional good techniques for this here.

2. TAPING

My last physical therapist had me using Leukotape to use the McConnell methods of taping my patella so it would isolate and move medially where it belongs. That has yielded mixed results, and I've used it quite a bit. Recently I found Kinesio Tape, which works on a totally different principle. Rather than immobilizing or restraining muscles etc. It allows full range of motion and instead encourages lymphatic / blood flow and may help muscles to contract / expand properly. It's all a bit voodoo-esque, but I saw so many Olympic athletes and Lance "Mellow Johnny"Armstrong himself using the stuff, so I figured "what the hell?" One of my big issues has been the swelling just below my kneecap that just won't seem to go away, so figured I could benefit from some lymphatic flow, whatever that may be. Well, so far, so good. It's hard to tell if the swelling has really gone down, but my knee has been feeling better so hey, GO KINESIO!

3. NEW KNEE REGIMENT

This one is still somewhat unproven, but I downloaded a new knee regiment. I've seen lots, and most of them were free, but I had to pay for this one. They seem legit with their money back guarantee, so why not? It seems pretty right on so far. It seems to stray away from all of the "strengthen your VMO" heavy stuff that seems to be out there. That makes more sense to me because as this program says, there are WAY more muscles connecting your knee to your hip, than your quads. And your hip muscles control the alignment of your femur, which directly affects patellar tracking. Which is my problem!!!

4. AVOID FORUMS LIKE THE PLAGUE!!!!

They seem like a great idea at first, don't they?? You throw your symptoms into the ol' Googler, and holy crap, you actually get some relevant results!!! You might even actually find some specific treatments after hours of digging through stale threads on "bike forums" or "knee guru" and think that you might be on to something. And then you dig deeper, past all of the snarky one liners, beyond the flame wars and other tom-foolery, still further into the depths of ultra-depressing threads that match your questions exactly, nearly word for word...only to go un-answered, just hanging there in cyberspace like a deflated wallflower at the junior high dance. And what do you have to show for it all of your desperate searching? A bunch of contradictory advice, scary horror stories and a massive headache to boot. Do yourself a favor and STAY AWAY!!! In fact, why are your even reading this? I'm not a doctor!!! Sheesh.

Looking for balance.

Yes it's a cliche. I don't care. I need to find balance in my life. Physically, emotionally. The massive general  imbalance in my life is manifesting itself physically. I hurt my knee by doing something stupid. But the rest of my pain is different. My body is telling me something. Get it together. Figure it out.

Big Knee Pain

Here's a link to a good breakdown of strengthening / stretching exercises for knee pain. There are tons of different version of these on the web, but this is one of the better comprehensive versions I've seen. No pics, but they're explained well enough without any. I incorporate some of these into my daily routine. You have to use what seems to work for you and your body. The most important thing is to avoid anything that aggravates your knee. You'll only make things worse.

LISTEN TO YOUR BODY!

Tilted Patella

One significant step along my ongoing (and seemingly never-ending) path to recovery, was seeing x-rays of my knee at a visit to the orthopedist. One of the three x-rays that were taken, showed a view of my knee from what would essentially be the P.O.V. of my foot, with my knee bent about 45 degrees. So basically, I could see the bottom of my patella. What it showed was that my patella was tilted laterally (to the outside of my right leg), instead of being down the groove between my femur (thigh bone) and my tibia (shin bone) where it's supposed to be. Hmmmm....

So great! Now we can see what the problem is! Just tell me what to do and I'll do it! Give me the miracle cure. Surgery? Stretches? Chanting?

Well...guess what? It turns out that there are many possible causes of this condition, including that maybe my patella already had a tendency to be titled before I ever got on a bike. WHAT?!? Seriously?!? In that case, it would seem that taking an x-ray of my left knee would have been in order. Apparently that wasn't what my doctor thought. What do I know anyway?

One prevalent theory seems to be that there is a muscular imbalance at the root of the problem. For instance, my IT band (the muscle that runs all the way from the side of your hip to your kneecap) is tight or too strong, and is pulling my knee laterally (to the outside), while my VMO (Vastus medialus - one of the four muscles that make up your Quadriceps) is weak and not opposing the lateral force and pulling the kneecap back in the other direction, or medially (to the inside).

OK, so all I need to do is strengthen my VMO and loosen up my IT band right? Problem solved!

I only wish it was that simple. I've been down that road for months with little to no positive results. Leg lifts, such as lying flat and raising my injured leg up in sets, along with work with a foam roller to loosen up my IT band have yielded bupkis, even after a lot of work an patience. I'm still incorporating these exercises into my daily PT regiment, but I think they are at best only part of the puzzle, or at worst actually aggravating the problem.

More on some new potential treatments soon.

Re-Focus

So it's been about 6 months since my last post. The original point of my blog was to chronicle my cycling adventures. Obviously that hit a severe roadblock after my knee injury. It's been a long and extremely frustrating path since then. My father passed away, my favorite activity vanished and I had to constantly deal with pain, even in every day activities. I've been to a chiropractor, an acupuncturist, an orthopedic doctor and a physical therapist. With all of that treatment, you'd think I would have made tremendous progress. I figured I would have been back on the bike months ago and out there mashing with rest of em.' Unfortunately that hasn't been the case at all and in fact, I have little to show in terms of progress in recovery. 

I've also spent countless hours scouring the net for any leads on a cure for this ailment. As is the case with virtually every other subject (especially the medical variety), there is such a wide range of opinions on the subject of knee injuries, that it can be at the very least, an extremely daunting endeavor. To add to that, the knee in particular seems to be an especially elusive body part to understand. With all of the progress I seem to hear about being made in the medical world, I am constantly surprised by how little is known about the causes and proper treatments of knee injuries.

While this blog has been mostly for me to document my cycling related experiences for myself, I'm hoping that as I re-focus my attention on knee injuries, that hopefully some of the information I document will be of use to others who are looking for answers.

And unfortunately, even with all of the information I've accumulated, I'm still not very far along in terms of recovery. I still can't really ride my bike without pain, and often have pain even from the most mundane activities. That being said, lately I've been closing in on some possible new treatments, and once again I'll push on ahead and hope that they work.