New Blog

I have started to a new blog … http://newrunningstart.wordpress.com … bit of a gap from this one, and the new one will have a more expansive theme, I hope 🙂

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In Closing

That which made me strong
but nearly killed me.
Its presence gave me life
when my last breath could have been near.

Fallen from a high place
slower than ever now.
Yet I am faster than ever
for in me I found me. 

Family bonds grew strong
and gave me strength.
True friends drew near, ever grateful.
Others disappeared, life goes on.

Awareness of self stronger.
Respect for others is how it works.
Life is finite.
Possibilities infinite.

Closing what was
a hard chapter in my life.
Dark and light, saw both
but wouldn’t change a thing. 

Thank you Mom
for our time.
For sending me back
it was not time.

Thank you for this life
the life I have.
Tomorrow is another day.
Today I run.

—–

Thank you to all who took time to read my posts and offer words of encouragement. 

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Penultimate

It is soon time to bring this blog to a close. As my recovery continues, I am less and less an injured runner, less and less a recovering runner, and more a runner again.

I have seen the best, and worst, in myself. I have seen over and over the kindness in people, how important family is, and how important it is to be thankful for each day we are here.

The Injured Runner soon hands off the baton. It will be a bittersweet step, but an exciting one.

Can you hear me now?

OK, the title has nothing to do with anything, but I couldn’t think of one.

Last night, I decided to jog out to our mailbox (about 25 yards) to check the mail, felt fine. I did the “big” loop around our parking area (about 50 more yards), felt fine. The right foot seems to be on the mend, and the left is feeling less limited. There are times where the left side seems to get kinked up on itself, like it gets stuck or misaligned. While I don’t force it, usually there is a significant crack, or two, or three, lurking behind such stiffness and it frees right up. The overall trend is improving, although day to day it can be a little better, a little worse. 

Alas, a few days ago I managed to tweak my back somehow, but at least the legs, feet and ankles seem to be doing OK. I think it is a posture issue at work (as they recently changed monitors on us, and I think the new set up is the culprit despite my efforts to work with good posture … as in, no slouching). 

I have been primarily swimming more (which might also partly explain why my back is a little tweaked) and deep water running. My big swimming days were 10+ years ago, so it may be that the ramp up in swimming, despite its safe nature, might be a factor. The crawl stroke does exert a lot across the back muscles. 

I think my fitness level has improved somewhat, although I am nowhere near where I was when my running was going well. One minor concern is that my cardiovascular fitness will be ahead of what the legs can bear, so will have to be careful to let the legs set the limit. My weight is now higher than I would like (sitting near 170 when I like to be about 5-8 lbs lighter). My experience has shown a few pounds of that is transient, so probably 5 lbs heavy now. 

PT will soon drop to 1x per week, and as soon as I have parity of strength on the two sides, it ends. Dorsiflexion and plantar-flexion ranges between left and right are pretty close, not exactly since the left side was tightened up intentionally from the surgery. Inversion/eversion are more limited on the left, but that will come over time and especially as running resumes. 

One thing I do NOT want to do is make the left as flexible as the right, as the right has been deemed to be too flexible. 

Perhaps one day I will venture out on the keyboard and comment on the whole minimalist running idea, having learned what I have over the past months. 

Sigh

So, this past Monday, I was given the OK to run again (well, start over again). The excitement lasted about 12 hours. 

On Tuesday morning, while feeding our cats as I always do, one got underfoot as I was moving about feeding them, and I awkwardly aimed my right leg to avoid stepping right on her. As I did, my right leg and foot came down kinda funny, and I managed to get a nasty roll over on the right ankle as I missed the cat.

I was checked at work by the onsite physician’s assistant for a sprain/torn ligaments, and she seemed to think all was intact. A nagging little pain persisted, and one of Dr. Wishnie’s colleagues verified the big ligaments were OK (not even sprained) but he spotted a tiny little bone chip/fracture; a tiny attached ligament yanked off a small piece of bone. The chip didn’t displace, so basically it will kinda mend itself back together. What this means is 4-8 weeks since it is as much a broken bone as any other. 

What can I say? It really just sucks. 

Winding Down or Winding Up?

It is hard to believe that things have come as far as they did. Truly amazing is that this is the same foot that I saw on 11/29. I have declared, as friends on Facebook saw, that the 4″ scar on the outside of the foot is a racing stripe. 

A lot of people told me, with good intent, to be patient. I think a better thing to say would be this: healing from such a major surgery takes time. Perfect! Ha ha … kidding. I think the lesson to share with others is that the body heals from such things, but it is incremental. I could not really measure visible progress day over day, save a day or two, but week over week and month over month, yeah, progress. So, a key thing to learn and remember is to have faith, do the right things, trust that the body is healing even when it is hidden in pain, and keep an eye to the long term goal and measure over longer time windows. 

I am continuing to do whatever exercise I can. Able to do fairly intense deep water running sessions now up to an hour (intense as in heart rate to 140 bpm). I also do deep breathing in the pool (above water, thank you very much). As I babbled about before, posture and breathing are SO connected. I am amazed at how good posture, even in the pool and vertical, really opens up the lungs. Lungs continue to recover. I don’t think I have full lung capacity yet, but I think the lesson learned on posture will help otherwise. 

Speaking of the lungs, for the first time the doc mentioned the prospect of saying bye bye to the warfarin in about 5 weeks. Now, thus far and knocking on cellulose, the drug has had no impact on me in any way, except for that little detail of saving my life… 

I have actually been able to “run” short distances, although from a distance it may not appear as running but slightly hurried walking. More of a fast walk, perhaps jog, with focus on toe pushoff as the calf strength (while improving) lags behind. I did a few very short stretches, 10-15 seconds, and long walks between. 

If all goes well, I may get the OK to run again next Monday! Of course, it is a start over and just means I can transition a little more exercise to terra firma over time, but as some nice folks told me, maybe starting over is not such a bad thing.

I will follow the method of a friend (Judit) who recovered well from serious foot injury and surgery as well. 

Day 99

Hard to believe that the surgery is that far back now. Wow. After the surgery, and while puttering around at home for 6 weeks, time seemed to stand still. I got sick of the AARP commercials, as well as “NoNo” and a zillion other commercials played all day long.

Progress seemed to be zero. I had a detour through the hospital, a lot of time to reflect and think over a lot of things that are right, and not right in my life. Both sides of that balance sheet are pretty full. 

At day 82, progress rate went into high gear. what a turnaround. I feel like I have plateaued but here is where perception and reality are off.

When I move my ankle, I feel tightness and I think, “Dang, not good.” What I am realizing is that I am moving it a lot further to hit those points now. And, when it moves, it isn’t so much the feeble, struggle to move mechanical stuff as it is a more controlled and movement based on flexibility and strength. 

I am closing in on two weeks, possibly, when I will be OK’d to run. I have tried a little “running” indoors, a glorified faster walk here at home, for about 10-20 feet on our straight runs of padded carpet. No problem. The real thing awaits. 

I am getting more strength in the calf both in function and measure. Kunal noted the left calf is “getting there”. Still some deficiency compared to the right but almost able to raise my body weight solely on the left foot (could not do this before surgery even). By now, the right has probably changed some (since my last run was at the beginning of October last year). 

Since getting a full head of steam in recovery, I’ve been swimming, deep water running, elliptical’ing, and indoor cycling. I tried rowing perhaps too soon, probably OK now (indoors, of course).

My INR level (measures effectiveness of warfarin) has been bouncing around but finally stabilized again. I am at the (at worst) 1/2 way point of taking that drug. Maybe my need for it will drop off sooner than the 6 month window. Note to self: ask the doctor what the criteria are to exit this drug.

My weight has mostly come back to where it was before surgery, maybe even a tad higher than I’d like but that will be fixed in time.

I’ve mentioned the BAPS board. Here is a picture of it in use. My PT has become more dynamic now, less “sit and stretch” and more “move and extend” stuff now. 

The next thing for me is jumping rope. No, really. This is something I could not do healthy, so I am not sure this is a good prerequisite for running but I will try. 

Kinda of a “post just to post” but I do want to keep this thing going. The process continues, so my endless babble will too. Need to keep thoughts written down so at some point, when I am hopefully running and fully recovered, I can look back, and be reminded what a precious gift we have in life. 

 

Standing Among Giants

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Left to right: Kunal Patel, PT, MHS (Kessler, Piscataway, NJ); Dr. Peter Wishnie (Family Foot & Ankle, Piscataway, NJ); myself; Dr. Dana Waters (Family Foot & Ankle, Piscataway, NJ)

I have to admit that I was a bit teary eyed when I was able to get everyone together for this picture. Such an amazing group.

Kunal has patiently worked with me (pun in there?). I think I’ve had about 25 PT sessions with him so far. On the first day, I just had the cast off and my foot was this gnarly looking thing. There was zero movement, no muscles left, pain all over, and a very grumpy, impatient patient attached to said foot. Today, the foot is beginning to compete with its rightside neighbor again.

Dr. Wishnie has been as much a friend as doctor. He answered the call when I had the PEs going, urging me to get to the ER. He called me there, and checked in on me throughout. He has provided exceptional foot care for me since about 1992, and is always accessible to answer questions. His staff and medical colleagues at Family Foot & Ankle are both first class and WORLD class.

Me, yeah, the tall dorky one who writes and Facebooks too much!

Finally, though, Dr. Dana Waters! She is the surgeon who reassembled what I took apart. She is that quiet presence and strength in this. I stand and walk, and will soon run, on her handiwork. She is the one who reminded me, perhaps taught me, that a key element in recovery is trust. She has multiple educational videos on YouTube, and if anyone wants to learn about foot and ankle care, those are the ones to watch!

From the bottom of my heart to each of them, thank you. They go beyond being professionals and are caring and compassionate. I am forever grateful and humbled to be blessed to be standing in that picture beside each of them.

P.S. The foot and ankle continue their remarkable and breathtaking recovery at breakneck speed now.

Breakthrough at Day 82!

OK, I was so excited after I realized what happened that I, well, found every possible reason to walk around all day long. Yessirree! Exciting life! Well, life is exciting, I am finding, even in the dull moments and the down times. 

This morning, I heard a particularly loud CRACK! as I moved about and stretched my ankle and legs to work away the nighttime stiffness that sets in. Now, these cracks occur pretty much every morning and all day long, but what was striking was where it occurred: right in the core of the tightest area. This area has resisted movement and was stubborn in loosening. Now, I hadn’t realized anything good had happened but I noted this. A crack of this magnitude in a new area means mobility coming right behind it. And it was the first too. 

As I walked at home this morning, I stopped multiple times and looked at my foot. What the f$%^! happened? Why is it suddenly so easy and comfortable? Why does it feel like left foot, right foot again, not Frankenstein’s waltz? Did someone replace my foot and ankle overnight? Well, the ankle part was done about 12 weeks ago but I digress. 

The change from yesterday today was completely unexpected. Well, not really… 

Kunal predicted it last week. Damn, he’s good. 

Shelves and Trust

In my first IT job, I worked for a systems integration consulting firm, primarily focused on telecom before it went POOF! back in the early 2000s. The company’s philosophy was built on the premise of using, and reusing, repeatable off-the-shelf solutions. The assumption was that most telecom companies needed to send basically the same information among billing, provisioning and customer service applications. So, they came up with a suite of connectors among these applications and they could just select whatever they needed from their inventory of solutions.

The cost effectiveness of reuse was appealing. Once a solution was built, they now had a product that could be sold over and over, cranking up their return on investment. Pop it in, charge a fee and move on. Clean and quick, high ROI.

One slight issue … every single enterprise customer (even connecting the same two applications down to the same versions) wanted or required something different. Each one’s business process was different, the growth rates varied, processing volumes varied, and so on. The off-the-shelf solutions needed tweaks (aka rewrites) for every single customer. The business model broke down even before telecom did back then.

SAMSUNG

Kunal Patel, PT, MHS of Kessler Rehab in Piscataway, NJ

Early on, I asked Kunal a question along a similar line. “Is there a standard progression of exercises and development you do with ankle patients like me?”

His answer went something like this. I won’t use quotations as I don’t recall exactly what he said, but anyway… No two patients are the same, recovery rates vary and what works for one may not (and probably won’t) work for someone else. He follows and observes each patient’s progress and adapts the PT to both what he observes in sessions and the feedback he gets.

Indeed, every session begins with questions on how I am doing, any pain or areas of concern.

The second part of what I wrote is also key. He is a keen observer, and whether I am among several clients there at the same time or the only one, he doesn’t miss anything and will often make adjustments accordingly (or give feedback).

Jumping topics…

As has been reflected in this blog, I have been frustrated at times. Yup, true confessions! I am closing in on the end of 12 weeks since surgery. I have been in PT approaching two months (since 11/29).

As a runner, I expect “training -> response”. (This is actually happening, but understanding the response part is the new ground for me here.) Just yesterday, I noticed some major improvements. These didn’t just happen all at once.

Long story short, movements and strength are increasing (they are closely related, I am learning). Working with Kunal, he is teaching me what needs to happen, making it easier for me to focus on what needs to be done. Two different things.

But I realized something … here comes the genius side of me!

I am still healing. No, really, it’s true.

The body formed a truckload of scar tissue around the surgical area. At first, I was annoyed. Get this crap outta there. The entire foot from the ankle down, after surgery, was swollen and the tissue as hard as hardened rubber.

But I am beginning to realize that our bodies have mechanisms in place. In this case, there were three major traumas … the initial injury to the ligaments, the damage to the ankle joint from running while misaligned, and the surgery itself.

The joint was immobilized both medically and by the body for initial healing and for protection. The primary task was to rejoin and heal those ligaments back together. Immobilizing was the only way, since at one point, stitches were the only thing holding it all together. Both doctors and body understand this. The job of PT now is to coax the body into easing off its self defenses, to retrain the new structures.

So, what is my point?

While I get frustrated still, I am understanding that the body is proceeding at its speed of healing, but healing nonetheless. My body isn’t going to let me progress any faster than it can handle. Motion limits, stiffness, soreness and, yes, still pain are all indicators of those limits. That limit is expanding, slowly at times and breakthrough speeds at others. I noticed that I was able to walk with a more firm push off from the toes than before, cool! but then after some walking, some areas got a little sore and some minor swelling set in.

Our bodies are pretty smart. Mine was and is telling me at every step before and after surgery what it needed. Trust…