Knee exercises for physical therapy

This list is what I have been doing 3 times a week (not everything every time). If you have knee issues, there's probably an exercise in here for you.

All of these exercises should be done fluidly and reasonably slowly, in control.

• Prone TKE
• T-Band Stand TKE
• Standing Hamstring Curl
• Leg Press
• Heel-Toe walk
• Single leg balance
• LAQ
• Ball bridge
• Ball hamstring curl
• NMES SAQ (isometrically sqeeze quad)
• NMES SLR (isometrically squeeze quad while raising leg straight)
• NMES Quad Set (put something under knee and isometrically squeeze quad while raising leg straight)
• Stool scoots
• Sideways-hip abduct
• Mini Squats
• Step up – forward and lateral
• Standing calf – raise single leg
• Lunges
• Elliptical machine forward and back
• Bike machine

…and don’t hold your breath while you do them…

Other things I have found helpful:

• Epsom salt bath at night
• Ice, ice and more ice
• Anti-inflammatories
• Carbonated apple juice to combat nausea
• Early bedtime and lots of sleep
  

I found a lot of these exercises (but not all) explained at

http://www.athensorthopedicclinic.com/docs/Basic_Knee_Exercises.pdf

Probiotics good for Celiac

Back in March 2009, I posted about probiotics being a good idea for traveling Celiacs. Now comes Science Daily reporting a study in the Journal of Leukocyte Biology explained in more common terms by Dr. Michelle Sullivan. She recommends a daily probiotic. There doesn't seem to be much downside except the expense, and the upside could be pretty dramatic.

Almost Straight...

It's been exactly a month since the surgery and my knee is almost back to being able to be straight. That's important, because if my knee can be straight, it can lock and support my weight through the skeleton instead of using my weak muscles.

The trend is generally very good. Tiredness is no longer a general concept. There's upper body (rare), lower body (more frequent), hurt leg (pretty frequent) and supporting muscles (very frequent). Bicycling seems to help a lot

The surgeon cleared me Friday to be in the pool (yay) and do aquajogging (yay, but he did give me a funny look on that question). I have just six little cuts/holes around my knee, and all the steri-strips are off now. The worst thing on Friday was that he reiterated the four months to jogging on the street/trails. That would have me waiting to be on the road until July 25.

I've really eased off the Tylenol - none so far today in fact.

My body has put on a few pounds, which I anticipated because of my solution to the nausea, but now would like to see melt away. Of course, nothing "melts away" - so it's diet and exercise for me. I really miss exercising outdoors. I was built to move, and this approach lacks camaraderie and actual moving through space. Maybe that yearning will ease up when I start swimming again.

Mass Celiac Screening Cost Effective

Screening young adults for Celiac is cost effective, says an Israeli study. It would be an excellent use of CDC money to do the same analysis for the US, especially since it appears it takes longer here to get a diagnosis (11 years?) than in Israel (6 years).

M Resort doing great job with Celiac diet

The Celiac diet is always a concern when traveling. I've been at the M Resort in Las Vegas for a conference, and they are doing a great job taking care of my meal needs. Usually, I give a report on the athletic facilities and so on. I can say that the ice machine always seems to be full enough for me to take the provided shoe bag and make really big ice packs for my knee. Usually, I don't like to be close to the ice machine or elevators, but this trip I made an exception. It's worked out pretty well.

Still moving slow

It's been about 10 days, and my knee is doing very well, in my opinion. Most of the swelling has gone, and I have been walking on it for nearly a week now and I've been off prescription painkillers for a week. It is not back to "pre-operation" mobility or strength yet.

It can turn revolutions on the bicycle stand now, but the right toe needs to be pointed down for it to work.

I have ups and downs. Usually lying down for a half hour will revive me. I'm sleeping about an hour past the tail end of my meds. When I'm awake, I started "feeling it" about two hours before the end, but now it's closer to an hour/forty-five minutes.

Still having issues with nausea. Coke and peanut M&Ms help, but those are not long-term solutions.

I have a business trip and have ordered a wheelchair. I just can't see myself walking through an airport yet.

Out of Surgery today, still a bit groggy

Well, it doesn't appear that being a Celiac affects surgery for an ACL much, but I did find out quite a bit about the medical process. Every step of the way, I've told every medical professional and coordinator about my vitamins/supplements and that I was a Celiac. (. I wore my Awareness run t-shirt more than once). It must have been at least 10-15 people. Low and behold, I'm being prepped for surgery, I am doing one last review and Celiac is not in my surgery records! We fixed that.

Probably all well and good as things went fine, but what if they had to transfer me to a hospital?

Anyway, at least my anesthesiologist had a sense of humor and said, "I promise I won't feed you bread while you're asleep."

I wanted to publicly thank all those who prayed for me and had me in your thoughts. Given the amount of damage my surgeon saw in my MRIs that first week, I am doing much better than average. Please keep it up, maybe these nerve blockers will wear off and I will be able to feel my leg again soon!

Another two weeks of wait and see

I went to the orthopedist today. The swelling, while much better, is not to a point where it makes sense to operate yet. Of course, one big question was about whether being a Celiac affects this at all. Celiac doesn't seem to bear much on the issue, as there isn't much to worry about from a donor tendon in the way of rejection for the autoimmune side. On the medication side, I will need to talk to the anesthesiologist, but again, no expected issues there. I was really glad for my wife's moral support and for writing my questions down.

I did leave the surgeon with the first few pages of the Celiac medical package from our local support group, which he scanned with some interest.

He did authorize me to again try to gently cycle on my computrainer, so I may try some of that again this weekend to see how it goes. He suggested mucking with the seat height to give some gentle encouragement to the knee flexibility. At first I thought it would mess up my setup, but upon reflection I think the move would be for the greater good.

Thanks to everyone for your kind comments as I work through this.

I tore my ACL

Well, no posts for a while usually means things are going really well, or really poorly. This time around it is really poorly.

I was out playing "driveway tennis" with my son when my foot caught up in the tree roots at the back of the driveway. Man, did that hurt. I have never wanted to get away from a body part so badly. Thing is, the part (and the pain) comes with you.

Well, an xray and MRI told me what I already knew from the popping noise. I've spent the last two weeks trying to keep up at work (not so successful), and manage the swelling (not so successful).

When you lose a functional knee and are in constant pain, it is amazing how your focus changes to getting out of pain and figuring out how to do really basic things like putting on a sock and personal hygiene. It's really nice to have two young, homeschooled kids to run around and carry things for me.

Never mind that moving around on crutches is a workout all by itself. I haven't done a proper "workout" since the fateful day. Saturday I said to myself, "It's been two weeks, get on that bicycle and stop feeling sorry for yourself." So I pumped up the tires, laboriously pulled on my cycling shoes, clipped in left foot, gingerly swung my right leg over and clipped in. Success!

Then I tried pedaling. Of course my left foot worked just fine, but my right knee didn't want to bend. So I tried backwards, then forwards. Each time my knee bent a hair more and with heavy exhalations I managed a full rotation. After about 20 I was done. Or so I thought. I couldn't clip out! Laughing at myself, I had to call one of my kids up to loosen my foot strap so I could slide my foot out and escape. Maybe next time I'll bring a crowbar...

Anway, I have some truly spectacular pictures of the swelling and bruising, which I may post at some point. I'll keep intermittent posts on how the rehab progresses.

21st consecutive Houston Marathon 5:16

Short news: I was physically ready to run a 4:15 or so, but it just wasn't my day. This year, I am happy to have made the marathon program for running 20 consecutive Houston Marathons.

Race Recap:
I'd been having trouble staying hydrated all week. Felt great at the start (maybe a bit warm?). I started feeling "weird" at mile 9. I stopped to put some more vaseline on my feet at mile 10 (I had some hotspots, but I was still bang on pace after accounting for stops and visits), and then absolutely spectacularly exploded at mile 11, with nausea, lightheadedness (which just got worse and worse until mile 19) and minor stiffness. I attribute the mess to a combination of electrolyte imbalance and lack of water/something I ate the night before (not gluten)/or a bug I picked up. It was absolutely the fastest "collapse" I had ever experienced in any long race. (Usually, I just see the misery coming for about a 10K or so...) I had medical cut off my pace band as irrelevant just past the half marathon. I ran/walked until mile 17 and then walked until mile 22, when everything suddenly lifted. I ran in the rest of the way, just walking up the hills on Allen Parkway. I probably passed 100 people in the last mile alone. I file this one in the "just not my day" category. (I was already planning my next marathon at mile 16 of this one...) and I may have to do another marathon somewhere else this year just for time and just because.

Couldn't get to sleep the night after... Sore but fine this morning. Handling stairs with relative ease compared to other years. At the end of the day, I'm glad I traded time for a sure finish, and I'm definitely wearing my 20 year veteran shirt every day ;-). Is three days in a row too much?

Humana won't take Celiacs in Texas

My wife was trying to price health care packages for our family. Humana had a big ad on the television, so she called and told them as part of the quote process that they would not cover Celiacs. The Humana representative admitted that "Celiac can be controlled through diet." but went on further to say that Humana did not cover Celiacs because "Humana can't monitor compliance with the diet."

This argument uses flawed logic. Using the same logic, they should not cover anyone who takes medication, either. Blood tests suffice. A little underwriting sanity appears to have gone missing at Humana.

Brilliant Celiac video from Mayo

Here's a great Celiac video from Mayo explaining the results of the Celiac study they published. He discusses the findings very clinically and very understandably.

At the end, he broaches the idea that one implication is that perhaps we should screen for Celiac in the general population, like we do for high blood pressure or cholesterol. I'm very much on board with that idea. It may happen on its own, anyway, because life insurers will start testing for the antibodies if they can.

Celiac 4x more prevalent in current Army recruits

I spotted this very interesting celiac article on Web MD. For some, currently unknown, reason, celiac disease antibodies were four times more present in current army recruits than those of the 1950s. This would imply that environmental triggers are to blame, which would imply we can figure out a way to decrease incidence of the disease, even in those cases where people were genetically predisposed.

It reminds me of the studies that showed the optimal time to introduce gluten to infant's diet. I wonder if the Mayo Clinic has checked for changes in that?

The other, more disturbing, finding, was that undiagnosed Celiacs of that era were four times more likely to die than the population at large. If that were to hold true to today's numbers... (Four million undiagnosed Celiacs four times more likely to die...). It is scary to think about and just confirms that it has never been more urgent to raise awareness.

Managed care insurers now have an economic reason to diagnose Celiac Disease

One of the barriers to awareness and diagnosis of Celiac disease has been the lack of enthusiasm on the part of health insurers. Now things have changed, and it is about time.

The Journal of Insurance Medicine has published a Celiac economic study by the Celiac Disease Center in Columbia that shows a decreasing cost after diagnosis.

"Researchers led by Dr. Peter Green, a professor of clinical medicine, said their study of a large managed-care database revealed cost reductions after diagnosis of celiac disease were attributable to decreasing trends in utilization of office visits, laboratory tests, diagnostic imaging and endoscopy procedures. "

This study is years overdue (see this two year old post including insurers), and it finally gives managed care insurers an economic reason to make sure all Celiac disease sufferers in their populations are diagnosed.

As a next step, I hope to see data-driven suggestions from these insurers soon. For example, it would be cheap and effective for them to send an email to segments of their population saying something like, "You have chronic iron-deficiency anemia. The differential diagnosis for that condition includes Celiac disease. Have you discussed it with your doctor?"

IBS sufferers should be tested for Celiac disease

More news outlets are starting to pick up the concept that Celiac might be the actual cause of many undiagnosed symptoms. I saw this article on Google alerts the other day, repeating the story that IBS sufferers should be tested for Celiac disease.

Here's the guidelines if you don't want to go hunting for them.

IBS patients with diarrhea or a mixture of diarrhea and constipation should be screened with blood tests for celiac disease, a condition in which one cannot tolerate the gluten protein found in wheat and other grains.

Of course, this blog brought this health tip out nearly two years ago. While the GI docs seem to be getting the message out, it would be great if some of the others, like Dermatology and those involved with neurological disorders, could get on board.

A little insurance for Celiacs on the road?

I saw a recent posting on a Celiac site about a study from Finland. It said that:

"Bifidobacterium lactis inhibited the gliadin-induced increase dose-dependently in epithelial permeability, and, at higher concentrations totally eliminated the gliadin-induced reduction in transepithelial resistance."

OK - all fancy words that basically say that a probiotic kept gluten from getting through gut cells (in a petri dish).

Now, I think that's really hopeful news and here's how I'm going to use it. First, a petri dish is not a controlled human study. I am not going off the gluten-free diet to give it a try, and I think anybody would be nuts to do so. But from time to time, a restaurant will do that for me without my knowledge. We've all been there and done that, right? So I think that I'll just start taking a probiotic with B. lactis in it during times when I'm at higher risk (like on the road for a race or eating out a lot, for example).

I've had some pretty good luck using probiotics after a course of antibiotics and never had a bad reaction, so this seems to me to be a pretty good and relatively inexpensive way to keep ahead of the cross-contamination issue. Peaking correctly for a race or event is hard enough as it is, and this approach might just be some reasonable insurance on the diet side.

Should ear drops for swimmer's ear be gluten-free?

I haven't been posting for awhile, because after I started swimming again, my increased efforts resulted in a truly nasty bout of swimmer's ear. Very painful - very annoying - very tiring. So I was back out of the pool for a couple of weeks. Here's what I learned:

• I should have been using earplugs to keep out the water
• I should have used a half vinegar/half rubbing alcohol solution and dropped that in my ears before and after the workout. Evidently, the vinegar is the correct PH while the alcohol kills the infections before they get started.
  
• q-tips can irritate your ear canal, so don't go there
  
• Antibiotic ear drops were, bizarrely, very hard to acquire, resulting in an extra day of totally unnecessary pain
• I really didn't care if my ear drops were gluten free or not (but should I?)

That extra day of pain reminds me of the (thankfully infrequent) times when I am absolutely miserable and am asking a pharmacist if the medication is gluten-free or not. You'd think that this information would be readily available, but it isn't, and it's especially aggravating on the weekends when the manufacturer is closed.

It makes me wonder when the pharmaceutical industry is going to wake up on this topic -- probably not until people start reporting adverse reactions...

Anyway, I'm thrilled to be back in the water today.

Celiac screening should be considered for IBS sufferers

The medical world changes oh too slowly for those who are suffering from Celiac, but it does change. The American College of Gastroenterology has released new guidelines for IBS sufferers, part of which includes ruling out Celiac disease. Of course, readers of this blog would have known that in April 2007, but it's nice to see the docs catching up.

The relevant guidelines are quoted here:

    --  IBS patients with diarrhea or a mixture of diarrhea and constipation
       should be screened with blood tests for celiac disease, a condition in
       which one cannot tolerate the gluten protein found in wheat and other
       grains.

GIG conference ROCKS!

The GIG conference was held this past weekend in Dallas. I went up Friday night after work for the Saturday session and drove home Saturday, but the long drive, expense, time away from my family, $4 gas and short sleep was all worth it.

The day started at 5:15, when my wake up call came for my 10 mile long distance run. Unlike other conferences, my running buddy was a fellow race director and we talked as only two GF long-distance runners can. Most of it was about the distance, training plans, etc. But a lot of it was about how we were going to meet our respective "next challenges" and in some part, how Celiac plays a role in that. So the miles "flew by" (Literally - she's fast, so I'd agreed to run harder than normal, and my legs are still somewhat sore). But it was an awesome run - and slightly less humid than Houston.

And then there was check-in and breakfast. Food vendors were all around with various dishes on offer, and there was the regular buffet line. I went for a corn tortilla, bacon, and eggs, but I stopped cold after the scrambled eggs. I went into what I call "cross contamination mode" as an entire tower of various breads sat next to the eggs. I told myself, "It's all gluten-free." It took saying it about three times, but I finally started to believe it. And that's when the security settled in - that calm feeling you have when you are "safe." It drives into your core and you say, "this day, I'm not worrying about food, period." A few weeks back, I talked about the "desperate hunger" of a diagnosis and the uncertainty around food. This conference was the antidote - where the food world revolved around me (like it used to, pre-diagnosis).

There was a "buzz" here, too. You wouldn't hear talk of poor business prospects here. Vendors all had smiles and talked about going from success to success in a market growing at 30% a year. Lots of individuals were taking on lots of initiatives -- new races, new newsletters, new research, new findings. There was more opportunity than people, and you could feel that in the air.

The MBA in me also noticed that people were wearing fewer hats as things have become big enough to specialize and divide responsibilities into what people are 'good at." People were in their element, researchers, nutritionists, vendors and participants didn't have to be all things to all people. There's a part of me that wonders if that will be a conference effect, or if people will carry that home, thinking, "THAT part of the community need is something I don't have to do anymore..."

I went to a few sessions. None were boring, so I may blog about them in the future. Time for bed now.

Exactly one year ago...

It's been a year since I've started blogging about celiac and training. So much has happened, but something special happened that I found out about yesterday at church. Exactly one year to the day after I had a discussion about my celiac situation with another runner, I found out she was diagnosed with celiac.

It's a moment that gives me mixed emotions. I'm empathetic as I remember the loss and relief I felt from my diagnosis and the hard times that immediately followed as my diet shifted. But I also remember the joy crossing the finish line at the Redman -- something only made possible by my improved health as a result of my diagnosis.

And it's my joy and the coming joy of those who start their own journeys to better health through a diagnosis that keeps me writing.