PKR Ligament Sprain in GoodLeg

[marieltha]

Update on my quest for quality sleep (Using CPAP DreamStation for mild SleepApnea for 7 months):
I returned to my regular doctor, a woman Internal Medicine MD, whom I like very much, to discuss my steadily deteriorating quality of sleep.

She sent me to have the CPAP machine checked. It is fine. Then she sent me to a Pulmonologist/ SleepApnea/Respiratory Specialist.

Exam showed my lungs and breathing are fine.
He downloaded all my machine’s data from Dec2018 to the present and carefully studied
all of it with me.

He asked if I would agree to a six-week trial of APAP, which allows him to prescribe a range of pressures rather than a single constant pressure. So during the night, the device adjusts my pressure and my heated humidifier in response to my breathing. It turns out my machine is both CPAP& APAP, so he switched it over. He also turned on several features of my device which were either off or only available with APAP.

I have only used APAP for four nights, but my sleep is very much improved! I’m now using a pressure range of 6-12 , whereas before, on CPAP, I was using a constant 6.

So far, I have fallen asleep faster, and each morning, felt more rested waking up!
AHIs between 3 and 4.5! Much better! Had deteriorated on CPAP to between 7 and 11+.

Interestingly, a new APAP feature shows what pressure I am using for 90% of each night:
So far, I’m using 10 or 11 pressure most of the night, so clearly, the previous 6 was insufficient pressure.

Sleep! Must sleep! Must have quality sleep!

 

[Celle]

LOL, pics of my feet touching now that my formerly knock-kneed legs are straight! Before my new PKRs, my thighs and knees touched, but then my feet and calves splayed out. I’m standing, looking down at my legs and feet—in awe.

We can see your feet are straight, but how about a photo of your newly-straight legs themselves?

 

[marieltha]

@Celle , will work on that straight leg pic....

Your suggestion made me look down at my knee scars. I had had MOHs basel cell removal and reconstruction surgery done 3 months before my first knee surgery, and asked (seriously) my OS if his scar would look like my face scar, which had been done by a plastic surgeon. LOL, my OS replied that he would try his best, but he was not a plastic surgeon. He did a great job, though. I’ll try to include the scars in the straight leg pic.

Both surgeons emphasized the necessity of using sunscreen on the scars to prevent the sun from making the scars permanently red. I’m continuing to do this, on my shoulder, too.

I am wondering if any folks have had better results with a particular sunscreen? @Celle and @Jamie, if it isn’t appropriate to ask this, just remove this question, or re-phrase it? Thanks

 

[Jamie]

The question is just fine, @marieltha. Any good quality sunscreen should work.

 

[marieltha]

Question for all, perhaps related to leg pain:

My question arises from my wearing my new watershoes (10mm drop I think—no higher) and loving them and then, when I put on my Brooks Addiction walking shoes(12mm), I find I’m uncomfortable—even my legs aren’t as happy. Feel tighter.
When I add my Rx orthotic, my heel is even higher.
I’m going to ask my docs (OS & foot), but would welcome any feedback here:
Question:
Do you find shoes with a higher or lower “drop”
(Difference in mm between forefoot height and heel/rearfoot height) more comfortable?

 

[Celle]

Maybe it's just the switch from one degree of drop to another within a short space of time that's causing the discomfort?

 

[marieltha]

Saw my foot MD yesterday.
He went over the foot and ankle MRIs that my OS had ordered. I’m including this here because the feet seem to affect the sprained ligament’s recovery.

He sent my Rx orthotics back to be modified.
This will lower/remove the additional hard heel that is underneath the hard orthotic. He can add a very thin top cushion when they are returned, if needed. He was reluctant to have them drill into the hard heel and insert a cushion as that cannot be easily redone.

He also did an ultrasound guided cortisone injection into the very swollen plantar fasciitis tendon in my foot. My first in a foot.

Ordinarily I would not do that in a foot, but honestly, it hurts, and if the impending hurricane comes near us next week, the drop in barometric pressure will make my arthritis here and in all my recent surgical bone sites ache. For me, weather is very much a health, pain, quality of recovery, & quality of life issue.

The foot feels much better. And with the left foot more comfortable, my walking is improving, and the ligament seems okay.

 

[Izabel]

Hello Marie ... I am finally visiting you!
I don't understand all your issues but they seem very unpleasant indeed! I had Plantar Fasciitis i my left foot (same as hip and knee) for a month when I came off my 6 week weight restriction beginning of May. Boy was it painful and greatly hindered my recovery and walking ability. Bit I iced my foot on a frozen can/bottle 'roller' and put a liquid gel insert in my shoe. I certainly would not have fancied an injection in it!

For me, weather is very much a health, pain, quality of recovery, & quality of life issue.

This is one reason I moved from the UK to Portugal as we have dry heat. I hope you keep safe from Dorian.

Izabel xx

 

[marieltha]

@Izabel
Thank you for your kind words, as always. I thought of you yesterday as we drove to the beach and I practiced going up and down stairs there a few times. My pool stairs are a bit steep (5”, 8”, 10”, 10”, & 10.5”), so I practice mostly on the bottom two. I only have one step inside the house and the wall is to the right, which is my shoulder surgery side, so practicing up is fine, but down is not.

Surprisingly, the foot injection didn’t hurt. I was conscious of the substance squishing into the tendon, but no pain. He guided it with ultrasound and used lots of pre stickey-pokey numbing, so perhaps that made a difference. His needle looked a lot thinner than those used for the two cortisone injections I had years ago in my knee, too. Also, he is a runner and has had 3 injections in his own foot for his plantar fasciitis, so perhaps that helps him pick the perfect spot.

Interestingly, I originally was referred to him by my dermatologist who said he was the local laser expert for toenail fungus. My OS had sent me to my dermatologist to have my nails checked before the knee surgery. My nails were okay, but he then discussed my need for orthotics. And it turns out his foot surgery specialty is torn plantar fasciitis repair in runners.

My plantar tendon has not hurt since I got the injection and the swelling in my bunion (arthritis & spur) is dramatically reduced, so I am glad I got it.

And thanks also regarding Hurricane Dorian. Hail Marys and knock on wood, he is staying well to the east of us, but that can change quickly, so we stay ever watchful. Saying prayers for everyone in its path. We might get a small amount of rain from its outer bands as it passes.

I still maintain weather for me is very much an integral factor in my wellness. I prefer humid weather to dry, though. Dryness makes me stiff. Cold, rainy, low pressure is the worst of all, which is what I grew up with in Boston, and do not wish to live in that climate again. Warm and humid is fine with me. Did better running the hot and humid Honolulu Marathon (age30) than the cool Virginia Beach Shamrock Marathon (age32), although I finished both.

PS It does not surprise me you are a poet as your posts are often lyrical. I have not written books of poetry, but I have had individual poems published, and continue to write and read poetry for my pursuit of existential balance. Loved your tigger post.

 

[marieltha]

My husband bought these napkins for me to ease my recovery.

 

[marieltha]

Ligament sprain is improving. It has been 3 months, and supposedly takes 5 to fully heal. My gait is getting more natural. I am walking longer and a bit quicker in the pool every day. Some practice on the pool stairs as well.

I am doing better since I switched to the 10mm drop shoes, but that may be covariant. I did experiment with adding a forefoot only insole (I cut them in half) in my 12 mm shoes to perhaps reduce the drop from 12 to 10 and they feel more comfortable walking. Some of it might be that the 10mm are Stability shoes and the 12mm are Motion Control(MC) so the whole MC shoe feels stiffer. All of this affects my gait, so for now I am wearing the 10mms most of the time so I can increase my walking.

 

[marieltha]

Up to 45 minutes in the pool: Walking for 20; stretches/floating for 5; walking faster for 15; stretches and stair practice for last 5. My pool stairs, from the bottom, are 5”, 8”, 10”, 10” and 10.5 to step out. I can only use my left arm for balance because of the shoulder surgery recovery (doing very well so I don’t take any risks), and the pool is a tropical lagoon style, so the deck edge is used instead of a rail. So I go up the left side on the 5,8,&10, the down the right side, 10,8,5, to use the left arm for balance. Did 6 sets yesterday!
Approaching nirvana.

 

[marieltha]

@Elf1 ‘s thread mentioned pool walking and seeing more walkers than swimmers LOL

After my first PKR, I was gradually returning to a gym and walking on the padded rubber floor. And pool walking at home (it’s Florida). When “my winter” came (see definition below), I switched to the outdoor Y pool (heated 81 to 83), as we don’t heat ours (cost prohibitive). I was struck by how many pool walkers there were (pre & post surgery knees, hips, backs, feet), and how much better and faster they seemed to be recovering than those I saw at the gym.

Years ago, just as I was moving from Virginia, several of the PT places there were adding small pools with underwater treadmills! @luvcats , any near you?

My blood pressure is low, so 90 air temperature to me feels like 80 for most people. So “my winter” arrives a bit earlier. My OS said for people with arthritis, the ideal pool water temp is about 10 degrees above their body temperature, so for me, that’s 87. I stay in ours in the 80’s. As it drops into the upper 70’s, I add scuba diver socks, gloves, beanie, vest, etc.
When I need a wetsuit, it’s time to return to the Y.

LOL, I grew up swimming in 50 degree Atlantic Ocean water! When it reached 60–once or twice in my childhood—everyone went in and stood there basking in the bathwater warmth!

 

[luvcats]

Happy Belated Birthday! I'm sorry I missed it. That's also Beloved's birthday.

The saltwater pool sounds amazing. I really really miss my water-walking. I do not know of any warm therapy pools. There was one in Colorado Springs, at the YMCA, but I never used it. I run very hot and I felt adding warm would just increase my temperature.

My whole body aches just now, longing for the freedom of a pool. It is super easy to overdo when you are recovering so I always go by the clock and not how well I think I feel. I remember getting back in and trying to go for 10 minutes. I managed, but between changing and showering and getting home, the first week I almost died of trying a little too much. If I'm lucky this time, it will only be 4 weeks until I have good closure on my incision and I can get back into the pool.

 

[marieltha]

@luvcats Happy Birthday to your Beloved, as well ! Leos celebrate for a month or more, haha, so September is fine for wishes. So me, your Beloved, Obama, Percy Bysshe Shelley, ....

I think Y pools try to strike a balance and end up around 80, which is cool enough for lap swimmers and warm enough for walkers.

 

[marieltha]

My cat is black, so I am in luck. I will give her extra hugs (with her permission, of course) for all the BoneSmarties who do not have a black Nurse Cat

 

[marieltha]

Just got new shoes. I researched the size guides, measured my feet as directed in cm, and I found big differences in the sizes, even for the same brand. Glad I measured.

In the pic above, I’m wearing the new Asics GT 1000 7 in a 10 1/2 wide. Biggest shoe I have ever bought! 8mm drop (difference between forefoot and heel).
In cm for length, it is the same as my very recently purchased Columbia water shoes (middle, purple, wet—just got out of the pool), which are a 9 1/2 B. 10mm drop I think; might be 8. These feel great walking in the pool. Until today, this was the biggest shoe I had ever bought.
The other is my old Asics GT 2000 5, size 9 B, which I dug out and started wearing when my Brooks Addiction (size 9 B) seemed too high in the heel, with a 12mm drop. These Asics have heavenly gel cushioning in the forefoot and the heel, and a 10 mm drop, but the toebox is too tight. LOL, I carefully slit the toebox mesh with my exacto knife to give my toes room until the new shoes arrived.

The Asics GT series are Stability shoes for Overpronators. The 1000 have bigger toe boxes and smooth mesh (no stitching over bunion).

My foot doctor advised me to go bigger to accommodate the Rx orthotics (being modified to lower the heel and make the heel softer). He also advised getting a wider width to accommodate not only the orthotics, but also my very high instep, as long as the heel fits. And I was focused on the toebox as I cannot have the bunion surgery until at least next year—have to get past the ligament sprain and way past the shoulder surgery.

I gradually break in a shoe in the house. So far, the new ones feel really good. I will update again.

Thanks to all who shared their thoughts here and in my Other threads on feet. The comments about new knees changing one’s gait seem logical.

 

[marieltha]

Two important updates:
1) My cattleya orchid is blooming again. So I made it my new avatar.
Cattleyas only bloom once a year, but many years, it produces a second pod about a month after the first.
Each pod has several blooms. Worth waiting for.
My only orchid with a fragrance. Intoxicatingly pleasant. Enjoyed from the deep end of the pool.
2) I love the new shoes.

 

[sistersinhim]

I wish I had a 'smellalaptop' so I could smell your orchid.

 

[marieltha]

Wednesday, September 19,2019
Followup with OS: Left PKR (March 2019), Right Medial Ligament Sprain (June 2019), & Right PKR (April2018)

Both PKR’s are doing very well. He did a lot of twisting, turning, pressing of the feet, ankles, legs, and knees).
Ligament sprain is healed and holding the knee.

Issues to Address:
-Stamina overall is better and needs to continue to improve
-Right knee/leg still hurts and is stiff
-Stride is shortened and gait is off.

Next:
-Continue walking in the pool and gradually increase pace
-Practice lengthening stride, as he believes my shortening it—normal reaction to the pain of the sprain—is contributing to the awkward gate and the pain.
-Use prescription voltaren (got this for my foot) on the right knee and add lidocaine gel 5% (new prescription)
-New shoes are good, but I need to start using the arch support/orthotics as the left foot is leaning in and also contributing to the gait issues
-Ice, as needed
-Pain meds, as needed (I am taking only Celebrex 2x day and the occasional Tylenol; might need more, especially for quality sleep and improvement of stamina

(This was foremost my RCR shoulder surgery 4-months followup, and 3 months sprained knee ligament followup, but he always checks my knees, legs, hips, and feet. (See my shoulder and feet threads.) Shoulder ROM got 5 Stars—yippee—so my balance should improve as well in the next stage of that surgery’s recovery, which also affects stamina and gait.)

>Next followup: 2 months (sooner, if needed)


Today’s mindful meditation (app) seems appropriate

PS to @sistersinhim : Love your new cat avatar