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Friday before the weekend I had a PT visit with Jacquie. My appointments are always at 7:30am, and begin the same each time. I head in and warm up for 5 minutes on the exercise bike, then stretch and use the foam rollers. At some point in this process Jacquie appears and asks if things have gotten better / worse etc. Usually I respond that things are more of the same, a good day here, a bad pain day there. I think it threw her off that I said they’ve been fine. I’ve been biking minimally, swimming regularly, and doing stretches and exercises daily. That’s not to say that I think I’m all better, my knee still throbs a bit before I stretch, or when I’m going down stairs, but things seems to be normalizing at the level of activity that I’ve been maintaining for the past few weeks.
To celebrate this minor victory and enjoy the (relatively) warm and sunny afternoon on Sunday, I rode to the grocery store to pick up the week’s supplies. The store is less than a mile away, so if things got bad, I could just walk it in a pinch.
I made it to the store in no time, and continued on another mile just for the sake of it. I remember why I am drawn to jogging and biking, but often have to force myself to go swimming. I love that cold feeling in my lungs as I’m riding downhill, and the warmth of the sun. I had to reason with myself for a mile before practicality won the conversation and I turned around. I woke up and swam this morning without incedent or stiffness. I’m very relieved and reinvigorated…I really needed this boost of confidence that I’m progressing, as well as the reminder of what I’m getting myself back into shape for.
There’s still snow on the ground, but my knees are feeling stronger and the sun is shining. I think a short ride may be in the cards today. Wish me luck!
Last week I saw another physical therapist, who Jacquie called in as a ringer to do a consultation with me. Rob is a veteran PT at Orthopaedics Plus, but also has a small tear in his meniscus, and battles with patella tendinitis like I do. His knee gives him much more trouble than mine does, but still he was able to impart some great advice and stretches that have helped him get back to normal. I learned some stretches and exercises that will strengthen my quads and hamstrings without putting unnecessary strain on my knees.
With his and Jacquie’s blessing, I’ve begun riding again. Sadly we’ve entered the cold and wet half of the year, so I scrubbed down my bike and have surrendered myself to my indoor trainer for the winter. While riding on the trainer is better as far as my knees are concerned, it’s basically the biking equivalent of jogging on a treadmill. Yea the motions are all the same, but all the things I love about biking are absent. But I suppose this is just a necessary step so I can get back to riding and jogging the way I want to as soon as spring rolls around.
My goal is muscle soreness in all the right places without knee or joint pain. After having been nearly dormant for the past 2 months, a morning of exercises and biking was enough to wipe me out and tire my legs, but I can tell I’m still putting strain on my knees. Looks like it might be time for a bike fitting. I’ve always considered it, but it seems a bit silly to spend more on a fitting than I did on the bike itself. Which I suppose raises a red flag that I definitely need the fitting, as I never have been completely confident that the size and shape of it are right. When I bought my bike, I never expected to jump headlong into cycling as much as I have, and the driving forces behind the purchase were the relatively low cost and relatively accurate size.
My second opinion doctor agreed with the first opinion. That makes 3-2; 3 medical professions who think that the problem is solely weak quads and strained patella tendons / IT band vs 2 medical professions who think there is a small tear in my meniscus. Good news?! I guess we’ll just trudge along working on quad strengthening and loosing up some exhausted tissue in my legs. As a part of this process, I’ll be receiving doses of dexamethasone via iontophoresis. Don’t know what either of those things are? That makes two of us, so let’s do some learning:
from the always accurate, never skewed Wikipedia:
Iontophoresis is a non-invasive method of propelling high concentrations of a charged substance, normally medication or bioactive agents, transdermally by repulsive electromotive force using a small electrical charge applied to an iontophoretic chamber containing a similarly charged active agent and its vehicle.
Still confused?
To clarify, one or two chambers are filled with a solution containing an active ingredient and its solvent, termed the vehicle. The positively charged chamber, termed the anode will repel a positively charged chemical, while the negatively charged chamber, termed the cathode, will repel a negatively charged chemical into the skin.
Ooooooooh, now it’s crystal clear. What’s that you say? You think that sounds a lot like a transdermal patch? “Unlike transdermal patches, this method relies on active transportation within an electric field. In the presence of an electric field electromigration and electroosmosis are the dominant forces in mass transport”
So that’s ionto, the process, but what about Dexamethason, the actual drug I’ll be receiving into my body via electrodes and wizardry? Well, it’s an anti-inflammatory which packs 60 times the punch of a cortizone shot. I’ll be attaching the negatively charged pad to my patella tendon, directly below my left knee, and the positive charge will be on a pad stuck to my left thigh. This is, without a doubt, the strangest thing I’ve ever had my body hooked up to, and it’s too soon to tell the breadth of the benefits yet.
Still curioius about dexamethason or iontophoresis? (I know you are) Turns out a Polish cross country skiier was disqualified and issued a 2 year suspension for her doping use of dexamethasone back in 2004. Uhhh?
My buddy Tony lives in Providence, and dropped me an email last night:
I was riding my bike home from work and some dick in a pick up truck flipped me off. Just honked, stuck out his arm and flipped me off like he was doing something as routine and obligatory as excusing himself after a burp. Guy on a bike? Flip! I mean…it seemed like he did it out of some weird sense of responsibility. I don’t know. It happens to all of us all the time, and I’m typically not one to give a shit when it happens to me but man, this one just stuck in my craw.
Having been to Providence a few times, with the exception of all the hills, it seems like a biker’s paradise. It’s a small city with a centralized downtown area, the roads seem wide, and there are TONS of bikes out there. I just can’t imagine where this pickup truck was headed that Tony caused such an inconvenience. Granted, I’m glad they flipped him off rather than buzzing him, but nonethless. I thought high school was over, but I guess the bully complex will never really go away.
Into PT I walked today, proud to tell Jacquie the good news that the doctor had dismissed the notion that I had done some real damage, but rather than relief she seemed more upset. Adding a pinch of self-doubt to her diagnosis, she had one of the other therapists run a few diagnostic tests. After some pushing, pulling, squeezing, and bending he thinks I likely have a torn meniscus. Shit! I guess it’s just a lesson that I need to be a better patient and push for the MRI, question diagnose, and go with my gut.
So back I go to a specialist, Dr Evans to get a second opinion. My appointment is set for 3 weeks out, so I guess between now and then I’m just going to stick with the exercises etc. Oh and jump through more HMO hoops.
On the bright side, by the time I have my appointment with this second specialist, we’ll have a new president!
NO INTERNAL OR SERIOUS DAMAGE!!!!!
I had a great consult with the orthopedic surgeon/specialist today, and after some tests and X-Rays he doesn’t seem to think I’ve done any internal damage to my knees. As he put it, I’ve got some “tracking” issues, but recommended I keep working on PT exercises etc to strengthen my quads. Considering surgeons like to perform surgery, he didn’t push for an MRI or to schedule another exam to see about the need for it. This is totally encouraging to me since it basically means that as far as his business is concerned, I would be a waste of time.
I wish I could show you a model like he had, but basically by “tracking” he means that rather than severe damage to the tendon or cartilage, my quads are simply not strong enough and have gotten exhausted from the amount of stress I’ve been putting them under. Once the quads and hamstrings are exhausted, they don’t hold he patella tendon, (which connects the patella and the tibia) in place, allowing the patella to shift when carrying weight. Because of the way the bones and tendons are lined up, there is a naturally tendency for the tibia to shift laterally, and the quads aren’t strong enough to fight that normal shift.
It’s not really bad news yet, but it’s a precursor to bad news. Jacquie did some more tests today since some of my symptoms have been getting better, while some have been persisting and/or getting worse. Turns out I need to go get an MRI to check for a meniscal tear. She and I had talked about the possibility of a small tear in my meniscus last month, but after having made great progress on the patella tendinitis, the meniscal symptoms stand out even more. I spent most of this morning on the phone finding an orthopedic surgeon who could see me in the near part of the near future (somehow I wrangled a 9am appointment on Monday) and jumping through hoops trying to get a referral in place. After the jump I’ve included my progress report from Jacquie, which is full of medical shorthand, some of which makes logical sense, some of which does not. Anyone out there able to read between the lines?
The good news…even if I do have a torn meniscus, bikers don’t get them, joggers do; and therefore biking is permissable during my recovery, but jogging will take some time to get back into. Slow and steady wins the race.
This morning on my ride into work, I saw a car door wide open. As I approached and saw a bicyclist wincing and breathing hard in front of the car, it clicked. “Did you get doored?” “Yeah”, he replied, and lifted up his shirt to show a half-inch deep, 4 inch long gash in his chest, starting around his collarbone, in the perfect shape of the corner of the door.
It’s easy to preach about how dangerous and stupid throwing your door open into traffic is, but to be completely frank, even when I’m driving I’m not as observant as I expect other motorists to be when I’m out biking. I drive so infrequently that I’ve lost the confidence that I suppose has shifted to my self assurance when biking. I think and hope that keeping an eye out for cyclists will become second nature in society as bikes become more and more present on the roads, but I expect most drivers won’t look for a bike before opening their door until that tragic one time where they connect with one.
When I first moved to the city, I walked, biked, and on occasion drove like I was still in the suburbs. Having never lived in an urban area, when my brother drives in the city he stops for pedestrians at an intersection when he has a green light and waits behind double-parked cars not realizing that they aren’t going anywhere. While stopping for folks at a crosswalk is great, doing so when traffic has a green is incredibly unsafe and impractical, and stopping behind a stopped car is simply innocence having likely never crossed paths with a stopped car with four-way flashers. I think programs like Anti-Dooring are great in raising awareness about the danger of bashing a person with a car door, but to be realistic, the only people visiting that site are cyclists.
New England was made for Autumn, and Autumn for New England. We survive the winters and thaw into the spring, which is lovely as well, but the clear sunny days are few and far between before the warm spring days turn into muggy summer weeks. But Fall…the air is crisp, threatening to get chilly, but the sun has been so warming and the sky so clear. I took yesterday’s great weather as an opportunity to go for a short (therapist approved) ride. I made my way over to Lynch Park, where I stopped a bit and envied all the folks walking their dogs around.
Come spring, and presuming my knees are back to full capacity, I will be taking the train to work in the morning, and then riding the 15 miles back in the evening. My friend Jay can think of nothing he would like to do less than ride for an hour on a Wednesday evening, but for me there’s not much I would rather do. I have been hypothetically planning my route; trying to decide if main roads or back ways would be my best bet, and landed on taking Rt 127 all the way from Gloucester to home.
This would make for an easy, direct, and beautiful ride but I had never actually been on Rt 127 on a bike, in a car, or otherwise. All of the locals that I explained my ride to advised against it, saying the road was too narrow, cars move too quickly, and that it would generally be unsafe. Turns out they’re really just trying to keep me out of their hair. In this part of the world, there are not many roads I can think of that are better suited for riding. The speed limit is 30mph, there is a big tasty shoulder, and road parking is forbidden for the whole way I traveled.
northbound through the Endicott campus
There were dozens of other cyclists out yesterday, and to my shock and awe many of them acknowledged me and a few even waved back. My leg-benders felt great yesterday, but have been complaining a bit today. I have the next couple days off from riding, so we’ll see how they feel riding over to therapy Wednesday morning.
Spoken Contract 