being a diva is great…except for the mostly negative connotation

I’ve mentioned before I have some knee pain but I don’t think I’ve ever written about the whole story. This is going to be kind of long but I think it might be good to write it all out if for no other reason than to have a record for myself even if no one else reads it. For the conclusion/current plan/plea for advice, skip to the last couple of paragraphs before the italics. First of all, I started running in 1992 after I finally left retail and decided to try to get my health back. I slowly built up to running several miles at a time, started enjoying races and ran the Long Island Marathon May 1995. After a while I quit doing races but kept running. I was always sensible about training and never had any real injuries. Anytime I’d feel something coming on, I’d ice, take a couple of days off and I’d be fine. I began seriously training for marathons two other times over the years but I’d start getting tendinitis or some other nagging problem and again, sensibly back off.

Before I had the hysterectomy in 2007 I had to take a couple months off from running because it was causing pain and discomfort with the girly bits. When I returned to running after the surgery, I began noticing some knee pain which I chalked up to starting over again and being 20 pounds heavier than I’d ever been. It persisted for months, I took ibuprofen and switched to running every other day. I kept my mileage down to 16-20 miles per week. The pain never really went away and began getting worse this year, which is what prompted me to finally see the orthopedic doctor that did my shoulder rehabilitaiton and eventual surgery back in June 2005 (mumford procedure/sub-acromial decompression if you’re wondering…makes me think I must’ve been sold some bum joints all together). After an MRI, she told me I had osteoarthritis and chondromalacia, which basically means a bunch of cartilage damage in the knee. She put me on diclofenac and I got a cortisone injection in each knee which didn’t really help. They contacted my insurance and I was approved for Synvisc, which is pretty much like a nice, cushy oil change for the knees. I did feel better after that and I think I was pretty much in denial…I convinced myself that this could be my last chance to run a marathon and proceeded with my training as planned for the Phoenix marathon in January. Overall it was going as could be expected, I was still in pain but at a tolerable level. The longest run I got to was 13.5 and while not totally pleasant while actually doing it I recovered fine.

The next week I had 15 miles scheduled. On my shorter runs I’d been having a sharp pain on the outside of my right knee that would immediately go away maybe 2-3 times a run. The frequency increased a bit and I thought maybe I’d have to back off training soon. I figured I’d go ahead with the 15 as planned then make a decision. Well, I should have known it would go poorly…the indicators were there but I wasn’t listening to my body as well as I had in the past because I was being stubborn about this possibly being my last chance to run a marathon given the state of my knees. I had to cut it short and had several instances of that sharp medial pain. The next day we left for Hilton Head to go to a wedding. At that point, I had pretty much decided I had to stop training for the marathon but I had no intention of quitting all together. I figured I’d back off the long runs and I’d be back to “normal”. So I took a day off then followed up with my scheduled 4 & 6 miles Friday and Saturday. The running and biking trails in Sea Pines, SC are amazing! There are miles and miles of paved trails and some of the vegetation makes it feel like running in a jungle. In addition to my runs, we did a lot of additional, walking around, played golf for the first time in about 3 years and did a 10 mile bike ride…in retrospect none of which was probably good for my knees considering the current state of affairs.

Finally on Sunday we planned to spend the day in Savannah before we had to be at the airport to head home. We began a walking tour and after 2 hours I noticed my knee was very sore and I was beginning to have a lot more of those sharp pains. We had lunch and I had trouble getting up…I had pants on so I didn’t really notice it but when I checked in the bathroom my right knee was about 3 times normal size. It continued to get worse and I hobbled back to the car leaning on Jim. By the time I got to the car, it was so swollen and painful I couldn’t walk at all and had to use a wheelchair in the airport. I called my orthopedic doctor first thing Monday morning but ended up going to the emergency room because my whole leg swelled and my foot was numb (we were worried I might have a clot) in addition to being in a lot of pain. They did an x-ray, doppler test, gave me drugs and recommended follow up with my orthopedic (DUH). Tuesday Dr. Andrews drained 45 cc of fluid from my knee, injected more cortisone and ordered another MRI. By the end of the day I was getting around without crutches. I took a couple of days completely off then tested it Friday with 30 minutes on the elliptical. It was still tender but pretty good. I walked 4 miles with Jim and the dogs on Sunday then helped with the leaves with no pain. Yesterday I ran 4 miles…I had just one little pull on the outside of the right knee again. Which brings me to today, one week later. While the serious pain is gone I have the soreness I’ve had every day for the last couple of years.  The MRI showed no tears.  This pretty much boiled down to a case of doing too much with a compromised joint.  She still never said I totally had to quit running but when I pressed it said I had come to her in pretty bad shape and that I should focus on non-impact exercise like swimming, elliptical and cycling.  By they way, I enjoy cycling and do it a lot when I’m in Arizona but it’s not practical in OH (weather, lack of bike lanes and inconsiderate drivers make it downright dangerous).  When the time comes that we finally move there I’m pretty sure cycling will become my knee “solution”.

I’m now at a crossroads. This has been really difficult to take the last couple of months. I have a feeling it is the same for other runners or cyclists or triathletes, etc. Once you’ve been doing it for a while it becomes part of your self image and self worth. It’s part of who you are. And what am I without it? I’m having a serious crisis of self.  Add that to the fact that I’ve never enjoyed the gym and you’ve got a very depressed diva.  I guess it comes down to my goals and health for the future. I have to force myself to realize I may need to modify my behavior now in order to enjoy a pain free future, no matter how difficult that may be for me now.  I’m almost crying just writing this…pitiful. I’d love to hear from other athletes about how you’ve dealt with similar situations. I need all the help I can get!

On a related note, my MRI reports. I’d also like to hear form any one with experience in this area. Chondromalacia patella, from what I’ve read is very common and lots of people will show this on MRI even if no pain is present. Prognosis is a little more uplifting, though it requires complete rest from aggravating activities for up to 6 months and can be hard to get rid of. From what I’ve read, osteoarthritis is hard to distinguish from this so I’m not really sure how to determine which is primary. This would have been a great question for my doctor, but I think even they have trouble differentiating. I’ve been on glucosamine/chondroitin for months and while I haven’t reduced pain it certainly can’t hurt. I also take flax oil for the omega-3.

Technical:

MRI 1, 9/21/09:  Mild patellar spur noted.  The articular cartilage of the lateral patellar articular facet is at least moderately narrowed.  Focal severe areas of narrowing of this lateral patellar cartilage are present.  Subchondral degeneration involves the patella dn teh adjacent anterior femur at the lateral aspect of the patellofemoral joint.

Mild to moderate focal narrowing of the articular cartilage of the distal femur is present.

No joint fluid or bursal fluid collections are present.  The meniscal cartilage cruciate ligaments, the patellar tendons and collateral knee ligaments are normal.  No stress fractures or marrow edema is present at the knee.

Impression:  Moderate chondromalacia of the knee and patella.  Focal areas of cartilage loss noted at the lateral patellar articular facet and at the distal femur.  Osteoarthritis patellofemoral joint.

MRI 2, 11/17/09:  The popliteal vessels are patent.  There is distention of the knee joint, which may relate to the injection of medication or pre-existing joint effusion.

The quadriceps tendon is not torn.  There is soft tissue swelling superficial to the quadriceps tendon and adjacent portion of the lateral retinaculum, which may relate to the therapeutic injection and arthrocentesis.  The cruciate ligaments, MCL and lateral ligamentous complex do not demonstrate tears.

Multifocal chondromalacia at the patellofemoral joint.  Chondral fissuring extending to the depth of cortical bond with subchondral arthropathic cystic change in the median ridge.  Narrowing of the hyaline cartilage at the lateral facet of the patella.  Subchondral arthopathic systic change of the lateral facet and anterior portion of the lateral femoral condyle.

The retinacula appear intact.  Slight patellar tilting but without evidence for lateral subluxation.  Medial and lateral meniscus do not demonstrate tears.  There is edema within the superolateral aspect of Hoffa’s fat pad, which may relate to the procedure prior to the imaging or this may relate to an abnormality of patellar tracking.

The popliteus tendon sheath is mildly distended.  There is soft tissue swelling within the popliteal fossa and extending superiorly and interposed between the musculature of the thigh.  There is also extension distally and interposed between the musculature of the proximal posterior calf.

Focal region of intraosseous ganglion formation at the anterior aspect of the intercondylar eminence and slightly medially.

Conclusion:  The dominant findings relate to patellofemoral chondromalacia.  Multifocal regions of shondral narrowing and fissuring.  Subchondral osteoedema of the patella, as well as similar findings associated with the anterior aspect lateral femoral condyle or lateral portion of the trochlear groove.

One of my online fibery friends and fellow runner, Claudia Hall Christian, just released her book “The Fey” in .pdf  format for free!  You can read it on your computer or for just 45 cents you can have it on your Kindle.  Or, if you want a paper copy of your very own, you can find it at Amazon. Congratulations to Claudia on her second serial fiction book!

Isn’t it about time for some knitting content?  I cast these on for the trip…toe up monkeys, 2 at a time on magic loop.  It’s been a while since I knit socks and it appears I may have lost some of my mojo along the way!  I went to do my standard short row heel and got holes!  Holes people…I thought I was way beyond that as an experienced sock knitter!  Ripped it out and started over.  Holes again.  Really?  I have no idea what my problem is.  Let them sit for a couple of weeks then ripped again and decided to revisit Maia’s Toe Up Gusseted Heel.  I’ll let you know how that goes.

Flash back to mid October…one week in Arizona turned into two, not that I am complaining!  The weather was fantastic the entire time and I was not looking forward to returning to the cold, rainy, Cincinnati fall.  The flooded kitchen project was supposed to have been completed by the 4th, then the 12th , but if you’ve ever dealt with any kind of home project like that you know that they are never on time.  It wasn’t Über behind though and we are thoroughly happy with the result.  It’ll be nice to have a kitchen again next time we are there although we still have to put everything back in the cabinets and do some dust and grime cleanup.

The main negative of no kitchen is having to eat every meal out, especially if you happen to be on a diet!  Despite that little wrinkle, I managed to lose 2.5 more pounds while I was gone.  I normally make good choices in restaurants anyway but keeping it down to that few calories a day was much more challenging.  I think I may have overestimated many meals because the lack of nutrition information at most restaurants makes it difficult to get an accurate total of what you’re really eating.  To recap the diet plan, I started on September 13 using Sparkpeople.com to count calories with a 1200-1500 calorie a day target, keeping my normal running schedule of 20 miles a week while gradually adding miles as I am training for the Phoenix marathon.  I also added in the 30 Day Shred DVD, but gave that up because it was causing too much stress on my knees.  Sunday the 18th was 5 weeks and I’ve lost 9.5 pounds so far.  I’m pretty happy with that but I think I could have done better if I had access to my kitchen the entire time!  Now here I am at the November 1 weigh in and down a total of 11 pounds in 7 weeks.  I had a little stall out week 6 and I’m starting to wonder if I should adjust my calories a bit?  Does my body think it’s not getting enough and starting to slow down my metabolism?  Maybe those of you a little more experienced with dieting can weigh in on that.  I know it can happen with too few calories and a lot of activity but I can’t believe I’m actually to that point yet.  The Biggest Losers don’t seem to have that problem and they’re working out way more than I do!

Since I’m sure many of you out there care little for the running/fitness/life updates I’ll start with the craft.  Be prepared though…this post will be a hodgepodge!  When Erica was here after labor day, we did a few little projects.  An “in the hoop” tissue holder (my first project of this type…muy fun!)  and a couple of business card holders for her and a friend done completely with the serger.  I think I may be addicted to the business card holders…they’re a great way to use fabric scraps and super quick, and easy.  Of course, I  had to do a tissue holder for myself and an making a business card holder to hold my embroidery business cards is a must.  I also worked on my Christmas stocking prototype while she was here.  I plan to offer them as a custom order in the store for the holiday season.

Now for the running/diet/shred update.  This week I ran 19.5 miles, did the 30 Day Shred DVD 4 times and kept my calories between 1200-1500 every day.  Unfortunately when I did my Sunday weigh in, my hard work really didn’t show.  I GAINED 2 pounds.  It stinks, but I’m not worried.  I know I did everything right and I’m pretty sure it was just some water weight from the weekend.  I can never keep it to weighing once a week so I snuck a peek today and my weight was back down to the same as after week one.  I’m leaving for Arizona on Saturday so it might be little difficult to keep the calories in my target range for that week, but I still plan to track them and keep it at least under maintenance level.  I certainly don’t wan to lose ground now when I feel like I’m on a roll!

Isn’t this the cutest running shirt?  I got it from the No Meat Athlete whom (yeesh…I always have to look that up…do you?) I follow on twitter.  The running carrot totally amuses me.  Speaking of running, I may have mentioned before that I have been suffering with knee and hip pain for about the last two years.  When I could no longer control it effectively with ibuprofen, I finally decided to go see my orthopedist at Cincinnati Sports Medicine (the one who did my shoulder in June ‘05).  I saw her again yesterday to discuss the results of my bone scan and right knee MRI.  The bone scan showed increased activity in both knees (ie inflammation).  From the MRI, I have many spots of thinning and damaged cartilage ranging from mild to severe and a mild patellar spur.  She’s thinking osteoarthritis, but I just made an appointment with a rheumatologist.  Osteoarthritis is not very common in people under 40 and the treatments can be different depending on which flavor of arthritis one has.  I just want to make sure I do everything possible to make sure it doesn’t get any worse if I can help it.  Overall, my pain was pretty minor since she gave me a steroid pack at my last appointment and switched me from mobic to diclofenac.  The pain yesterday though was terrible.  I got a cortisone injection in each knee.  Not only was it very painful going in but later in day I’m pretty sure I had “cortisone flare“.  My knees were super painful and swollen.  I laid on the couch all night and iced religiously even in the middle of the night.  They’re better today but still sore so I skipped my run.  I’m not looking forward to the possibility of a Synvisc injection in a couple of weeks if my insurance approves.

So what does all of this mean for my marathon training?  I’m not really sure yet.  For now I intend to continue my schedule as soon as the injection soreness is gone and see how I do.  Physical therapy is focused on strengthening the quadriceps and other muscles around the knee to support it better.  In theory, with the pain under control I can get stronger in those key areas and take some of the pressure off the joints.  Any weight I can get off will be helpful too since every pound lost takes 4-5 pounds of pressure off the knees.  If I can get back down to the “low-normal” weight range this would mean 80-100 pounds of pressure off my joints for each step.  That would have to help some!

I finished these July 21st and have been way too lazy to post about them so far.  This was my second time making Jalie 2908.  I started writing at Pattern Review when I started sewing, thinking I’d make notes as I went so I didn’t  forget anything!  Good plan, but I stopped right after the pockets step.  I’ll do the best I can to report what I can remember.   I got the denim on clearance at JoAnn’s.  It’s very stretchy and thin which didn’t result in the greatest look at the end.  I cut the same size as last time (U) but since they were a little big before I should have plenty of seam allowance this time to do proper finishing (seam allowance in this pattern is 3/8″ and isn’t enough for flat felled seams and difficult to serge after). I embroidered the pockets with this pattern at a width of 5″. I placed the pockets just about 1/8″ lower this time so they won’t be in the way when I top stitch the yoke. I serged the side and inseams of each piece before continuing (I decided that serging after the pockets is probably a better idea for next time).

To get the print of the pockets to show on the inside when the jeans are finished, cut the pieces as usual from the wrong side of the fabric. When assembling, the right side should face out in steps 14 and 15 of the pattern.  I tried the rocketboy waistband method on this pair.  While I love the way it looks, I really should’ve interfaced (it rolls) and made the contrast fabric sit more towards the inside…it shows a little bit from the outside at times.  Despite cutting the waistband longer, I had the same issue as last time.  When the time came to get everything assembled it was just a bit too short.  I still haven’t pinpointed what my problem is there but will make sure to cut it extra long when I try this again.

One thing I do love about this pair is the inside seams.  I got the new 9mm flat felled Viking foot and tried it out.  It took me a bit to figure out exactly how to use it but it seems to have come out correctly.  I just used the pieces as cut…I don’t think the offset effected the fit.  I did have a major boo boo though that resulted in a lot of seam ripping, multiple times.  If you look closely you can see the stitching on the back seam/yoke area is a bit wonky.  It was a miracle the fabric even held up through all of the ripping I had to do since it’s so thin.

Once they were finished, I immediately embroidered pockets for my next pair.  I meant to start the next ones right away so I could really take what I learned here and have a much better result.  By the time I get around to attempting them again it’ll probably feel like I’ve never done this pattern before!

In knitting…you’ve probably heard of Wollmeise.  Much coveted.  Hard to get.  For just $5 you can get a chance to win some of your very own and support a good cause in the process.  I’m also donating $2 per skein of sock yarn sold until 10/1…even the ones on closeout.  I have Noro, Malabrigo, Opal, Ranco and Tofutsies, so stock up and contribute to the fund!

I started a “diet” last Sunday.  I chose Sundays as my weigh in day, in part, to keep me a little more cognizant of my eating on the weekends.  I’m almost afraid to say this out loud but I lost 5.5 pounds this week!  I was able to keep my calorie count each day between 1200 and 1600, ran 18 miles total and did the 30 Day Shred DVD twice.  I realize most of that loss is probably water, but it’s still nice to see the numbers on the scale moving in the right direction.

Speaking of the shred, I could hardly walk yesterday.  After doing it for the second time (didn’t wait a full 24 hours due to scheduling…that may have been bad) my quads felt like jello immediately after finishing.  They are still sore today although not nearly as much as the first or second day.  I feel it a little in my chest too but nothing in the arms.  I’m going out to purchase the 3 pound weights later today which should make it MUCH more challenging.  In the back of my mind I have toyed with doing the DVD again today, but sanity won out.  I’m staring my marathon training this week and I need my legs to function.  Assuming the quads aren’t too bad after my run tomorrow, I’ll do it then.

I fully expected to be VERY sore today after doing the 30 day shred for the first time yesterday.  I must need some heavier weights because my upper body feels completely normal.  I was shocked.  Since I could hardly do the the push ups I thought my arms would be screaming for mercy.  Part of the problem might be that  I did the first day with what  I already own, which are 1 lb strap on weights.  I’ll be making a Target run to get the 3 pound weights instead.  As for my lower body…my quads are sufficiently sore.  Not sore like the time I did walking lunges at the gym with weights but sore enough to really feel it every time I lift my butt off a chair.  I could definitely feel them on my run and convinced myself I should take a day off from the shred.  That is, convinced until I got home and read Plurk where Popping Bubbles announced she completed day 2…which of course made me feel like a big fat slacker.  So I did it.  I officially think the first set is the hardest although my opinion may change when I get the heavier weights.  I’ve yet to find any definitive answer about whether this DVD is meant to be used every day (strength training typically is every other day but I’m not sure there is enough weight used here to justify it as true weight training).  In my research though, I did find a great site called Shredheads.  When I have an answer about that aspect of the Shred, you’ll be the first to know.  Have a great weekend!

Unfortunately for me, the Jillian Michaels 30 day Shred DVD was waiting on the doorstep when I got back form errands this afternoon.  I promised myself I’d do it today as long as it arrived before 5 pm.  So here I sit, newly shredded.  I can say with some certainty that I will be sore tomorrow.  Last time I did lunges like that I could barely walk for 2 days.  It was hard, as most comments on Amazon reported.  However, I did run 4 miles already this morning so maybe it wouldn’t be quite as bad if one were fresh.  There is no denying my upper body weakness though!  The weights weren’t bad since they’re light but oh my, the push ups.  I think I did 3 “boy” ones before I had to modify to “girl”.  Pathetic.  No wonder I had trouble lifting the cat litter I purchased today into my trunk!

I managed to take some before pictures but don’t expect to see them any time soon.  If I’m able to stick with it for 30 day and if there is really a noticeable difference, I may be persuaded to share.  After doing the workout, I realize what I really should have taken a picture of is my arms.  As weak as I am starting out there is bound to be some improvement in that area for sure!  As for my diet, day 6 and going strong.  I’m anxious to do my weigh in on Sunday morning and see if my diligence has paid off.  In case you’re wondering, I’m not following any kind of magic diet (although I am a vegetarian).  I’m tracking my calories on Spark People which is a fantastic free fitness and weight loss site.  I’ve been keeping it between 1200 and 1500 calories a day (difficult with the running but slightly easier with the no drinking) and eating lots of vegetables as usual.  Here are a few things you might like to try for healthier eating and/or dieting…some of my favorite products:  Kashi Go Lean Cereal, Kashi Autumn Wheat Cereal (both full of fiber and PROTEIN…hard to find in a cereal), Quorn (thank you Chris!) and Boca Vegan with Organic Soy.  Happy eating and let me know if you decide to try the shred too!

No craftiness today just a big fat slice of (what I hope will be) motivation. One of my Plurk friends recently mentioned the Jillian Michaels 30-day Shred DVD .  I’m not a DVD workout kind of person.  I run.  I bike.  I hike.  I occasionally do a yoga DVD but generally, I like to be outside as much as possible and not stuck in front of the TV.  I do enough of that later in the day!  However, after reading the 1400+ glowing reviews at Amazon.com and taking yet another look at Jillian’s beautiful abs I decided it was well worth $11.49 to try it.  The idea is an intense workout for 20-24 minutes instead of the typical longer one.  Great for those short on time and really, who isn’t?  Of course I’ll report in and let you know how it goes.  Check out the Popping Bubbles blog for more reports…she plans to start tomorrow and I may too depending on when the DVD appears on my doorstep.  I was thinking about sharing before and after pictures but I quickly came to my senses!  I just don’t think I’m that brave although the thought of having to put pictures up would likely be great motivation to stick to my diet.  At the very least, I’ll take before and after pictures for myself so I’ll at least have multiple concrete ways to judge progress. Maybe you want to join me?  lol…maybe not?

In other news, I’m on a diet!  I’m always a healthy eater but I’ve been stuck with the weight gained from my “issues” that resulted in the hysterectomy thing two years ago.  I’m still in the healthy range weight wise, but I’m at the very upper end of it.  My clothes haven’t fit for a while now and I think I’m finally at the the point where I’m disgusted enough to really do something about it.  It’s a little difficult to restrict calories while running 20 miles a week but so far I’ve been able to handle it.  It’s only been five days though so we’ll see how that’s sticking after a couple of weeks!  Increased mileage should help, which leads me to announce:  I intend to train for the Phoenix Marathon in January 2010…with a 16 week training plan that starts next week.  The only thing that might put a crimp in my plans is the ongoing knee/hip pain I’ve had for well over a year.  I’ll have to see how my body handles increased mileage, but after seeing the orthopedic sports medicine doctor today I’m feeling much better about my chances.  She started a treatment regimen of physical therapy and stronger prescription NSAIDS (my PCP started me on some a month ago…helped but still some pain).  I’m also having some blood work and scans done so we can try to get this figured out.  Wish me luck!