Moving Along

I'm feeling kind of at loose ends at the moment - waiting for things to happen. They start happening next week! But right now, I'm filling time with chores.

The good news is, I've really been feeling a lot more energetic recently. I've motivated myself by scheduling things to happen, and I'm out there doing things to clear the decks so when they do (happen), I'll be able to take advantage. So chores and more chores it is - gardening and house, mostly. But I'm getting things done that have literally sat on a list for years. Trivial things, not major improvements, but things that I notice or that make a little difference in each day. So some feeling of satisfaction from that.

And more satisfaction from the fact I am clearly stronger than a year ago. It's obvious in my weight workouts. It's also showing up in the activity stats my watch collects. So far this year, my average steps are higher than the previous three years. That makes them the highest since my counted steps fell off a cliff at the end of 2022. (Why did they fall off a cliff? I went back and looked - I think I decided to let my knees determine how much I moved overall. The knee operation was in November 2023 - and I spent much of the year waiting for it.)

The less good news includes my knees - both of them - are hurting more than a little. Not so that I can't walk, just enough for me to feel them every time I climb stairs. But I've decided not to allow them to limit me so much. I'm squatting and lunging and stair climbing away. And walking and standing. My doctor has assured me that I will not damage the knees by using them, and I choose to believe him. And really, they usually feel at their worst when I start an activity, and feel no worse, or even better, as I move along.

More less good news is that my weight loss has slowed or stalled. I weigh every day I'm home, and the weight jumps around a lot each day: down .4 pounds, then up .8, then down .3, then down another .1, then up .2 .... Pop quiz: did I lose weight or not? Picking a trend out is not so easy - I have to use averages, step back and squint. Are any of the numbers the lowest I've seen this year? That's a positive sign! But then up 2.4 pounds the very next day! I won't stop the daily stepping on the scale, but I'm only rarely spending any time figuring out what that means for the trend.

I am spending that time right now, because I'm coming up on the time to order my next four weeks of meds. Is it time to increase the dosage? I'm definitely having more food thoughts, a change from a few weeks ago when I was more gliding along. So continuing to look at the weight data is important, but so is assessing how much effort I'm putting into managing my food. I liked when it seemed more easy and natural to make the right choices.

So I'll continue to monitor for the next few days. Unless I have a big whoosh of a loss in the next week (usually heralded by peeing my brains out), I'm going to request the next higher dosage. The good news is, that will give me two weeks to get used to that higher dosage (5.0) before I go away on vacation. The internet has many horror stories of side effects - I don't take them all seriously. But someone pointed out that this first step increase is the only time the dosage is literally doubled. Each additional increase is another 2.5 mg, but  it's a smaller percentage increase. 

To make me feel better, here is the big picture - my weight as an adult:

Each horizontal line is 10 pounds. The red line is where I stabilized before. 
The blue line is my goal weight in previous weight loss efforts.

 

I'm back down to the pre-intuitive-eating weight, before I decided "Fuck It, I'm just eating". Yay! And on this scale, you can't really tell that the slope has tapered off in the last month. So I really like this picture.

 

 

Stronger Next Year

My gym! Rowing machine along the back.
I just installed the bar to help with balance exercises.

I did not have a great year physically. It started with recovering from my knee surgery, carried on through a summer of increased migraines and still not up to snuff on my knees, and crashed and burned as a result of my vigorous (but fun!) sailing vacation, where I injured my rotator cuff and generally burned out my whole body.

Through it all I tried to keep moving and working out in my basement gym. (I love my basement gym, and I enjoy working with my personal trainer there.) But there were definitely days on the couch where I hardly left the house. I felt old. I felt feeble. I was fat, and nothing I did seemed to affect that. I woke every morning feeling like the Old Red Woman, bent over, stiff, wobbly, and in pain. I felt frustrated that my body was so frail. I was preparing myself for a new reality of being old and feeble. I told myself that I actually was old, almost seventy years old. Any time there was a news article that another celebrity had died, the first thing I did was check their age. So many of them younger than me!

But by late fall, I felt myself getting better. Stronger. More capable. Actually doing things. Feeling competent and capable. Walking still did not feel good, but I adjusted and spent more time in my home gym working with weights or my rowing machine or on the stationary bike my BIL gave me. I went back to the mental disciplines I had learned over the years of dealing with pain, meditating and observing the pain with kind curiosity. I had some adventures, on the water and on the scoot. I had some actual good days, where I woke up feeling good. Not stiff. Not bent over. Not feeble. Ready to face the day, get out there and do things.

The election results hit me like a gut punch. As I got out of bed the following morning, I was initially fine, but by the time I had walked the length of the house to let the dogs out, my back had tightened into a full fledged spasm. SPROING! I was bent over, leaning on furniture like a toddler doing her first cruise around the house. I pulled out my tool kit, things I know, deep down in my body and mind, to be true. First, mentally: "there is nothing wrong with you. You are safe. You are fine. Yes, the back is clenched, but it's not broken. Yes, the world has gone to shit, but you are safe. Your body is safe." Then I started my series of exercises/ stretches that I know deep down are going to help. I also reached for the tylenol, because comfort is an important part of feeling safe. 

This worked! It took a couple of weeks - the back clenched every morning for a while - but it got fainter, and gradually went away.

Around this same time, my primary care doctor told me that based on my testing, I have great lung capacity and a strong heart, but I have shit endurance. She prescribed aerobic exercise, specific amounts at specific heart rate levels of effort. The next week, my neurologist reinforced this - certain levels of aerobic exercise seem to have a protective effect on migraines.

The view my trainer has from my phone while we video.
I have all the toys! I bought my first weights in 1995,
and I've been adding equipment ever since.

So I'm all in on the cardio now, added to my twice-weekly strength training and daily warm up stretches. I have the devices to keep me going indoors this winter- a rowing machine, a (bottom-of-the-line no bells-or-whistles) stationary bike. I have a mini trampoline in front of my TV. And I dusted off my original, built of wood in Minnesota, Nordic Track ski machine from 1993! Using the NT was the first time in my life I enjoyed indoor cardio, back in the day. It needs refurbishment, but it turns out that while the old ski machines are no longer made, there are enthusiasts and through a sub-reddit I found a guy who sells refurbishment kits with the most common replaceable parts! It's on my list to get it fixed up - probably a few hours work.

I found that walking can't get my heart rate up high enough to meet my PCP's exercise prescription. I try hustling along, but the heart stays stubbornly beating slowly. Only up very steep hills does it go up- and I can't currently sustain that for long enough. This all may change as I get more aerobically fit.

On the Road Again…

Sunset from the wharf;
Arrow points to my motel room

 I went to California to see my girl, but to be honest, this trip is at least as much for me. Adventure, going out and seeing and doing new things, is a big part of my self-conception. In the past couple of years, I’ve felt my life shrinking down. I love being at home. I love days where I am totally on my own, just doing things around the house and sinking down on the couch with a good book or three. But I don’t want to succumb to lowered expectations. I want a bigger life. And so here I am, in beautiful Santa Cruz California, ostensibly to see my girl but also to push and test myself. 

There’s something about California light on a sunny day that is special. No sooner did I pull out of the rental car garage than I had to pull over and put on my polarized dark sun glasses. At once, the scene so full of brightness as to be dazzling, became manageable but beautiful. A zillion shattering shades of green clarified into recognizable plants. Deep inpenetrable shadows popped into focus. Flowers were blooming, skies were a deep bright blue. I took the single winding road that led from San Jose, at the south end of Silicon Valley, up over the mountain ridge and down to the coastal community of Santa Cruz. 

Art on the wharf

While I love exploring, there is also comfort in going back to a place where I’ve spent at least a little time. Far from feeling at home, but not truly foreign, either. I am so happy I sprang for the extra cost of a beach-front motel, instead of the perfectly adequate but not special place I stayed last summer. The place is a low-slung two-story building built close to the cliff road along the water, with its back firmly towards the road and its face enjoying the water. Once through the gate and onto the property, there are unrestrained views to the town beach, wharf, boardwalk, and out across the large Monterrey bay, all set off by nice landscaping and spots to sit and watch the beach and water. From my room I can not only see the surf, but hear it. Yesterday morning, sitting on a terrace overlooking the beach, I realized the other noise I heard was seals barking from the wharf. The wooden structure under the flat top of the wharf is beloved by them, having many support beams that are comfy places for them to flop around. On my first visit here, I spent a long time watching them, enjoying the dynamics as they constantly shifted around and challenged each other for the nicest spots.

Watching beach life from the motel terrace

This location is also convenient for places to eat and shop. The first night I had a bowl of clam chowder sitting at a bar on the wharf, watching the sun set and chatting about the local brews with a couple of software bros in for the day from Texas. “Downtown” is a mile away, and I’ve walked there a couple of times for meals, with and without my girl. Any random glance in this place would make it clear we’re not in Maryland anymore. Palm trees and succulents, mission and arts and craft architecture, signs proclaiming “anarchist garden spaces” (ok, I might find that last in Takoma Park!). 

My first morning, I woke shortly before 5 am local time and decided I might as well get up and drink coffee. I’m not really going to be here long enough for it to be worth adjusting to the time zone. First light was at 6. First, there was an orange glow above the hills on the horizon. It expanded, shaded to bright yellow, and kept on growing both horizontally and vertically. Finally, with an intense brilliant yellow shimmer, the sun peeked and then rose into a circle about the horizon, centered in my window. Wait, what??!! I’m in California, this is the goshdarn Pacific bloody Ocean, why am I seeing a sunrise, not a sunset? I had to get out my tablet and Google Earth, and set it up so that I could get oriented. Santa Cruz is at the north end of Monterrey Bay, a big scallop in the north-south coastline of California. I’m positioned to look across the Bay, facing southeast, hence the sunrise. The sky took a couple of hours to deepen into the brilliant blue from the day before. I don’t think I’ve seen such a spectacular sunrise since I was at sea on my way to Bermuda in 2021.

Much of Santa Cruz town is flat, sitting on a plateau above the ocean, with steep cliffs down to the water. The walking is great, around town and on a path along the cliffs. The campus is up a mountain above the town, heavily wooded. There is a lovely arboretum, where my girl and I spent a nice time in the brilliant sun wandering and talking and looking at exotic flora. Tbh, ordinary California flora is pretty exotic to me, but I guess this stuff, from similar climates in Australia, New Zealand, and South Africa, are special. My knee is still recovering, but it’s holding up well. I’ve had more steps yesterday and today than any day since my operation, and except for needing to stretch it, I’ve been fine.

Otter and kelp; art on a traffic island

The first day and yesterday were brilliant blue; today is grey with occasional drizzles. Sitting on a terrace overlooking the beach yesterday (while my girl took care of some school business in the motel room), I watched beach volleyball, surfers (all in wetsuits), and a bevy of women swimming in the very cold water. The air temperature was in the 60s, but the unrelenting California sun made it very warm (and I slathered my exposed skin with sunscreen). Santa Cruz is said to be where Hawaiians introduced Californians to surfing - it has a surfing museum and several Hawaiian restaurants and bars. (I plan to get some poke tonight). 

Things are well with my girl, and increasingly, I’m sure they will be well with me. Such a nice trip!

New Knee!

 I'm very optimistic at the moment. Could drugs have something to do with that? Maybe? But drugs are part of the protocol, I'm supposed to be taking them!

Prep for the operation started well before Tuesday. I had a bunch of pre-op appointments to get cleared, and then there were elaborate instructions about cleaning myself the night before and morning of the operation, showers and special microbiome killing sponges to wipe everywhere. Surgery was scheduled for 8 am, but I had to be there two hours early. My BIL picked me up on the dot of 5 am, and followed me through the registration process. There became a standard call-and-response at every single stop - at least a dozen times that morning:  "What is your name?" "When were you born?" "Are you allergic to anything?". I had a qr code on my wristband that was scanned at every step.

In preop, (more wiping with special sponges), many people came by to introduce themselves. My surgeon came, (he signed my leg), a resident, a med student, and three or four members of the anesthesia team. ("What is your name?, etc., again!)

BIL stayed with me until they put the IV in, before starting the sedation. I gave up my phone, and they gave me a spinal block. By the time they wheeled me into the operating room, I was dead from the waist down. I couldn't feel a thing. The operating room was startling to me, not at all like Grey's Anatomy. Stark white, brilliant florescent lighting, almost shabby ceiling retrofitted with electrical mains and heating vents (my main view) and the room was really large - maybe they would have two patients in there at once? (BTW, they are opening a brand new surgical center next week, this was the swan song for the old side.) There seemed to be a lot of people in there! Shortly after arrival, they stuck my IV with sedation, and I was out.

I woke up still in the OR, still dead from the waist down. Whoever talked to me then said things went really well, and confirmed it was the partial (not a full) knee replacement, yay! I got wheeled down to recovery, where I stayed for a while, long enough to have two nurses because of a shift change. The goal for recovery, said the nurse, was to be able to bend both knees, raise both legs, and wiggle all my toes. Then they could move me on into a room, since I was going to be admitted. She raised my leg to demonstrate, and it was very disorienting to see my leg and feel nothing from its visible movements.

At first, recovery was AWFUL! I had the most awful shakes, shivering all over. Actually, the spinal block was still in effect so I have no idea if I was shivering below the waist. But above, my goodness! It came in waves, with a build-up, peak, and rapid fall-off. I tried to retreat to my mindfulness techniques, focused on my breathing, and that worked great in between the episodes, but when my body was uncontrollably shaking that was all I could think about. But then, sensation began to come back to my legs. First tingles, then the nurse said I was wiggling my toes. It was the weirdest thing - trying consciously to send a message to my toes to wiggle, and feeling no feedback that I was successful. But slowly, slowly, the feelings came back as the shivers abated. I got curious, and explored where I had feelings and what movements I could execute with my legs. It helped. All told, from shivers to feeling back in my legs, was about an hour. They had added a nerve block for the knee to take effect as the spinal block wore off, and so there was a magic moment when I felt great - zero pain! No shivers! And then they brought lunch, and I was hungry and scarfed down every bite. Then I realized I could have my stuff back and I got my kindle and phone and ipad, no boredom ever.

While still in recovery the PT folks came and got me up. It was good timing, I needed to pee, and really didn't want to use a bed pan. So I walked with a walker to the bathroom, and then to a stairwell, where I climbed two stairs - a hurdle I'd have to get into the house. When I got back to my bed, I was exhausted and in pain.

Finally I went up to the room. The nurses were really good at writing names down on the little white board in my room, I really appreciate that. Sadly, it was a very small double room and I had a fractious, noisy room-mate. We weren't allowed to close the door, so noise and light were constant. By the time dinner arrived, I had lost my appetite and "discomfort" had grown to pain. Over the course of the night, I had enormous heartburn pain, nausea, and stomach cramps. I had brought my noise-cancelling over-the-ear headphones, and a silk eyeshade, and that's the only reason I got any sleep at all. I listen to books, and all night I would tee up a chapter, close my eyes, and hope for sleep by the time the chapter was done. But I would open my eyes to realize my roommate was making a phone call (to Australia?) or complaining about something, or simply moaning. Of course, they came in to check vitals, give me drugs, and generally keep me from getting any rest. So I slept maybe twenty minutes at a time?

The following morning, I was awake at 5 and so was my roommate. But after the escorted trip to the bathroom and a new set of drugs, I actually got some deep sleep! An hour or two at least. All day, my knee hurt, but less than my stomach. They had added an anti-nausea med and also tums, and maybe that helped. I had PT and OT folks visiting, and they told me what to focus on for the next week, until I start PT. Two of my surgeon's residents stopped by, and they each emphasized how well the operation went. I mean, their eyes were glowing! I hope that bodes well for recovery. The hospital sent me home with twenty pages of discharge information and four pill bottles (to be supplemented with two OTC drugs at home). Helpfully, the medication instructions included the timing for the next dose of each. 

BIL, who had checked in on me many times, took me home. It was so nice to be swarmed by the doggos! He heated up some soup for me, but I couldn't manage more than a few swallows. I hurt all over. But I verified I could walk with the walker throughout the first floor, get into and out of bed, and go to the bathroom. BIL courageously stood by in case I needed him, but I didn't. Shortly, I took to my bed. In a few hours, my friend came over for the night, and it was comforting to have someone there, even if I didn't need them to do anything specific. Restless and uncomfortable all night, with intermittent books, but I took joy in the fact I could actually roll over to one side, off my back. (Other side not available yet.)

Another friend, who lives a ways away, came down later on Thursday. She made supper, and we watched a movie (NYAD! See it!). I was in bed by 7:30 pm (despite a couple of naps during the day). Again, a restless night, but at least five hours sleep (with ten hours in bed) according my tracking device.

Managing the medication is the hardest thing. I can take six different drugs, have to take at least three, and they all have different timings and limits. So of course I made a chart and I write it down. I am slightly addled from the pain meds, and I find I might not remember having taken a pill minutes after I did. So I am assiduous at checking them off. I am cautious on the strongest pain med, because it makes me woozy. I'm writing under its influence now, so please let me know if there is something here that's inappropriate. But by backing off some on the optional meds, I have got my stomach back under control, and my appetite is back. The fact is, the pain meds work, and if I don't take them there is a risk I'll do much less movement, which is bad in itself. So I'm taking less than the max, but not swearing them off completely. 

Today feels better than yesterday. I took a shower! (Hand wand and sitting on a stool.) No naps today, planning on a good night's sleep. Hopefully, tomorrow will feel better still.

Doing my Best to Move

Tuesday's hike was filled with wildlife!

My knees still feel better, but it's not perfect. There is some pain, especially up hill, and my muscles definitely are weak and also I'm stiff and inflexible. The more I read about Greece (coming up in November) the more steps I hear about... so I'm trying. In addition to my twice-a-week hour with my trainer, I'm doing 45 minutes once a week in physical therapy, and I have a 75 minute tap dance class once a week. But I'm still trying to walk every day, and run through the basic knee exercises on days without either form of PT (personal training or physical therapy). I'm not quite making that goal, but I'm doing much much better than I was a month ago.

I've found joy in the walking again! And that helps me to get out there!

Taking a page from both K's blogging and also from my earlier years, I'm posting a quick update every day in a special blog for that purpose. The link is on the right side of this blog, but here it is as well:

Nan's Quick Log

I'm using the automatic posting from different devices and apps I have that keep track. So far, I've only posted when I do a deliberate exercise walk, run, (or in one case) kayak, not my incidental movement. I'm still experimenting with what works. I was looking for something I can do from my phone, because the apps that make the record are on my phone, and I don't boot up the computer every day. Because it's not a complete habit yet, sometimes I'm posting a day late.

I don't expect anyone to comment there, but knowing that maybe someone will see it is part of the motivation to do it.

I used that blog years ago - the last previous post before I started using it again was 2014!

Knees Are SO MUCH Better!

Today I took what I want to be my "normal" morning walk - out the door, down into the park, back up through the neighborhood, about a mile and half, with some significantly steep but short hills down and up to the park. I've been doing this off and on for years, but recently I've fallen way off. The fact that it hurts before I even start, and will hurt more once I get going, has been one of many barriers. (Other barriers include my reactive barky dog, any weather less than optimal, having to get dressed, and sheer inertia.)

But this week, I've had to head out first thing, just as the sun comes up, to do a daily vacation backfill on a citizen science project, hyper-local network of national precipitation reporting, CoCoRahs.  It's on the "normal" route, so some days this week I've kept on going to complete the loop. Today was the first pain-free day in months! 

My knees have steadily deteriorated over the past several years. I tore my meniscus and had it repaired back in 2018. But now, it's a loop. The more the knees hurt, the less I move. I went to physical therapy a year ago, after they were really bad. Symptoms included not only pain, but also restricted mobility - I simply couldn't bend them all the way. The PT really helped with both pain and mobility. I was then motivated to keep moving by active vacations, in March and April. But perhaps from overuse, the knee pain grew enough worse that it grew increasingly easy to blow off the daily walk, despite my fantastic Iceland vacation coming up. After all, I had satisfied myself with what I could do in March and April, Iceland in July would be just as good, no?

Well, no. A couple of months off from active training eroded both the quality of my knees and also my aerobic fitness. I did a whole lot on the Iceland trip, but it was hard. I didn't do as much as I wanted. There were often options for different activities and I backed off the most active ones, hiking up volcanoes for example. I spent a fair amount of time in my nice little cabin, with my feet up and knees bent, popping tylenol and rubbing stinky and persistent but effective voltaren gel into both knees. They never once didn't hurt on the trip, and haven't really stopped hurting since.

When I got back from Iceland, I signed up for a trip to Greece. More about that another time, but everything I've read suggest all the places I'll want to go will involve stairs with no handrails. Time to fix these knees!

(As an aside, I am fully bought in to the mind-body approach to pain management. I can minimize suffering I have from pain, and even reduce and even eliminate some pain, through mindful meditation and somatic practices. It has really helped me avoid catastrophizing about issues, and my back pains and even migraines are less of an issue. These practises also help avert physical symptoms manifesting in response to external or internally generated stress, something I clearly used to do a lot. These practices include breathing, visualization, and self talk approaches that really help keep things on a more even keel. 

The way I think about these practices and my knees is this: my knees have mechanical issues that send messages to the brain. I can interpret these signals as pain, or call them sensations, and I can observe them from a distance with kind curiosity. All this helps, but there is value in also trying physical and mechanical things (exercise, strengthening, pain medications) to reduce the volume and urgency of the messages being sent to my brain.)

My previous sports-medicine doctor retired, and so I found an orthopedic surgeon to consult. My basic questions were, what could be done to help the knees short of replacing them, and was I damaging them them further as I used them? I wanted another prescription for PT because while I know many exercises for the knees, I find the skilled supervision helpful. 

The doctor said no, I couldn't damage the knees with movement, was happy to give a referral for PT, and also suggested cortisone shots in each knee, which he did right then and there. The actual shots were quite painful, but it only lasted for a few minutes until a local anesthetic kicked in. Then, over the past few days, the local anesthetic wore off and the steroid gradually kicked in. 

And hooray, they seem to be having an effect! 

The doctor said, and my independent reading confirms, that the only proven interventions to actually improve the knees (as opposed to alleviate pain) are exercise and weight loss. No supplements have been shown to have more than a placebo effect. So I can do whatever I want in exercise, if done correctly it will help, but the pain will likely be there. If I can bear it, I can do it, and if I keep doing it, I can keep doing it!  As to weight loss, that is a topic for another day.

I celebrated this improvement by putting in for a place on a short overnight sail on my schooner, about a month from now. I had held off, thinking about all the ladders on the ship. But now I'm ready to go for it!