The View from Sports Center

Chapter 14: March 2008

The month of March trampled over me like a one of my dogs romping through a flower bed. As I looked over my journal entries and a few of the earlier chapters, I could see that I was one busted up guy struggling to keep it together; keep working, keep showing up in life. I chronicled some of the March events in Crying with Christine and The Plan.

By the middle of the month, my daily pain levels were averaging about a 6-7/10 and sleep was between four and five hours a night. By the end of the month, the pain levels had dropped, although not a lot, to 4-5/10 and sleeping had increased to around six hours a night.

Below are a few more entries from my journal and as before, my comments are in italics.

Sunday, March 2, 2008

Right hip pain is still here...not sure how much better it is and it was a lot, lot worse yesterday...maybe I sat too much on Friday. Started wearing the V-Loc brace today. Maybe this helps...hard to tell right now...taking a few steps still hurts a lot. Really noticing the decrease in activity and how little I can do. When I read this, I thought, "Who is this guy? What is he doing?" Sadly, it was me.

Wednesday, March 5, 2008

OK, so the hip pain is better. I cut back on sitting. Started Celebrex too. Have more buttock than hip pain though. I set up a work station in the movie room at the bar so I can sit on the edge of a bar stool and get some work done. This seems ok. Still painful when I get up but not nearly as bad as sitting in the zero-gravity chair or a regular desk chair....feeling crunched by this sense that I should be doing more...working on something to get past this issue but not sure what else there is to do really. I can remember being surprised and feeling let down by how badly my good old zero gravity chair had failed me. I slid out of it onto the floor many times before I finally tossed a pillow in it and said good bye.

Thursday, March 6, 2008

Hip pain is definitely better...5/10. Had to sleep downstairs due to the flu, coughing, etc. Coughing hurts..a lot. So, having the flu right now seems like a double hit. I'm doing some drills in Sports Center but something's off...I don't feel much better.

I did two interviews re: the new project I'm working on. One yesterday and one today. Really tough to do because my hip hurts practically the whole time but I feel like I need to get these done..probably shouldn't be doing it...the car ride, the time sitting of the interview itself, the car ride home. Ok, so, this entry, when I read it, I laughed out loud. You know things are bad when you think a 5/10 pain is an improvement! And, the flu! I even had the flu shot!

Saturday, March 8, 2008

Really bad night. Woke up around 2:30AM with severe right leg pain..all the way down the leg. Got up and tried to walk around but I couldn't...got back in bed but couldn't get comfortable..pain was high 8-9/10...I laid down on the floor, prone but couldn't stay there. My leg hurt too much. Got up and put on the V-Loc brace. Felt a little better. So, I tried lying down on the floor again, prone. This time, I could do it and the pain only went into the thigh. So, I went downstairs into the movie room, climbed into the recliner on my right side and fell asleep for an hour or so. But around 5:30AM, the hip hurt too much and I had to get up....might be a really long day...

I had another interview yesterday and am supposed to have one tomorrow but I am going to cancel. I can't keep doing this.

Do I need to see Gordon? This was the start of just a crack in the denial armor.

Sunday, March 9, 2008

A better night, thanks to Vicodin. So far, the day hasn't been too bad. I don't sit at all and avoid bending, stooping, etc. Still wearing the brace. Christine came by and had dinner with us. We talked some about my injury, how I was feeling. She thought that I should open up more emotionally; that the more upset I became, the less I showed it. I told her how Ross had asked me if I was angry and that I wasn't or at least I didn't feel it. So, later I thought about it this some more. Am I really angry? Sad? - yes. Grief? - yes. Maybe even a little depressed - yes. But, while reading "Emotional Resilience", I learned that feeling depressed comes from the energy drain of unexpressed anger. So, where's the anger? Why don't I feel it?

So, I did some research on anger and found that frustration, irritation are mild forms of anger. And, the best way to process it is at the time it occurs..if you don't express it, feel it, anger turns inward...leads to depression and lowering of self-esteem.

Tuesday, March 11, 2008

I saw Gordon today. I felt really bad in his office. Seemed like it took forever to get out of the car and into the building. A couple of reflexes were really slow..maybe absent. One of the muscle tests hurt so bad I actually shouted and it wasn't anything elegant either...went over the MRI...herniation and it looked huge to me..we talked about options including surgery and I really don't want to go there...I was scared after I left his office. I think the magnitude of the disability really hit me right in the face when i couldn't complete the exam, couldn't put on my shoes, and almost couldn't get back in the car.

Saturday, March 15, 2008

I woke up at 3:30AM with right hip pain...had trouble getting back to sleep. I nicked my nerve yesterday at Sports Center getting off a piece of equipment and then again right before I went to bed. I leaned over to kiss Ellen good night and felt a jolt of pain run down my leg. When that happens, the pain lingers, it's almost like it's vibrating, for a long time; usually hours.

So, the pain in my hip is a lot worse today. And I have a lot of leg pain. The whole leg. I'm tired...trouble focusing...can't read or work on anything...my mind feels like it's got a ton of sludge in it. Finally realized, sitting is out. Have to make notes lying down.

Sunday, March 16, 2008

Feeling a little better this morning but leg pain woke me up again around 3AM. I didn't have to get up though; guess that's a win. I feel better mentally today like I can actually think. Not as tired and feel more optimistic. Might even try to get into a pool.

I still hurt but I noticed that I can bend forward while sitting in a chair and tie my shoes. Problem is I can't put them on; can't cross my legs and can't put on socks without hip and leg pain and it's a nasty pain too. So, I just wear slip on shoes - some might call them shower shoes - and they look like the lead character, The Dude, in the movie "The Big Lebowski". I'm not as cool though. I'm starting to make some more concessions - shower shoes.

Tuesday, March 18, 2008

Bad night again..awake at 3:30AM with right hip pain. Could not get comfortable. Had to get up. Good news is that the symptoms go away fairly fast but the bad news is, I have nothing to do. Just hanging out at 4AM is not fun. Giving some thought to the inversion table. Lower pressure on the spine, can do it anytime, and would give me something to do at 4Am. Could even meditate in it.

Wednesday, March 19, 2008

Tough night. Lots of pain. Stiff, sore, tight. Up at 2:30AM...not getting much sleep and that makes thing worse...the whole day feels lost, foggy, dull. Bought the inversion table. Spent 20 minutes in it. Feels good on the back and helps decrease leg symptoms.

Saturday, March 22, 2008

Bad night. Awake at 3:30AM with leg pain..had to get up...took a Vicodin and I hate that I have to do it but if i don't I feel like I might gnaw off my leg...I couldn't read in bed last night...leg hurt too much and it just got to me...I felt worn out, I hurt, and I lost most of everything I enjoyed and then some and now, I can't read. I cried....in bed. Can't remember doing that before...Ellen just hugged me and I cried it out. This was one of the worst nights for me. I didn't write much in my journal and even now it's hard to put into words what it felt like. It was a combination of feeling weak, vulnerable, fragile with despair or a sense of hopelessness.

Sunday, March 23, 2008

Horrible night. Leg pain was really bad. Got up at 2:30AM and then tried to go back to bed at 5AM. Have felt really awful all day...lower leg is burning, aching...lower back hurts...I have the chills...really tired. This day, combined with the night before, was the low point for me in the month. I was starting to really consider surgery. I wasn't sure I could take too many more nights and days like this.

Monday, March 24, 2008

Finally a better night..slept almost 5 hours. Had a second opinion - surgical - yesterday. He basically agreed with everything Gordon said except he thought if surgery was required, we could do a slightly less invasive procedure and he offered to assist with Gordon. So, I'm feeling better about surgery if I have to go that route especially having two surgeons in the room.

Wednesday, March 26, 2008

Slept almost 7 hours! Woke up with low level of leg pain...2-3/10...had a lot more leg pain yesterday because I sat too much. I had a two hour meeting and even though I got up some, it just is impractical to get up every 15 minutes when you're trying to make a point during the course of the meeting. I was basically selling a new concept I'm working on and you just can't do that by getting up and down..or at least that's what I'm selling to my self..maybe that's not true..but the thing is, I sat too much. The key to helping my spine heal is controlling the pressure on it throughout the day.

Sunday, March 30, 2008

I've had about four nights in a row now with better sleep...about 6 hours a night. It's not enough though...am really tired during the day...teeter-totter was a great idea...feels good while I'm in it and I feel like I'm doing something that will really help me and maybe it's the sense of control; that I'm doing it not someone or something else? My leg pain is better...around a 5/10 more often...and during the day, I'm able to control it fairly well...the night is the worst followed by sitting. I can control sitting; not the night.

For most of March, sleep eluded me. No matter what I did - medications, postures, supports, meditation - I couldn't get past 4 or 5 hours and those were not uninterrupted hours either.  Parents with young children probably know something about this - the sleep deprivation. Near the end of the month though I noticed an improvement and found that just one more hour of sleep made my day much brighter and enjoyable - but I'd be lying if I said things were great; that I was content with my situation and progress. I knew I still had a long way to go.

The questions in my mind were, "Will I make it? Can I get all the way back?" And, these questions were not at the front of my mind everyday. They were resting somewhere else in my head like a married couple on park bench smiling as they enjoyed the scenery. How did I discover this? Writing. Writing first about what I did that day, how I felt about it, and letting my thoughts just flow. Then, questions appear on the page as if I'm using some sort of Quick-Quote Quill from Harry Potter. It just happens.

The questions are still there but the answers are getting clearer.

Are You a Good Dancer?

These are a special pair of shoes that a parent wears while dancing with his or her child - from Finland.

It's one of those things that you stumble onto while doing something else (like working on Chapter 14 :-) and some part of your brain suddenly chugs into gear clicking and clacking away. Helping people overcome an injury, at least for some part of the process, is a lot like letting your kid stand on your feet while you dance. You need some regular sorts of movements, walk straight ahead, back, sideways, so you can once in a while throw in something unexpected. That's when kids laugh, right? They don't laugh much as you just plod along foot after foot. No. They laugh when you swirl, or surge, or hop, or take a huge, gigantic step.

And now that I think about it, isn't surprise one of the better things in life?

Are you working in enough surprising moments? Daily? Weekly? Monthly?

Chapter 13: February 2008

I started journaling, writing, regularly, almost daily, late last year after I read, "Journal to the Self" by Kathleen Adams (a great book by the way). Before then, I kept a digital journal of sorts, notes about what went on during a day, when I started my first rehab process for my other spine problem in 2003. But, I found that I just didn't enjoy it. It was hard to lug around a laptop and the medium isn't any good for things like an artistic rendering of how I feel about something - not that I am at all talented in that area, although it's on my list of things to do while I'm alive  - or if I just want to draw, in color, one word across the page in all caps. I guess I just don't want to be constrained. A lot of life is like that - constraining. You have to do stuff, go places, be a certain way, look a certain way. I just wanted some space to NOT be a certain way, think a certain way, talk a certain way. Just be. So, enter journaling.

Just about everyone I talk to about this has the same initial reaction: "Aren't you worried that someone might read it?" And, I guess that is one of the things you have to get past. But, let's be honest. If someone is reading your journal, there's a good chance that your either dead or very incapacitated so you can't do anything about it anyway. Besides, the benefits of writing completely outweigh the worry of someone reading my thoughts and ideas after I'm gone. But, it took me a while to get to that point though. While I was enrolled in a writing class a couple of years ago (you didn't think I got this good all on my own now did you?), I asked Ellen to promise me that if something happens to me that she wouldn't let anyone read anything on my computer because it has all sorts of unfinished, raw, ideas, stories, articles, etc., and I couldn't bear the thought of people reading unfinished work. She said, "Trust me - that's about the last thing I'll be worrying about. I'll be looking for passwords to all of our on-line accounts!"

Just in case someone stumbles across it though, I wrote in the front of my journal, in huge letters, "STOP. THIS IS PRIVATE AND AT THIS POINT YOU ARE EMOTIONALLY TRESPASSING. CLOSE THE BOOK NOW."

I even named my journal, "Probitas" - Latin for honesty. If nothing else, a journal should be a place where you can be completely honest without worry of retribution, abandonment, ridicule, or conflict, among other things. The more you journal, the more your journal becomes your friend and sometimes, the only friend you have.

Here's what I wrote in the opening pages of Probitas from last year:

"I strive to be honest with my self and others; to be kind when I'm honest; to be true to who I am. I want to be clear, confident, calm, solid, and fun to be around but always aiming to be true and honest."

I've learned that what I wrote is a really tough thing to do. But, I also learned that just by trying, by re-focusing your self to those things, you change. It's a moment to moment thing though. I know that I can be self-centered, clothed in layers of denial, hiding from the truth, afraid to feel and say what I feel but that is just a moment. Later, I can change and I change by facing and acting on my intentions - the things I stated above. The more moments I string together like that, the closer I get to being me.

To explain the process of healing, what was in my head, how I felt about things, I have included selected entries from my journal starting right after I returned from the ski trip and first felt symptoms. If I have added my thoughts or reflections, you'll see those in italics. I decided to use a daily entry just like my journal. If you've been following this journey from the start, some of the entries will sound familiar but before long, you'll be in entirely new territory.

The next several posts will be like these - journal entries with some interpretation or comments - leading up to the present day.

Monday, February 18, 2008

Since last Wednesday, have had right hip and buttock pain. Mostly when I sit and getting up to a standing position. I'm fairly sure this is from the fall I took skiing. Seemed to be getting better but on Saturday, the pain really spiked. I can't stand up. I'm crooked. Can't walk for several steps. Sleeping seems ok though which is weird. Haven't exercised since last Tuesday so I may need to go into Sports Center or over to Ross' place to get the loads right. Can you tell that I'm already living in denial? I can't walk, am crooked, can't stand up, and what do I do? Try to solve it on my own and without any idea of what I'm trying to overcome. This is a great example of how powerful denial is: it blocks you from reality. This gives you time to come up with answers and solutions but often the denial goes on and on.

Wednesday, February 20, 2008

Started some meds for my back issue yesterday..a Medrol Does Pak that I hadn't used for something else..an illness I think. I think I'm better...but I can't sit and standing up is just really bad, nasty.

Saturday, February 23, 2008

Right hip pain was worse yesterday. Cramping is bad, tight, sore, This sucks. Have to go to the clinic..get on the Newton...can't walk. Medrol hasn't helped much. Ok, so, this is a little over two weeks from the injury and oddly, on this same day, I met Christine up at Sports Center to talk about a possible project on helping clinicians deal with clients who are in denial and how to best manage the emotional elements of injury! And, I am smack in the heart of the very thing we're meeting about!

Later that same day: Cannot keep my mind present at all...totally consumed by pain...why is there...what is it..how long will it be there...as hard as I try, I cannot be present. My mind flits back and forth from the pain to something in the distant future...back and forth...

Tuesday, February 26, 2008

Sleep was fair. Right hip pain woke me up...couldn't get comfortable...had to get out of bed but really hurt...couldn't stand..had to hold onto the bed and just sort of wiggle my leg around and put some weight on it...not good. Another odd combination of events: I was also reading MINDSET by Carol Dweck.

Friday, February 29, 2008

Didn't sleep well last night at all. Got to bed later than usual...hip pain woke me up at 4AM...haven't exercised in a couple of weeks and I can already feel the worry monster about gaining weight...Maybe the right hip is better..not so sure...feels really in the joint though...maybe I hurt the hip too? Am starting Mobic. Went to the Sports Center Hall of Fame party last night...what a great time. It was just so awesome to hear the stories of how people's lives changed from the things they learned at SC...I stood all night...completely did not trust sitting, well, actually getting up from sitting, but standing isn't so hot either at least for three hours or so. As you can probably tell, I'm still not really seeing what is going on with me. I think I'm better but am worse at the same time. I'm just trying stuff - meds, positions, whatever. I can tell you that at the end of February, I was miserable. Not sleeping, hurting a lot, worried, but was also keeping all of that stuffed inside of me which I think, in retrospect, amplified the problem and the pain. My mind and body were ramping up the volume but I refused to listen.

When Less is More

I may be in the minority about this, but the kind of exercise you need for something like knee pain depends on why you have knee pain.

The kind of treatment you receive for heart disease depends on the nature of the disease; the kind of treatment you receive for a loose shoulder joint depends on why the joint is loose. Seems logical to me to conclude that the kinds of treatments (exercises) you receive or do for knee pain would then depend on why your knee hurts.

Like I've said before, pain is not THE problem; it's A problem. So, just because the front of your knee hurts, doesn't always mean that making your muscles stronger will solve the pain. It might, if you're lucky, but the less fit your are, the longer you've had the pain, the less likely that something like the exercises below will help for the long term.

One of the main problems is gravity. Climbing stairs, squatting, kneeling, sometimes walking, or practically anything where you apply force to your leg often turns into a frustrating and painful experience. The force or load of the activity on the tissues of your knee is greater than those tissues can take. The result is that you hurt.

Ok, so you might be thinking, "Well, then if I make my muscles stronger, then I should be able to take the force of gravity; the force of going up a flight of stairs."

Well, here's why just trying to strengthen your muscles often fails to deliver significant functional change; like climbing stairs, squatting, jogging.

One of the main reasons people have knee pain is due to osteoarthritis of the knee. This is a condition that causes a weakening of the cartilage that lines the end of the femur (thigh bone) and tibia (shin bone). The cartilage is weak, thin, frail, and fails to provide sufficient protection for the bone. It's like having lousy shocks on your car.

Now, some people don't believe that you can actually strengthen your joint (cartilage) despite the evidence that you can. What we have suggested for many years, it'll be over 20 for me, is that joints respond best to a load that matches what the joint can tolerate. For joints with osteoarthritis, the concept is No Pain, Gain. So, if squatting down to sit in a chair hurts, it's not the squatting that's the problem. It's the load that your knee joints must carry during the squatting motion. If you weighed less, and I'm not suggesting the solution is weight loss, although sometimes that would be a really good idea, in almost every case, your knees won't hurt. Now, something else that's very cool about joints is that when you perform squats at a level of force that the joints can tolerate and are consistent with the exercise (we like to use a Total Gym for this), the joints respond; they adapt, become stronger, sturdier, and can tolerate more force. Strength training for joints is a different kind of exercise regimen than strength training for muscle. When you try to use a level of resistance that muscles need to get stronger, osteoarthritic joints hurt and don't adapt. Instead, joints want less load, more motion and what you'll get is less pain and more strength and function.

Don't buy it? Well, this idea of reducing load during exercise to reduce knee pain in people with knee osteoarthritis was recently studied in two groups of patients: one group exercised in water while the other exercised on land**.

Care to guess which group had more pain relief and better function?

For osteoarthritis, less load, more motion will usually translate into less pain and more function.

P.S. Guess who else needs to know this.

References:

* Lu, Tung-Wu LU, Chien, Hui-Lien, Chen, Hao-Ling. Joint Loading in the Lower Extremities during Elliptical Exercise. Medicine & Science in Sports & Exercise. 39(9):1651-1658, September 2007.

** Jamtvedt, Gro, Dahm, Kristin Thuve, Christie, Anne, Moe, Rikke H, Haavardsholm, Espen, Holm, Inger, Hagen, Kare B. Physical Therapy Interventions for Patients With Osteoarthritis of the Knee: An Overview of Systematic Reviews PHYS THER 2008 88: 123-136

The Painster

Juli, my father-in-law's girlfriend, painted this for me after reading my description of pain in Chapter 7. It's brilliant.