Monumental past few days!

As I was updating my friend, Jane, of my recovery today over email I realized how monumental the past few days have been. Here's what I said:

"Holiday was good. Alon & I went down to Minturn (just past Vail) and spent time with his Aunt, Uncle, and bazillion cousins. Felt really good to get away and the long break was just what the doctor ordered! ...this was our first departure from Boulder in over 3 months.

"I am doing great! Last week had its hiccups, but I finally feel like I am fully transitioned to 100% weight bearing and using one crutch without much pain (still working on strength, balance, and stability). I still walk kinda funny, but we'll work on gait mechanics in PT [and in the pool]. I also took my first shower STANDING UP while we were in Minturn, so that was exciting... and made it to the second floor of BCAP for the first time this morning."

In addition, I made it out to coffee shops (Atlas and Trident) THREE times this weekend. THAT really makes me feel like I am getting back to my old self again. HOORAY!

Right now I am listening to Billy Joel's "We Didn't Start the Fire" and that also just adds to my good feelings and excitement to keep carrying on like a bad ass! Who doesn't want to dance when they here that song? :-) For your viewing and listening pleasure: http://www.youtube.com/watch?v=eFTLKWw542g

Going to 100% ain't so easy

So this week I started transitioning from two crutches and 50% weight bearing to one crutch and 75-100% weight bearing. Day one of walking about with two crutches and 75-100% weight bearing was not painful, but by evening time my knee was very swollen. The next day I awoke to more swelling and stiffness, particularly around the top of my shin bone and knee cap, and pain on the lateral side. No fun. Called my doctor just to notify her, and the advice was to back off, ice, elevate and try again in a couple of days. 

This past week continued to be difficult to keep swelling at bay while trying to increase weight bearing. So, for just a few minutes here and there through out each day I would try harder with one or both crutches. Again, there usually wasn't pain when I would walk but swelling would ensue later on.

Overall, I'm taking 1000-2000mg of Tylenol each day and rubbing some anti-inflammatory ointment on my knee which seems to help. Also ICING and ELEVATING! A few times a day every day this week, whether I am home or at work or at someone's house. It helps with any pain I have and certainly the swelling.

Today, I hobbled around mostly on one crutch. The foot pain was by far the worst today. It felt pretty awful since last night and this morning it was just as stiff and soar and painful. Walking on it sometime (in the past) would help loosen it up, but today it was just feeling worse. Oh well, I walked anyways, and as I did I said to myself, something like, "Foot, you are fine just stiff. Knee, you are strong and loose. Engage your quads and glutes. Press down off that toe, straighten your leg, and walk as normally as possible." That's a lot to say to oneself, but I was hoping it helped.

Also, I have been continuing my work outs. I took Wednesday and Thursday off, since we traveled for Thanksgiving. I was back at it Friday night for about an hour and a half (while Alon grocery shopped, bless him!). Today, since I walked so much and did more weight bearing, I will skip the gym (suggested by my PT).

Extension is still a challenge, though it wasn't in the beginning, it is now. PT this week got me flexing (bending) to 125 degrees, slowly and painfully. I was informed that my PT will continue until I can walk completely normally and do other activities like lunges without hesitation. Also, April (PT) said that she will continue to "bend me" until I reach 135 degrees. And that until I can comfortably and easily achieve 135 on my own, she will continue to work with me on that. All of this was very reassuring as I had a minor freak out, fearing getting booted out of therapy too soon. I was told this would not happen and not to even worry about that. Not that I have an unhealthy co-dependency with PT, but I see it as critical in my long-term recovery that I was afraid the "health care system" would "dismiss" me before I actually was ready. Not the case here. Sigh of relief.

Next week, or maybe tomorrow, I REALLY hope to do some pool therapy and work on my gait and body mechanics. Also, I want to increase my "shuffling" without ANY crutches, which I have been doing here and there, to perhaps fuller steps (no shuffling). This has been an awesome week in terms of fast turn around but also seeing the two steps forward one step back a lot too.

"Body Practice vs. Mind Practice": An Article from Elephant Journal

Freeing the Body, Freeing the Mind: Connecting Yoga and Buddhism

By Michael Stone

Source: http://www.elephantjournal.com/2011/11/freeing-the-body-freeing-the-mind-connecting-yoga-and-buddhism/

How can we use the body to study the mind, and work with the mind through the body?

Over the years, I’ve found it increasingly frustrating that Yoga is continually reduced to “a body practice” and Buddhism “a mind practice.” This makes no sense to me. Anyone who has practiced deeply in both traditions knows that the Buddha gave attention to the body, Patanjali the mind, and that both traditions value ethical precepts and commitments as the foundation of an appropriate livelihood. I organize a community in Toronto called Centre of Gravity Sangha, a thriving group of people interested in integrating Yoga and Buddhist practices.

In the Buddha’s teachings, the body is used as the primary object of meditation, so that one can study the universe not through books or theory but through one’s subjective experience. Likewise the Yoga postures, when practiced with breathing and sensitivity, become opportunities for deep meditative insight because they are designed to calm the nervous system. This grounds us. When we move within the various shapes of the yoga poses and tune into the internal energetic patterns of our breath, we are working the habits of mind as well. Though the Yoga postures we practice in modern Yoga studios have obvious therapeutic benefits at physiological levels, some teachers and schools seem to have forgotten how the postures also teach us how to work with the mind. And for most of us, our troubles are not simply in the body – primarily, trouble is in the mind. How can we use the body to study the mind and work with the mind through the body? By experiencing how the two are completely interrelated.

There is a fundamental affinity between mind practices and body practices. Think of them both as curves in a grand mandala that continually spirals in, on, and through itself with no beginning or end. When I work deeply with my mind, I only do so by giving attention to the body: I witness its processes, from breathing to listening or seeing. The same is true when I study the intricate holding patterns in the web of my body (called koshas in Sanskrit); I end up seeing where my mind sticks, where it can’t focus, where it gets caught in refrains of old tape loops. What I thought was “body” is mostly mental. The Buddha says “Leave the body in the body.” When the Buddha teaches mindfulness practices, he begins with the bare awareness of body.

“The old Indian practice of Yoga,” writes scholar Karen Armstrong, “meant that people became dissatisfied with a religion that concentrated on externals. Sacrifice and liturgy were not enough: they wanted to discover the inner meaning of these rites.”Turning inward means taking responsibility for the spiritual path by focusing on the microcosm of reality that exists in the body’s functioning in this and every moment. Although yogic practices can supposedly be traced back some five thousand years, and although yogins have described their paths and discoveries in very different terms depending on their respective cultural vocabulary, they all share the same common focus: the body is the primary object of meditative inquiry.

 

When we begin by taking care of the body and paying attention to its workings, we find ourselves focusing the mind, settling the breath, and learning much more about the nature of reality than we’d know by extroverted thinking alone. There are some things we just can’t figure out with ordinary thinking.

Just resting in feeling the sense of the body without any notions or concepts, we begin to tune in to the glorious operation of the natural world that is only available to a quiet mind. Of course, the mind is not separate from the body in any way – it is just a seamless continuation of the sense organs. We begin with the body because it is always present – it is the very apparatus we need to receive and explore any corner of the natural world. We use “the mind” to explore “the body,” but as we get closer and quieter, we come to see that mind and body are inseparable. The seeker Uddalaka in the Yoga Vashista, a story that interweaves Yoga and Buddhist philosophy, enters a remote practice place and begins practicing Yoga. After some time he exclaims,

Just as the silkworm spins its cocoon and gets caught in it, you have woven the web of your concepts and are caught in them.
. . . There is no such thing as mind. I have carefully investigated, I have observed everything from the tips of my toes to the top of my head: and I have not found anything of which I could say: This is who I am.

If we approach Yoga practices simply through books and words, and not direct contact with the physical and material reality of the body and breath, all we are left with is conceptual scaffolding. We can’t know these practices from the outside. They were never meant to be mere philosophy or codified ritual. Knowing about practice is not enough: we must drop our “knowing” and feel our way into present experience by seeing things clearly. By seeing, the old yogis are not referring to the eyes but to what the Zen tradition calls “the true dharma eye” — the eye that sees without clinging, without sculpting, without allowing what is seen to get stuck into the web of like or dislike. The spirit of Yoga and Buddhism embodies a radical approach to human experience — we begin practice through paying attention to what is here in this moment. Each and every one of us can wake up without needing to adopt a new ideology or belief system. When we return to present experience through the sense organs themselves — eyes, ears, nose, tongue, skin, and mind — we enter the freedom of this very moment, and the old paths of the yogis come alive here and now. There is no freedom in just repeating the words and rituals of the old masters — we must express freedom and interdependence through the action of our whole being and community through mind, body, and speech.

Every morning we wake up under the same bright northern star the Buddha saw when he awoke one dawn in his early thirties. Every moment we breathe the same molecules of air that once nourished Santideva, Dogen, Thich Nhat Hanh, your parents and their parents. Perhaps practice also fulfills our responsibility to the yogi-poets and wanderers who long ago struggled with aging bodies, unreliable thoughts, and an imperfect culture. They took great care in putting together words and phrases to articulate their path: they tried to leave maps for us, so we can enter way life happens in a way that motivates us to meet reality in an embodied and creative way.

Michael Stone is author of Freeing the Body, Freeing the Mind. Visit him online at Centre of Gravity.

Update: Week 12 (the three month mark... Yahoo!)

Monday

Met with my surgeon, Dr. Fulkerson, this afternoon. Alon came with me. In a nutshell, Lauri said"...I am so proud of you and so happy for you. You have made it over the hump. I am not going to have to go in and scope out any scar tissue. You are going to be fine. Keep working as hard as you have been."

She was very pleased with the fluidity with which my knee could bend and move (to about 115 degrees) and confident with my progress. The reassurance and feedback was very validating.

We all sighed with relief and Lauri gave me a very tight-lipped, reassuring smile and head tilt of "job well done". It was wonderful. I gave her a high five! You can tell she was also pleased that her hard work in surgery did not go to waste.

I was approved to weight bear at 50% (two days ahead of schedule). Do that for 7-10 days. Then doc said go to 75-100% with one crutch for 7-10 days. She gave me the leeway to trust my body and mind and take an extra day or so to transition where and when I need to (within the range she specified).

She also cleared me to go swimming, hot tubbing, and take baths! Yay!

Also, Dr. Fulkerson said the stabbing pain and soreness on the medial side of my left knee is likely a result from scar tissue. The scar tissue has built up significantly on the lateral side (where the tibial plateau was crushed) and where part of the incision is. This is pulling my knee cap slightly to that side causing some of that pain on the medial side. 

I also told her about the "figure four" resistance exercises that I am doing with April (my PT). We started those last week. That exercise works the muscle from the inside of my left knee, up the thigh, across the quad, and diagonally over to the IT band. That, along with weight bearing is likely the trigger for the knee pain. 

Lauri said if any consistent pain surfaces on the lateral side to let her know and that is of concern because that is where the majority of the damage was. Right now, I just feel some tenderness where the hamstring and quad attachment points are along the thigh. So I think I am in the clear right now as well.

I will see her again on December 2nd. We'll take more x-rays then (no x-rays were taken at this last visit).

Made it to the gym at 9:30 at night for a 25 minute work out. 15 minutes on the bike and 10 minutes of foam roller (on IT band, hamstring and calf) and some quad sets/extension stretches. It was a hard day and I felt like crap when I went, but glad I did.

Tuesday

Kicked some booty in PT: bent to 120 again. Grudgingly. I still cried on like the last 2 bends. It is still just so damn painful - all over the place. From the ankle to various parts of the knee, calf, quad, hamstring, and of course low back - which eventually relaxes as I begin to relax into the pain and try to let it go. I only took the 500mg of Tylenol before this session. The flexion/extension with April was slightly more painful, but I did not feel the "drug fatigue" that I would have felt had I taken the oxycodone. I think I'll save those for bed time (as needed). I was completely wiped out come 6:30, so Alon and I order Thai. I ate - quickly. Took a hot shower - slowly. And was in bed by 8:40. Took valium to chill out the overall soreness and pains in my knee. Asleep by 9:30. Zzzzz.

Wednesday 

Worked another long-ish day: 5.5 hours. That feels about perfect to me. Anyways, rested for a bit afterward but within 20 minutes of being home and literally putting my feet up, I could feel my leg start to stiffen and cramp. I went to the gym promptly doing my full routine. My knee, leg, and low back felt very loose while biking today. The rest was "routine". Might try swimming and hot tub tomorrow evening with Alon.

Thursday

No go on the physical activity today, outside of going to work (another 5.5 hours). Felt pretty tired, swollen, and soar with bouts of stabbing pains in my knee. All "normal". I was blessed with a very nice massage and girl-time from my friend, Bree. That was by far the highlight. She is awesome. I wish we could find more time to spend together. Anyways, despite that I still took a bunch of meds before bedtime (which was about 9am) = 500mg ibuprofen, 325mg Tylenol, 5mg oxycodone, and 5 mg Valium. I was out like a light... till about 4:30/5am. This seems to be the norm for the past couple of weeks - the waking up at 3 or 4am. Fortunately this time, I only stayed awake for a short period of time.

Friday 

Worked a solid 5.5 hours, sluggishly yet productively. Good to know I can still get things done :) Bumped my PT appointment to 4pm instead of 4:30, hoping that I will have a slightly increased reserve of energy. I took a 5mg Valium before the appointment to chill me out during the "bending" portion of PT - because I can get pretty worked up physically, mentally and emotionally - and ESPECIALLY when I am as tired as I am. I guess it kind of worked. Progress in that regard was 123 degrees of flexion. Extension is getting harder (to be expected with continual progress in bending). So two tricks I was taught this week with that one is to lay down, face down, on the bed, legs hanging off the edge of the bed just above the knee. Sounds yucky, right? Well, if my knee is not even close to hyper extension because of all the scar tissue, this exercise is fine. The other trick is to prop my foot up about a foot with my leg extended straight and just keep relaxing the leg and knee. Hold this position for about 5 minutes (same as the other one), and then come back to bending. Both feel excruciatingly painful in the end, BUT absolutely essential to get and maintain full extension in my leg. I did take 1000mg of Tylenol today. Seems a bit over the top but at this point my liver considers that a break. There is a pot luck at my friend Katrin's tonight. I hope I make it, but it's not looking good (energy-wise). There is the whole "mind over matter" thing, so who knows, I could get a second wind! This weekend is all about RELAXING and RECUPERATING. Boulder may get a good deal of snow Saturday, so I am hoping to cozy up inside, drink copious amounts of tea, read and maybe do arts and crafts, and grocery shop if I absolutely have to.

That last paragraph was a complete stream of consciousness but I don't feel like editing it and organizing it. This is after all, more a like a journal sometimes than anything else. I learn something about myself, and maybe my reader picks up a thing or two as well.

Take care and love to you all.

The Down-Swing to the Up-Swing

That sadness and fear and weakness that I pushed back during physical therapy on Friday seemed to resurface Saturday evening. What a surprise. 

The sharp, frequent, stabbing pains through the medial side of my knee were really getting to me. They've been happening with more frequency the last couple of days. I am certain it is from increased, constant weight bearing at PT from Friday. 

I had a somewhat "full" day Saturday with out over doing it, I thought. Started the day with a lovely Skype session with my brother Mike and his girlfriend, Alicia, in New York. Got a quick and tasty breakfast burrito at Illegal Pete's with Alon. Viewed an apartment (with a billion stairs and down branches everywhere). Scooted around Whole Foods with Alon (me: in a power scooter that could literally turn on dime, a 1000 times better than the Target version). And in the afternoon, I finally sat for about two hours while I got my hair colored. I decided to take the day off from the gym/PT. I was feeling fatigued since I woke up but decided to continue activity at a relatively slow pace, checking in with myself (did I want to go home and sleep or go grocery shopping with Alon? for instance). By late afternoon and night time, I was completely beat, a bit cranky, and the pain had not subsided at all despite 1000mg of Tylenol since morning. Alon and I cooked dinner and watched two movies. I iced my knee a bit, later on putting heat on the medial part of the knee. I was trying everything.

Did I mention Boulder was experiencing 60+ mph gusts yesterday? Today it's not so bad, less wind up, but still up there at probably 30-40 mph. Anyways, that kind of wind always makes me feel unsettled, even on a good day. And surely challenges my stability (physically and mentally) while on crutches.

As I write this and reflect more on my day yesterday, I realize, "Shit. I did not actually take it very easy." Well, I tried. I did go slowly, if that counts. The conversation I had with myself yesterday was "If I went home I would be letting the fatigue win and probably feel sad or something." 

I was starting to have regrets later in the day that I didn't go to the gym, since I was feeling so crappy. Alon reassured that I was fine and it was probably an okay thing to do (and it was).

The balance I was trying to achieve was activity without increasing my pain while not giving in to fatigue. That's hard!

By night fall, as I tried to stretch and massage my left leg in bed, I wept. Whether it was pain, fatigue, or frustration that set it off. There I was, crying yet again. Oh well. It was, again, cathartic. I remember yelling (in a nice way!) to Alon in the other room, asking if he could please put away the left overs from dinner. He was like, "Sure." Here's the straw the broke the camel's back last night: the fact that I couldn't do it; I couldn't muster up the strength to crutch to my wheel chair in the other room, put down the crutches, wheel into the kitchen, put everything away in Tupperware, clean up, and put stuff in the fridge. It was just too much. There's got to be a word for angry-self-pity-weakness-discouraged. That is what it felt like.

Anyways, that was my moment last night. The down swing to the up swing.

I woke up with a headache this morning. Scarfed down a bowl of gluten-free granola and drove to the gym, where I proceeded to do rehab work out. I felt good about getting there and that is was the right thing for my body and mind. I was still very stiff and sore when I work up. The work out did help with that. The interesting part again was the first few minutes on the bike. I just cried. Discretely trying to wipe the tears from my cheeks. I focused my pain, tiredness, weakness, and frustration into the healing process and strength of my leg. I listened to some good music in my headphones and 15 minutes went by on the bike. I continued with the rest of my work out and headed home about an hour and a half later. Slightly less tired, slightly less pain.

Update: Week 11 - Mind Over Matter

Mind over matter:

In no other instance was this truer than a shared experience today during my first half hour of physical therapy with April and Alon.

I was bending at 116 degrees. We'd done it three, maybe four times. We'd been going for about 15 minutes or so, of bending and extending (straightening). Sharp pains increasing like daggers stabbing through the side of my knee. The knee began to tighten. Mentally I started to feel weak and tired. (I was actually tired going in - I think the oxycodone I took an hour before hand was making me feel fatigued. I may skip it next time, since the only time I seem to take them is right before PT). My hip was lifting off the table. Then I could only get to 110 degrees or so. Frustration and weakness set in. The tears began to fall. My breathing got short. April reminded me to stay calm and try not to get anxious or down on myself. Alon demonstrated deep inhales and exhales. I mimicked them.

"Don't let it get to you!" I thought to myself, then said it out loud. 

"Acknowledge the pain and fear and frustration, briefly. Then, tell yourself to RELAX."

"JUST RELAX." I repeated over and over out loud.

"It's okay. Calm down. Relax into the pain. You're okay. Nothing bad is going to happen."

Then, we got to 116. 118. 120!

I actually felt relaxed. My body was laying in a somewhat peaceful state. My mind was somewhat peaceful as well. The discomfort and tightness in my knee and quad was there, but it was not unbearable. I was talking. Taking long slow inhales and exhales. LAUGHING EVEN. We were making jokes of some kind. I think I said, "Let's do it for all the American Soldiers!" (Being that it was Veteran's Day.) I was half-joking (at least Alon & April laughed) but also trying to find any inspiration or distraction I could to KEEP GOING and OVERCOME.

Bent at 120 degrees we held this for about a minute. I relaxed and straightened the leg (always painful after bending like this). Then back to 120, not two, not three, but FOUR TIMES. I was absolutely amazed. My mind and heart and soul had overcome the mental and physical barriers of pain, fear, weakness, and frustration yet again. Right then in a matter of moments.

It was some kind of bliss seeping through a sieve of pain and frustration from sheer will and determination. I felt liberated.

Update: Week 10 (going into 11)

So as of Sunday, November 6th I started weight bearing 25% of my weight, or roughly 40 pounds, onto my left leg. How this happens is I stand with my right leg planted on the floor and my left leg on a scale. I press onto the scale until it reads 40 pounds. Then I walk around trying to mimic that weight and sensation. I'll come back to the scale a couple times during the day to see if I am maintaining that pressure. It's hard! Usually I am at about 25-30 pounds when I think I am at 40. It doesn't hurt my leg much at first, it's mostly awkward and feels slightly unstable. 

I am also experiencing some of the "pins and needles" or tingling feeling in the bottom of my foot, mostly on the ball of the foot, towards the middle, and along the arch way. This happens as I walk and put added weight onto my leg and foot. It's normal. It means I am getting sensation back and re-establishing those nerve endings and pathways to my brain. It's uncomfortable, temporarily painful, but I just keep walking and the tingling tends to work itself out.

I am being mindful to not develop a limp in my stride, just keep it as smooth and steady as possible, which right now also means walking quite slowly. And I am trying to even out my hips as I walk as much as possible because Lord knows my left hip is rotated and a few inches (it feels like) higher than my right hip from holding the leg UP and out of the way for so long.

My low back gets a little cramped up from time to time, but mostly my body is holding up well.

I am still going to PT twice a week and the gym on off days - aiming for at least 4 days per week at the gym (doing the same exercises as I do at PT). I've had some struggles recently getting to the gym, from tiredness, soreness, etc. but once I get there I end up feeling 100% better! On that note, I encourage you all to get your asses to the gym or at least do SOMETHING physically active EVERY DAY. Your body will love you for it.

Last week's PT stats are as follows: added 3 different types of squats to the hour and a half session (ouch!)... good, effective, and tiring. My range of motion last week was something like 98-110 and 98-112. Today I went 98-116! And on my own, I could bend my leg (after some warm ups) to 113. That was incredible! I couldn't believe it. I really need to stop being so hard on myself and give myself some more credit... as stated by my physical therapist. She said I am making great progress, and to expect some harder days and nights ahead (again!) as I start to weight bear more and increase exercises and mobility.

I'm doing a lot more around the house - that is: cooking and getting my own meals regularly. Not so much cleaning, feeding kitty, or making the bed or anything yet because I'm just not that agile or stable on two feet yet. But the last couple days, I've given myself a bunch of extra time in the morning and I'm fed, with tea to go, and ready for work in about an hour and a half. The hot showers in the morning (with hot water on my leg) still really help loosen up my muscles and give me time to work on flexion and extension in a seated position.

I have a care provider coming just once this week and once next week (while I am at work) to do some house cleaning and cooking. Then, hopefully I will be back to my home routines... which at that point, might include shoveling snow! BOOO :(

Speaking of yard work, Alon raked the front and back yard this past weekend. I watched. I longed to just rake the yard. I really would have enjoyed that. God, it is hard to just not be able to do certain things like that. I am thankful for Alon and know I'll be back at it soon enough, but damn, I still have a good deal of sorrow and frustration some days.

The other day I had a dip in mood, feeling sorry for myself and what came out of my mouth, to my surprise, was "I can't believe this happened." It's true. I still can't believe it sometimes. From the wisdom and truth of my physical therapist April today, she said something like, "You gotta have those moments and let yourself feel it. But at the end of the day, where is your anger and frustration going to get you? (The answer: Nowhere.) Focus all your (my) energy on working hard, healing and getting stronger. Focus your energy and emotion right into the knee!" And that was the moment today when I bent to 116 degrees. Good stuff! Powerful. Our minds are our greatest barriers sometimes. This whole process is really about balance and awareness, in every way. Isn't everything?