PT, the Gym, and Pain

What, pain again?  Well, first we'll talk about PT.  Then working out.  Then...yeah, pain.

I have been going to PT for 4 weeks now, I think.  Sarah, my therapist and I have become good acquaintances.  We each have two daughters, 20 months apart--mine are 26 and nearly 28 and hers are 4 and 6, but 20 months is 20 months and not that many women have children that close together. 

Your physical therapist is by necessity very intimate with you.  Sarah straps a belt around her, puts a towel over my groin, and yanks on my leg for a while.  We have conversations, all while I'm lying down.  I've devised a method to count my reps and still talk.  (I love to talk).  I almost always feel good when I leave--but I'm also in pain.  The manipulation, while a good thing, also is painful.  It pulls my leg past where I feel safe letting it go, takes me literally out of my comfort zone.   But the sessions start with heat, also on the groin, and when I started, I couldn't relax my leg while the heat was being applied, and now I can.  In fact, I nearly doze. 

Then when we're done, I drive around the corner and go to the gym, which is in fact, upstairs--the same building. I chose it that way.  I figured I'd get to the gym at least twice a week this way.  And I do.  Sometimes three, but at least two times.  Once upstairs (I take the elevator now--I am simply not torturing myself with two flights of stairs, which is what there is) I do the elliptical.  This particular elliptical isn't frighteningly high to get on, and doesn't make me hurt to use.  I'm doing 11 minutes now.  My feet often hurt.  I'm going to say that I'm not getting as winded--I must not be, because I can't remember.  After that I do things where I sit.  I'm ready to sit.  Also...work my upper body.  In spite of being in not great shape (or maybe sort of passable shape, I have no idea, my hip has me so thrown) I'm so solid and so muscular that I can tell a difference almost right away.  I can lift more dishes out of the cupboard.  I stood around holding the cast iron frying pan the other day, while people made up their minds about what I was supposed to cook.  I can reach higher.  (I can make my boobs bounce and when I've been working out for a while, I can do them individually--probably a skill that generally involves a pole, but whatever).  I've been finishing up with crunches on the balance ball, 100 of them.  Today I was considering shooting for 200, but I had to be back out, in normal clothes, by 2, so I passed.  I might start working up to 200, though.  The stronger my core is, and the more I can engage my lower abs, the easier it is to walk and to stand.

And then, after the ride home, where I sit for 20 minutes (ish), comes the pain.  It is a deep pain, from above my left hip, through it, down my thigh (oh...my thigh....), to my knee, and then down my shin and to my arch.  It hurts all the way down.  A shrill, pulsating pain.  The heated seat in the car helps some.  But the pain stays, will stay now, for the rest of the night.  It abates a bit when I stand, but then, if I stand too long, it gets worse.  It improves when I walk, but then, again, if I walk too long, gets worse. 

It is of ultimate good.  The goal is to improve range of motion (which has occurred, to an impressive degree) and more, to strengthen the left adductor muscle, which is what they cut for the hip replacement.  Also, the gluteus, or as Sarah calls it, the butt muscle.  Well, yeah, the butt muscle.  I suppose.  Those muscles have atrophied.  This bothers me, a lot more than you'd think to look at me.  I work to build them up, I work all the time to build them up.  I make them do the bulk of the balancing or pushing when I'm working out.  I'm coaxing them all the time. 

I want a good outcome from this. I don't want a revision, I don't want an infection, I don't want the recovery time to be longer than it needs to be.  I don't want a shrunken leg, I want to wear flattering shoes again, I want to be as normal as I can for as long as I can. 

I want to climb a flight of stairs without holding on.  I want to take a long walk.  I want to climb to the Schloss in Marburg, and I want to climb the hill in Montmartre, which I've never laid eyes on, but have certainly read enough about.  I want to climb a Wendeltreppe, should one present itself.  I want to go out in Paris (my older daughter wants us to take a trip to Paris together) in high heels. 

When I am eking out the last painful rep (to help the range of motion, to build the muscle) it's easy to want to roll over, shove the knee pillow between my legs and doze off, but I want the other stuff too much.  There is a picture of my great-grandmother, my mother's mother's mother standing with billowing breasts and a basically billowing body, and she used a cane, (to hit people sometimes) and I don't want to be her.  My father's mother's mother was tall and skinny, but those genes went to someone else--someone who wasn't me or my cousins. 

Age now keeps receding.  56 is not what it once was, to the point where no one knows exactly what it is, and what should be.  But whatever it is, I want it to be the most current it can be. 

Pain

Pain is a remarkable motivator.  Pain, and I'm not saying this to be dramatic, is my constant companion.  Except maybe when I'm sitting.  Sometimes.  Which is sort of evil in itself, because I'm sitting there, feeling normal, and then I stand up and WHOMP! it hits me again.  But pain is what got me to the doctor.

I think I know why my hip deteriorated.  It's a long story and actually sort of boring, but let's just say that for the last seven years, the pain has been increasing steadily.  Late winter it finally got to the point where I more or less had no sort of life--pain prevented me from a five-minute walk.  Going grocery shopping, even with that walker in disguise, a shopping cart, left me in a sweat.  I finally decided I had to see a doctor, and so I finally made an appointment. I didn't exactly pick one out of a hat, but I more or less did.  I went to the same practice my father had gone to, before he died, just less than a year ago.

The first visit was awful--because I hadn't been in so long.  My primary reason, of course, was the pain in my hip, but there were many more things to be interested in.  My blood pressure.  The fact I hadn't had a pap smear since 2002.  The fact that I hadn't had a mammogram in that long as well.  I still haven't gotten my colonoscopy, to be honest.

Well, those things were addressed, and I'm the proud owner of four meds a day, two for blood pressure and two for pain.  Does this make me happy?  Not in the least.  But it does give me something to work toward.

So here's what I found out, when I wrenched the attention back to my hip.  I found out that the cartilage is completely gone and that it's bone on bone and that I limp because of the loss of cartilage--my left leg is now 4 (or so) mm shorter than my right one.  I found out that the only way to fix that is a hip replacement.  I'm 56.  I've heard both--you're too young!  and, better to do it now, while you're young!  I don't feel as though I have a huge choice.  The pain is too intense.  I've been attending physical therapy (which also causes pain, but at least I think it's getting me somewhere) and so I can do more things than I could before, but the pain in there.

The pain is always there.  The pain is there when I cook, when I work out, when I walk, when I drive, when I sleep or try to sleep.  When I have sex.  When I brush my teeth, when I go to church, when...you get the point.  And one of the most frustrating things is that it's unpredictable.  I have no idea how bad it's going to be at any given moment.  Sometimes it brings tears to my eyes (and I don't cry that easily) and sometimes it recedes and I'm nearly my old self. 

I'm a little afraid of a replacement.  The doctor I finally fetched up with (and more about him and the others, another day) seems to think I'm a fine candidate.  I'm looking forward to a lack of pain.  I'm looking forward to going on walks.  But I'm also looking forward to high heels.  That was something I googled as soon as I started thinking seriously about a hip replacement and before I had even seen a doctor.  Could I wear high heels after?  (The answer, if you're interested) seems to be yes, if I'm good about PT and if I'm patient.  I'll probably never be able to wear skyscrapers, and those vertiginous platforms are probably out, but I think I can probably do 3" again, if I'm good, and patient.

And then, with any luck, the only pain I'll have to worry about is if the shoes pinch.

In the last month

So, okay, this is what has happened to me in the last month:

One month ago today I went to see an orthopedist, because I have osteoarthritis in my left hip and I need a hip replacement.  He was dreadful.  He was simply dreadful.  He, among other things, told me I was never going to lose weight without gastric bypass surgery and that anything that could be done to alleviate present pain would have a negative outcome on future surgery and told me, without my ever having mentioned them, that I couldn't have narcotics.

So okay.  That was a Monday.  And then on Thursday I went and, well, tried to have a breast biopsy for some suspicious stuff except that after a half hour of mammograming, they couldn't find the spots and sent me home.  So that was good.

Then on Friday, I saw the GP, who gave me the rest of the results of my blood work, which was basically that I'm a fat, middle-aged woman.  My cholesterol is up and so is my blood sugar.  Interestingly, she gave me six weeks to see what I could do. 

I saw another orthopedist, who was much nicer (and he's the one I'll give money to, when the time comes) and who prescribed physical therapy.

So.  I forgot the handout about how to eat with diabetes, but the main thing I got was to cut out carbs.  And I told the nice doctor that I wanted three months to try to lose weight before we decided anything about surgery. 

And then I came home and I started eating differently.  I'd like to say I had some epiphany or something, but it was mainly that I didn't want to tell people I had Type 2 diabetes, because, well, I hate being cliche.  I started eating less meat, fewer carbs, and more vegetables and fruit.  And after a physical therapy session, which I purposely had at the one at the gym I belong to, I went upstairs and worked out. 

In the last month, I've lost 12 or 13 pounds. I say this imprecisely for two reasons.  One is that the scale fluctuates wildly and the other is that I fluctuate somewhat, though less since I started taking a diuretic for my blood pressure.  (Just if you're interested, that pisses me off, too). 

I have a big bowl of fruit every night, with some Greek yogurt stirred in.  Then I don't graze all night--AFTER 11. 

I eat salad every day.  I'd like to say I don't remember the last time I had a sandwich, but that's a lie, since I went out to dinner and had a French dip, but I'll say I don't rightly remember the last one I had here at home.  I do have skinny cheese, an egg and either ham or salmon, every morning on light crisp bread (what, you say, LIGHT crisp bread?  Is it even visible?) and that sort of gives me the carb fix.  I won't lie.  When my husband makes toast, I salivate--the smell of the yeast! 

So here I am.  I feel kind of piggy today, because I had spaghetti for lunch (with spinach and tomato sauce, mostly to finish the sauce, which was a second-time leftover) and then out to eat for dinner, but there was no way I could finish all those fries, I had a salad and right now I feel completely stuffed and, frankly, kind of icky. 

But this is my belief.  That everyone, really, knows how to lose weight.  The question is whether or not they do it.  How much they fool themselves into believing they can get away with.  What they try to slip in.  God knows I've done it.  And not to diss Weight Watchers, but I got way too good at the system and started not losing weight on it.  This is easier. 

Do I feel better?  Well, honestly, I probably won't really feel better till I get the new hip (and funnily, the second doctor actually examined me and said that my body configuration--not a ton of fat on the hips, basically--was not one that was terribly concerning for complications) but I will say that I do have more energy and the ability to do more things.  I went shopping this morning!  In a department store!  I couldn't have done that a month ago, in fact, a month ago, I wasn't able to do it when I tried.  So actually doing my exercises helps, with my range of motion and my strength and stamina.  Then I end up in probably worse pain than I would have been in because I'm not a sitter-arounder by nature and I do too much--but that's okay.  I did it. 

I'll be back to keep track of progress.  The interesting/noteworthy/scary thing here is that...it's not hard.  It's not actually hard.  I'm just doing it.  I more or less made the most of my natural inclinations, which is that I like real food, I'm not that much on sweets and I have fairly good ability to make good choices.  Portion control is huge, but the interesting thing about portion control is that it gets easier as you get used to less food.  So I have to say there's not a lot of suffering going on here, which may be disappointing on some level, but whatever.  I'm happy with two squares of chocolate, so that's fine. 

Right now I have two goals.  One is the end of the month, which I see the GP again.  I want my numbers to be good enough that I have evaded medication.  I think I probably will, because the time before the last bloodwork was pretty much Molly bar the door, as far as eating goes, and they STILL hadn't gotten me to where I absolutely needed meds, that second, or I would die.  So when I do get tempted, I realize I'm working toward that, and while 20 pounds is probably unrealistic, I'd like it a lot if I could manage that, so that's a deterrent when I want to indulge.  (And when I do indulge, I'm fully aware that it's indulgence and not regular life).  The other is the end of the summer, when I see the orthopedist again.  I'm not sure what I want him to say, because he was encouraging anyway--but I guess I want to have made the effort.  And you get to the future perfect (interesting name for that tense in this case) by making the effort every day in the plain present. 

So here I am. I guess I could say I'm working toward the future perfect.