Ragemaster

Yesterday, as I went to the laundry room to put my clothes in the dryer, I went down a small staircase.  Since I still have issues going down stairs, I made a conscious effort to descend properly and use my left leg.  When I got to the bottom I continued towards the laundry room, I noticed something felt weird in my leg.  I looked down as I walked and noticed that with each step that it was bending the way it was supposed to.  Bam -- just like that I went from limping everywhere to walking normally.  It was completely involuntary.  Before the staircase I was still walking straight-legged and afterwards I was normal.

Since then I've been almost completely normal walking everywhere.  A few times when I start walking I notice that I'm goosestepping again, but now I know what it feels like to walk normally so I quickly change my gait.

I have a feeling that this process is similar to what Dilbert creator Scott Adams went through with his vocal disorder.  Though I would argue losing your voice in certain situations would be much worse than limping, the "remapping" of an area of your brain happened more or less involuntarily.  Adams figured out he could get his voice back by rhyming and once he knew what it felt like to talk normally, he could speak much more easily.  Now that I know what it feels like to bend my knee when walking, I can do it on a whim instead of trying to force it and look even weirder than with the limp.

Tomorrow I get to try the regular stationary bike instead of the recumbent one.  Range of motion hasn't been an issue for awhile, but I still can't bend my leg all the way back without it getting really tight.  I can get to almost 150 degrees.

I notice that I'm starting to do things more normally, like bringing my leg up to tie my shoes instead of awkwardly leaning down to do it.  Going up stairs is fine, but I still have that initial worry when I go down them.  In Raleigh, just about everyone asked me about why I was limping, so I definitely have more progress to make in terms of walking normally.

At PT they are adding in more rigorous exercises for my hamstrings and quads and increasing the weight each time.  My leg looks like it is getting better, but it still is pretty small.  Every day I still do my normal free weight routine in the morning and do almost 30 minutes on the bike and elliptical later.  I've been adding a couple minutes a week to the elliptical/bike routine and it seems to be getting easier.  The bike doesn't hurt my quads as much but it still leaves me more sore after 15 minutes than I would have been before the surgery.  I figure about Thanksgiving I can move to the resistance trainer for my road bike and soon after I'll have enough stamina and leg strength to hit the roads for real.  The only problem with the road bike is my habit of crashing into the injured body part, making it worse.  I really don't want that.

It's interesting to watch the progress of everyone else at PT.  A lot of people have had knee replacements or surgery on their knees and appear to be going through a similar rehab process as me.  Today there was someone I hadn't seen before on crutches and was using the same passive range of motion machine that I had used for the first couple weeks.  It made me think how far I've come and how that guy will go through all the stuff that I've done and eventually be walking again.  A girl that's been in there a lot when I'm in there went from not doing anything to using the stair climber and elliptical, and is now doing the walk/jog on the treadmill.  A lot of the older patients with knee replacements I see gradually do more on the bike, but haven't done the elliptical or the stair climber.  The physical therapist probably tries to match their rehab with their ultimate recovery goals.  Running probably isn't something you can do on a knee replacement.

At this point I think I could just do most of the machines and exercises on my own in the rec center after biking or the elliptical.  However, I would need some guidance as to when to try the road bike and start running again.  From those that have made it back running successfully, they seem to start back at four months at the earliest and usually five months or more after the microfracture.  I could go off that.  I do know that I'll have to do the old walk/jog routine and probably wouldn't do it every day either.  I would also have to get some idea of how far I could work up to runningwise until it would be considered risky.  These are all things to keep in mind as I progress, but I still have a lot of time left before I get to them.

Halfway to running?  Another ten weeks and maybe I can try.

Today at the PT, one of the assistants put me on the treadmill and said I should go as fast as I can -- even run.  I guess he doesn't really understand what I've got, especially since the doctor was adamant about me not running.

The daily increase in weights and the addition of the stairmaster, leg curls, and leg extensions have started to help my strength.  As usual, though, my leg doesn't look any bigger.  I still have a limp when I'm walking since it seems that I've reprogrammed the walking part of my brain to compensate for the brace.  Now I've got to unlearn that.  Walking back from the office today, I made a conscious effort to bring my leg up bent, almost marching to try to get rid of the limp.  I felt better doing that but it still isn't anywhere near natural.

Stairs have gotten better and I have a hard time believing that I can go up and down them without pain.  When I see stairs, I see fear.  It takes a lot of courage for me to go down them using my left leg.  Up isn't so bad, but going down, before the surgery, was when I had all the problems.  It seems to be a huge improvement.

Over the weekend I was heading towards campus when I passed a group of law students.  One of them was talking about her knee and how she had been running on it for months with it bothering her.  It turned out it was a torn meniscus.  It sounded a lot like what happened to me, before the surgery, but tearing the meniscus has a two week recovery time from the surgery.  You can walk out of the surgery and go right back to running after a few weeks without any serious problems.  With knee injuries on the brain, I pick up all kinds of stuff about people getting hurt that I wouldn't have even thought of a year ago.  Tons of football players get into trouble every weekend and you hear about it on the commentary.  Like the girl I overheard a few days ago, I overhear all kinds of conversations about people and their knees hurting.  And, of course, at PT, there are plenty of people with knee problems, lots of them coming back from knee replacements.

Lately, I've really felt unable to get away from everything, that no matter where I go I've got to share my personal space with other people.  The smallest things are starting to bother me.  In the office, there's at least seven or eight other grad students around talking about stuff.  Outside there are mobs of tourists and other students -- I get asked for directions at least once every few days and someone always stares at me because of the brace or limp.  In my apartment, I've got to deal with my roommate and his fiancee.  Yesterday, I realized what was missing.  Running and biking somehow alleviated that "walls are closing in" feeling: it's hard to get mad when you're tired.  On the roads or trails there isn't anyone to bother me and everything just gets zoned out.  An hour of running or biking feels like three or four hours of doing work or reading or just messing around on the internet. Without it, days just whip by and I don't get the same sense of accomplishment.  Hopefully soon I will be able to bike more and I won't feel like I'm going insane.

Tomorrow I'm off to Raleigh for a conference and I'll see how it goes in an environment other than school.  I'm hoping there are bikes or elliptcal machines in the hotel so I can continue to work on my range of motion, leg strength, and just get in some kind of workout.

Today it was back to the orthopedist to evaluate my recovery process.  The PT gave me a letter to take along and I voiced my concern that the brace I've had to wear is killing my gait.  I've been walking around the apartment without it, but it's really annoying being out and about with it on.  It's hard to bend my knee when the brace is on correctly and it's even harder when I've got long pants on and it sags down my leg.  Finally, they let me take it off.  The brace did give my leg a stronger and more protected feel and now with it off I can really tell the strength difference between my two legs.  Hopefully I should be walking without a limp within the next few weeks.  So many strangers have asked me what I've done to myself and I've got to tell them at least part of the story.  A lot of them think I've torn my ACL, but at least with that, they can reconstruct it in the worst case and you can go back to normal, but for me the damage is done and will never be completely repaired.

The doctor advised me not to run, but at this point it's still obvious that I shouldn't.  Again, excluding the problem of damaging the microfracture area, my leg wouldn't last five steps of running before my quad would erupt into an inflamed mess.  I'm really starting to get sick of all these appointments and long periods at the physical therapist.  I understand that it's so I can get better, bike again, and maybe run, but it's really tiring.  I adapt to the increased weights and more bike/elliptical resistance, but the recovery process is mentally straining.  I remember being fed up with previous long lasting injuries where my coach wanted me in with the training room every morning doing the same kind of stuff.  This is like that but on a whole new level.

The PT still wants me to continue with them on strengthening and returning to nearly full range of motion with my leg.  Yesterday I got to 140 degrees, so I am getting there.  I know my teammate said he still doesn't have full range of motion in his bad leg.

There have been periodic arguments on LetsRun about the different articular cartilage repair methods, none of which are extremely robust.  It seems that most people on the message board and other boards that I've seen get microfracture for deep cartilage tears.  It's the go-to method for an attempt at repair since it's minimally invasive, has a moderate recovery time, and a good success rate compared to the other two techniques.  Autologous Chondrocyte Implantation is a new method where a small sample of your cartilage is taken out in an initial surgery, grown in a lab, and implanted over the defect in a second surgery.  They open up your whole knee to put the new cells back in and there is a ~2 year recovery time.  Apparently the cartilage is much stronger than fibrocartilage so it's better for long term results.  Most insurance companies don't cover it since it's considered an experimental procedure.  It seems that if this technique was improved/matured so that the recovery was shorter and became more mainstream so insurance would cover it that it would be a good option.  In the case where my microfracture doesn't hold up, maybe in ten years there will be a solid procedure to replace missing cartilage.  I've also heard of stem cell injections into the knee to help repair, but that seems almost completely unheard of and there aren't any proven results.

I finally got hold of my teammate who had microfracture on his knee a few years ago.  We talked for over an hour and I got an idea of what his take was on the whole injury->surgery->recovery process.  It was good to actually talk to someone that I knew that had this done to get an idea of where I stand.

I knew that he had some kind of knee issue that required surgery and a long recovery but I wasn't sure that it was microfracture.  It happened to him during the summer after my junior year of undergraduate while he was a freshman.  I remember talking to my coach over the summer about how everyone was doing and he mentioned my teammate as having some kind of major knee issue that had to do with the cartilage.  I remember returning to school and practice in the fall and seeing him do his therapy in the athletic training room.  Every time I went in there to get some ice or stretch, he was in there on the bike or doing some kind of exercises.  There were plenty of times I remember being in there and he wasn't having a good time or something was hurting and the trainers were telling him to take it easy; that there were good days and bad days.  Finally, I don't remember seeing my teammate doing workouts again until March of my senior year -- he started having issues in April or May of the previous year, so it was quite awhile before he was back to training normally again.

I didn't really think too much of it -- when I was healthy and running well I tended to forget about those on the team that were injured.  They went to the meetings at the beginning of practice and then I didn't see them until I was stretching or in the shower.  Usually I only really paid attention when someone I ran with regularly on maintenance runs or as part of a workout group suddenly disappeared one day.  I would be aware that they were injured for a few runs or workouts and then it would kind of slip my mind as I got used to them not being around.  Of course, when I was the one that was injured, which happened at least once per season, I always seemed aware of everyone else that was hurt.  We all spent plenty of time in the training room trying to get better.  Overall, I spent most of my worrying about trying to stave off or heal my own injuries. It seemed that some tendon or muscle was always about to take me out of the lineup, was in the process of keeping me from running, or trying to blow up again as I restarted training.  Of course, once one problem was on its way out, something else was desperately trying to start up.

Unlike me, my teammate said there wasn't anything that he remembered as the cause of his cartilage defect.  His doctor said he probably ran into something, but he didn't remember doing anything like that.  One day he remembered running a steeple race and being fine, and the next day on a long run the pain started.  It slowly got worse for awhile as our coach told him the problem was an IT band injury.  After a lot of stretching and no improvement he went in to see a doctor at home, which eventually led to his diagnosis.

His defect must have been more weight bearing than mine, as he said that it hurt when he walked, whereas mine didn't.  Like me, my teammate also had a lot of popping and locking in the joint with every leg extension.  Before the surgery, his doctor told him that the microfracture-induced fibrocartilage would most likely last about three or four years, enough to get him through his college career, but after that it might break down.  My doctor didn't really say this, but this short-term success seems to be the general assessment on the Internet.  He (and my PT) have said that the tissue will break down faster if I return to hard training, so I'm not really inclined to do that.

During the surgery, the doctor had to move my teammate's patella so that it wouldn't rub against the microfracture area.  The idea was so that bending the knee wouldn't scrape away the fibrocartilage-forming clot.  I was kept in a motion-limiting brace to prevent this from happening for the first couple weeks, but I didn't have my whole patella adjusted.  He said the defect area was about the size of a thumbnail, which seems to be smaller than the area I had that was more like two thumbnails.  My teammate said that he didn't have any pain in the microfracture area after the surgery but he could feel something in there sometimes.  Following the surgery, he was on crutches for about five weeks, biking at about two months, and then started running at about five months.  It was about seven months before running seemed more normal.  He also remarked that his leg strength didn't come back until nearly a year after the surgery and even today, four years after, the bad leg still seems smaller.  He still can't squat on his bad leg either.

My teammate remarked that I should really focus on abductor and adductor exercises which the PT really has me focus on.  It's one of the things I work on during my morning routine.  He remarked on this because he had a lot of tendinitis issues as he returned to running that would have been lessened with more leg strength.  Other than that, my teammate made it through the last two and a half years of his college career successfully and wasn't held back by his knee.  His mileage was high and he did all the workouts and raced well.  I remember running with him through some of the more treacherous trails around here last year, so I know his knee could definitely tolerate trail running.  He still ran 50 miles a week through the summer and is still doing well today.  It's great to hear that his microfracture procedure and recovery were a complete success and it's a good motivational tool.  Since I don't have to worry about burning eligibility or missing races, I can take it easy during my recovery and not force anything.  As I've mentioned before, just being able to run again to some degree will make my surgery a complete success.

Yesterday marked over two months since the surgery.  I've come a long way, but there's a long way to go too.  I'm now allowed to bike and elliptical on my own, so I took advantage of that today and went to the school rec center: 15 minutes on the bike, and ten on the elliptical.  This I did in addition to my usual morning weight routine which takes nearly 45 minutes.  It would be great to bike outside, especially since the weather is nice today, but I don't think I'm ready for that and won't be for awhile.  My leg still shakes with weakness after 15 minutes.  Also, it seems that my good knee has been hurting and popping some, which must be some kind of compensation problem.  I'm hoping it's nothing serious and just a mild consequence of putting most of my weight on the good knee, since the pain started when I was on the crutches.

Last night one of my old teammates who goes to dental school in Richmond came down to see the team massage therapist.  I dropped by while he was there since I hadn't seen him since the summer.  The massage guy, who punished and tortured me for so many years, had an interesting comment about leg strength that I hadn't heard before: your quads should be 20 percent stronger than your hamstrings.  That is, if you are on a leg press that works your quads, you should use 100 pounds if you are using 80 pounds on a leg curl machine for your hamstrings.  No wonder runners have so much trouble with knees: quads get very little action compared to hamstrings and calves.  Biking can change that, though.

My teammate's got knee issues like I do and has been out ever since dominating the Boston marathon last spring.  He really hasn't been able to run since then and an MRI indicated grade 1 or 2 damage to the articular cartilage.  That's where the cartilage is bruised or has a small divot in it, but not like my grade 4 where it's chipped out all the way to the bone.  He seems so motivated to run again and get back into regular training, but with permanent damage like that, it may not be possible.  Since his damage wasn't as severe as mine, the docs say surgery wouldn't accomplish anything, which leaves him out in the cold if the pain persists.  Hopefully most of the pain is caused by some inflammation from whatever he did and once that subsides he'll be able to run again, but if I were him I would change my mindset.  Right now, I would consider my recovery a success if I am able to run 20 -30 miles a week.  It's so bad because he was running so well and even got some sponsorship offers.  Maybe it's not as bad and he'll be out there kicking butt again soon.

It begs an interesting philosophical question: would you like to run the race of your life knowing that you would never be able to run again?  You would sacrifice everything to blow the field out of the water.  Your time and place would be so much better than you ever hoped it would be, but when you finished, you would never be able to start again.  Would that be worth it instead of having a lifetime career of running but only making modest personal gains?  I don't know for sure, but I do like running just to be outside and to feel like I accomplished something.

I'm finally making some headway on the latest school project.  It should be an interesting experiment since we will get to wear some sensors for awhile to test our model.  Since we are going to use human test subjects, my advisor blindly checked off some box about it when sending in the research proposal to the school.  Now they are making us fill out all this liability stuff and explain our exact test procedure when we aren't really finalized on everything.  And, we, the researchers working on the project, are the only ones who are going to be the subjects, so I think we are completely aware of any "dangers" that go along with wearing some sensors.

Lastly, I got home to vote absentee at the city municipal center when I was on fall break.  I got that taken care of since I'll be at SenSys on election day.  Really, I don't think either presidential candidate matches my choices.  Obama's tax plan raises marginal tax rates for those who make under $45k per year (poor grad student). McCain plans to freeze all research spending for a year after he enters office.  Obama hasn't even finished a full term in the Senate; McCain is going to be 80 if he gets elected for two terms.

Both have the wrong idea on the economy.  The problem goes beyond government regulation or lack of it.  It starts with individuals.  A lot of people today are lazy and want everything for nothing. They want the car and house they can't afford, so they go into credit card debt and default on their mortgage.  They want the college that puts them $40k in the hole only to graduate and bus tables.  They want health care and retirement benefits without lifting a finger.  These people purchase what they can't afford and then expect everyone else to pay for it when the repo man comes knocking.  It's a sense of entitlement and it drives me mad.  Here's a hint to fix this mess: stop buying stuff that you can't afford or shouldn't be, get off your ass, and start contributing to society.  The same mindset of the CEOs with enormous golden parachutes and corrupt politicians taking enormous sums from lobbyists is present in everyone.  If this persists, we'll be in a barter economy real soon.  The problem is that the candidates and government can't blame the constituents without taking heat for it and risking their own jobs and re-election.  The solution starts from the bottom up, with you and me, not from the top down (government).

The physical therapist suddenly increased my activity level.  Until this week, everything was pretty easy, but this week was different.  I do the bike with hard resistance -- it feels like going up a steep hill for 15 minutes.  Since my legs are so weak, it probably isn't that much resistance, but it sure seems like it.  Then, they had me get on the elliptical.  That was about the highest my heart rate has been since before the surgery.  If that wasn't enough, there were tons of step and stair routines that they started me on.  Until now, I avoided stairs as much as possible and always put my weight on the good leg.  Not anymore.  Plus they increase the weight each time I come in for all the weight machines and free weights.  This, combined with my free weight routine in the morning really wears me out.  It's probably because I'm not used to it. 

The PT thinks the pain I'm having is coming from where my IT band attaches to the tibia, which is good because it's not in the joint.  He said a lot of pressure was offloaded onto my IT band after the cartilage tear as a "protective" measure.  It seems to explain the shockwave of pain I had that went up from below my knee when I had the tear and when I had occasional pain during the two or so years leading up to it.   Now, it kind of makes sense since I haven't bent my leg much and everything has tightened up.  Stretching more should help this and I've already noticed it feeling better towards the end of the week.  Overall, my leg strength is getting better but I still have trouble walking correctly and it's still going to be awhile before I can bike for a prolonged period of time.

No more crutches.  I gave them up last weekend and it's been great ever since.  I have a great deal of trouble bending my knee properly when I walk which is going to take awhile to work out.  The therapist shortened the brace which helps, but everything will come in time.  My range of motion is better too, at about 120 degrees, but at that point it feels like my leg is going to break off.  Until that improves, I won't be able to use the regular stationary bike, much less the road bike.

I think my leg strength has improved significantly in the week that I've been walking and I no longer feel like I'm about to topple over.  At PT they have me using the leg press and this hamstring machine with actual weights instead of the spring machines I was using before.  Hopefully that will help me get back to normal more quickly.  My leg still looks like a stick and it takes an incredible amount of effort to stand on my right leg and lift the bad one.  15 minutes on the recumbent bike is getting easier and my leg isn't shaking when I finish.  I can't imagine what would happen if I tried to bike with real resistance or even run at this point.  I wouldn't last two steps.  Again, it will take a few more months to really get everything back.

The physical therapist thinks that the popping and pain that I get occasionally is scar tissue.  "Scar tissue" seems to be the catch-all explanation for pain that I've received from my past coaches, multiple massage therapists, and athletic trainers while on the team.  What is scar tissue, anyway?  Why does it cause pain?  Is it really "scar tissue", or is it the kneecap digging out the formation of fibrocartilage?  I couldn't really find a definitive answer on the internet, so I'm not really sure.  I know you get scars from really bad cuts, maybe the scar is swollen and gets in the way of other stuff that moves around, which is what causes the pain.

I've continued to do leg strengthening and upper body exercises in the morning and going out for walks in the afternoons.  It's better than nothing, but now that I'm walking again I suddenly have the urge to go out and run and bike.  Nobody had better ever again bother me about being obsessive about running every day.  I went every day because I could, because I enjoyed it, and I knew that I might as well "get while the gettin's good."  Because on a day like today, I might not be able to run and I don't have to regret any days that I was too lazy to go.  Lots of guys on the team would give me grief about running every day during the active rest phase of our training.  I knew that I was healthy and in shape and I wanted to make the most of it.  It's a waste if you don't, because there will be days when you are injured and can't go.  So, I say to those with good knees: make the most of every day and don't waste your talent or effort: get out there and run.  Enjoy it.

Today while doing one of the leg exercises at the therapist and then again when I moved my knee at my desk, I felt the unmistakable pain I had before the surgery.  It was just as sharp and pronounced as ever.  I wonder if there is any new tissue at all where the microfracture was, or if there was, I've destroyed it.

It's the pain I always felt for the first minute or two on the bike, but it would go away.  When I ran the pain seemed different, almost duller and deeper in the joint but just as uncomfortable.  Before the surgery, I don't really remember having that kind of pain when not running or biking.

I know what I do that causes it: extending my leg when it's off the ground.  I have to try to avoid doing that.  I didn't think much of it when it happened the first time today, but the second time really got to me.  I'll say something to the PT about it on Friday.  Until now, I didn't have much pain at all in the knee, especially where the microfracture was.

It could be a sign that I've been a bit too aggressive coming back since I did do a few minutes of biking and I'm almost off using one crutch.  The doctor wanted me off the crutches soon and the PT seemed to think my progress was fine.  Maybe if I go a bit easier on things I will have spared my knee.  I know almost everyone has pain following microfracture, but I wonder if the pain they get is the pain they had before the surgery.

Hopefully it's okay, but I've got a feeling otherwise.  I'm really afraid of being a cripple for the rest of my life.

Yeah, that's progress.

This week at the physical therapist was good from a flexibility standpoint.  I can now sit on the edge of a table and let my leg hang down without any tightness.  I couldn't do that at the start of this week.  Because I can now bend my knee to 90 degrees -- and move the brace that much, I can now get my left shoe on without using a giant shoehorn.

I've progressed to using one crutch for a lot of my getting around, but when I go longer distances, I still stick to two.  My knee feels a lot more stable than it did and it seems to tolerate the weight bearing more without getting sore.  Slowly, I will try to walk farther with only one crutch and I am already going short distances without anything at all, but I feel kind of like I'm on stilts.

Yesterday, the weather started taking a crap and it's been terrible outside.  While I was headed to and from the office in the miserable mess, at least five people asked me if I needed a ride or help getting around.  I did have to go farther than normal to get to my parking space since it seemed everyone drove.  Nobody ever said anything to me before.  Maybe that says something good about human nature when stuff gets tough. 

I need to go to the grocery store but I don't feel confident enough to go by myself since I can't really carry much with only one crutch.  When I do, it throws off my balance.  The Trader Joe's is open that rose out of one of the new vast swaths of clearcut woods.  I thought about going in there after my appointment today, but it was a complete mob scene, since today was the first day it was open.  I figured it would be bad when everyone at the physical therapist was talking about it.  People were almost parking along the highway to get in there.  I'll go back after some of the hype dies down and when I'll be able to get around better on my own.

They finally gave me my diploma today and for the longest time I thought I hadn't done something that I was supposed to in order to graduate.  I was supposed to get it in August.  Finally, this morning I got an email and I went over to the registrar and picked it up.  No real ceremony this time.  It looks just like my other one except that the president has changed and it reads "Scientae Magistrum".  They didn't give me a cover for it either, so I've got to get something to protect it.

Next week I'll get to ride the bike.  Of course, the therapist's idea of riding the bike is probably a lot different than mine at this point.  It will still be good to start back, though, even if it's just ten minutes of slowly turning my legs around.

Today was my first day with the physical therapist.  It went really slowly -- I was there from 2:30 until after 5.  Apparently someone that worked there wasn't in which caused the holdup, but I can't just carve out 3 hours of my day to just mostly waiting.  Even the receptionist remarked that I had spent seemingly most of the day there.  I spent probably 30 minutes total actually doing stuff.  They said it should be much faster next time -- I hope so because I have to go three times a week.

It really wasn't anything that I hadn't seen or done before in the training room, but at least I made some forward progress for the first time.  It was mostly leg exercises, but I was put on a range of motion machine and got up to 50 degrees with the brace off.  It felt really weird with it bent that much but it didn't really hurt except a little each time the machine increased the range of motion.  They set the brace at 50 degrees so I can now move it more.  I also have the go ahead to walk more on one crutch.  Like the doctor said, the goal is to try to be off the crutches in two weeks.  That will be great. 

When the brace was off, I remarked that my left knee seemed swollen compared to the right.  Instead, the PT said that it wasn't, only it just looked that way because I had lost so much muscle in my quad.  My left leg above the knee has a circumference 3 cm smaller than my right, and now that he said that, it's really noticeable.  Mostly, the brace is on so I can't see it except for when I shower.

Like the orthopedist, the PT said he was optimistic about me returning to running, only that I probably would not be able to do any serious training or races.  He had several microfracture patients in the past and said that I've got to really be careful since one guy had to have several surgeries after running too far and really screwing things up.  Again, he remarked that recovery is different from individual to individual.

At least now I have some kind of progression to look forward to, even if I'm only taking small steps towards a target that's hundreds of miles away.

With injuries in the past, and with this one, the actual 'getting hurt' part is extremely frustrating but there isn't really anything I can do about it.  Once whatever it is that is bothering me crosses a threshold, there's no going back and no decrease in training or extra stretching or icing will allow me to keep running.  Usually that threshold comes really fast after the onset and by the time I realize anything is going on, it's too late.  That was especially the case with my knee.  One step I was fine and the next, pow!  I did have a lot of soreness in my leg just beneath it for quite awhile leading up to the meltdown, but no way I would have predicted that it would erupt into torn cartilage one morning.

The actual rest period kind of goes the same way -- it's frustrating, but again, it's out of my control.  The damage has been done so I just have to sit tight and wait for whatever it is to heal.  In previous cases, however, I just couldn't run, but I could do just about anything else.  This time, I can't even walk.  But, that's coming to an end.

It's not until I start to come back that things really get tough.  Then, things start to come back under control.  The choices I make and the things I do start to have an effect on how quickly I can return to normal.  Try to do stuff too fast and the injury will come back and I'll be out for even longer, perhaps permanently in this case.  Don't do anything at all or not enough and recovery becomes agonizing and difficult.  There is some optimal level of increasing activity, but it's hard to figure out what that is.  Even when I was on the team and with the help of my coach and the trainers, nothing ever worked out perfectly and I found myself suffering a lot of setbacks when trying to come back from an injury.

It isn't just the difficulty of figuring out what and how much to do when that makes recovery hard, but the entire transition itself that can be a real pain.  The amount of time and effort required is just so much more than during the most difficult weeks of normal training when I was running track and cross country.  Going out for a run or workout every day is pretty easy because it's pretty much the same kind of thing every day and I've done it a zillion times before so I know exactly what to do.  Even alternative exercise isn't all that bad since I get into a routine with biking or whatever it is that I'm doing instead of running.  Unfortunately, in this case, I really can't do much of anything.  However, when I start to come back, there is this transitional phase where I'm forced to do things differently almost every day -- all kinds of weird strengthening stuff and the gradual addition of more activity (which isn't always running).  It takes a lot more time and effort than I'm used to, but in most cases it's the only way I'll ever get back to normal.

It's now time to start coming back.  Yesterday, I went to the doctor and now I can start walking again, slowly.  Within two weeks or so, I am supposed to try to get off the crutches completely.  I've slowly moved around the apartment with one crutch and it's hard.  My left leg just isn't used to it, but it doesn't really hurt.  I'm also supposed to take off the brace and gradually try to increase my range of motion in the leg.  I've also got to set up PT appointments which will probably also help with my return to walking normally as well as range of motion.  That will involve all the weird exercises and will probably be at some strange time of day so that I feel like I have a lot less time than I used to.  I'm sure eventually they'll help me figure out when I can start biking again and hopefully even run.

At this point, I can see I still have a very long way to go.  The past four and a half weeks has seemed like forever, though each day individually seems to go by pretty quickly.  The weather suddenly changed and it's no longer the typical jungle summer weather but cooler and like fall.  I know that it probably won't even be until the end of the year or even into next year when I'll be able to run again.  The long, drawn-out recovery process is what makes things especially hard.  My teammate who went through this same process was back to full strength in over six months after the surgery, but it's different for everyone, and I don't even know if I'll be able to make it back.  If the microfracture didn't work, I'll be back to feeling that awful grinding pain again when I run.  I have to hope for the best, and at the least, I'll be better off than I am now.

I noticed today when I had the brace off that my left calf is down to almost nothing. It's going to be rough coming back. I'm not getting as much popping in the left knee as I was a few weeks ago, which makes me think that something has started to fill in the hole of missing cartilage.

Everyone else seems to be out doing stuff with their perfectly fine knees. My mom ran in the half marathon at the beach last weekend, my sister runs regularly and is playing in a rugby game next weekend. A few of the guys who were close to my year have continued to run and do some races -- one guy I know posted pictures from a nasty 18 mile mountain pass run in Colorado. My roommate back at school has started to run again after a year off and is out exploring the area every day. I did hear that one of my old teammates who ran a solid marathon in the spring is still out with patella tendon issues, so I'm not alone.

I was up at school one day last week to see my adviser and I also stopped to talk with my old coach. It was great to talk to everyone, but I still wasn't comfortable with being back at school. When I came back home, I was exhausted. Once I can walk again, things will be so much easier. At school, I had to plan how to get around without running into staircases or steep hills. All the doors to the buildings weigh ten tons and are almost impossible to open when on crutches. They also have those worthless anti-slam things on them that cause the door to close on you as soon as you try to go through it. Having the disabled parking placard helps a lot because otherwise, I'd be crutching for several miles to get to the office and to the hall when I went to see my coach. That said, here at home I still make an effort to get out each day and go around the block, which takes 15 - 20 minutes. It's getting easier, but it still isn't fun.

I'm starting on a new school project so work consists of looking for state-of-the-art papers. I don't particularly enjoy reading research papers, but otherwise I'll neither have many ideas for research nor will I know if the work or problems I am interested in has already been solved. I'm now officially a Ph.D. candidate so I won't have to worry about taking any more classes. From here on out, it's going to be research, which is exciting. Of course, success has a new meaning: it's no longer the grades you get, but whether or not your work gets published. This is going to be hard. Of course, it's still possible that I can graduate without publishing anything, but an employer would really think twice before hiring me if my research wasn't that great. I could also start a business of my own, but that would probably mean that my work was sufficiently good (and published) that it would be worth selling.

There were a few unresolved issues with the paper we just submitted for review, but no matter how it turns out, it will be a good learning experience. The past six months or so have been a complete paradigm shift and there were so many new things that I picked up on that it will be a valuable lesson for what to do in the future.

Overall, a lot of things have happened that are different from "normal". Not all of them are good (like the whole knee deal), but I can learn from everything.

This brace is extremely annoying and it would be great to just take it off and run free...

Instead, I'm stuck with it on and can't move my leg more than 30 degrees. At my appointment, they removed the stitches, which surprisingly didn't hurt at all. The emphasis was that I'm to remain partial weight bearing at least until my next appointment three weeks from now. I'm sure after that I'll probably still have to wear the brace, but they might give me more range of motion. I might be able to start some kind of PT program then too.

Because of the brace, I still can't bike, even with no resistance. The doctor said if I have a Nordic Trac or some kind of flat elliptical that I might be able to do that real easy, but I'll have to wear the brace to prevent more than 30 degrees of movement in my knee. The pool would be best, but I couldn't wear the brace in there and nor could I guarantee that I wouldn't bend my leg too much. It seems I'll be stuck with my leg lifts, crunches, and free weight routine.

The real issue is just getting around. It's so frustrating to shower or to put my shoes on and I can't really carry anything. Everything just takes a lot more time and patience.

I'm just going to have to continue to hang tough for awhile. It drives me insane whenever I see someone running or biking and there were plenty doing it today at school. Of course, I think about how good their knees probably feel and that they don't have any cartilage missing.

I've now been stuck in this brace and on crutches for over a week. So far it hasn't been too bad, but it's real difficult to do a lot of things that I took for granted before. I'm not sure how I'll be able to get along at school by myself -- I can't carry anything but a backpack and it's a real chore to shower and to get food by myself. I'm hoping that I'll become more adjusted to this and be faster -- it takes me an hour to get ready in the morning compared to about 15 minutes before. I'll see how things go on my own on Thursday and into Friday when I have to go back to have the stitches removed. Driving is going to be interesting and hopefully I'll be able to get my leg in the car with the minimal amount of movement the brace allows.

I started a weight routine for my legs and upper body which is the best I can do since I can't run or bike. It should help some when I eventually am allowed more range of motion in the brace. The brace has done wonders for my hamstring flexibility though. I have been putting some weight on the left leg since the doctor and PA said I am allowed to, but I stick to the crutches when I move around. I'm real paranoid about screwing up the healing process and knocking out that clot in the knee that's supposed to form new cartilage. There's still a few times each day where I'll move and I can feel the knee pop right in the area where I had the microfracture. I really hope that's not the kneecap destroying part of the clot that's in there. I'll have to ask about that on Thursday.

There really isn't much else I can do except work on the school project during the day and watch the Olympics at night. The stuff I'm working on still has problems and the conference submission deadline is at the end of the week. Each test case in the experiment takes about 5 hours of CPU time so each time I change something it takes quite awhile until I see results. And there are a lot of test cases, so I need as many as 20 or 30 processors running simultaneously to get results as fast as possible. I used to wonder why there was a need for systems with so many processors, but now I know. Each group of tests also spits out about a gig in raw data which also illustrates the need for a large amount of storage space.

I really hadn't watched that much of the Olympics before whenever they had it, but I don't really have that much else to do this time around. I always watched some of the track stuff, but that was about it. Personally, I didn't think the coverage was all that great since there seemed to be an insane amount of commercials. Also, since there were so many sports, they couldn't show everything, so the time was broken into small chunks of each. I didn't get to see some of the stuff that sounded interesting, like the sailing or whitewater rafting stuff, shooting, or the modern pentathlon (which has cross country). There were a lot of things that I didn't find as interesting, like diving and gymnastics, which seemed to last forever and require a palate akin to a professional wine taster in order to distinguish between a good and bad performance.

With the entire world watching, you would think that all the athletes would be on their best behavior as a representative of their country and as the best in their sport. Despite this, there seemed to be a bit of showboating and poor sportsmanship. One guy in taekwondo kicked a referee in the face after being disqualified. A wrestler threw his medal down on the mat after being angry over a judge's call. In the qualifying heats of the 4 x 400, Great Britain's anchor taunted the Jamaican runner behind him as they finished. And of course, there was all the showing off for the camera by Jamaica's Bolt in the 100 and 200 -- this was so bad there is even a YouTube video mocking it. There were many cases in the qualifying heats of the sprints where those in the front would pretty much slow down and walk across the finish line. Before the championship season every year in track, our head coach always said if we did that we'd never be wearing a uniform again. Of course, these instances were probably the exceptions rather than the rule, but it only takes a few bad apples.

Now that the Olympics are over it's now on to the hype of the conventions and the fall election. I'm getting sick of a lot of it especially since Virginia is considered a "swing" state. There are tons of ads on TV, most of which are really annoying. There are too many attacks on the other guy and not enough emphasis on the good qualities of either candidate.

Maybe by the time all that is over I'll be back on my feet again and things will be more or less back to normal. Maybe I'll be crippled for life, but I'm trying to do everything I can to avoid that.

Everything seems to merge together now that I can't bike or run or really do anything. Usually, every day is defined by the running or biking that I did. Now I don't have that and it could be awhile before I'm permitted to start again.

Yesterday I went up to the orthopedist for the first visit since the surgery. The PA took the brace off and the bandages for the first time since the surgery. My knee was and still is about the size of a softball with three small incisions. After leaving to converse with the orthopedist, the PA readjusted the brace to allow for 30 degrees of motion and also said I could start putting weight on it. Weight bearing almost immediately after microfracture surgery seems to go against every other case I've heard of because it may damage or impair the formation of new cartilage. The orthopedist said it was because of the location of the injury that I can put weight on it almost immediately, but it still has me worried. The pioneers of microfracture seem to agree with the orthopedist's assessment since the images indicate that the problem was in or near the trochlear groove.

Now that the brace has been adjusted some, it is easier to move around some as well as sleep at night with the brace on. It also makes a world of difference just to be able to shower. It's a major pain to get the brace on and off since I need help. I've started doing leg lifts and some calf raises that the PA recommended that I start on and I'm sure once the brace is loosened or comes off I'll have to see a PT. I added some upper body stuff with free weights as well since I can't really do anything else. No matter what, it's going to be a major uphill battle whenever it is that I'm allowed to return to biking or running. I remember going out on a ride with one of my teammates when I had something that was preventing me from running, but my teammate had been unable to do anything for months and was finally allowed to bike again. I went pretty easy, but dropped him within the first 20 minutes anyway. That's going to be me.

The pain is pretty much gone, but sometimes there is some throbbing. It isn't any worse than it was before the surgery, which is good. I've heard that a lot of people that get microfracture are in more pain following the surgery than before and it takes several months before it feels better. Again, this is probably due to where my injury is. It must be that most people get cartilage tears in the lower and outside parts of the femur compared to me, which is higher up and more towards the middle where the kneecap goes. I have felt a click a few times when bending the knee and it's right where I've had trouble. I'm not sure if this is okay or not, but it doesn't hurt or seem as violent like before the surgery when it would happen. I guess I'll find out in due time if everything heals correctly. As I've said before, I don't want to screw this up and have to get a second surgery or be unable to bike or run.

At this point I don't know if I'll be able to function at school by myself since opening doors, showering, and even driving may be difficult. I can drive, but it's a matter of getting the leg into the car since I can't bend it much. I've got another appointment next week to remove the stitches and I'll probably stay at school at least one night then. I really don't want to be a burden on my roommate but I can tell my parents don't care for it either. I would really like to try to gain more independence.

After the appointment, my mom and I went by the DMV to get one of those disabled placards for the car so I wouldn't have to walk/crutch very far from the car to the office. Otherwise, not only would I have to go a long distance, but I'd also have to face a couple staircases. I nearly fell on one when we went over to the computer science office.

I spoke with my adviser to let him know I was still alive and that I can work from home, which I'm doing now. I also got some stuff for my candidacy application taken care of, but it's not finished. Maybe by next week, I'll be a Ph.D. candidate officially.

The deadline for our project is within a week or so and it's having problems, but I'm doing the best I can to get it finished. Since this is my first conference paper it will be a good learning experience no matter what. I can build on my mistakes and do something better next time. I'll have plenty of time to make improvements.

I am now one day closer to running again without pain. After a month of having the surgery looming, I finally had it and no longer have to worry about it.

Honestly, it was an interesting experience, excluding the fact that I can't do anything for quite awhile and am in a bit of pain. There weren't many people in the hospital while I was there, but I still had to do a lot of waiting. The building was really nice as was the room that they put me in. In the new hospital in Williamsburg, all the rooms are private, which I guess is unheard of.

After I checked in, I sat in a waiting room with my parents and then we were called in to a private room, in which I changed into a gown and waited some more. It was about two hours before anything really happened. Sometime after 9, a nurse came in and followed up on a bunch of medical history questions that I had been asked on Friday. She hooked me up to an IV of electrolytes and then I just watched more TV for nearly an hour. The anesthesiologist came in and talked to me for a minute or so, confirming that they were doing microfracture on my left knee and then quickly explained how the anesthetic would be applied. The surgeon came in right after that and again quickly talked to my parents and me about the knee operation. He also took a marker and wrote "Yes" on my left knee. Then it was time.

All the waiting was really making me nervous, so it seemed even worse when a few more hospital staff came into the room with the anesthesiologist to wheel me into the operating room. I realized that I had already taken my last steps, for they wouldn't let me walk in there on my own. Just as they pushed me out into the hall, the anesthesiologist took a needle of something and shoved it into the IV tube. The staff, along with the anesthesiologist, wheeled me down a long maze of halls until we got into the operating room. They asked me if I was feeling drowsy, but I thought I felt fine. In the operating room, they wheeled the stretcher I was on next to the operating room table and asked me to crawl onto the table. In doing this I realized was feeling a bit tired.

I really don't remember much about the operating room except that it was big and it was really bright. A few of the staff started talking to me, but I can't remember what we were saying. I think it was about school. Then, they put a mask on me and we kept conversing, but again, I can't remember what was said. I don't remember feeling very tired or anything either.

The next thing I knew was that I was in the recovery room. There was a clock on the wall and it was about 11:30. I knew I left about 10 for the operating room, so I was surprised that it took as long as it did. Though there were at least five or six other beds in the room, there was nobody else in there except for a nurse. The nurse noticed I was awake and told me to close my eyes and go back to sleep. I didn't want to. I remember saying a few things to her, but I can't exactly remember what. I remember looking at the computer next to me which had an EKG readout and the nurse said something about my pulse being really low and that it kept setting off an alarm. I could hear it beeping. At some point the surgeon came by and said something about removing a one inch piece from my knee. I felt like I was in the recovery room for about five minutes before being wheeled back into the small room where my parents were, but when I got there and looked at the clock, it was 12:15. That made no sense to me, so I must have passed out again at some point.

The whole anesthetic experience was really weird since I've never had gaps in my memory like that. I've never lost track of time nor do I usually forget the topic of conversations that I've had in the recent past. It was like someone had hit the fast forward button on my memory.

Oddly, I didn't have any pain when I finally became completely coherent. A new nurse came into the room and told my parents and I everything was done and that the operation went well. The nurse, like the one in the recovery room, also said that my pulse was really low and that it kept setting off the alarm on the EKG. Looking at it, my pulse was in the 40 bpm range, but occasionally went over 50 and turned the alarm off. Then it would go down again and the alarm would start screaming, so she just turned the thing off.

Looking down, I noticed I was in a huge leg brace that covered my entire leg, from ankle to upper thigh. The nurse went over some quick instructions about what to do in the next few days, which included some foot exercises to prevent blood clots. She gave me a sheet with the orthopedist's appointment number for a follow up appointment that I am supposed to make. I've got to go back up to Williamsburg on Thursday for the follow-up and hopefully they will remove the bandages so that I can shower.

After that, I put on some clothes, got into a wheelchair and was taken out to the front where my dad pulled the car around.

I didn't get to talk to the orthopedist again before leaving, but he had a good conversation with my parents about what went on in the surgery and about what to expect in the short term. He gave them a bunch of pictures from inside my knee. He took out a 1-inch piece of cartilage that had been floating around in there. One of the pictures had it next to a ruler and it looked to be about 2.5cm x 1cm. That was a lot bigger than I expected and I've heard that microfracture has lower success rates for larger areas. There were some pictures of the microfracture area, which greatly contrasted from the smooth areas of undamaged cartilage. The tear was really jagged and rough. After looking at the pictures, I'm surprised I was not in more pain over the past several months.

The orthopedist told my parents that I should be able to move my leg to about 30 degrees without any rubbing of the microfracture area against the kneecap. When I go to the next appointment, in addition to removing the bandages, set the brace at more of an angle so I can move around better and hopefully drive. I'm not sure about any kind of range of motion stuff, like spinning on an exercise bike. It seems that others that have had this surgery are able to do range of motion exercises fairly soon (and that it's important to do so), but it seems different for me, maybe because of the location and size of the injury. I guess each doctor has a different approach. My parents said the orthopedist seemed very optimistic about my recovery and that the tear really wasn't that bad. It's kind of hard for me to form an opinion about that until I really start the recovery process.

Yesterday after I got back I just sat in front of the TV and watched the olympics. I convinced my parents to let me eat in the kitchen instead of just sitting on the couch. Getting up to go to the bathroom became a major chore, but I've moved around on the crutches a bit more now and it is starting to get easier. I had no pain whatsoever until about 8 last night and then whatever local anesthetic they gave me wore off like flipping a switch. Then it really started to hurt, a lot like it hurt when I last ran, except over a larger area. Taking the prescription painkillers only helped a little and they also made me dizzy.

It was also hard to sleep, which was a combination of the pain and the brace, which kept me from moving around much. At some point in the middle of the night, the pain subsided a fair amount and it's been a lot better ever since.

It's hard to just sit here while everyone else is out and about. My sister has been in and out several times since I've been here and my mom went out running. At this point it's difficult just getting a bowl of cereal. I'm glad I came home because I would be in trouble if I were at school by myself. I'm hoping that it will get easier within the next week or so in order for me to go back to school and go to the office. I really hope that I'll be allowed to do some kind of range of motion type stuff soon to help ease my conscience. The longer I can't move my knee the more paranoid I'm going to be about it when I finally get the chance to do so. Of course, all the while I'm going to get extremely out of shape which will make any kind of recovery all the more challenging. But, now that the surgery is behind me it's a lot easier to focus on the things I need to do to get better.