Yes, kind sir, she sits and spins

I find myself at an odd confluence of events today. I hope that you know me well enough by now to know that although I pay attention to my body and appearance, I’m far from obsessesed with the Western standard of beauty for women. It helps to have realized it is unobtainable for me.

However, I am starting to think that the pregnancy weight I put on with Thane will not actually come off by itself. Call it a hunch. I would like my maintenance weight to be the weight I was before I started procreating lo eight years ago. This is a matter of 25 pounds. I believe this is achievable, having worked my way back to it before between the boys. So when my husband asked if I would join him in this diet he’s done a ton of research on, and which he has found efficacious before, I figured this was a good time to attempt the challenge again.

The diet is a called the Slow Carb Diet and is more or less a geek’s attempt to optimize weight loss. In some studies, it’s been shown to be more effective than other forms of diet. My husband did a ton of research on it. The basic concepts are this:

1) Eat all low glycemic index foods: lean meats, vegetables and legumes
2) Eat no high glycmeic foods: any form of carb, fruit, diary, sugar, sweetener. Any food that “comes in white” is right out. (With exceptions).
3) Take one cheat day in seven and eat all the carbs you want (to prevent other cheating, and to prevent your body from going into starvation mode)

In practice this means that breakfast is eggs and beans (breakfast is the hard part). Thank HEAVENS I drink my coffee black! Lunch is dinner leftovers. Dinner is a compliant meal like split pea soup, cassoulet, black bean casserole, morrocan chicken, lentil soup…

Snacks have been the hard part. I’ve probably had more nuts than I should. Hard boiled eggs are great for this. Veggies with hummus become the culinary highlight of your day. My husband says the hardest part is that you get absolutely not taste of anything sweet with this diet. It’s true. Even artificial sweeteners are out. He says the flip side is that you “reset” your perception of sweet, so that a glass of milk or an apple seems deliciously sweet.

I’m on day three, and so far I’ve been compliant. We’ll see how it goes. I figure that an attempt is better than no attempt, and that the possibility of success is motivating. My weight is pretty stable, so once I’ve lost the weight, i believe I will be able to keep it off using more normal dietary constraints.

If you’re curious, here is some other information on the diet:
http://www.fourhourworkweek.com/blog/2012/07/12/how-to-lose-100-pounds/
http://gizmodo.com/5709913/4+hour-body-+-the-slow+carb-diet
http://www.npr.org/blogs/thesalt/2012/09/10/160757730/low-and-slow-may-be-the-way-to-go-when-it-comes-to-dieting


A few weeks ago, I had finally decided that my knee was far enough from right — nearly 18 months after massive knee surgery — I was not content with the condition of my knee. I can’t cross it. I can’t kneel. It hurts with the weather. And most importantly, the differences in strength between repaired left knee and normal right knee are more than obvious enough to be seen in my legs. They’re still working differently, and my body is pulled off center. Like weight loss, I’ve concluded this won’t fix itself. So I went to my orthopedic surgeon – expecting a PT prescription.

Instead, he gave me a prescription for spinning class. Greaaaat. Now, I believe that when you ask for medical help and advice you should consider it, and assuming it passes the sniff test, you should implement it. I suppose I shouldn’t have needed an orthopedic surgeon to tell me that I needed exercise for my knee, but apparently I did. Having gotten that advice, I treat it as sacred as a PT prescription, and decided that logistic impossibilities aside, I needed to comply.

In truth, I am really feeling the need for exercise. I don’t feel strong, or flexible, or powerful. I feel weak and fragile. My two mile a day walking simply isn’t enough, or the right kind of exercise. Of course, the flip side is that I truly do not know where I can find two hours a week to go to the gym. I will simply have to be opportunistic about it. But that is no excuse for not trying.

So I have signed up for a froo froo gym with a gazillion classes* and exercise equipments and the kind of strutting gym rats that have provided disincentives for unathletic, pudgy geeks like me since the gym was invented. Fortunately, I’m no longer 22 and do not care for their disregard.


So here I am, in February, with mounds of snow on the ground, on a wacko diet that means I can’t have Honey Nut Cheerios for breakfast and the kind of gym membership that everyone has and no one uses.

I’ll let you know how it works out!

*Critically, it has about 16 spinning classes a week and child care and is less than 5 miles from my house.

A year of zombie life

September 16th is one of the dates I remember. On September 16th, a year ago, I became a zombie.

Apple picking with knee brace
Apple picking with knee brace

The story is this: 14 year ago, I went skiing for the first time and snapped my ACL. Being young and dumb, I figured six months of limping was normal for a sprain. Then 18 months ago I jumped off a wall and tore my meniscii – both of them – badly. A summer of physical therapy, then I re-injured it and the MRI showed that I had massive damage to my knee. I was scheduled for an ACL replacement surgery and repair of both my meniscus.

I think that exactly this time last year I was fading in and out of consciousness, in and out of pain. I don’t remember that day too well. The rest of the week I spent ensconced on this very couch, an awesome ice pack circulating cold water over my bruised and violated knee. It was a long, slow, obnoxious journey back to (mostly) full mobility from there. I hated the crutches stage. I limped for months and months. Even now, I can feel that my knee is different than it’s partner on the right.

There are a few things I bring out of this experience.

First is gratitude. My new knee with its excellent function is a gift. There was a person who chose to be an organ donor. There was a family who affirmed that donation – in grief – after they lost that loved one. We all think about donating hearts and lungs and livers: the life-saving organs. But there is so much more than just that. There are tendons, eyes, skin – things that make life better. I carry a bit of my donor with me – and it carries me. There is a person who lives on, in some small way, in me. And I am grateful.

Second is also gratitude. It turns out that chronic pain and difficulty moving are mentally, emotionally and physically debilitating. Last year was one of the hardest – the worst – years of my life. This year has, so far, been one of the best. There is more to it than just pain and disability vs. no pain and ability… but that is a huge amount. It is salutary for the young and able bodied to see the world through other’s eyes. I’ve been fearful walking across slick ground in a way I never was before. That gives me sympathy and care for the octogenarians who always walk with such caution. I also being to understand the toll chronic pain takes on its sufferers.

Finally, there is the moving on. This appendage has taken up a tremendous amount of space in my psyche in the last year: with the pain, the fear, the disability, the limitations. But that’s pretty much over with. Now I have all this lovely extra space in my thoughts for new things, like guitar!

So that’s a wrap. One year later, I am signed up for the next Red Cross blood drive and saying, “Sayonara knee preoccupation!”

Lilac loveliness

Grey and Adam admire the nest. Thane tries to grab onto Adam's backpack.
Grey Thane and Adam admire the nest. Thane Grey tries to grab onto Adam's backpack.

It was a busy weekend this weekend – even by my criteria. There were about 6 loads of laundry, 3 sets of dishes, two lawns mown, a three year old’s birthday, two aikido practices, one jello mold attempt and one 60s dance party. And that was just Saturday.

Today after church, I decided the weather was so lovely that I had to find my way down to the Arnold Arboretum for my annual sniffing of the lilacs. It was glorious weather, and glorious sniffing, for all it was two weeks before the planned Lilac Event, with the warm spring my timing was perfect. We wandered, romped, rolled, rough-housed, sneaked, ran and sniffed to our heart’s content. I realized, actually, that this annual event last year was just about the last time I walked without limping in the last year. I was much better, but very nervous on the rough ground today.

Anyway, the pictures I took reminded me that oh! I have a camera! And I should maybe download the pictures on it!

So here you are: a few pictures from recent days!

Knee analysis

This morning I went in to physical therapy, walking flawlessly down the hall. “So what’s up?” my PT asked. “Funny you should ask….” He looked downright put out when he heard the extent of the interior damage. “Let’s retest you and get a new baseline.”

So I laid down and bent my knee. I straightened it. He moved it left and right, up and down, all around. Finally, he put his hands on his hips, “Are you sure they had the right MRI, because there’s no instability at all in your knee.” So it’s not just me… I really am super stable sans ACL.

Still, I have a big decision to make. It’s not ok for me to spend the next several years of my life never bending my knee. Moments like that dinner will happen again, and you know… sometimes it’s not convenient not to be able to walk for several weeks. So I’ve more or less decided to get surgery. I was sure pretty much from the get-go that I’d get the meniscal tears mended. The recovery time (as in normally walking) is 2 – 4 weeks on that, probably more like 4 since I’m having two procedures done. I can do both ACL and meniscal procedures at the same time. The recovery time for an ACL reconstruction is 4 – 6 weeks. Both procedures will require months and months – up to a year for ACL – of physical therapy afterwards. With the ACL reconstruction, it will be 6 months before I’m up to my usual habits as an elite athlete. (Oh wait…)

On one hand, I seem to do pretty darn well without an ACL. On the other hand, the “incremental” cost of an ACL replacement is 2 or so weeks from just a meniscal tear. I also save “incremental” physical therapy costs by bundling the surgeries. Additional data points to consider:

– not having an ACL makes it more likely I will tear my meniscus… which means this whole scenario could happen again
– meniscal tears make arthritis more likely
– I am pretty active. I like hiking and would enjoy playing raquetball.
– my children are 2 and 5 … a two year old is hard to manage with a healing knee

So my tentative plan is this:
1) Plan for surgery in mid-September. (I’d like to enjoy my summer, thanks!)
2) Spend the next two months getting my knee super strong and healthy to make my recovery period as short as possible.
3) Can’t help but wonder if it would be better if I could lose some weight. Of course, if that was easy vanity would have already accomplished it.
4) From mid-September, with say 8 weeks of serious knee instability, I’m likely to be walking well by mid-November. This means that by the time the snow flies, I should be pretty stable.
5) Six months from September means that by next summer I should be fully healed, and should be able to, for example, go backpacking.
6) Surgeries are done on Tuesday. I’d probably take the remainder of the week off (sort of depends on how I’m doing with pain meds) and then work from home for another week or two.
7) I’ve done some investigation on my dr. and hospital, and they seem middle of the road: not the best in the state but perfectly fine. Is that good enough?

There’s absolutely never a good time for a young, working mother to be out of commission for a month. But I do need to be able to walk, and this appears like a permanent solution (assuming I never, ever, ever go skiing ever again).

So I’m curious what you guys think. Am I missing a data point? Am I correctly interpreting the abbreviated recovery? Do I need to replace the ACL at all given the stability? What would you do in my place?

ACL? ACL? We don’t need no stinkin’ ACL!

I waited a long time in the doctor’s office before he came in. The walls were plastered with various problem joints: knee, hand, ankle; and the ways they can all go horribly wrong. I averted my eyes from diagrams of pins and screws and plates and fractures.

Finally, after a good wait, the doctor came in. “The more we look, the more we find!” were his opening, cheerful comments. “They told you about the ACL tear, right? Here, you can see it on the MRI.” (I could do no such thing.) Then he directed my eyes to several other locations on the screen, “You can see the roughness and tears in the meniscus over here. And over on the other side – that white spot is a cyst formed because your knee is leaking fluid. There’s another tear in the meniscus on that side. And see this bruising? This must have been from your recent fall. It will take quite a while to heal. We call that a bone bruise.”

At the end of the session, I have five things wrong with my knee, three of which must be addressed:

1) Completely missing ACL. He says I must’ve torn it 12 years ago when I went skiing for the first time, and I haven’t had one since.
2) Meniscus tear 1 (lateral) – from my recent fall
3) Meniscus tear 2 (exterior) – from my recent fall
4) Cyst – from the meniscus tear
5) Bone bruise – from the recent fall

The cyst and bone bruise should heal themselves – or be healed by treating the meniscus. But that’s not one, but two surgeries laid out there. I would have to get ‘scoped for the meniscus. The ACL recovery would be rather more involved, probably including a cadaver tendon threaded through my knee and attached at both sides. Recovery would be in the months – to possibly a full year before I’m 100% A-OK! And lots and lots of physical therapy. (Although there’s a good prognosis that 100% A-OK would be the eventual outcome.) I honestly don’t know if I am going to do the ACL surgery, or if I’ll do it now. Maybe 7 and 10 would be better ages than 2 and 5 to be out of commission for a few weeks. And if I’ve gotten this far without an ACL… do I really need one? I’ve apparently hiked the Wonderland Trail without one. On the flip side, they make meniscus tears more likely, and meniscus tears make arthritis more likely. I think Dr. Google and I will have a long chat about this, but there’s no rush. The doctor said I could be a triathlete without an ACL – running, swimming, biking are all ok activities. Basketball, soccer and side-to-side activities are a real problem. I’d probably need a brace for even hiking.

The meniscus tears are more acute. They’re the probably cause of my swelling and pain. And possibly I have them because I had no ACL to protect me. So I have consented to the scoping surgery. I’ll schedule it for after my summer vacation.

The crazy thing is that with all this bad stuff going on in my knee… I’m actually walking ok. Not perfect, but ok. I was walking almost perfectly, WITH all five of these elements in play. I can walk distances without harm. I have most of my range of movement. I’m just…. kind of scared of it all. It all sounds like a big, painful deal that will have me flat on my back for weeks. I mean, when I got really sick this winter I couldn’t even take a few days off from my responsibilities – and I could make it upstairs. How would I do with weeks flat down and months of weakness? I don’t have TIME for weakness.

So that’s the news. I suppose the bright side is, well, I’m wasn’t overreacting to this injury!

Update on el Knee-o

I went to the Orthopedic Surgeon today. (Actually, I went to the very nice PA who works with Orthopedic Surgeons and had about a billion times more time to spend on me than the surgeon did.) I explained my mysterious knee-malady. She agreed that the knee looked really really swollen. She pulled it and twisted it, trying to figure out where the boo boo was. The originally injured tendon was right about where it should be at 10 weeks of healing. The stiff tendon was fine. The swelling? Was downright mysterious.

Then, she aspirated my leg. NOTE: If you have problems with needles, do us all a favor and stop reading now.

They could've at least given me a Spiderman bandaid....
They could've at least given me a Spiderman bandaid....

OMG.

For those of you not following along closely with my entire life story, I have what we like to call a “high pain tolerance”. I gave birth without drugs – without so much as tylenol – TWICE. But I’m really kind of personally struggling right now. There’s this long-going knee thing and the back thing and the two-year-old-asserting-himself thing, and the constant feeling that I’ve completely fallen down on everything I need to do. I’m having a hard time. This, I truly believe, has an impact on one’s ability to tolerate pain.

First the PA pulled out a bottle of licodaine. This is a sign you will not enjoy your next 15 minutes or so. Then she pulled out two hugely ginormous needles with veritable vats of suction capacity. My confidence in my buffosity began to wane. The licodaine burned. Then the big needle. I won’t go into exactly what she did with it. Let’s just say that the licodaine was insufficient, I screamed several times, and at the end there was 30 ccs of clear yellow fluid in the syringe.

She’s sending the fluid into the lab to check for things I hadn’t thought to worry about (infection, lyme disease, gout). I’m also to be scheduled for an MRI so we can get to the bottom of this mysterious swelling. (She seemed skeptical that sitting with my knee bent had cause it, but by gum the correlation was so unmistakable!) She says my knee should feel better now that it doesn’t have 30 ccs of extraneous fluid in it. I’m still waiting for that.

But boy, am I out of cope. I hope the boys are superlatively behaved tonight, or they may find themselves headed to bed at 6:15.