Physical Therapy Peers

It helps to have a bit of a view….

Every Tuesday and Thursday morning, at 9:30 am, I meet up with a group of friends. We’re not meeting for breakfast or coffee or anything that would require talking to each other. Instead, we meet at the Boulder Centre for Orthopedics. Actually, these people I’m speaking of have no idea they’ve become a part of my twice a week circle or that I’d refer to them as “friends.” It’s best that way. It started the first time I did PT on site – week 3 post op. I arrived 15 minutes early because I always arrive places 15 minutes early. I’ve still not gotten used to the fact that Boulder is a much smaller town than I’m used to and it never takes me as long as I anticipate to get from place to place. As I sat in the lobby area that held a dozen or so chairs and looked out onto the open area with exercise bikes, weights, portable steps and a reformer-like machine, I did what I always do. I people watched, which is what I call it as it doesn’t sound as rude as blatant staring. This time and place felt different from my usual “spying” because I could see that I had something in common with many people in the room, namely the ones in shorts who were exercising a new knee. Watching them, OK, spying on them, has given me the opportunity of seeing either what’s next for me in my knee journey, or taking pride in how far I’ve come when I see the new patients, still in their hospital issued, white, and terribly unattractive, support hose. If I’m close enough to see either the steri-strips or the vertical scar that runs the distance of the knee cap, I take note because we’re members of the same club.

On my first visit, I still had the stere-strips lined up over my incision and was using a cane. A month later, in the same lobby, I’m drawn to the patients that come in (in shorts) that are using a walker or a cane, also with the steri-strips evenly spaced down the long incision. I know the pain they are in and I know the fear they will experience when the compass-like measuring device comes out because I’ve been there and it wasn’t that long ago. They have become my measuring stick for how far I’ve come. It’s a necessary part of recovery because sometimes, especially on a bad day, it’s hard to remember those days of maneuvering up and down the two steps that connect my kitchen to my living room. It’s also important for me to see the patients whose knee scar is a faint line and who are doing high reps of deep squats. They are ahead of me. They are my goal.

I’m gathering information. I’m in detective mode.

A few days ago, while working on some balancing exercises with my therapist, Esther, she told me (nicely) that I needed to focus on what I was doing. I told her I agreed whole heartedly but was a bit distracted at the moment. A police officer with a shackled prisoner in an orange jump suit, were making their way to the other side of the room, passing just feet away from where we were working. I realized I was staring, full on, wide eyed and with my mouth dropped open. Esther didn’t seem to be as distracted as I was, which indicated to me she had seen this before. She stopped counting reps and explained.
“We get prisoners on occasion who need physical therapy. Usually on their hands. If a hand injury isn’t treated soon, mobility is lost.”
“How do they injure their hands,” I asked, wanting to dig into every detail of the strange and somewhat uncomfortable situation that was unfolding in front of me.“I don’t know… well, I have ideas about it… maybe from punching people?? But I can’t say for sure,” Esther answered.
The police officer and his prisoner moved to the back of the room where the prisoner sat down at a table and a therapist took her place on the opposite side. I couldn’t see what was going on, but assumed it was the hand therapy Esther had spoken of. Unfortunately, once I had completed the exercised, Esther, had me move to a different area to work and I lost my view of what was far more interesting than people limping in with canes or walkers on what I guessed were 3 week old, knees.

Yesterday, I saw a man walk into the physical therapy room with slow, measured steps. I was on the Exercycle, getting in my 30 minutes of warm up before my session when I saw him. He was wearing the hospital-issued white ted hose and was using a walker. I put him at 2 weeks out — long enough that he was driving (he was by himself) but not long enough that he could take the ted hose off. He looked like he was in pain and I knew exactly what that pain felt like. I wanted to shout out words of comfort to him, but also didn’t want to be creepy. Thankfully, someone beat me to it and casually told him as they walked past that it would get better. That person, also in shorts, with the long scar that ran vertically down his knee cap, had just finished a round of squats with his therapist. I’d put him at 2 months out. Ahead of me. I’m getting good at this.

I don’t know any of their names, nor do they know mine, but I am connected to this group because of the scars we share. I also know where they are in their journey. We all know, but it’s possible that the others aren’t as invested as I am with their spying followed by writing about it. I’ve been coming to this place for PT for a month, but it seems like a very long time ago that I was the new one in the room when I walked in for my first sesion. It was an assessment session, with no exercising, along with measuring my flexion and removing the stere-strips. That appointment opened my floodgates of emotional tears and an intimacy that my all business, not much fun therapist probably hadn’t expected. It was my last crying episode and now I spend my time trying to get Ingrid to engage with me rather than have her uncomfortably handing me a tissue. (Esther is her assistant and is much more talkative, but my sessions always begin with Ingrid.). On one of my first visits, I asked her when she thought we might have our first snow. Weather is always a good conversation starter (I’m from the midwest after all) and although I don’t care for small talk, I dove right in with my snow question. Her answer was brief and immediate.
“Depends on where you live. In the mountains, it will be sooner.”
I let it go and tried to redirect my attempts at conversation to something I thought might interest her more. I asked her if it’s hard if her patients don’t do the exercises or after a few weeks decide they don’t need to come any more. Bingo. I hit my target. For the first time, Ingrid was animated and began to share stories that confirmed my theory of the frustrations physical therapists face with some of their patients. That is what I now reach for when I’m tired of the silence as she massages my leg followed by the flexion measurement, which no longer has me bracing but instead, puts me in competitive mode as I want to beat my last measurement. For those who have gotten a knee replacement and are familiar with the measurement, I’m at 135, or about the same as my other knee. I’m thrilled. Today, I added another talking point – my Halloween costume. I described how I added my own “artificial knee” to a skeleton unitard, complete with a little stuffing to show some swelling. She loved it and insisted I get a picture of me in it and made me promise I would show it to Dr. Bowman at my next appointment, which happens to be in a few days. I figured he should get the credit, so added the tag. It could be a business booster for him.

Exaggerated size and puffed up to show swelling, but my new knee really does look like a bikini (I used my X-Ray for reference…). Card says: “Knee by: Dr. Bowman”

As I was leaving my last appointment, a very fit man came in wearing shorts, with the telltale line running down his left knee, visible, but faint. As he and his therapist were walking back to one of the rooms, I heard the therapist say,
“We always have to tell our Boulderites that a a rest day is not a bad thing. It’s important and necessary.”
I couldn’t hear his response, but assumed the therapist’s words were directed at him. I did a quick assessment of my own rehab and recovery situation, wondering if I would fall into the “typical Boulderite” category of one who is pushing their way too hard and too fast towards recovery. For one, I drove to my physical therapy appointment, and didn’t ride my bike or roller blade or skateboard or any number of ways people in my very fit town navigate their way from one place to another. No, I’m good. I do my daily walk(s), my exercises and hop on an exercise bike at the gym for 30 minutes several times a week. I also feel no guilt if I want to chuck it all and sit on my couch and watch old movies or reruns of Friends. Those days don’t happen often, but when they do, I get the ice and the pillows for elevation and embrace them, remembering the therapist’s words about rest days. I’m an obedient patient.

Class of 1973, 50 years later

Our wearable cheat sheets…

I’m several days out from my 50th high school reunion, which means I’m still in the energetic flow of conversations I had, faces I tried to remember and hugs that took me back to times when the self that I am now was still forming. I have to grab my words before the event loses its sense of urgency and life returns to my present day normal.

Spending two evenings in a roomful of people who are the same age as me and share many of the same memories, some dating back to elementary school, is powerful and becomes even more so with time. With the exception of my siblings, my cousins and my parents, there are no other people in my life that can say they “knew me when…” and that alone gives this group of 65 or 70 people a weighty connection. Some I only talk to at reunions and others, when I see them, I’m reminded of how lucky we are that our friendships are still holding strong after more than five decades. We are not the same people we were five decades ago when we walked across the floor of our overly packed high school gym in steel blue gowns and mortar boards to receive our diplomas, but those teenagers still live quietly inside of all of us. For many of us, it’s the only age we are remembered by in this group of people.

So many of the people I surrounded myself with on Friday and Saturday night hold parts of my memories that I have forgotten. They were witnesses to parts of my life that I sometimes wonder if I’m remembering correctly or if they even happened at all. They can give me clarity — where I was, who I was with and did I look happy? They are still able to confirm my presence at the party, the dance, the sleep over or waiting tables at Denny’s. They can also tell me that I wasn’t there, even though I wanted to be, so much so that my memories may have penciled me in, because I was grounded or had family obligations. Sadly, the grounding happened on a pretty regular basis in my later years of high school. I didn’t do well with rules. I also didn’t do well with being grounded and devised my own escape routes, but that’s another story for another time.

Four of us, from four different parts of the country, all stayed with Terri and her husband, Lawson, at their beautiful farm house in the suburbs of Kansas City for the weekend. Mornings drinking coffee in our pajamas at her kitchen island, quickly rolled into afternoons, still talking, still with more stories from so many years ago. We are five women who have been friends for over 55 years. It’s a gift that grows in value with each passing year. As I sat in that kitchen rehashing not only the night before, but decades ago, there were moments that I looked around the room and we were 16, not 68. Time disappeared.

For the Saturday night event, we had name tags that had our senior picture on them next to our name. Even without the reading glasses (that most of us needed), it was easier to steal a glance at a photo than try to read a name. At the Friday night event, we only had name tags that we filled out and attached, although not everyone complied, which meant for some awkward comments of “of course I remember you” when of course I didn’t. It felt like an appropriate time to lie.

I saw a classmate who I easily recognized even though I hadn’t seen him since the last reunion 10 years ago. I approached him, called out his name and came in for the hug. He responded appropriately then discretely began to move his head to the side like he was looking for something — the something being the rectangular white badge I had affixed to my shirt with my name written on it in bold black ink.
“ You don’t know who I am, do you?” I asked him.
When he was close enough to read my name tag he said my name out-loud with surprise and gave me a big hug. There was more grace in not remembering or recognizing classmates at the 50 year reunion than at past reunions. After all, 50 years is a long time and very few of us looked like we did in high school. I had brown hair at the last reunion for starters. There were a few who hadn’t changed, or aged it seemed, but unfortunately, I didn’t have time to ask those few exceptions about their skin care regimens during our brief time together. Time was short. Too short.

These people, some of them friends since my early grade school days, hold parts of the stories I’ve lost and I do the same for them. For the most part, none of it matters as it’s been such a long time, but to have a touchstone to my past that is as real as the person in front of me is a gift of time that I cherish and the reason I’ve made it to every reunion so far. I came close to almost missing this reunion though and was still on the fence four days before the Friday night event. I would only be one month out from a total knee replacement the weekend the reunion was scheduled. When I told my doctor I was hoping to go to my reunion at four weeks out, and make the nine hour drive as I knew it would be too soon to fly due to the risk of blood clots, he was apprehensive. He gave me one of those “let’s wait and see” answers, which I learned growing up usually meant no. He doesn’t know me though or how hard I will work towards a goal of something I want. I had an appointment the Tuesday before the reunion weekend and he told me he was amazed with my determination and setting my sights on my 50th reunion had worked. He said it was a go, told me to have fun and not forget to elevate and ice when I had the chance. As he was leaving the room, he turned around and asked me how many years on the reunion. I proudly told him 50, then realized how old that sounded. 50 is a big number and even bigger when talking reunions. We’re past middle age, but not ready to claim “old” or “elderly,” which is more in line with my parents. We don’t know what to call ourselves.

I’m home now, after taking two days to make the nine hour drive, to make the journey a little easier on my knee. I’m usually a barrel through, eat in the car kind of road tripper (ask anyone who has ridden right seat with me), but this time I was forced to slow down and stop every hour and a half to walk around. Given that it was pouring rain for most of the journey, a lot of those walks were through truck stops, the bigger the better. I was wandering up and down the aisles with shelves lined with camo gear for so long that one of the employees asked me if he could help me find something. I told him no. I was just browsing. I looked suspicious. Who browses up and down each aisle for 15 minutes in the hunting section of a truck stop?

My house that is almost always quiet, seems exceptionally quiet now. Unlike the two nights I spent staying up until after 1:00, I was tucked in by 8:00 on the night I got home. Granted, it was 9:00 central time, but it was still early. I was exhausted and my knee was not happy with me. I apologized to Rhoda (my new knee) and reassured her I’d be more mindful of her care once home.

I miss my high school friends. There is a fragility that lingers long past the goodbyes while wondering what the next 10 years will bring. Or are we at the point, given that we’re 68 years old, that the space between reunions should be shortened? The poster with the 60 plus names of classmates who had passed was hard to look at and hard for me to take my eyes off of. We are all the same age. I’m sure I wasn’t the only one who wondered who in that room Saturday night would be added to the list of names on the poster the next reunion. Reunions are a rare visual of the passage of time and it seems like the accelerator pedal is being pushed a little harder than I’m comfortable with.

When I was 14, Terri, who was hosting me all weekend, gave me a journal. It was larger than the typical journal with 8×10 pages and a black cover with gold embossed trim. It was by far the fanciest journal I owned or had ever seen for that matter. On the inside cover she wrote, “Blank pages await your inspiration. I remember being very moved by her gesture. She knew I wrote and I’m sure I shared some of my work with her (bad poetry that makes me cringe), but it was her seeing and acknowledging something inside of me that had begun to percolate, that was so touching. I filled every page of the journal that resides in a trunk packed to the brim with other notebooks and journals filled with essays and letters. When people talk about what they’d grab in a fire, I think of myself hoisting the large trunk down 28 steps, hopefully with a knee that is stronger than it is today. Before I left on Sunday, she gave me a journal she bought for me a while ago but had forgotten to give to me. Just like the one she gave me 50 plus years ago, this one will also be filled in time. It is just one of the countless threads of connection I was reminded of throughout the weekend. Threads that have woven themselves into my beautiful tapestry of life, one memory and one row at a time. I added a few rows to that tapestry this past weekend. The colors may not be as bold as they were 50 years ago and you may have to move in closer to see the true beauty, but it’s still there in all of its glory. Row after row, memory after memory. “Blank pages await your inspiration” — for living, for writing, for life. I’m still holding onto those words.

To all of my classmates who had a hand in shaping the person I am today and showed up in person so I could hug you and share memories with you, thank you. You are my “I knew you when…” friends and that, holds a lot of weight… more with every passing year.

Left Knee, Part 3

Rhoda’s first portrait (she’s the one that looks a little brighter and shinier than the other one…)

Three and a half weeks ago, I was resting comfortably in the pre-op bed under a heated blanket with my sisters and my daughter seated across the room from me. I remember commenting on how “spa-like” the experience was given the heated blanket. The nurse told me to let her know when the blanket loses its heat and she’d bring me another one, then added that the “spa-like” feeling would be short term. Unlike a spa, I had an IV in my arm and instead of the gentle sounds of nature being piped into the background, I heard doctors being paged. And I was afraid. Afraid because I knew what to expect and the warnings of “it will be painful and the recovery is long and difficult,” were hard to dismiss. (The “warning,” by the way, came directly from my doctor). My left leg was marked with an “X” to indicate it was the knee that was getting “replaced” and below the “X” was my doctor’s signature. Every one who entered the room first asked my name, my birthday and which knee was to be operated on before introducing themselves. I know it was protocol but it became almost comical. I couldn’t help but think about what my 4 year-old granddaughter had asked me a few days before my surgery.
“What if they saw the wrong knee off?”
I told her they check and double check to make sure it’s the right knee before they do any “sawing.”

My doctor had come in briefly and went over the timeline with me, answered my questions and said he’d return when it was surgery time. He wasn’t wearing the usual blue scrubs I was expecting, but instead, had on biking shorts and a tee shirt that looked like it had seen better days. His hair was smashed and misshapen on one side, I’m guessing from the bike helmet. I asked him, jokingly, if he had ridden his bike over and he said he had, but only from a nearby surgery center. Given that this is Boulder where the athleticism is constantly surprising me, that other hospital could have been in Denver.

And now here I sit, 3 1/2 weeks later, on my couch, with my legs not stretched out, not in a massaging ice cuff, but rather, in an 80 degree angle with my feet on the floor. It won’t last very long because it’s still uncomfortable, but for now, I’m sitting like most of the world sits and am feeling pretty proud of the position.

I never knew about knee flexion degrees or angles until a few days after surgery when a physical therapist came to my house and got out her measuring device — a device I would become very familiar with. The oversized protractor, that took me back to my elementary school days and trying to remember which math device was the protractor and which was the compass, now indicates to me that discomfort is coming. When I realized the angle was going to be measured every PT visit, I became competitive (with myself) and would push to get my knee to bend just a tiny bit more than I thought possible. I’ve been told I will probably never have the extension I used to, which would be bringing my heel to touch my backside as in a quad stretch exercise, but I’ll be close. It’s hard to hear things I’ll possibly never be able to do again and I hadn’t given it a thought until the first physical therapist I worked with mentioned that 50% of knee replacement patients can no longer kneel. Really? What if I was Catholic? I’m not, but what if?? What about yoga poses that begin in a kneeling position? She also told me there would be a handful of sports I’d need to give up — basketball, soccer, pickle ball and running for sport. I’m good with that given that none of them are sports I participate in, and as far as the pickle ball goes, I will now have a valid excuse for turning down the many invites I’ve gotten. And one more — skiing moguls. Unless I want to come back in because my replacement has worn out, I’ve been told to stay away from the bumps on the mountains when skiing. I don’t care about any of those things but when you’re told you should never do something again, I’m suddenly interested in women’s soccer leagues and moguls and the Boulder Marathon that was this past weekend. Of course these are activities I never would have taken part in before, but hearing that they are no longer an option if I want to maintain a healthy joint makes me feel like I’m missing out. Even the kneeling, that I may no longer be able to do, is now suddenly appealing to me. There is weight in the word “never.”

My emotions the past three weeks have run the gamut. I’ve been thrilled with my success, discouraged that I’m not further in my recovery, proud that according to the PT’s I’m so far ahead of the game that “if it was a race, you’d be on the other side of the finish line while others are still tying their shoes,” yet discouraged because it still hurts. I’m trying to be patient. I’m trying to give the pain free moments the same amount of time as the ones with pain. I’m trying.

Last week, I went to my first PT session away from my home and I drove. Small victories. Before starting any exercises, my physical therapist had me lay on the table and began removing the steri-strips that had been placed over the incision that was joined with glue. Although it had been three weeks, it still felt like the small line of steri-strips were what was holding both sides of the incision together. I questioned removing them so soon. Ingrid, my therapist, reassured me that the “cement had hardened” and the strips were no longer needed. I couldn’t see what she was doing but still felt uncomfortable with what she was doing.
“I think it’s going to bleed,” I said. As soon as the words left my mouth, I knew how ridiculous they sounded. I thought about my 4 year-old granddaughter who walked into my house a few days earlier barefoot, because she likes shoes but hates wearing them, and noticed she had a bloody big toe. I asked her what happened and did she need a bandaid? Did it hurt? Was she OK? She calmly glanced down to her her toe and said,
“Oh this? Yea. It’s fine.”
She’s 4. Be like Muna, I thought to myself while I braced myself on the table.

Ingrid reassured me that it would not bleed then gave me a towel to put over my face to give me further separation from what she was doing. When she finished, she reassured me that no tourniquets were needed (a sense of humor is a bonus for physical therapists), and she was finished and although I didn’t need to look at it at that moment, eventually I would have to look at my leg. I had shorts on (as requested) so it was hard not to see the 7 inch scar that now divided the center of my leg into halves. Tears started flowing because that seems to be what I do now when I see physical therapists. Ingrid asked me if it hurt. Not physically, I answered, but it no longer looked like my leg. I’m not familiar with my new leg and for some reason it’s making me sad. She nodded and gave me the box of Kleenex from a nearby table and we proceeded with the exercises. In between exercises she stopped, looked at me and said,
“It’s probably a good thing you didn’t go into the medical field… you know, with the whole bleeding thing and all…”
Ingrid is serious and focused, and doesn’t say much, but what she does say makes me smile.
“Yea, I’d have my eyes closed too much to be good in the medical field,” I confirmed.

I couldn’t help but think about what a friend had told me regarding her first PT appointment and how she sobbed the entire time, not really knowing why. Maybe her telling me that had freed me up for doing the same. It’s sure easier than holding back the tears. Another friend who had gone through a knee replacement a few months earlier told me not forget the emotional aspect of a knee replacement, even though the physical part is the part that gets all the attention. I didn’t really understand what she meant when she told me that just days after my surgery, but I do now as I’m trying to find ease and comfort with something that isn’t either. Ingrid told me that as much as I’m getting used to the new knee, the new knee is also getting used to me. And that’s when I named her. If I’m going to have this part of my body tag along with me for the rest of my life, the least I can do is try to become more familiar with her and giving her a name felt like a good start. Her name is Rhoda. It came to me instantly, but there could be a lot of reasons for her name. First off, the character in the Mary Tyler Moore show, who was my favorite — the outspoken, bohemian, free-spirited woman who lived upstairs — the character who I felt I had a better chance being like than Mary, the star of the show. And secondly, rodilla is knee in Spanish, and I always love giving the language I’ve spent so much time trying to learn some recognition. And so I named her Rhoda.

Before I left the physical therapist office, my therapist’s assistant, Esther, said something about a client she had come in right before me and I thought she said her name was Samantha. When I asked what body part Samantha was working on, Esther quickly corrected me and said,
“Oh that’s not the patient’s name. It’s her new shoulder’s name.”
I’m right in line with Rhoda. Given that I see my physical therapists twice a week for at least a few months, I need to make sure they are both properly introduced to Rhoda. They may also offer her apologies in advance for the pain they might inflict during future appointments.

And so my journey continues… days are slow, weeks are faster. I’d much rather be writing about walking adventures in other countries and my discoveries encountered along the way, but instead, I’ll continue to record the journey of the hinge in the center of my left leg that is forging its own trails as it learns to bend. It’s not as exciting as the walks I’ve written about for so many of the past Septembers and Octobers, but trust me, it’s every bit as hard as an 18 miles day climbing uphill, with a head wind in the Pyrenees. Just not as scenic.