BLOG/BLIARY:  Living with Bilateral Quadriceps Ruptures and Repair
   

This blog/bliary is intended as a forum for those who have or have had bilateral quadriceps tears (and subsequent repairs).  If you'd like to add information or experience here, please e-mail me at JimClawson@virginia.edu and I'll fold your comments in.  This is how I looked in the 3rd week after the fall.

My New BQR Friend, Jim Falvo's Amazing Story

9/24/06

On 9/2/06, I was descending a flight of stairs in Istanbul, Turkey, and both my legs gave away.  I heard a distinct "pop, pop, pop" in both legs as they collapsed.  The next day, MRI's confirmed the diagnosis, bi-lateral quadriceps tears.  It was very painful, terrifying, and confusing since I had no sense of weakness, fatigue, or advance warning.  Getting home from Istanbul was a grueling experience made possible by a generous client and the warm flight attendant staff on a Delta flight.  Since then I've learned that this is a relatively rare event; the first surgery on bilateral quadriceps ruptures (BQRs) was only done in 1949, two years after I was born. If you've had or are in the middle of a BQR event, I hope my experience here will help you.  And if you're willing, I hope you'll write and share your experience with me and others.  I couldn't find any blogs on-line that covered this kind of experience. 

Given the lack of warning, the first question for me was, "how did this happen?"  I have three theories at the moment, a) "weekend warrior" syndrome over exercising earlier in the day, b) side effects of high doses of cholesterol controlling medications (statins), and c) age.  I suppose it could be a combination of all three.  I'd worked out in the hotel gym that day, and then taken a walking tour of Sultan Ahmet's palace, and then had a(n aggressive) massage early in the evening.  I'd also had my daily dose of anti-cholesterol medicine (Vytorin) doubled from 40 mg to 80 mg the previous December.  All year long I had the vague awareness that my leg muscles seemed to be shrinking.  I played basketball for 40 years and had strong quads.  More recently, I was active in taekwondo, yet I was aware this year that my quads seemed to be shrinking.  In July, I was holding a pad for a ten year old in taekwondo class, and as he struck the pad, my shoulders gave way--creating bilateral rotator cuff tears.  Again, I believed/sensed I "should" have been able to hold that amount of energy.  One of the web sites I visited said that for BQRs to occur there usually is some underlying "systemic" basis.  Was it ALS?  MD?  MS?  That caused me to reflect on the dosage doubling of the year.  Finally, although relatively vigorous, I'm 59 and at 6' 1" and 235 overweight and aging.  

"Ruptures of the quadriceps tendon occur relatively infrequently and usually occur in patients older than 40 years. A strong association exists with numerous systemic diseases and prior degenerative changes in the knee extensor mechanism. Ruptures most often occur unilaterally. Bilateral ruptures are highly correlated with systemic disease but have been reported in healthy patients without predisposing factors." http://www.emedicine.com/orthoped/topic274.htm, 9/5/06

 Despite the rarity of BQRs, there was a fellow passenger on the plane who'd experienced one recently, walking down a slope on a golf course.  He and his wife gave me wonderful tips on how to manage life during BQRs, and not being able to find a web site like this, I wanted to make this available for others in the same predicament. 

9/3/06

Only two of the hospital staff spoke much English, so the whole experience in the hospital, while okay, was lonely and confusing.  The orthopedic surgeon was a highlight, upbeat, cheerful, and very capable.  The first thing he ordered was a set of leg braces, and then got me to stand up and move to the door and back.  That was terrifying, and he was right--if you can't walk with braces, you won't get home.  The hospital did not accept my US insurance, so I was faced with cash payments and reimbursements or going home. 

My wife and friend were trying to organize a direct flight home for the following day since I'd missed my flight on this day.  They were able to find a non-stop flight to JFK--as opposed to going through Frankfurt or London and that was a huge help.  This was a Sunday and it was a lonely, painful, depressing day.  Again, the surgeon organized Sunday delivery of the braces and walker so he was doing what he could. 

9/4/06

Checking out was a lengthy process, so the noon departure seemed good scheduling or if anything early.  I was planning to take a taxi to the airport since they'd requested a wheelchair on the flight reservation.  My client out of the blue called and said they'd ordered an ambulance to get me to the airport and also called the airport to advise them in advance of my situation, and that was a HUGE help.  Without that, I'd have never made it.  We were going high speed, up on sidewalks, over median strips, through traffic lights, and I eventually arrived at the plane ten minutes before they closed the doors. 

As I was being wheeled down the jetway to the plane, a Delta flight attendant raised her arms and cried out, "My dearie, what have they done to you?  Don't worry, you're with us now!"  She seemed like an angel sent from heaven.  And throughout the long, 11 hour flight, she and her colleague mothered me and made the best of a bad and painful situation. 

Here's a BIG tip.  I had to keep my legs with the aid of the braces perfectly straight .  Standing up and sitting down therefore become a big and painful problem.  I didn't learn until two days later that instead of keeping your whole body straight (my natural inclination), it's MUCH easier to stand if you lean forward at the waist as much as you can and extend one arm out to be pulled on and push with the other arm.  Putting your weight forward like this and extending one arm puts more weight forward of your center of gravity and greatly facilitates the standing.  As it was, we had an attendant behind pushing me to my feet to visit the men's room and that was a difficult challenge. 

When I got to JFK and my connecting flight, they got me down on the tarmac and then concluded I wouldn't fit on the regional connector.  I must say that Delta stepped up to this and transported me with an agent to LaGuardia and the larger shuttle to DC and got me on the plane and off the plane on the other end and into my wife's care.  Despite all their well-known financial troubles, Delta service on this, making my trip home happen, was outstanding.  I was exhausted, not much help, and depressed.  And they got me home. 

As I mentioned above, my traveling companions gave me lots of great tips about how to manage the next three months.

9/5/06

We arrived home at 1:30 am exhausted after a 20 hour straight-legged journey from Istanbul.  Our master bedroom is on the second floor, so my wife had arranged a bed on the living room couch.  Shortly after arising, we acted on some plane advice and called a medical appliance vendor and ordered a hospital bed with over head crane/trapeze, porta-john and wheelchair.  To my surprise, they arrived by 3 pm that day and I was able to have a regular bed, now my home/office/desk/couch/bed for the next two months or more. 

Surgery would have to wait for another week, the following Tuesday.  So we began a week of waiting. 

9/6-13/06

While it was frustrating waiting to get back on the road to recovery, we did learn a lot during this week.  Here's what comes to mind ten days later (after surgery):
* Get a bunch of rubber gloves and a stockpile of wet ones.
* Susan had already bought two urinals and a bed pan and baby powder.
* We had wireless router in the house so I had internet and email connections immediately.  We set up a table with laptop and printer/fax/scanner on one side.  During this week, I drafted an article, outlined a new book and sent it to my publisher for review, and edited three chapters with my senior research associate on another book.
* Use DRI FIT/DRI PLAY golf shirts.  I'm an avid golfer and the night we used an ordinary cotton T-shirt, I got a hundred little bed sores on my back.  The dri-fit technology wicks moisture away from your body and is MUCH better.
* We use a blue rubber band rehab exercise band and a weighted bar for upper body daily exercises.  I feel so much better after doing my daily routine:  30 pulls (the band is tied around the crane) on the band (left over and still in use for the shoulder/rotator cuff tear rehab), and 50 inclined pushups on the 18 pound heavy bar. 
* High protein snacks instead of high carb snacks.  It'll be a challenge not to gain weight.  Don't eat if you're not hungry, it feels better to have empty gut instead of full gut.
* We are using two lap trays, one for the computer and one for breakfast and meals. 
* If you like to sleep on your side, as I do, a BQR is a problem.  I learned to pull one foot up with the toes on that foot on the other foot and gradually slide my hips over so the braces were laying on top of each other with no stress on the top of the quads.  Later I learned that if you put a round pillow or two small flat pillows between your feet, rotate 45 degrees so your feet are tilted and then using your hand lift the lower leg brace of one leg up on top of the other and then rotate your hips, one can sleep for half an hour or an hour.  The pillow takes the pressure of the braces off your knees.  The extra weight of the braces means your bottom leg goes to sleep after a while, but I'm able to make this somewhat complex series of moves some 3 times a night so I can give my moist back a rest and get back into a more comfortable sleeping position.
* Be sure you keep your braces on while you sleep or nap.  Sudden twitches can cause your legs to bend and that hurts like crazy.  After surgery, that can pull the pins and sutures out. 
* My feet began to dry out a lot and it felt like the tendons were shrinking.  Ideally, your feet need to be massaged with lotion once a day or more.
   One floor living would be better.  That said, we'd still need a hospital bed for the raising and lowering features.
* Every morning, we developed a good routine:  braces tightened up (on loose at night), porta john, walk to kitchen sink for shampoo and body wash, tooth brush, etc.  The walking is good.  Clean sheets, clean pillow cases daily.  All new and clean everyday is a big emotional boost.  My wife, Susan, is an angel, saint, godsend, diamond.
* Wrap two pillow cases around your legs before you put the braces on because the foam pads irritate the skin, and I got one or two big lesions.  I take these off during the day so they breathe, but they work well at night.
* Take the braces off during the day.

9/14/06

Surgery Day.  We'd had to visit the doctor once for pre-op evaluation and decided to use a medical transport service at least for these two visits.  We found one with a new kind of wheelchair technology.  Instead of using the elevator mechanisms most commonly found, this fellow had a new system, a simply ramp like they use on newer car towing service trucks.  The back of his van folded down into a ramp and he pushed me up and secured me to the floor.  It was easy, fast, and secure.  Much better than the elevator systems.

There were two options for anesthesia, epidural and general.  I opted for the "I don't want to know" general route.  In retrospect, I'd think about this more.  See below.

There are, my orthopedist said, two kinds of operations:  if there's anything left of the quadriceps tendon hooked to the patella, they can stitch the two ends together.  If not, they have to drill into the patella and either insert little metal "pitons" with barbs and loops for the sutures or drill all the way through and loop the sutures through.  I ended up with 3 pitons in one knee and two in the other.  He said it was like sewing the ends of two mops together--the muscles are not a clean sheet, rather a bundle of muscle fibers that you have to try to stitch together as many of them as you can. 

I found three or four sites on the web that explain this pretty well.  The best one for me was this one:  http://www.arthroscopy.com/quadrep.htm  That document is shown here.  Note that it has two very interesting links:  the first one shows an animation of how the knee works with the energy transfer from the quadriceps muscles across the quadricep tendon, through the patella, and through the patellar tendon to the tibia.  The second link shows a four to five minute video summary of a quadriceps tendon repair surgery.   Quadrep document from Arthroscopy.com     

9/15/06

I was hoping to go home the morning after surgery, but I felt awful.  I'd used a lot of morphine the night before, plus the general anesthesia left me feeling nauseous.  So we stayed another day. 

9/16/06

We went home today... and it was one of the worst nights ever.  The intubation left my upper lip swollen and black and blue and I had lots of air in my stomach and bowels that were gurgling and very painful.  I felt diarrhetic, nauseous, in a lot of pain, and it was a miserable night.  I believe now that the epidural route would have made for a more comfortable two days after.  Maybe not.  Anyone have experience with that? 
Ice on the knees two or three times a day felt really good.  And reduced the swelling and black and blue-ness.  Here's how I and the knees look after the surgery:

9/17-24/06

The hospital PT gave me two exercises to do:  stretch your toes straight away from your body, not in circles.  This flexes the calf muscles that act as a pump to move fluids away from the area.  The second is to press your knees gently into the mattress and hold for six seconds.  This gently flexes the quad muscles to try to keep them in some tone and slow down the atrophying without tearing out the sutures. 

We've settled into a routine now--up in the morning with the daily shower, hygiene, exercises, some walking.  I felt good enough on 9/23 to get up three times (it's a process, put the knee caps on, put the pillow cases on, put the braces on, adjust the bed, arrange the walker, Susan lifts legs over and down, bend, reach pull up, and go) and get a little exercise in my legs.  We wait now until next Wednesday when we get the staples out and can begin the first week with 15 degrees of flexion.  I remember how painful it was to try to tear the unwanted healing adhesions between layers of skin and muscle when I had my previous rotator cuff repair (eight years ago), so I'm expecting this will hurt as the therapy gets more aggressive later on.

Friends have been a big boost.  Students have come by to visit.  Cards and flowers.  One of my best friends drove from Ohio to visit one night and show me his new hickory golf clubs.  And I have to be careful not to do too much on-line shopping center. 

The US lost the Ryder Cup.. Great golf, sad for our side.  Okay, if you have things to add from your experience, please feel free to email me and I'll post/edit/add. 

9/27/06

I visited the doctor today for my two week post-operative visit and got my staples out and the okay to begin physical therapy at 30 degrees of flexion.  We’ll do that for about 3 weeks before going to 45 degrees.  He okayed being up and around as much as I can on a daily basis with the braces and walker.  We were able to make the trip with just me and Susan (without using a medical transport).  She slides me in sideways in the back seat like a morgue drawer.  So, making little baby steps of progress.  It will feel good to be able to bend my knees a little while walking and sleeping. 

Everywhere I go, when I comment on my concerns about statins, more data just keeps tumbling out that seems to point to the statins as major contributors to this phenomenon.  I’m completely off them for the time being and working on managing my cholesterol with natural means. 

Another tip we learned for fighting bed sores is to use Solarcaine with aloe during the morning "hike" to the kitchen sink shower.  We let the Solarcaine dry on the way back to the bed and then apply baby powder and this works well to keep the sweat sores down. 

We've been up 3 times a day for the last two days, fifteen minutes morning noon and night.  After today's visit, we'll try to ramp that up to five times a day.  The more one uses it, the faster it heals.   A pair of padded, fingerless, batting gloves or weight lifting gloves help a lot, too, to ease the weight from the walker on your hands.  The big bandaids you see on the photo to left are only to protect the scars from the braces bands, not to keep the wounds together. 

9/29/06 It was a very good morning, slept in a little, emptied out e-mail inbox (something I'm usually not able to do during regular schedule), did my heavy bar lifts (65), blue band pulls (30), leg lifts (ten on each side up to 2 feet in the air), leg spreads (up six inches and in and out ten times), quad presses (ten on a side), ankle-calf pumps (10 at a time on both legs maybe 6 times during the day).   Walked around the tree in the driveway, maybe 80 yards altogether, did my shower, and had my favorite breakfast and felt great. 

We read about vegetable juice fasting in the Natural Pharmaceuticals manual and plan to try that tomorrow.  I'm hoping I can use this opportunity to lose some fat as well as muscle.  Then we went to get a haircut downtown.  It takes an extra 20-30 minutes to get ready to go, trussing up, inching to the car, but trying to make little bends with each step, and then sitting in the wheelchair for the haircut and beard trim.  I was worn out by the time we'd gone through the bank, the dry cleaners and the pediatrician's.    But it was a good day.  Walking is still "unnatural" but getting better.  And I have something I can do proactively now to help the muscles knit and rebuild. I have to be careful, all tell me, to not try and overdo it.  Patience. 

With disuse, we notice that one's feet begin to shed alarmingly.  Susan's found some various foot creams and sprays and we're experimenting now to see what best keeps the feet intact.  All the normal callous from walking is flaking off rapidly now.  Ideally, one would get a foot job twice a day.  Susan uses a little finger nail brush to get the larger flakes off and then a short lotion massage and an anti-whatever spray that works well for ten hours anyway. 

It takes a lot of trust to be in a wheelchair being trundled down concrete and aggregate sidewalks, over handicap ramps (that are NOT level in any direction, so beware), and through shops to the hair dresser.  Don't go too fast--a sudden rut or stumble and the patient (that would be me) can / could go tumbling out headfirst onto the ground.  Slower is better, something Susan never thought she'd hear me say.

By now, I'm going 7-8 hours in between doses of hydrocodone (instead of prescribed 4).  I wait until the accumulation of aches and pains mounts to discomfort and then relent--which helps at night too for sleeping.  I use two pillows a round one (between my ankles) and a flat one (between my knees) in order to sleep on my side and after a while, everything begins to ache.  But now, I can raise my legs (straight out) up two feet in the air, so it makes the switching much easier. 

I fret over the two torn rotator cuffs suffered in a taekwondo incident in July.  I'd postponed consideration of surgery on them until late fall and after the golf season.  My orthopedist didn't think I had torn anything there in an examination in July, howerver the MRI showed 2 centimeter tears in the supraspinatus, infraspinatus, a partially torn biceps tendon, and meniscal fragments floating around in the right one (which he'd repaired already eight years ago) and the left one feels the same.  He said he'd only ever seen one other case where the musculature was strong enough to do what I do and yet show tears.  I can feel the aches and pains and catches and clicks in my shoulders all the time, but have no energy for having them repaired anytime soon now. 

I'm taking red yeast rice and oat bran muffins daily now to try to substitute for the Vytorin to see what my cholesterol base line will be in late October at my next cardiologist's visit.  Also 1000 units of E to help speed the healing and the usual vitamins plus to combat GERD, Prilosec (2).  I'm reading and learning a lot about the possibilities in a more natural approach.  We'll see if it works.  Susan also put me onto River God , an historical fiction novel about the Hyksos invasion of ancient Egypt.  And I've outlined a new book, written 3 chapters on another, and drafted an article and taught a class in my home.  Going along at 20%... it's frustrating.

10/1/06 Yesterday was a good day, exercise walks morning noon and night, and healthy eating.  I finished Duane Graveline's book, "Statin Drugs Side Effects" this morning and was impressed with several things:  a) he asserts that inflammation is the real culprit, not serum cholesterol level, b) the list of symptoms/side effects was scary accurate with my symptoms.  To wit:  hand tremors (I've had odd and unexplained tremors trying to write long hand), hand numbness (I've had four surgeries on my hands to relieve hand pain and inflammation of the tendon sheaths, muscle and tendon weakness and atrophy (my current bilateral quad tendon tear and the July rotator cuff tears), gastro-intestinal distress (for the last ten years while I've been on statins, I've had GERD and take double prilosecs daily for it), numbness in the legs or feet (I've got a patch on my left leg under my front pocket that is permanently numb it seems.  I'd attributed it to carrying my car keys in my left pocket for years, now I wonder), memory lapses (I've felt frustrated lately that I'm forgetting names and events and citations much more than just last year), toe tripping/stubbing (one man moved to leather shoes to stop stubbing his toe, I do this maybe 3-4 times a week), and occasional dizziness (I was attributing this to the Lexapro.)  Given what others have experienced and written about, there seems to be just too many "coincidences with a common factor" to ignore.  I've just begun "The Great Cholesterol Con" by Colpo and find it very well written and inviting. 

Graveline also pointed out that "Red yeast rice is virtually identical to Merck's generic lovastatin, known by the trade name of Mevacor and one 600mg capsule should be roughly equivalent to Mevacor 2.5mg."  Page 152.  So, although I just found out about this "natural" approach to cholesterol reduction, I'm going to stop taking it.  I find Dr. Graveline's writing style to be very confusing and so cannot recommend him as an easy-to-read author, however he has amassed very interesting and powerful information--you just have to wade through to get to it.

I was also able  to use the regular bathroom today, so those of you who are wondering about when you can go back to the regular method, for me it was about 18 days after surgery.  One does need some means of assistance sitting and standing, a rod in the wall, a sink cabinet to use your elbow on, or a partner.  Clearly, a seat extender (raises the height of the commode) would also be a big help.  I can raise my legs now, and do side scissors.  The PT recommends sets of ten on both twice a day... I'm doing maybe 3 times a day. 

One other thing.  I find that standing with my feet side by side is scary and unstable and makes me worry about toppling over.  I recommend standing when you need to rest with your walker to stand with one foot ahead of the other.  In taekwondo this would be a mini front stance, parallel toes pointing forward but one behind the other, about shoulder width spacing.  As in the martial arts, this stance is more stable than the typical side-by-side stance of the casual "stander."   

10/2/06 Had my second PT session today... including soft tissue massage to try to ease the adhesions building up from the healing.  I remember this from my rotator cuff repair... it's an achy, sore, good feeling.  Then they wore me out with fifteen reps of straight leg lifts, side scissors, adductor and abductor lifts on my side(s), and quad presses/flexes (hold for ten seconds each).  I walked in with the braces and walker and out having gone in the wheelchair for my first visit last Thursday.  I was able to sit in the chair in the waiting room by myself and stand up by myself, so that's a step forward, too. 

I'm reading historical fiction on ancient Egypt, Wilbur Smith's River God (done), and now Warlock.  Very entertaining and educational.  And doing a little Internet research on the nature of blogs in case I need, you think I should, upgrade this. 

Every day now, I feel a little bit of progress.  I'm still dying to play golf in this beautiful weather.  And my friend sent me some hickory clubs too, so I'm eager to get back to them. 

10/5/06 Thursday.  The night before last I didn't sleep well, read lots in Warlock during the night... so I was tired yesterday, but got a lot done.  Scanned the Turkey receipts with my bedside office setup, did e-mails, so I'm staying sort of connected at the school.  We talked about blogs and how to improve them, so I'll be learning more in the months to come. 

Last night, we went to sleep after Bones, took 3 Vicodins during the night, one every four hours because they start to ache especially if I turn on my side, and one half melatonin, so I slept well.  Felt good this morning.  Had my usual breakfast of omelet with Canadian bacon and Swiss cheese and green peppers, frozen raspberries in soy milk, and a cup of tea.  Then, went out for my morning walk, through the sliding glass door, along the patio, sidewalk and onto the driveway and around the mulberry tree in the middle of the circular drive.  I did eight revolutions, by far the most, felt good, and could walk for several steps just using the walker to balance a little.  Jaws came with me the whole time and was so attentive and always by my side.  He left once to go get Susan, but she was cleaning, so he came racing back like a little torpedo with his ears back and his short legs disappearing with their speed.  He's so nice to attend like that.  He's guarding me and can sense my injury I think. 

Susan and I have decided to do a veggie juice fast today.  I'm going to do 2 meals, she's doing three.  Several books suggest this, to detox our systems and shrink our stomachs a little.  I do want to lose some weight and get back below 200 again.  I don't think that will hinder the healing--especially since I'm taking Vitamin E daily, too. 

I have PT #3 this afternoon... Tuesday's workout wore me out, so this should be good.  I could walk much better this morning. 

The leg braces are both loved and hated.  Loved when I need to get up and move around, hated when I want to sleep--the angle locking hinges are so thick they press on my other knee and make sleeping a challenge.  I'm a side sleeper and this injury makes that very difficult.  I can go 30 minutes or so on a side, though, and then have to turn over (which takes five minutes) or go back on my back--which gets sweaty and tired and needs AIR. 

10/6/06 My third PT session yesterday was mostly soft tissue massage trying to loosen the developing layer adhesions, and some ice and electrostim.  I was a bit worn out given my 8 revolutions of the mulberry tree.  But the incisions are looking better.  Here's what the knees look like at 3.5 weeks after surgery.   

Sleeping is getting easier... despite the bulky leg braces.  Lying on my side, I can put the top leg not on top now, but farther over on a big pillow beyond the bottom leg so it relieves a lot of pressure and the 40 degree (30 d set plus ten degrees of "slack") bend makes that much more comfortable.  It's raining today, so I didn't go out, but rummaged around in the garage to get some vertical, load bearing time in.  I had an ache in my chest today and want to be sure I don't develop pneumonia lying around.  Susan said she might take me to the mall to walk around, but not sure I'm ready to confront the mindless, thoughtless masses yet.  She had a facial at the spa next to the PT facility yesterday so we're trying to take care of the care giver, too. 

If any of you have information or comments on the "statin to muscle collapse" connection, please email me. 

10/7/06

I’m SO confused.   Everywhere you look, people say “the lipid hypothesis” (lower blood cholesterol means lower incidence of heart disease) is accurate.  See the screen capture below.  Yet, Colpo’s book, the Great Cholesterol Con, states very clearly re-analyzing the Framingham Study that in people over fifty, decreases in serum cholesterol level were actually correlated with increased CHD.  He even shows the charts!!!   If you’re under 50, you might have 11 percent lower risk... if you’re over fifty, low serum total cholesterol is correlated with increased CHD. 

I’ve begun eating oat bran muffins (see this link for the “Scoop on Bran” http://www.wegmans.com/eatwelllivewell/healthyEating/fiber.asp ) which raises dietary fiber and is supposed to reduce cholesterol, BUT gives me a lot of very uncomfortable gas and each muffin is like 350 calories.  JEEZ!!!!!!  Graveline and Raskovn also say the lipid hypothesis is false and dangerous.  If I could, I’d just stop eating altogether.  DANG!!!  This is so frustrating!!!  WHAT CAN ONE EAT???  Without damaging yourself.  If serum cholesterol is NOT the bandit, then eating bran muffins doesn’t make sense except if you’re irregular.  I feel like a flippin’ helium balloon.  I have to take GAS-X constantly to stay comfortable.  JEEZ.    

If I'm taking statins to lower my serum blood cholesterol (SBC) but having muscle collapse as a side effect, I don't want statins, but don't want heart disease either, how does one lower SBC without statins.  If the lipid hypothesis is not accurate then why worry about SBC at all?  HELP! 

Here's a link to "The Scoop on Dietary Fiber" if you're interested.  I was since the oat bran connection is turning out to be so uncomfortable gas wise and not so hot calorie wise....  DANG!!  http://www.wegmans.com/eatwelllivewell/healthyEating/fiber.asp

 

10-8-06 We had a good long outing yesterday, going to Best Buy to pick up a few items, then to the school to pick up mail.  I met a colleague there who knows about knee problems since his wife had had hers replaced.  He commented, prophetically as it turned out, it's not a smooth, monotonically increasing process.  There are bumps in the road.  Last night was a major bump in the road.  For the last two days, I'd been experiencing some pain in the right side of my rib cage and lower abdomen.  I was worried I was getting pneumonia, so I was trying to breathe deeply and yet every breath really hurt.  Coughing hurt as well.  When I was upright and walking/shuffling around, it didn't seem to be a problem.  And I didn't have a fever or feel otherwise punk.  Last night we watched a movie and then I watched the heavyweight championship of the world between Valuev and Barnet (we've come a long way down since the days of Marciano and Ali). 

Shortly after I turned in, my right side began to hurt like crazy with most of the pain just behind my right clavicle.  It got worse and worse (they always ask in the hospital what's your level of pain on a ten scale, this was an eight); for a while I thought it might be a heart attack, but the pain was on the right, not left, and didn't feel like my heart.  Was it gas?  Was it torn muscles?  I couldn't figure out what was going on, but the only position that gave any relief, that modest, was sitting straight up.  My wife/saint/angel/nurse brought me some topical analgesic spray she'd gotten from the chiropractor's, and a heating pad and an ice pack.  The ice pack felt best.  I ground out an hour and half like this, unable to sleep or find any real relief.  The only thing we could figure was that I'd stressed/sprained the intracostal muscles along the right side by reaching above my head and over the bed frame to the right to lift the wicker basket of medications (morning doses every day).  It's heavy, maybe eight to ten pounds, and I'd noticed at the limit of my ability.  But again, I'd had no sense of overdoing at any of those episodes. 

Last night the pain was awful.  I took another vicodin and was finally able to sleep for a couple of hours.  When I awoke, my left heel was killing me.  Jeez.  Is my body just completely shutting down?  I'm worried that my whole musculature system is just failing.  So now at the moment, the least of my problems are my knees... every deep breath hurts all along the right side, my right clavicle feels like it's been run over, my left heel feels like it was slammed down on a concrete floor, and both shoulders snap and catch when I move my arms (from the July taekwondo incident).  The thought of having to have those both repaired (the right for the second time) is more than I can contemplate at the moment.  I'm a mess.  Susan thinks all of the natural bodily compensations caused by major trauma are just kicking in.  It was not a happy night.  Maybe it's all sympathetic pain watching the 7' 325 pound Russian champ pound on the 6' 3" Barnet for 11 rounds.  Whatever. 

I feel totally confused about what to eat, what's going on with my muscles, whether or not to be taking statins, and whether I'll ever feel good again.  At least it's not raining on the Dunhill Cup championship at St. Andrews.    I need to rally today.  I keep trying to wean myself off the Vicodins, and have been getting up to four hours in between designated doses (eight hours between taking), but when I do, the aches and pains roll back in and make it hard to focus or relax. 

I have my doctoral seminar tomorrow for 3 hours at the school.  Need to prepare for that today and tomorrow.  I was looking forward to it, but am feeling swamped at the moment.

I was sitting up for dinner in a recliner chair yesterday afternoon, a good thing, and there was a large woodpecker hunting grubs in the trees in our back yard.  He was so beautiful.  Bright red topknot, white underneath, gray back... very intent, vigorous pecking, quick movements from here to there... gorgeous.

Three hours later  Okay.  Whine whine, whine.  Enough.  I got up, got to my walker half way across the room without assistance, went up the one step to the bathroom & kitchen level frontwards, did my upper body exercises, some leg lifts, got up and down out of the recliner twice by myself, so I'm making big progress... all first time things.  

8:00 pm:  I had more firsts and a good afternoon.  Went to Sam's Club and walked around for an hour.  Sat in the recliner chair all afternoon instead of getting back into bed.  Got up and down a lot unassisted.  Still ate too much for dinner... I need to get to "dinner as pauper" principle.  Legs feel good.   Put my shoes on alone for the first time, got from bed to walker by myself.  The day started out awful and got pretty good.  Susan put some 8 hour heating pad on my clavicle.  I hope I can sleep tonight. 

10-8-06 Hurray.  I slept very well last night, with no melatonin and only one Cataflam, the NSAID pain killer that they gave me in Turkey.  It has lower side effects and worked quite well.  Reading the downsides, I learn that the main problem with NSAIDs (non-steroidal anti-inflammatories) is GI irritation and bleeding.  The books that highlight the "myth" of the lipid hypothesis suggest that inflammation is the real culprit.  I wonder if NSAIDs are not a better insurance against CHD???

Anyway, had a good walk today, sat up for breakfast, had my shower, did my upper body weights leaning against the bed (first time), and feel good.  I have my doctoral seminar on teaching technique this afternoon and am ready for that.  It's a beautiful day, a grand day for golf, and I can't wait for that chance. 

10-10-06 5am: Yesterday brought with it, for me, an horrible and devastating insight.  I was asked to see and finally did late last night how my "natural" (genetic?) impatience and assertiveness has become in the last month overbearing and counterproductive.  I've been reflecting on this most of the night.  I've been told in the past that I have a somewhat "intense" and "assertive" style and approach.  My father and my brother have / had some indications of OCD (obsessive compulsiveness) and I suppose I have some mild forms of that.  They seem to have been exacerbated in the last month.  I'm realizing that my communications with my colleagues at school have been more "assertive" than usual.  My teaching in the doctoral seminar has been very frustrating this go around, not being there for the first six classes, coming in as the "outsider" and in retrospect, trying too hard to establish a relationship that in the past came more naturally; and teaching all of those classes while on hydrocodone.  Pressing upon my family silly requests in the attempt to maintain some tiny measure of control over my life and personality. Being more aggressive in my e-mails with my golfing and traveling friends than I've ever been.  Expressing irritation at vendors who are slow to deliver from on-line purchases.  There's a pattern when I try to look at it more objectively.  It terrifies me.  I'm trying to understand it.  One explanation would be that in this situation, restrained in the majority from my usual habits and outlets, I've become more demanding in the few social outlets I have in some misguided attempt to try to regain control of my life.  I think that's had a negative effect on most fronts including relationships I've built up over decades.  Even this blog is an attempt, I guess, to try to be "productive" during this period of enforced, outside-in diminuition.  I have read about, for example, cancer patients who have had to "fight" their disease and to stay alive.  Here, I think at the moment, my fighting the thing has been counter productive.   It pains me deeply.  It's an on-going challenge in life, I suppose, to balance the desire to be and the desire to fit in.  "Eccentrically creative" is one thing, while "obnoxiously annoying" is quite another.  At the moment, I think I need to retreat.  I'm feeling a little helpless and small. 
10-11-06 As the day wore on yesterday, things got better.  Some friends and students responded to my emails, and that helped me get back on track.  Susan and I "made up" and that always makes the day better.  I was exhausted throughout the day and it was the first day in 4 weeks that we didn't do our morning routine.   So no bath, no clean sheets, etc.  It was PT day, and I got a very good workout: soft tissue massage which feels great (both sides still adhesed, I wonder if some 3M or J&J scientist isn't working somewhere on a biodegradable teflon sheet that orthopedic surgeons can insert below the skin that will prevent this and allow for natural decay and resorption five weeks later....  then my usual exercises, leg lifts, side lifts, with one pound weights this time, and quad crunches with the ball between the knees, then 20 minutes of electro stim (first at 16 then at 22) under ice pack.  At the end, new, calf lifts and toe lifts... like we do in taekwondo.  I'm struck with how similar the rehab exercises are to many of the things we do in TKD every time.  Susan made a nice, light dinner and we went to bed... 

We're both missing the human contact even though she's sleeping in the room so we can be together.  Touching toes in the night, holding hands while sleeping, rump to rump, the little human, warm touches are lost even though she's just over there on the couch.  It's a big deal.  We lament that the rented hospital bed is only a single. 

Although the right shoulder was the one that felt the worse in July when I was holding the TKD pad and tore my rotator cuffs, the left one is giving me much more pain and discomfort these days.  We didn't X-ray or MRI it, and my orthopedic surgeon may not believe it needs repair.  The daily aches and catches in the left shoulder are worrisome and fearful as in the back of my mind I think about having to have that done while trying to recover from these knees.  I'm like 80% convinced it was the statins and that awareness that I've done this to myself by taking those pills is very frustrating and angering.  Typing and raising my shoulder to rest hurts on the left side. 

I look forward to the days and detest the nights--because of these blankety blank braces.   They are so uncomfortable to sleep in.  In Turkey, they gave me an Australian brand, QII Universal Light model, that is adjustable for length and girth above and below the knee.  I'll post a photograph of them later today.  I wear pillow cases between the skin and brace since the foam and plastic pads tend to abrade my skin.  During the day though, they make it possible to get around and as I get around more and more, they are staying on longer and longer (can only take them off while lying in bed legs extended and with no weight).  I paid the equivalent of $350 in Istanbul... I see on-line here similar models for about $180 so there was a premium for having them shipped to Turkey.  They tend to slide down since the general shape of the leg is an inverted pyramid, but there is a foam strap immediately below the knee, so if one has any kind of calf muscle, it keeps them from going down too much.  One of the American models I saw had an extended lower half that went down to the ankle to help prevent this slipping while walking/shuffling. 

Today is scheduled to be a quiet day, the only outing to be going to the movies that the girls have engineered in the afternoon.  That will be a bit of a test, but shouldn't be as long as teaching my 3 hour class.  They've already told me no large drinks and that I'll have to sit there throughout so they don't miss anything.  A close friend wrote in passing in an email yesterday, "take care of yourself."  That's the issue, actually.  I want to.  And the number of independent things I can do now, grows each day a little, so it's getting better.   And I hate being dependent like this.  My upbringing in the high Rocky Mountain desert valleys was around self reliance and no excuses, so this condition drives me nutty.  Already, I've partially re-organized the garage and my office and learned to get out of bed and to the bathroom and anywhere really so long as my legs last---so it's getting better.  I haven't tried a flight of stairs yet.  Nor a shower.  Nor the uneven surfaces of the lawn.  Nor the steep slope in our driveway.  But getting there.

The weather man says it will be a light winter... I hope so.  I'm done with snowy, icy winters (growing up in Idaho the snow was often 4 feet and temperatures well below zero F) and especially with uncertain legs and balance.  I'd rather play golf. 

It's seven am... my wife is sleeping/dozing on the couch with Jaws who likes to crawl under the covers and sleep curled up in a ball next to her belly.  My "normal" six am clock has long since kicked in.  And first light has appeared through the cracks in the curtains.  Another in a seemingly endless stream of recently similar days is beginning: sleepy body but not enough to overpower my awake brain to go back to sleep, gasy stomach, achy legs, cumbersome braces, overlaid with the sadness and tension of my 27 year old son's disability and presence in the house, and the sense that life is getting shorter.  It's been a tumultuous year... frequent interesting and rewarding international travel, several very new experiences, one child pulled out of school with severe anxiety and depression, pulling out of that, another child going off to school as a transfer junior, another moving back into the house after co-signing a lease with her then fiance, and the eldest moving back in after a severe break with reality and a stint in the hospital.   I'm amazed that Susan has been able to keep it together, frankly.  Her ADHD makes it very hard for her to cope with the regular vicissitudes of life not to mention all that's gone on this year.  And shooting even par for the first time ever in tournaments.  Publishing another book, my third in three years.  Being awarded a chair by my colleagues.  Being invited to test for black belt in TKD (although I cannot, it was an honor to receive the letter).  Starting a little internet venture that so far is profitable.  Is this the high point in my life?  Is it down hill from here?  My step dad never recovered from his broken hip as so many report.  Can I stand to have my shoulders repaired later on?  Will I be able to play golf again? Will Susan be able to continue as she has in these last few years to find her normal self, the self that was so deeply suppressed and stuffed and denied her growing up?  The one thing in life I'm most proud of is helping her to find herself. 

That 30 year effort has helped me define my life's purpose--to help people find themselves.  It permeates my teaching, my consulting, my work with careers courses and our new commercial web venture, www.CareerNextStep.com, and my private and personal conversations.  If my openness here in this blog generally seems odd to you, my philosophy is this:  we can only learn when others are willing to share with us the unvarnished reality they experience.  The behind-the-curtain superficial conversations no longer interest me at all.  Life's too short to spend in discussion of social facades. Those few friends with whom we can talk about anything with fear of rejection and judgement are like precious jewels, diamonds in the social desert.  Susan, Tanner, Robert, and Erich whom I pay $100 an hour (!).  My shoulder is aching badly now... I need to stop..

10-12-06 10 pm to 7 am, nine hours of totally unassisted sleep.  Wow!  My first 24 hours without any pain or sleep meds of any kind.  That's a big step forward.  Another was that yesterday am, while Susan was sleeping, I went down the slope of the driveway to get the paper.  Bad idea.  Scared my self silly.  It's about 20 degree slope, and I was scared spitless going down and couldn't turn around.  At the bottom, I had the option of waiting there until Susan came looking for me or going back up.  When I got back Susan looked at me and said, you look pale what happened?  Anyway, later, they took me to the movies; we saw Departed.  Excellent film.  One of Scorcese's best--but with the typical shock value violence he likes.  But, wow, so intense.  I couldn't breathe for two hours.  Used the handicapped theater ramp/wheelchair seating area for the first time.  The whole family went.  I was mortified when I got back to realize I'd missed an appointment of an international visitor who was coming to see me that afternoon; I've gotten out of the habit of checking my Outlook calendar in the morning.  Later, it turned out to be for the best, he had come but went home and went to bed with a high fever and severe flu like symptoms.  I'm seldom glad I missed an appointment, but that was one.  I don't need the flu on top of all of this. 

I'm feeling more optimistic this morning.  Glad to be over the "bump" of the last two days.  I bought Susan a new laptop so she can surf the web on her own and it came; big hit and she's a happy puppy last night and this morning.  She's a natural seamstress, but not a natural electronic/button person, so she's a bit nervous about it all, but so far, so good. 

7pm:  It was a very good day.  I discovered this morning that I can now walk across the room holding my walker off the floor.  I was able to walk all the way to the PT door the same and to the car on the way back the same.  Only one time did my knee buckle--but it didn't hurt, just gave way, but the brace caught me and no pain or damage.  We did some new exercises today, notably "short arc quad lifts"--with towels under your knee, flexed at max 30 degrees, just raise your foot ten times without raising the knees.  That was a good exercise. 

10-16-06 Monday 7:30 am:  Saturday we watched our son play soccer in a local co-ed league.  That involved "walking" across fifty yards of uneven lawn.  I sat in the wheelchair and was wiped out at the end.  But every day, a little bit of "stretch."  Sunday evening, I stood in my walker and hit 20 golf balls into the net in my back yard with one arm.  That also wore me out.  It's amazing to me how much one's muscles atrophy with little use in so little time.  All those years sitting at the computer and doing desk work, it's no wonder my abdomen is not so strong.  They even had a show on the Golf Channel on that-- the man was explaining how desk/office work with us bent over at the waist makes us stand and walk stooped and become "old" before our time.  I'm grateful for taekwondo that teaches us to stretch and stand up straight to perform well.  I need that every day as soon as possible. 

I've written a "summary" paper of my findings to date, sort of like this blog but with a focus on the statin-cholesterol-muscle weakness linkages and with quotes from web sources and summaries of books.  If you want a copy of it, please e-mail me.  My biggest issue is, I believe, weight.  I weigh 240 and need to be below 200.  The ONLY time I've been able to lose weight in the last 20 years was the 3 months I went Atkins.  I lost 20 pounds and my cholesterol went down.  And we're surrounded by carbs.  Everywhere.  I have an acidic system/stomach/GERD and sometimes the only thing that feels good on my stomach is toast.  My daughter did find some good noodles for spaghetti last night, with 9 grams of fiber, 17 grams of protein, and 38 grams of carbs.  It's better than the usual noodles. 

Full size, long pillows are a big help in sleeping.  Little pillows aren't good enough.  Get the big ones..one for your head, one for each side so when you turn in the night you can put one between your legs to ease the pressure of the leg braces.  Learning to sleep on your side with the legs splayed instead of on top of each other also helps.  Unless of course you're a natural back sleeper--which I'm not.  By splayed, I mean the top leg well forward or well back so it doesn't rest exactly on top of the bottom leg.

All the kids are / were home this weekend with boyfriends and it was all just too much.  By Sunday night I was exhausted.  We'd missed the daily routine and foot work.  It just takes much longer to do the simplest things, even now that I'm semi-mobile.  Getting up, exercising, bathroom, kitchen sink shower, breakfast, etc. all takes more than two hours.  It's great to have them all here... and with all the chatter and energy, it's just a bit much.  I was back to one Vicodin and a half a melatonin last night to sleep well.  My legs are aching in various places now.  The physical therapist said it would be like this--that as I became more mobile, I'd find more aches and pains here and there where the muscles tore or were stretched etc.  It IS good to be able to hold the walker up and go for a while, though. 

I have class today.  And a house closing beforehand.  I hope I can last through the day.  The truth is that PT daily would be good.  It's hard to keep up with the details of the PT even though I do them all at least once a day and am walking a fair bit.  The BPQT research shows that accelerating the rehab process does NOT result in better results, in fact, in worse results. 

10-18-06 Wow, the last two days have been big ones.  First, I got a big letter from a fellow BPQTer in Oklahoma who experienced similar difficulties in the spring of 2006 playing tennis.  We're still coordinating stories, but it's clear there are some major similarities and differences that might be helpful to others.  We'll organize that and share it with the world soon. 

It was raining, that huge storm covering the eastern US yesterday, and I had PT again, going to move the braces to 45 degrees from 30.  They took my braces off and measured my natural bend and it was at 50 degrees, so the move to 45d was not a big problem.  I walked around the therapy room 4 laps and she said, okay, now to the rack!!  They had a device on the wall with rubber bands and I did fifteen pulls on each leg in each of all four directions with a light yellow band.  Felt good, got up a sweat.  Then we went to a new machine, a NuStep, like a recumbent step machine with adjustable arms.  It was a little tricky getting into at first, but then it felt really good, like subsidized walking, and I spent ten minutes there.  I liked that one, nice easy stretch at the end of each stroke, don't have to go fast (I was doing 28 minute miles I think).   Then more ice and electrostim and walked out of the place with my walker held six inches off the floor. 

This morning we went for a follow up with the orthopedic surgeon.  Walked in for the first time with my walker off the ground.  He dug out a stitch that was coming up through the seam with some pliers.  I think he wanted to see if I'd yelp.  It came out after four or five gouges and no yelps.  A little blood, a bandage and he says, okay, let's move 'em to 75 degrees.  WHAT?  I says, we just moved them to 45 yesterday!!  He says, okay, let's go to 60--it's only another ten degrees from what you've got going already.  And then after five days move them again to 75degrees.  He believes in movement.  So I walked out of the office with another 3 week follow-up scheduled and my braces at 60 degrees.  He says I can try sleeping without the braces in another week.  Wow.  Just don't bend your legs ninety degrees.  So, I've moved my computer set up from bedside, to a hospital table beside the bed and am sitting on a chair with two pillows under me and flexing my legs so they have just a nice little tug, light pull, while I'm typing.  I don't want to be going into therapy tomorrow and having Lisa or David saying, AHA, now the BIG RACK for you!!!  The light gentle tug, either while walking/shuffling or sitting seems to be getting the job done.  A big insight from my last nine years of taekwondo is that a little at a time in stretching works wonders.  Not too much too fast or it tears.  Just a little gentle tug every day and it stretches out.  My left IT band, the outside of my thigh, is very tight.  I think I pulled / tore the muscles there when I went left wise down the steps in Istanbul.  Lisa said there'd be some new aches and pains appear as we get closer to normal. 

10-19-06 What a therapy day.  I got up about 7 and did my usual routine.  That takes about 3 hours.  I did walk across the room, up one step to the dining room level, across, down the hall and to the bathroom and back without my walker.  Big confidence step today.  It felt "normal."  Not scary.  I sat for an hour yesterday and again this morning, at a chair and computer by my bed pressing the legs to where they just tug--a light stretch.  That was wearing and tiring.  Though just sitting.  But I could feel the stretch.

I got a pedicure at 2 pm, my feet were getting really skanky--I couldn't reach my toe nails enough to tend to them.  That was a bit exhausting, and I could just barely make enough bend to get my feet into the tub.

At PT, I got a strong soft tissue massage to loosen the adhesions.  I've been taking Vitamin E 1000 mg in the morning--and the therapist confirmed that this will help the scars to disappear.  My "natural" bend was 62 and 64 degrees, so I'm staying a tiny step ahead of the "rack." 

I walked around the indoor track at ACAC (the place where I'm getting my therapy), 1/12th of a mile, without the walker!  Wow.  It wore me out though.  Then 15 step ups and downs on a 2 inch step.  Ha.  Up was okay. Down was difficult.  But I did it.  Ha!.  Then back to the NuStep.  I really like that one.  I was up to 10 resistance today, and going faster.  So, making progress.  Bit by bit. 

10-20-06 Yesterday was one of those "one step back" days.  After the heavy PT session, my legs were aching all evening and I couldn't sleep.  So I took two vicodins four hours apart during the night.  Still didn't sleep very well, but finally.  When I "awoke," I was exhausted, a bit groggy and somewhat depressed and disoriented.  Susan says she notices a big difference in my demeanor after I've taken the hydrocodone.  A friend recommends valerian root and kava, so we'll try that next time.  I had to cancel two important appointments during the morning and just spent the day in a blue funk.  I have the sense now that the PT has caught up with my natural flexion limits, the next three weeks are likely to be painful and more like this.  Just sitting in a chair with max flexion hurts/aches and after a while it becomes central focus.  I AM out of the bed/crib for my computer work, so that's good.  I'm watching all the golf tournaments and worried that I won't be able to go down slopes or hills any more without the terror of whether they (the quads) are going to give way again or not.  There's NOTHING above my kneecaps it seems, just bone.  Where did the 45 years of hoops quads and 9 years of taekwondo quads GO? 

At least the weather is sunny and beautifully fall here, so that's upbeat.  And my new friend in Oklahoma, Jim Falvo, who had this happen five months before mine.  What a story he has.  See the link at the top of this page.  It turns out we have a ton in common. 

I used a little vibration on my knees yesterday.  It felt good.  I don't know if it does any good, but it felt good.  There still are some adhesions we have to work on.  They worked hard on them last PT session, (Lisa and Dave), but they are still hooked up.  It's a challenge... and that stuff hurts, too. 

Okay, today is a better day.  Going out to watch my son play soccer with his co-ed team.  That's pretty benign but gets me up and moving and walking.  We went to the soccer game, then lunch, then to Sam's Club... I was worn out by the time I got home.  I did hit 20 balls into my net with a collector's berylium Ping Eye-2 7 iron and my new MP-32 8 iron.  Both felt sweet.  Just chips... 1/3 shots.  But without a walker, just the leg braces.  So that's a big step forward.  My hips and lower back are the sorest just now.  And the left IT band.  I can tell my quads are still like not there... a bit wobbly every now and then, but making progress.  Will they ever get better?  Will they ever get strong?  Will I be able to descend slopes on the golf course?  Go down stairs? 

10-22-06 It's Sunday morning.  I've been up and done my exercise routine and had breakfast.  Susan took me for a walk down the street with the dog, a first since the surgery.  I used two walking canes, but they're too short despite the fact I bought adjustable ones.  I need to get some walking sticks that go up to shoulder height.  But that's a first.  I also woke up in the night irritated, and found one of the brace lock pins inside my underwear.  Go figure.  That was the last straw.  I took the braces off about 4 am and said, okay, going to sleep without them the rest of the night.  I woke up briefly once with a little pain, and went right back to sleep, so it looks like this is going to work.  AND it was the first night since surgery I've dreamt.  Some dream about chasing people or being chased and I remember thinking, dang, be careful, because if you're chasing people, you could hurt your legs.  It's amazing what the brain does even in the night watching itself dream.  I plan to sleep without the braces tonight.  I cannot wait!  I've been hating the nights! 

I did some modest hip drops this morning while changing some light bulbs.  About four and not quite down to my brace locks, but that was good and wore me out.  Then Susan took me out on the street, so I had a good work out already this morning.  I'm at the computer stretching my knees toward lock... it's a tug on the top and I have to loosen the band above the knee on the immobilizers (GII from Australia, Universal Light adjustable model, got them in Istanbul.). 

I got a little hand sewing machine in the mail.  I hope to put some Velcro on my snap off athletic pants and some golf hats.  Susan thinks I'm crazy, may be. 

I tried valerian and kava last night; it seemed to take an edge off the pain from stretching, but it gave me a headache.  I think I'll try Advil tonight.  With all the vicodin around I seemed to have forgotten about Advil. 

I hit some chip shots yesterday with my new irons.  About twenty.  No leg action, but just a 1/3 swing, all arms, but without the walker.  AND I walked out to the net without the walker as well, although I did lean on the club a little. 

I still have to work on the adhesions.  I can sit here and stretch the knees for about 15 minutes then it hurts too much.  And I can tell the incisions are still adhered to the skin, so have to work on that. 

10-24-06 Yesterday was a good day.  I went back to occasional Advil instead of hydrocodone and valerian/kava and that worked really well.  I still don't like going to bed and Sunday night, I tried without braces, but a strong twitch with pain scared me, so I put the braces back on.  A half a melatonin later, I finally nodded off.  We awoke later, about nine and began to get ready for my afternoon class at 2:00 pm.  I did walk down to the end of our street and back a little over a third of a mile, so that's a big improvement, and best of all, it wasn't hard, actually felt good.  I was using my new walking sticks, 52"ers with a walnut knob on the end, and was motoring along. 

I love my breakfasts, it's my favorite meal:  Susan makes an egg or egg beaters omelette with Canadian bacon, swiss cheese, green peppers and occasionally mushrooms, with a little ketchup, frozen raspberries in a small cup of soy milk, and a cup of Constant Comment tea.  Very healthy, and mostly low carbs.  She's been making raisin oatbran muffins as well lately, and I'm torn about them:  good for cholesterol maybe, but high on carbs.  I want to lose forty pounds.  Dang.

BUT, the day went well, I took Advil before class and so taught without hydrocodone and that went much better.  Jim Falvo, my new friend in OK, was a visiting professor by web-conference, and taught a lot about distance learning.  He teaches at University of Phoenix that uses a lot of "flex-net" or totally web based classes.  Susan taught the next session on experiential learning (the doctoral seminar is on how to teach--a requirement of our doctoral program).  I had to walk around a lot in the building and to get back to the car, so it went well physically. 

Several Second Year MBA students were kind enough to put together a lovely creative large get well card signed by hundreds of students.  It was a lovely ceremony and I was moved by their thoughtfulness and kindness.  It was wonderful.

After a very nice dinner of salmon, cole slaw and brown rice, I watched some football and our UVA alumni Tiki Barber who is so very articulate on camera--and went to sleep without braces.  FIRST night all the way through without braces!!  Hurray!!!  I was able to sleep all night, again with a little melatonin.  I was supposed to go to 75 degrees yesterday, but was afraid, so just before I went to sleep, I changed the braces to 75 so I was "legal."  Ha.  The dog needed to go out this morning while Susan was in the shower, so I put them on and walked him up and down the patio barefoot (it was COLD), and didn't collapse, so today is a new level stretching day.

Jim Falvo had asked me about "rubber band" tendency for his thighs to contract and snap his legs out.  I haven't had that, but I have had an unusual thing after waking up, a kind of tingly stretching thing.  When I wake up, my legs want to contract/stretch/tingle.  I find myself contracting my "quads" for maybe 10 seconds or more and all the while there's a total tingly, tickly, almost electro-stim kind of feeling throughout--almost like a quad orgasm.  This happens maybe twice every morning, and it feels really good, kind of intense, but like every muscle fiber in the quads are "wakening."  I imagine this is what dogs or lions feel after sleeping a long time and they wake up and stretch so seemingly languidly.  I think this is actually good for the muscles--it feels good and it feels like every fiber is exercising. 

"Muscles" is a weird word.  There's an INDENT on both thighs where my quads used to be.  It's so very weird.  I used to have defined, strong quads, and all this past year, they've just been atrophying at an alarming rate.  I'd do side stretches in taekwondo and would need to sort of push myself up with my punch fist on the ground to switch.  And getting down off airplane steps, I'd have to go sideways.  And now, I had Susan confirm this, I have strong hamstrings, with muscle, but my quads have just disappeared.  It's so very weird.  Susan says they'll come back, BUT I wonder, what caused this and if we don't solve that issue, what's to say it won't happen again?  I'm still convinced it's the statins.  My step mom called yesterday and said my sister was told to begin taking statins and she said no, she didn't want weak muscles and a bad liver.  How did she know????  I wish I'd been that smart. 

Okay, 75 degrees from today on.  New era.

YIKES!  DANG!  FIDDLE DEE DEE!  I was shuffling over to see Susan on the couch and my right toe caught on something and excruciating pain shot through my right knee, and for a second I could see myself tumbling in a heap on the floor, took two stumbly steps to the right, and caught the door frame by my bed.  A few cuss words later, Susan grabbed me around the waist and we stood there for a few minutes. She's an angel.  What was it?  The dog had "buried" a bone under the edge of the throw rug we have down on top of the area rug and that had created a little hump in the edge and my toe caught it.  DANG!  I noted to Susan that that stumble was way more "severe" than the one I had when I tumbled in Istanbul... and this was a toe, that was a slight bump on the right heel on the corner of the step. 

10-25-06 9:00 am:  I waited for Susan to wake up this morning.  Then we loaded up and went for a walk.  It's a beautiful, crisp, clear, fall day.  Beautiful day for golf.  We walked down to the end of the street and back and then part way up to Burton Court, so that's about 5/8 or 3/4 of a mile.  BIG improvement.  The braces keep falling down and it's actually easier now to walk with them loose and not constricting.  I went up the slope on the driveway with the walking sticks, and that's a big step up.  And then I did my high form, yu shin hyong, in the driveway.  My feet don't move very much, but I can do my arm movements mostly okay without losing my balance.  I did them without my sticks or a walker.  If I feel good, I'm going to try to go to my high belt class later today and maybe just watch most of the time and do what I can.

Then when we got back in, we went up and down the stairs, once on the right leg and once on the left leg, going up facing up, and coming down going sideways.  I tried to get into the shower and could.  And lay down on my bed and could get up.  We are headed for the second floor and our usual bedroom!  HURRAY.

I tried to get into the car yesterday in the front seat, and can't quite do that yet, maybe when I get my flex to 90 degrees, next week. 

10-27-06 Friday 11:00 am:  I think Fridays have settled in to be my "step back" day.  Maybe because I learn new things on Tuesday at PT, and then do them on Wednesday and Thursday and then go back to Thursday afternoon PT, and do more, and well, last night, I had very painful spasms in the IT bands of both legs.  They feel like sinews and wires extending down the outside of the thighs to the knees--and it's where they hit the knees that it hurt.  I stayed on Advil and then about 4 am after the fourth one, I took some flexeril, a muscle relaxant.  That is a once-every-8-hours medication...and I definitely should not be operating heavy machinery right now. 

Yesterday, I felt great.  We walked a mile, half out and back, and I felt good.  I'd gone to taekwondo the night before (Wednesday).  It felt good to be back in uniform and back in the dojang and back on the mats, even if I could only do 1/20th of moves.  Today, I'm groggy, but my IT bands don't hurt anymore, but I think I'm going to relax, ease back, and take some naps.  I had my first bowl of Frosted Flakes in years--somehow it sounded good.  It's raining.  A good day to sleep and chill.

10-29-06 This has been the psychological fight weekend.  Thursday I had a double workout and that night I had very painful muscle spasms--so I took a muscle relaxant early in the morning and felt grumpy, frumpy, and sore all day.  Friday night I took the flexeril in the evening so that helped me sleep and avoid spasms during the night, but Saturday was rainy and depressing, and Susan went out day and left me with two dogs alone, so I was feeling down and frumpy- and tired of being in the darn hospital bed.  Sunday, I went to the golf course and Susan helped me get around a little throwing balls to flat places.  It was a big boost just to be out there and in the fresh air and with my buddies.  It wiped me out, though, so back to bed for a nap.  And then change the braces to 90 degrees--according to the orthopedist's schedule, which I did during my nap.  I'm clearly NOT at 90 degrees yet.  Jim Falvo (above) said he was "stuck" at 70 degrees for 4 weeks and then one day, they just loosened and 'moved."  The rehab and flexibility is clearly not a linear, smooth slope.  Class tomorrow, time to review and prepare.
11-6-06 I had been scheduled to play in a national hickory golf tournament in Pinehurst this past weekend, and although I couldn't play, my wife, angel that she is, drove me down there so I could hang out with my friends and watch.  We stayed with my very good, best friend from Ohio, Tanner Stewart, and watched him and his partner, and my former partner and his new partner and friend play in the foursomes match on Friday and then in the stroke play on Saturday.  I had more firsts during this trip.  I began halfway through by learning to drive the golf cart.  Braces were set at 90 and legs at about 80 so it was JUST enough bend to make that work.  I also played nine holes in a practice round on Friday afternoon.  That went reasonably well with no lost balls and a 48 with hickories.  I even outdrove the boys on two holes.  I had two total flubs/shanks/fats, but other than that, hit the ball reasonably well for having an immobile lower half.  I'm working on the one-plane swing from Jim Hardy's book, and it's a lot simpler than the two-plane version I've been on. 

I drove halfway home from Pinehurst, and then got wiped out.  By the time Susan had gotten us to Charlottesville, I was ready for a long nap.  But all in all, the trip went really well. 

I moved my braces to 105 degrees last night keeping up with the doctor's schedule...but my legs are at about 80.... At night over the weekend, I noticed that the patches under the incisions feel like internal scabs now, kind of a tiny itchy feeling, not harsh, mostly pleasant, and when I bend my legs as far as I can in bed, I can feel this patch slightly moving and it feels "good" like I'm slowly moving the stretch.  I still don't have stamina, but I hope it will come.  The muscle mass isn't apparent to me yet, but I'm hoping.  Getting up and down out of regular armed chairs is surely adding something; that's like doing hip drops.  Plus I'm pulling myself with wheeled chairs to strengthen the hamstrings.  Using un-armed chairs in restaurants down there didn't work very well, and Susan still has to pull me up on those, but getting there.

So, this week, I should be able to try my first solo trip to the office.  We'll see.  I think Susan will still take me to class this afternoon.  But, I'm getting there.  These last two weeks have shown a lot of "firsts" since surgery. 

Still at the moment, my favorite is the NuStep... it gives three things--muscle strengthening, flex stretch, and aerobics all at once.  My kind of machine!

11-7-06 It's a rainy Election Day in Virginia.  I couldn't sleep well last night, my knees hurt, and I was wired for some reason.  I think the water bed's coolness which I like makes my IT bands tighten up and by early morning, both the outsides of my knees are aching, but some Advil and a piece of toast handles it.  We voted (the handicap sticker which only came last week, is very handy now, ---order it soon, it took 2-3 weeks to come.) 

I had PT again this afternoon... and we went to 88 degrees on the left knee and 91 degrees on the right.  Both stretches are painful, but I feel that they're coming along.  I've maxed out on the color bands on the wall board with my four-way hip stretches (did 15 each way today with the black band about 8 feet from the wall), did 20 step ups on both sides with a six inch step, and the ball pulls to add to the stretch, and then some NuStep for ten minutes.  I also did the bicycle rocking for the first time, almost, but not quite enough to go all the way around.  Jim Falvo had told me about this, and I'm finally there.  I did go in without my walking sticks for the first time, and they commented how well I was doing in so short a time.  I don't know, don't have anything to compare it to, but if it is fast, it must be the taekwondo conditioning.  But why didn't that save me? 

My biggest problem in life right now is what to eat and weight.  It's been plaguing me for years.  I think I'll try no dinners.  That should cut out about 10,000 calories a week!!  Breakfast like a king, lunch like a prince, and dinner like a pauper, eh? 

I did get my school office all cleaned up last week, threw out a ton of stuff.  And now need to do the same at home.  That's my goal this week. 

I'm able to stand now without braces and put my braces on and off.  So that's a confidence step forward.  We'll see what the orthopedist says on Monday.  I hope to go in with and come out without.  We'll see.  I also got an email today from the ER nurse in Istanbul, the only one of any who could speak any English.  She said she wanted to become an au pair in the US---and she just wrote and said she had!  In Maryland.  Good for her, realizing her goals so quickly. 

11-9-06 I met a woman in the physical therapy lobby the other day.  She was older and in a wheelchair, so I sat down beside her and asked, stupidly, "what are you in for?"  She said, "Oh, I'm not here for me, I'm here with her!"  Then, I noticed she only had one leg.  Oops.  "Oh," says I, "what a nice friend you are!"  She replied, "I'm her aunt.  I lost both my legs, and I'm fine.  She had to drive 3 hours to get here, so I came along with."  I glanced down; it was a prosthesis.  She says, "Yeah, the left one they took so high I can't even fit a prosthesis on it."  "May I ask what happened?"  "Atherosclerosis.  I had some little sores on my feet and my doctor told me to go home and soak my feet in dish washing detergent.  I did, and it rotted my skin off, it fell of in chunks, and then when I came in to UVA they had to take my legs.  But I'm fine."  Wow.  Quit whining about your little knees, Jim.  

I drove downtown today, to test the concept of driving in Charlottesville.  And the braces are starting to bug me, so I must be close to the time that they should come off.  I walked gingerly without them from the bed to the closet last night, and it worked.  I see the orthopedic surgeon on Monday...maybe no braces thereafter.  I skipped taekwondo last night, my back was aching after teaching the faculty development seminar and it didn't seem wise.  Susan cannot believe that I'm backing off.  I'm really going to try to ease off a bit the next five years and not push so hard. 

I also noticed that on the drive down to North Carolina last Thursday, one week ago, my first time in the front seat, a BIG step, without my noticing, the locks on my braces really chewed up the interior panel on my new car.  DANG.  Really chewed it up.  I can't believe I didn't notice that. 

I was able to debrace and step into the shower tub, shower, and step out on my own yesterday under Susan's careful eye.  It's comforting to have her overlooking.  I'm amazed at how quickly new emotional habits form, becoming attuned to the caged hospital bed, the walker, etc.  It takes/took a while to get out of the hospital bed even when I was "able," and then "up the stairs," and then "into the car."  I drove downtown today and was totally comfortable with it.  It's just the getting in and out that's still dicey.  But doable.  I can't believe it's only one week since I was able to surprise Susan by getting into the front seat.

7 pm:  PT was good today, an hour an a half and we had more post-surgery FIRSTS today.  Drove the car to PT, so proof of concept of my driving in Charlottesville is made... next stop solo trip!  At PT I got my legs to go all the way around on the Schwinn airbike, backwards, with the seat high, and very slowly at first, but then got up to 20 revs per minute for 5 minutes.  Therapist okayed the use of the Walkfit (non motorized treadmill at home) IF I have braces on and just tried that and that works okay.  AND the NuSTep no longer gives me a stretch at the top, so I got on the step treadmill next to it, that was a "step up."  AND I took my first unassisted shower tonight, from debracing to bracing and all in between, so that's a step forward.  It takes LONGER but, I can do it.  Step by step, getting better bit by bit.  ONly a week ago, I was trying to get into the front seat of the car on the way to NC. 

11-14-06 Wow, it's been a tumultuous weekend and beginning to the week.  Last Friday, Susan took the girls hiking, so I had lots of post-surgery firsts:  solo driving to work, solo shower, solo walking the dog.  AND I got a letter from my cardiologist who is adamant that the statins have nothing to do with my BLQRs.  And since I haven't been on statins since the accident, here's what happened to my blood reports (it's terrible):  total cholesterol up from 125 to 238, tryglycerides and LDLs tripled.  SO, I'm going to have to go back on Vytorin it looks like.  Readers please note these results compared with the data presented above.  I'm going to try to go on 10/40 to begin with to see what that does and if I notice any muscle issues along the way.  It's so confusing.  My cardiologist says statins are so safe they should put them in the water like flouride.  Wow. 

Saturday, I played golf with the early birds and had an 89, down ten from my first post-surgery score, so progress there.  Then Susan and I went on our first post surgery date, a movie, (The Prestige--VERY good.) and a quiet dinner together.  That was long overdue and wonderful.  Saturday evening, I went to observe Master Kwon Jae Hwa's seminar at taekwondo--he comes maybe once a year or less to do testing.  I was itching to be out there. Our local Kyosanims were kind enough to re-introduce me to him even though I wasn't in the seminar. 

Sunday dawned raining.  I went to the TKD testing.  There were nine first kup red belts (my rank), one man, two women, and six teenage women, and all passed.  I SO wanted to be out there.  Maybe next time.  Then we went to see three one level living houses.  By the time the afternoon ended I'd been up and down ten flights of stairs, so by the time I got home, I was whipped.  The good news is that Susan decided she liked her home the best, so were headed for remodeling in order to get one floor living. 

Monday was to be my longest day at the office so far including a 9-12 meeting and a 2-5 pm class.  In the middle of the meeting, I had my orthopedic surgeon checkup and he said okay, you can take the braces off.  I waited until the evening, last night, to do so, but got around okay after the initial shock and worry about tipping over.  Tipping bilateral quad tear rehabbers?  Easier than tipping cows in the old days.  The OP MD said I could go to "whatever she wants" in PT (that's scary), and that he thought the tears were not a result of too much exercise OR the statins, just getting older.  DANG!  And he said not to worry too much about a repeat, just be careful, do what you can and don't do what you can't and keep going.  And he's a very pro-athletics, sports kind of guy.  It's frustrating not being able to find a reason other than "aging" for all of this.

The meeting went well, we went to lunch.  Class went well: we simulated a press conference for budding professor/doctoral students, and then practiced their research presentations for job talks.  And coming out of the school, I got involved in several conversations about school business, and didn't get home 'til 6:30, so I'm amazed and a little scared at how quickly the old habits and pressures and time demands creep back in.  Susan had had dinner ready at 5:30 thinking I would be wiped out, so my hour late arrival was not so good, but actually I felt better than I thought I would.

The bad news is that I couldn't sleep.  Too many thoughts rolling around and too much mail and stuff to do, and my knees ached more than usual, woke me up.  I think without the braces, they have to work left and right now too to keep from tipping, and that's adding some pressure..  All those books I thought I'd read, and write, and mail to answer and somehow, it's still piled up in three foot high piles on my home desk.  This morning, I've been up and about without the braces and did my first no-brace, mid-night bathroom run, another first.  So the bedside urinals will become a thing of the past now. 

SO, today, to the day, EIGHT WEEKS FROM SURGERY, I'm walking around the house in my denims.  THAT feels great.  Another first.  I solo walked the dog without braces this morning and came up the steeply sloped driveway.  All right!! I have no idea really whether this is fast or slow.  It seems faster than what I saw on the web, but who knows. 

4:30 pm:  Whew.  I got back to the school today as a committee chair, had a committee meeting, and then went to PT without braces for the first time.  That was good, pretty demanding, and I got a good workout.  Lisa and David do a great job.  My knees are at 100 and 97 L/R respectively, so although the left one remains the more tender, it made a little jump this week.  Doing the wall sits to strengthen my quads was scary since it reminded me of the original fall.  But, making more and more progress.  I'm struck with on the second day after braces how quickly the pell mell pace of the regular world comes back.  It's scary.  I'm missing the more relaxed pace of the last month--able to get around, but not rushing anywhere.  I like that.. productive but not rushing.  I want to learn how to live that way.

11-17-06 PT yesterday, Thursday, was good and intense.  My knees are at 105 degrees on both sides, so good progress.  But I was wiped out at the end and went straight to bed for 13 hours.  That didn't happen last week, and I'm wondering if it's related to being back on Vytorin for a week.  Also, I've been teaching in a 3 day seminar on Career Transitions, kind of my coming out professionally after surgery, so maybe that's it.  And not having braces. 

We did several new things in PT, wobble board, calf stretching, ecentric control exercises on a 2" step, and it felt fine, and I got a good sweat going.  I was on the step machine for 10 minutes, HR at about 110.  I was able to use the normal commode this week first time, but it's not easy--I need something like the tub and countertop to get back up again...it's lower than a chair.

I'm still looking forward to some additional post-surgery firsts:  crossing my legs, getting onto the floor and back up again, touching my heels to my tush, standing up without pushing off with arms, kneeling on any surface (hurts even on the bed), going down stairs face forward instead of sideways, getting back to a regular taekwondo class, etc.  But making progress. 

11-18-06 Another first this morning, putting on my pants with out holding on to anything---one leg standing and insert the other.  It was cold, but I played golf, 18 holes with the ring leader of the usual early bird group, but there were only two of us.  It was fun.  I lost three balls and shot 92, so not a great effort, but I was out there. 

I'm in the "stretch and ache" chapter now, it seems.  My right knee feels the worst, like there's something going on inside the knee... like it wants to lock up or is swollen in there.  It hurts.  So, I felt more "tentative" out there today... even though my flexion is at 105 degrees.  So, sort of holding even at this point.  And wondering if my legs will ever look normal instead of the bulbous knee Frankenstein look I have now. So after the morning outing, watch UVA/MIAMI and OSU/MICHIGAN football today.  Relaxing.  I taught two half days in a 2.5 day seminar this week on Career Transitions (for UVA alumni) and that was fun... and it tested my stamina.  Okay... chillin'.  AHA!  I was able to cross my legs, both of them, sort of, not fully, but on top of the other knee.  It feels weird on my incisions, but able to get them up there. 

Okay, can't "chillin'" for too long.  Watched the end of the UVA/MIAMI game and then went to mow the lawn.  Another FIRST!  I was able to mount the mower and cut the lawn.  That felt good.  It looks so nice now.  Okay, back to the Buckeyes and Wolverines.

11-19-06 Cold this morning, a frost delay at the golf course.  I had a nice 39-42 = 81, though, and won two skins after chipping once and two more chip lip outs, thanks to AJ Bonar's techniques in "AJ Reveals the Truth about Golf."  Thanks again, AJ!  I was able to put my own pants on again standing up, so that's day two for that one.  My swing still feels dorky with no lower body movement yet, but getting there.  We went to see the new Bond movie as a family, and that was fun.  And then I finished mowing the lawn, easier to get on the mower today than yesterday.   And sawed down some dead tree limbs tonight for exercise, got my heart rate up.  And did 20 situps on the stomach machine which stretches my knees at each rep and they feel really good now as does my stomach.  I need to do  more of those.  I feel safe getting on it now, though still a little hard to stand up, but easier now from my office chair.  Susie says, soup's on, so gotta' go.
11-22-2006 We've been working on ecentric muscle control (descending) in my last two PT sessions, first 2" step and then on Thursday, I picked out a 4" step and Lisa said, okay, try it.  Yesterday, I went down the steep slope on our driveway to the mailbox without poles, face down, and it worked.  That's a first.  Another first, this morning, I went down our stairs face down (not sideways), holding on for dear life on the handrail, but did it.  And then again at the office, so my ecentric control is increasing this week. 

I've been lax on exercise this past week with all of the school appointments and meetings, so today, some friends came over and took me on a walk, about a mile and a half, with my poles, and it was all I wanted, but felt good to be back out and going around.  Then I got on the Total Gym and that felt good too.  So, some progress on Turkey Day.  Happy Thanksgiving to all of you and your families... the glass is half full.  And thanks for our wonderful loving, helpful, enduring, patient, fantastic supporting spouses.

11-28-06 Tuesday:  ten weeks from surgery.  Susan and I had a flu/cold virus over the weekend and that was miserable.  Tuesday's rehab session, as always, was a good one with some post-surgery firsts.  I did twenty sit down/stand ups without arm assistance from the PT table.  And did my step ups/step downs without arm assistance.  I still needed to have a little hand balance help on the small trampoline (one leg standing) and on the ecentric (4 inches, but touch down and back ups, so more difficult than just stepping down), but my balance is improving.  Both knees are at 112 degrees now, so I exceeded Lisa's goal of 110 by that session.  I'm doing most of my stretching in two ways--whenever I sit down I push forward and heels back enough so there's a slightly uncomfortable tug across the knees and then try to hold that as long as I can, way beyond 30 seconds, maybe 2-5 minutes.  Sometimes that means they are locked up when I try to stand, but I think it's stretching the tendons.  Dave (PT) says it's better to go in and out in that position... I have to try to remember that.  The other stretch I do is a gravity stretch when I'm on the Total Gym doing my arm pull downs.  I cannot put my heels under my butt as I used to, so I let the legs "hang" in the air and do 10-20 pull downs in a set so it works my stomach, my arms, and gravity is stretching my knee tendons the whole time.  Another first, I was able to drive my clutch (standard transmission) car (a little two seater) for the first time today.  It was a bit of a challenge getting in and out, and I had to use all of my new flexion to make it happen, but it worked.  So that was another step forward.  Here's what my 15 year old baby looks like.

I've also heard from three other BLQR folks.  That's gratifying since when I was searching, I couldn't find anything.  I'm glad that the site is helping a few (after all it IS a rare event).  Here's a summary of their stories so far.

From ERIC HARRIS:  "My name is Eric and my dad just had the same exact surgery that you had.  He fell on Nov. 19th at his brothers house and we called for an ambulance.  He went to have an MRI on the 20th and was having surgery at 10:00pm on the 21st.  We saw your story on the internet and it really helped us out a lot.  I was wondering how you were doing now and do you have any more tips that you could share.  My dad is 61 years old and he played sports all of his life.  He is now a Pastor and a Headmaster at a private school in Cartersville."  "My dad does not have a theory (about why it happened), but he has and still is taking statins for high cholesterol.  He was not involved in heavy exercise daily, but during his younger years he was.  Dad had a rough day yesterday.  He did finally have a bowl movement, but he was still complaining about stomach pains afterwards.  He is starting to get sores now and the gas pains are not getting any better.  He has an appointment for next week to see his orthopedic doctor, but I still don’t know how we will get him there.  Hope things are getting better for you, good luck, and thanks again."

From LEONARD ANSIN:  "Hi Jim;  We searched the internet, using Bilateral Quadriceps Ruptures and Repair and came across your blog. It appears that I have the same situation.  While my wife and I were visiting family in St. Louis, I tripped and ruptured both Quads. They took me to a local hospital who did an xray. They had no idea what the problem was. They put both legs in straight  leg embracers and told me to see my doctor as soon as I got back to boston. We were lucky and got a flight back the next day and proceeded to have an MRI. My orthopedic doctor, looked at the MRI and said I needed immediate emergency. So on October 25th, both legs were operated at Boston’s New England Baptist hospital. (they were great) I stayed in the hospital for 4 days and then went to rehab, in Brookline. After 10 days in rehab with plenty of PT, they put me on Bledsoe braces and was sent home. At home I’ve been lucky to have the visiting nurses association with PT, OT, Home health aid coming 3 X a week. The nurses, PT etc have been terrific.  It’s now 4 weeks since the operation and I’m going stir crazy. The legs bend 70 to 90 degrees (the dr wants both kegs at 90 by next Monday). I have plenty of exercises to do, use a CPM machine that stretches the angle. I do not wear the braces at night.   Tonight for the 1st time my wife and I went out to a local restaurant, just to get out and have a change of scenery (very important). I have been getting off the Percoset, since it makes me feel strange."

From LES KINNEY:  "Hi Jim,  I enjoyed reading your blog. What a location to have multiple quadriceps ruptures.  It is like a worst case nightmare I was made uncomfortable just reading of your dilemma, regardless of the seriousness of the injury.  I hope your recovery goes smoothly.   I have a question for you.  Was it your two quadriceps tendons that ruptured or was it the quadriceps muscles themselves above the tendons that ripped?  Nine days ago, I had "hip resurfacing" surgery on the right hip, the left one was done six weeks ago.  For your information "resurfacing" is a misnomer.  It is an investigative method of hip replacement that is less invasive then the standard hip replacement surgery.  Anyway, during the operation the surgeon must manipulate, turn, and spread the muscles in the thigh including the quadriceps in order to complete the resurfacing.  After the operation the leg is bruised, stiff, and very tender.  After attempting to get out of a chair at day nine, I felt a tremendous amount of strain in my operated qaud - no explosion or pop but terrifyingly painful. Since that happened four days ago my quadriceps- especially near the side is more painful than it should be - in fact very painful.  I am wondering whether I ruptured the quadriceps muscles.  I do not think it is the quadriceps tendons.  After on and off again icing, rest, elevation, etc I can walk but with difficulty.   I have been researching on the internet for something to give me some hope it is a second degree strain vs a third degree rupture. I can't get in to see a orthopedic for testing until at least next week.  
      
Best Regards,  Les Kinney
PS I am your age, was in excellent physical condition, (weights etc)  who also has been taking statins for four years. I started telling wife on several occasions during the past two years that I appear to be losing muscle definition in my legs way beyond the obvious explanation of aging."

12-24-06 Susan and I have been on some R&R in Arizona.  It was a golf trip scheduled a year ago with my golfing buddies, and one of my major goals as soon as I realized my predicament in September.  I was able to attend, and able to play every day, although I needed some help negotiating the slopes, especially down.  Actually, the pneumonia that was diagnosed three days before we left was more of a hassle.  I thought the dry Arizona air would help clear out my head and lungs, but so far, although my lungs aren't hurting anymore, my ears and sinuses are still clogged.  I've begun doing my taekwondo forms every other day or so in the driveway, and I can tell that jumping and spinning are still way out of the question, however, I can do slowed down versions of them with limited knee bends.  I plan to renew my weekly schedule with TKD in January.  Pretty much on my wish-list/plan in September.  I am still very hesitant going down stairs, holding on to my wife's shoulder or the hand rail or both, but can go face down, so that's good.  I missed having my Total Gym to do the one legged leg presses while gone, but was happy to be back on it this morning.  I walked a mile this morning, did five forms, and then my TG workout including two sets of 20 reps at about 45 degrees on one leg.  Later, my right knee was sore and had a little sharp pain, but not bad.  Susan's brother highly recommended a new book, Ultrametabolism, so she's been reading that and really likes it so maybe if we both can get on it, we can lose some extra weight.  I like the philosophy in it.  AND I had my blood tested just before leaving and the letter was back when we got home:  after one month of taking 10/40 Vytorin, my total cholesterol was down from 238 to 156, triglycerides at 108, HDL at 46, and LDL at 88, and liver tests were normal...so in my cardiologist's words, "excellent."  He thinks statins are so safe you can put them in the water.  So.... we have to put all of that new data in the context of my concerns listed above. 

While in Phoenix, we met a man and a woman at lunch.  Her husband had just had robotic prostatectomy--with the doctor in another room and four small holes around the patient's abdomen and one in his navel, they removed his prostate.  Wow.  At the Mayo Clinic.  But then the man mentioned that he had a friend in New York who had a BLQR that occurred when he simply stepped off a curb! I don't know what he'd done earlier in the day, however, it may be that when a set of tendons are ready to go, it doesn't take much to cause the "last straw" or rupture.  In Jim Falvo's case and mine, we could make a case for "overdoing" earlier in the day.  I'm not so sure about the other cases we've found--(which are few so far, only 5). 

1-1-07 Ah, a new year.  I've noticed that some days are real setbacks...like yesterday, I felt old, tired, and thinking I'll never get back to "normal."  Today, after a good night's sleep (yes, went to bed early for New Year's at 11) and a 2.2 mile brisk walk in the rain with my wife, I'm feeling more optimistic.  I did get to 3 TKD classes this month, all with braces, and each exhausting, but gradually, I can tell I'm getting stronger.  It's amazing to me how quickly one's conditioning "goes."  I suppose the bout with pneumonia didn't help any...still feeling the after effects of that, clogged ears, fatigue, low energy, but getting there.  We had sunny weather last week and over the weekend, so I got two rounds of golf in under sunny skies and modest low 50's temperatures.  Susan and I are reading Ultrametabolism recommended by her brother who lost 35 pounds "easily" on it...so we're trying that "lifestyle" change.  So far, so good.  It's a time for resolutions, yes?  Lose weight, exercise more, get a black belt, write two books, don't fall down any stairs.  Enjoy every day.  A colleague and fellow member at the university golf course had a heart attack and died last week at age 55.  Enjoy every day.  Okay... Happy New Year to all, best wishes for a leg happy, strong quad year.  Pay attention to your quads!
1-3-07 My orthopedic checkup came at the 4 month and 1 day mark.  He didn't look at the incisions but tested fairly aggressively with his hands... one hand behind the knee and the other pushing on the front of the shin and saying, "push!"  He concluded that the right knee was weaker than the left (which is sort of opposite to what I thought from PT) and advised more weight work and eccentric muscle control--push up on a sled/Total Gym with both legs and let down slowly with one leg.  His experience was that that strengthened the quad faster.  It could be worse;  I spent 20 minutes helping an elderly Greek lady/patient into his office and she could only take tiny two inch steps.  Enjoy every day. 
1-7-07 We left on this day for my first international overseas venture post surgery, to Cairo, to consult.  We spent a week there, visited the pyramids, Susan rode a camel, and visited the national museum in addition to the teaching.  I'm glad Susan came along as it was exhausting and there were several dicey stair flights getting into and out of planes or airports with the bags.  I was slow going down and up stairs.  Occasionally a fellow passenger would help with my roller. 

Cairo was disappointing--ugly socialist blockhouses all sprouting dozens and dozens of satellite dishes, and everyone seemed to be on the make.  It was shocking to see cars going both ways on both sides of the divided highways--and the lack of lane lines which when they had them were ignored anyway.  We did see King Tut's funeral mask and other interesting artifacts in the museum. 

1-20-07 This past week was my first full week at work since surgery.  I was slammed.  It's one thing to teach one class (last semester) and it's quite another to begin with a full schedule of faculty meetings, teaching meetings, classes, and all the other activities involved in full time academia.  Wednesday, Thursday, and Friday, I went to bed at 7 or 8 pm and slept til the usual 6 or 7 am.  My ears are still clogged after two rounds of anti-biotics, so I'm trying allergy meds and that seems to be helping.  But with the jet lag from Cairo, ears clogged and constant drainage, and the sore knees, it was a very challenging week.  Susie and I walked 3 miles today, my longest yet, so I'm behind Jim Falvo on the walking routine.  By the time I got back I was ready to flop, so it was about right.  I did go to three taekwondo classes this week, all with braces so I don't over do and over bend or break something.  They were all as much as I could do, but I'm trying to just do that and not more.  After walking or tkd, my knees often have pangs of sharp pain across the suture points...so I'm being careful and trying not to over do.  A couple of times this week, I just felt like I'd never get better and than I was on the downhill slide to death.  Needing two hours a day of exercise or more to get back in shape, I don't see how that can happen with a regular work schedule.  I'm typically booked from 8 to 5 or 6 every day...without the exercise.  I need to slow down my schedule in order to get that two hours a day, but I can't see how it's going to happen now.  Next edition of the leadership book, plans for three new books, teaching three courses this semester, plus some consulting.  But one of the five principles of traditional taekwondo is "indomitable will."  Never give up.  I was thinking that yesterday when our instructor said, sit on the floor, legs straight out and make a U with your hands and touch the floor but not your feet..... still have a ways to go....  Enjoy every day. 
1-23-07 I've gotten lots of interesting new ideas lately. Here's an update from Jim Falvo in Oklahoma (see his story at the top here)   Jim – speaking of getting old…or maybe it’s more like “getting a clue” (which I apparently still don’t have), I think I got a little too over-zealous in Kris’ step class a week ago when I decided that I could use a riser under the bench and . . .dang her for making the class so much fun . . .I got carried away and hopped over the bench a couple of time back and forth…or maybe it was more like a dozen times. Anyway – no, the quad tendon is OK – I felt this sharp pain in the bottom of my foot but it went away and I didn’t think anything more about it….but it keeps coming back and now I think . . . or at least I hope that I just bruised my plantar fasciiatis. I’ll know tomorrow after I got see the foot doctor. I’ll keep you posted. Lesson to be learned from me: act your age.

And here's an update from Leonard Ansin in Boston:  Are you quads still stiff?  My operation was Oct 24 and my quads are still stiff.  This means when I bend the knees I can feel the stiffness.  What’s the angle you can bend at?  The max I am up to is 105 for each leg.  (NOTE:  I'm at about 120 now.  JGC)  Hopefully in 3 months I can get to 125.  I also have an issue with stamina.  But that is improving, slowly.  (NOTE:  same here at 4 months.)

And here's some interesting data on the possible statin connection and a web site you may find interesting.  Jim, I read your blog a couple weeks back. The fact that you had very strong legs and had kept them in good shape for years is very important. Muscle weakness/atrophy is a known side effect of statins. You can google "statins side effects" or use this link (http://medicine.ucsd.edu/ses/adverse_effects.htm). The fact that muscle weakness is a well-known side effect indicates your doctors are woefully ignorant. (NOTE:  My cardiologist and orthopedic surgeons both knew of this bad side effect and argued I didn't have it. It's listed in the Statin Side Effects book noted above.  JGC)  If your injury was tearing of the muscle fibers, then there is a very strong likelihood that the statins contributed strongly to the event.  If it was tearing of the connective tissue, then it is less likely.  (NOTE:  My doctor said it was the tendons that tore, not the muscles.  JGC)  You ought to get yourself a CK test. Some of the problems with statins can continue after you stop taking them, leading to kidney damage amongst other things.  Good Luck, (name with held for privacy)

 And here's a report from a fellow patient in Virginia:  Jim,  I just found your blog today, and read with great interest. Although my problem was a single leg, my experiences after the accident have been similar to you.  On Nov 2nd, when leaving my house at 6:30 am to go to my office (I'm a dentist), I went out the back door into the garage. It's about 4 ft from the level at the doorway down to the slab of our garage...................My first step down was on the right foot, and the next step down with the left found a bag with empty bottles instead of the expected tread (did I mention, I hadn't turned on the light into the garage). So, my left leg went straight out, and my entire 205 lb body weight went straight down on the right leg which was already partly flexed, with the sole of the right foot unable to move off of the step. Anyway, in that millisecond (which seemed to last several days), as I was airborn, I felt my right heel hit my right  gluteus, and heard the "pop" of my quad coming undone. It was a relief to finally hit the concrete floor, and I actually felt pretty good. Of course, when I tried to stand I found it was impossible, and was quickly taken to the E.R. at Va. Beach/ Sentara Hospital.  After all of the requisite tests, and scans, etc a friend/patient of mine who is an orthopedic surgeon agreed that I needed surgery. In my case, the entire tendon had come away from the patella, and was still intact with the muscle................so, my repair was very simple for him to do. It's now been 8 weeks, and my recovery has been uneventful, but I'm by nature impatient with things, and I don't make a very good invalid!  I played golf yesterday at my club, Baycreek, up in Cape Charles, and managed a 101 on the new Nicklaus Course there, so I wasn't too disappointed....................just nice to be outside, and playing.  I really feel lucky compared to what you've gone through, but still much of our experiences have been the same......................I look forward to reading about your continued improvements..................as I said, we've got several things in common (I've owned 2 black 928's in years passed, I took Lipitor for about a year, but quit just out of a feeling of not wanting to take pills, I'm mid-sixties, love golf............in fact was in Pinehurst last summer to watch the Open, and now am about to embark on my physical therapy for my injury).  Good Luck,  xxxxx

Okay, that's enough for today.  Regular work has stopped my informal workouts for the most part... it's hard to find time in the regular day to make it happen.  I need to get better at that now that I'm back on the "regular" schedule.  Thomas Jefferson said (and he founded my employer) that we needed two hours of exercise a day... if he did it, I guess I have no excuse except that I'm not as smart as he was and therefore am not so efficient. 

1-31-07 I'm on my first post-surgery solo trip today, in Atlanta, so not too stressing, 70 minutes without a stop or connection.  The first half went okay.  I'm realizing it was good to have Susan with me on the first two domestic trips in December and then the Egypt trip in January--but I'm doing well so far.  I'm trying not to walk "like old people" as my tkd instructor would say, standing up straight, shoulders back, trying to be and exude young again.

I've noticed this past week, doing my one-legged eccentric controls on the Total Gym that my ability to descend stairs improved more of a quantum jump than anything.  I began working hard to descend carefully rather than step clunk, descending to land lightly on each step and that's helped my muscle tone a lot.  I was able this past week to descend stairs (the ORIGINAL culprit) without holding on if not carrying anything.  That's a big step forward.  I'm still slow, but able to do it. 

I've also noticed that after riding the bike for 30-40 minutes I sometimes get sharp momentary flashes of sharp pain across my kneecaps.  Not sure what that is, but it's there.  And after doing taekwondo (still with leg braces set on 105 degrees) as well.  And they seem to be diminishing.  I looked at a model of the kneecap in my orthopedist's office and the quad and patellar tendons and realized that in a "normal" setup, the patella is encased in this tendon material, it goes around as well as attaching to the top and bottom of the kneecap.  I'm not sure if the post-surgery situation will have the tendon material re-encase the patella or not.  I hope so.

I'm using ScarZone to reduce the scar tissue appearance and I'd say my scars are 75% white and melding in and about 25% still a little purplish and blotchy.  I don't like the look of my knees anymore, they look skinny, weak, and trashed.  I used to have strong, quaddy knees. 

My spirits are good today, was able to sleep in a little, go to the gym for 45 minutes, have a quiet breakfast, and now after lunch begin working.  The onslaught of the school year, consulting, administrative stuff, publishing and writing stuff, and family stuff had been overwhelming the first three weeks of the year, but I feel calm and healthy today.  It's a sunny, cold, nice winter day in Atlanta. 

2-10-07

     We had snow on Monday-Tuesday, and it was scary, but my good wife cleared the way to the car for my 8:15 meeting.  She’s a gem.  We’ve still got that dangerous phenomenon of day melt, black ice sheets on the night time parking lots, so I’m being hyper careful.  We went to the movies last night and were extra careful of where to go and walk.  We met three ladies getting out of their car next to icy stuff by the curb--I offered to help her out and she said she had bad knees, no cartilage and was moving up on double replacement.  I was sympathetic.  We chatted on the way to the movies. 
     My full time schedule is wreaking havoc with my exercise plan—it just takes longer these days to do anything, AND when I walk the 3 miles or do taekwondo, my knees hurt for the next day, so I’m slipping into a low exercise lifestyle and I need to do the opposite.  It’s a challenge.  I need to begin new PT series, but traveling to London next week, so again, the schedule gets interrupted. 
        I’ve also noticed that during the rehab last fall, I developed what I would call “old skin” on my legs—drier, less supple leg skin and these, what would you call them, age bumps, little bumps that are like small spontaneous scabs… dang.  Part of the aging process I guess, but the leg injuries seem to have accelerated all of that. 
       My knees still feel like cardboard on most days, but the weight/gravity technique of letting the legs “hang” in mid air while I do my Total Gym pull downs seems to be helping my flexibility a little.  But there’s none of that springy-ness of “normal” tendons when I get to the max, it’s just a sudden stop, that’s it, so there’s very little “give” in the new tendons once they get to their final degree of flexion.  At least it feels that way. 
       Okay… take care.  My wife says I’m doing amazing and she adores me.  That helps more than anything, frankly.
       One other thing.  I find myself becoming more cranky lately.  Last fall with only one class and the leisure of doing what I needed to do for daily hygiene and exercise, it was better, but lately, I'm testy, cranky, and impatient.  This is probably due to several factors:  the snow and ice, the on-going soreness and intermittent pain in my knees, the frustration in TKD and on stairs, the fact that my ears and sinuses have been clogged for two months straight despite three rounds of anitbiotics, the background threat of CVHD with cholesterol medicine and being overweight, my publisher reminding me that I've got major contractual constraints on what I can and cannot do and a full time schedule with teaching and writing and consulting.  Whine, whine, whine.  Observation is, though, I'm more cranky.  I'm trying to fight it but my colleagues might say, jeez, what happened to the old cheerful Jim we used to know?  The short term answer is I've lost my legs and my ears.  Got to fight all this and win, cheerfully.  The irony is that I'm closer to my kids and family than ever before.

2-11-07 Susan and I went to the gym today and I did my longest workout since surgery, an hour on the treadmill, with two fartleks of 15 degrees incline (max) for two minutes each.  I was at about 3.7 mph so did about 3.7 miles (go figure), my longest so far--and my knees didn't hurt afterward.  My heart rate got up to about 156 on the fartleks and was about 125 or so most of the time.  My knees have been hurting for two days after taekwondo, so I'm backing off a little there. 

I have a trip coming up to London and there's supposed to be a storm that night, so I don't know if I'll make it or not.  It'll be my first international solo flight since surgery as Susie went with me in January on my first overseas trip to Cairo. 

2-15-07 I'm in London on my first solo post-surgery international trip.  It's gone okay although the three hours in the car trying to get to Dulles through the 15 state blizzard was not fun.  And we're in an old traditional inn so there are lots of stairs and two step rises, etc.  I'm finding that at the end of the day, I'm pretty worn out, so I've declined to go to dinner so I can rest and get to bed early.  Walking down the halls today, my knees felt that cardboardy feeling again and sometimes had a little unexpected "spring" to straight.  So all of the neuro-muscular connections are not there yet.  Will they get there?

Jim Falvo also sent in this additional note: 

One comment you made about the appearance of the skin on the legs reflects my thoughts, as well. I noticed that when I do an inverted “V” stretch (hands and feet on the floor) and look at my upper legs, the skin appears wrinkled and “old-looking.” I also notice large blood vessels that appear to be near the surgery site (they bulge when I stretch). My theory is that the channels are rebuilding themselves and will eventually supply the area with its normal supply of input-output such that the skin will return to normal….at least it’s what I’m hoping will happen. 
     In other news, we bought a Great Pyrenees puppy to go with our little Maltese. We’ve had “Henry” about three weeks and he’s doubled in size and weight. He’ll eventually get to be about 140-160 pounds. He’s already a challenge for me to lift but I intend to keep up with him and use his growth as an impetus for me to get stronger. Anyway, Kris and I took him to the vet yesterday for his shots and I learned something interesting and, perhaps, applicable to our BQTR. The vet mentioned that large dogs can have tendon problems later in life if they get some sort of immune problem where the body attacks itself in the presence of . . . some term he used that basically means there’s a threat to the body. Anyway, I asked him if humans could suffer the same outcome and he said he didn’t know for sure but it was a possibility.
     What I’m wondering, Jim, is since no health care professional seems to have a rock-solid explanation for our injuries, is it possible that we suffered some sort of viral or bacterial infection that caused our immune system to attack our tendons. The vet said that the dog who suffers tendon damage doesn’t necessarily have to be subjecting the tendon to movement that puts a load on it for it to tear. This makes me think back to what was going on with my general health at the time of the tear and, by golly, I was suffering from something that was weakening my body. Remember…and I might not have told you….that six weeks before I tore my quads, the tip of my little finger was broken when I tried to catch a tennis serve that someone hit which was out. That break should not have happened by a ball that I misjudged which skipped off the end of my finger. And then a few weeks later I came down with bronchitis. See if you can recall what your general health felt like when you were in Istanbul.

3-3-07 It's been a while since I've written.  I haven't picked up physical therapy since the holidays, and I think it's showing.  I've made an appointment to go back next week--this required a new prescription and evaluation session given the HMO's annual allotment of therapy sessions.  I'm pretty good now on the flats, but still tentative and slow on the stairs and slopes.  We had some ice storms which were terrifying, but we got through those without a fall.  I went my longest post-surgery walk Sunday, 4 miles, using my walking sticks and was exhausted at the end.  We did 35 minutes on the elliptical machine at the gym today and that was all my legs wanted.  But I'm getting more regular now that there are two weeks, exams and Spring Break, before classes begin again.  If I'm careful to take Advil before taekwondo and slather Ben-Gay or the like on my knees before hand, they don't hurt as much afterward--a good suggestion by my instructor.  I'm still wearing the braces for taekwondo.  I can set up fine in golf swings now, so some of the strength is coming back.  It's clear to me that I'm going to have to work on the quads from now on to keep them strong, not just assume that TKD or walking will do it.  I did 3 sets of quad lifts after the elliptical at 45 pounds--and that was about all I wanted.  I have had a "relapse" of my left rotator cuff (from the TKD injury last July) this past week.  It was hurting so bad it was hard to raise my arm in the car.  I'm working again on the rubber bands, "sword removal" therapy to try to strengthen it as well, and some day it will need repair, I'm sure.  I was depressed thinking about that, but my wife reminded me of a former NFL acquaintance we met in the store the other day who's had fifteen surgeries on several joints, so the thought of having six inch scars on all four corners was a little easier to consider.  ONce again, my angel wife comes through.  I'll write more after next week's therapy session.  Susan and I are studying Espanol, and have taken three classes now.  Todos las mananas, caminamos y practicamos Espanol. 
3-18-07 I'm back in PT and working hard to build up my quads.  In the first session we did 100 squats on four different machines--and I was wobbly at the end.  We duplicated that in the second session last Friday and also weak after, but feeling stronger this weekend.  The therapist said, "I wish everyone worked as hard as you!" so that was a nice compliment.  I'm also working on the scars--ScarZone is a cream that works well, and I'm using silicone strips now--and they promise they almost make the scars disappear--however, you have to tape them on at night so they don't ball up and come off.  I'm using waxpaper to store them on during the day.  They are working well, too.  I did play 36 holes of golf today--well, one round with 3 balls on every hole, so I got three scores--and 270 (too many) swings in.  My knees were a bit worn out at the end, even though I was in a cart (had two toenails removed two days ago, so couldn't walk that far) but the walking back and forth from "Cart Path Only" rule was very good exercise.  I actually sort of skipped down the stairs today on my way out to a program dinner.

Jim Falvo had his one year anniversary and went back to the scene of the accident to hit a couple of tennis balls.  Here's his report on his progress:

Hi Jim,  Well, one year has come and gone. It’s hard to describe the emotions I felt yesterday especially when it was time to return to the scene of the crime at the exact moment it happened. It’s funny, Jim. As I was reaching in the closet for my rackets and looking for a ball to hit with, I felt like no time had elapsed at all. It was just like, “I’m going to go play tennis now. No big deal.” Even the car ride to the courts with Kris felt normal. And getting out of the car and walking onto the courts seemed unexpectedly normal. However, when I took my position on the opposite side of the net from Kris, I started to feel like I didn’t belong there.  We had asked a gentleman who was hitting with his son if he could take a few shots of my first hits since the accident exactly one year ago. When he was ready, I told Kris, “OK, try to hit it right to me.” She provided a perfect feed and I felt like it was going to be easy to hit the ball just like always.  As you can see in the forehand shot, I look like I know what I’m doing. And in a sense, that’s true. I KNOW what I’m doing but I don’t FEEL like I do.  When I was going through the hitting motion and the weight was shifting forward, I realized that I didn’t belong on the tennis court -- at least not yet. In an instant, I suddenly relived the trauma of the moment when I felt something horrible happening to my body that awful day. As I was hitting that first shot, I felt a reflex to “hold back” and “don’t go for it.” That meant that my conviction to hit hard and follow-thru suddenly became anemic as I felt messages from my surgical site bombard my brain with feedback saying, “What the heck do you think you’re doing?!!”  So, OK…I got my first hit inside the court. And now comes Kris’ second feed, this time to my backhand. Only this time her feed goes too far to my left and, as you can see in the second picture, I can’t move fast enough into position to hit the ball. We’re only talking about having to move three feet. Good grief!  Now I’m thinking, “OK, let’s just get this over with. One more shot and I’m outta here.”  Kris feeds a perfect ball and I lightly hit a slice backhand over the net and breathe a sigh of relief that I’m still able to walk. Psychologically surprised at my reticence to hit, I nonetheless want to reflect my overall satisfaction at exorcising the demon that brought me down a year ago. By facing my fear, I’ve officially started back on the road to total recovery. Anything less than that will now be unacceptable to me. Thus, I pose with Kris and stare at the camera lens thinking, “I’ll be hitting with this young lady full-throttle one year from today.” And so ends the journey that I’ve visualized for so many of these past months.  Jim, it’ll be hard for you to “Face Your Giant” in the same manner because you’d have to travel back to Turkey on Sept 2. And you’re probably not as OCD as I am about these types of things. Nonetheless, I think it’s important to set goals and strive toward them s-l-o-w-l-y. Here’s an important insight I got yesterday.

Remember when I mentioned in earlier emails that my surgeon originally told me during pre-surgery consulting that it’d probably take about a year to recover? Well, I later learned that he based that assessment on his experience with a unilateral quad tendon rupture in a younger person who did not suffer a pulmonary embolism. Guys our age with bilateral ruptures can add about six months to his original estimate to return to near normal. So that means about 18 months for you, Jim.  For me with the embolism, it probably means two years. And I’m OK with that because it presents the same kind of challenge that we face when earning a doctoral degree or running a marathon.  Anyway, I gained additional insight yesterday when Kris visited her orthopedic surgeon for a nagging knee problem and I went along for the appointment. As it turns out, this doctor tore his Achilles tendon one year ago playing basketball and hasn’t set foot on a court in over a year despite appearing to walk normally. He said he’s still about nine months from total healing (and he’s in his 40’s). He says that “once you start feeling like the strength is returning to your surgical site, allow another nine months for healing to occur.”  Wow! While that may come as a shock, it is somewhat comforting to know that our seemingly slow recoveries will eventually resolve over time.   Well, I better go but wanted to give you a glimpse of how things went yesterday. We didn’t have time to see a movie but did go enjoy a nice pasta dinner.  Hope your grading is nearing the end as spring break beckons. Thanks for your well wishes and friendship, Jim. Make haste slowly, good buddy!

 

4-8-07 Easter Sunday.  Final round of the Masters.  This week, I had my 3 week checkup after having two toe nails removed.  He said I was a "fast healer," but I don't feel like it.  Dealing with the fungus after 8 years has been more challenging than I thought.  I'm minus two nails permanently now, but haven't been able to walk like we have been or go to taekwondo.  That was not so good.  We went two miles this morning, and that wore me out, so took a little step back this past three weeks.  PT has been good, though, intense.  Developed a new exercise this week to help my hip drops--holding on to a door jamb with the tips of the fingers on both hands and doing hip drops.  When I do them without that, I either fall over backward or lean too far forward and my knee caps begin to hurt.  They don't hurt if I keep my shins vertical, straight up.  Then I got a little virus of some kind that hit me for three days, but beginning to feel better now--right foot with toe nails still sore but getting better, GI tract settling down, left foot plantar fascitis is settling a little--didn't hurt too much today walking.  It's hard to keep up the energy and positive spirits when all this is going on.  My friend in Ohio goes to the gym daily... and with my teaching schedule and meetings, it's hard to make that happen.  And I'm clear that it's essential to my long term recovery. 

I get lots of encouragement from the handful of "bros" who've had this and have written in.  Here's a new one from Mr. Bill Gallagher who had bi-lateral patellar tendon ruptures 40 miles into the wilderness!!  

Yes, we were about 40 miles into a 90 mile canoe trip.  One knee blew out then (literally).  If you have had it happen you know the “pop” etc.  Spent about 1.5 days in an abandoned ranger cabin we found before deciding to make it out as a group.  Fashioned crutches and immobilization for the left knee out of tree branches and a foam sleeping pad , then set out about making our way out.    Knee 2 tendon ruptured when I heard an ATV coming down an abandoned skid road and I spun around to try to get his attention.  Fortunately I was able to scream loud enough to get help  (mostly from the pain).    Helicopter rescue, and a painful trip back to the states loaded into the back of my Chevy Blazer.

Rehab was very SLOW.  Spent about 8 weeks in a transitional care facility.  Some of the complications on the left knee had to do with the length of time between injury and repair.  Also, I have recently read that there are differences in the actual surgical repair as compared to how mine was done.  In addition to the stainless suture material tying the tendon to the patella, did they run any fiber or steel up to your quad ABOVE the patella?  Seems to me just from a mechanical perspective this would have REALLY enhanced the rehab process as I would have been allowed to actually start rehab sooner.

I walk normal without an obvious limp unless I become tired from over exertion @ work.  Jumping is something I don’t have the courage to do , and running is really more of a fast paced walk for me.

4/27/07 I had my last checkup with the orthopedic surgeon last week.  He tested my knees by holding the knees and then asking me to either push out (quads) or pull in (hamstrings) and then checking on the extension and flexion range of motion.  He said he didn't need to see me anymore for this injury, but to take it easy getting back into running and jumping.  And then he said, "I'll see you in six months."  I said, "what?"  And he said, well, these things go in runs, so I'll likely see you again for something else before too long.  DANG!  THAT was NOT what I wanted to hear.  That said, I have a torn left rotator cuff from a taekwondo injury last summer, so I'll have to get that fixed as soon as I can't play golf any more.  I notice now that I'm returning slowly to TKD that the arm/shoulder strikes irritate it and it hurts the day after I train.  That's okay, I AM going to continue until I get my black belt at least.

The Physical Therapist in my last PT session the day before I went to see the orthopedist wrote up a summary report.  I have 130-5* of flexion in both knees..and 4/5 strength in both legs in flexion and extension.  She wasn't nearly as "strong" in testing as the orthopedist, however, given what she's seen, 4/5 is not so bad I guess.  Susan, my angel wife, says she thinks I'm doing marvelously given what happened, but I still am hesitant on the stairs in both directions.  I'm still wearing my braces at TKD, at least until I feel that it's safe to not.  Our Grand Master is here this weekend, and since I struggled to get through an hour long class yesterday (1 on 1, I was the only one who showed up, first time in 10 years that's happened), I'm a bit worried about the two hour sessions he runs.  My knees are a bit sore today, so I'll give them a rest and try NOT to overdo tomorrow between 3 and 7 pm.  The last thing I want to do is re-rupture them while trying to impress our "sabunim" from Korea.

I also got a nice letter from a gentleman in Dubai who had a unilateral quad tendon tear.  Here's his report:  

     Mine happened while I was hurrying down stairs to answer the door. I got to the 3rd last step and extended my right leg toward the 2nd last step. My right foot slipped of the edge of the second last step and landed on the last step. My right leg bent under the weight and momentum carried my full 100kg forward and dumped it at speed on my by now flexing right knee. The result was a loud crack and the sensation that I had been hit from behind by something heavy. Needless to say I yelled some unprintable expletive and went down like a ton of bricks.  It was early morning and I was well rested and relaxed, being on vacation. The only additional factor I believe may have had some influence on the injury is that I’m a type 2 diabetic, although I have had only been diabetic for around 18 months at the time.  I cannot imagine what it must be like having a bilateral rupture, although your blog has certainly described everything you’ve been going through.  I’ve just started doing half squats without weights, so my rehab proper has just started. I can now go up stairs right leg first but I can’t do many stairs at a time yet. I’ve found walking in the swimming pool against the resistance of the water is helping and also there is a slope in the pool which, with the aid of the buoyancy, I can go up and down properly. Unfortunately I have no medical cover for this and so my PT visits are minimal. I tried something new in the pool last night – I adopted a sitting position in the water with my feet on the floor and then pushed myself backwards across the width of the pool using only my legs – sort of walking backwards with my legs moving from 90 degrees to roughly 180 degrees during the pushing exercise. This really seemed to work my quads.  I’ve also discovered that walking on tip-toes “forces” the knee to bend and not lock back while walking.

5-9-07 We walked four miles both Monday and Tuesday this week, my first foray to four miles after the toenail surgery (and plantar fascitis in the left foot), and while it was good, it wore me out.  I was going a good 4 mph clip for the first little while but was about 1 mph by the end on both days.  Nevertheless, feeling stronger and stronger each day now that I can walk,  Oddly, taekwondo helps the plantar fascitis, not sure why, maybe the stretching and/or the twisting.  I began doing a little jumping jack in class this week, first time since the accident, and that seems to be going okay.  I can tell my feet are not strong enough yet, it hurt a little, but gradually this will build up the foot muscles and it will be okay soon.  This morning, we went to the gym and did our usual, 30 minutes on the elliptical and then I did my leg presses, 40 reps at 200# on the leg press (up from 180# when I finished PT), and quad lifts (3 sets of 15 at 80#), and assorted shoulder work.  My left shoulder has been hurting again, the rotator cuff tear from teaching taekwondo last summer, and doing taekwondo seems to aggravate it with all the circular motions we make, BUT, I'm determined to get my black belt, so hanging in and won't have it surged before then.  Played golf this weekend, had 42-38 = 80, and won $20, so that feels good.  Went to the range last evening and hit both metals and hickories for an hour, that felt good.  We're also planning some remodeling and having fun with the architectual program and alternative designs.  The first piece of a five piece project should begin in two weeks--a solarium over the back patio, about 40' by 15'.  So, the legs are gradually getting better.  I won't claim anything above 60% of what they used to be until I can jump in taekwondo.  It would help if I lost 40 pounds, and now that I can walk more vigorously, maybe that can happen.  I still have the sweet tooth. I took Susan to see Rod Stewart for our 30th Anniversary.  We had front row seats, on the left side..  WONDERFUL concert.  I was up dancing the whole time--wore myself out.  Today, it's good to be alive.  Sunny weather, grass is growing, legs are recovering.  Life is good, mostly.  Oh, I'm still using ScarZone cream intermittently, maybe 2x a week, and the silicone patches, maybe 1x a week to reduce the scars.  Should be doing them more, have been slack on that.  Will try to do better while they're still a little purple (at least over the knees).  I have little pain now, occasionally when standing up from a chair or going up and down stairs, but intermittent.
5-11-07 We walked 2 miles this morning and then was able to get back up to 40 reps on the Total Gym at second peg from the top, so my arms are rebuilding, too. I'm also hitting balls in the back yard with a weighted driver, and that feels good.  Hope to hit taekwondo this afternoon, too.  The knees still feel like cardboard a bit, when I bump them, I can tell all the nerves are not yet "normally" hooked up.  But getting better... 
5-15-07 This email from Jim Falvo today deserves it's own spot.  Wonderful insight:

Jim,

I forgot to mention in my earlier message today that I have been fortunate to receive some very useful information about the healing process related to our BQTR. This came about as a result of my visiting a back doctor to seek relief from a nagging pain in my lower back that I’ve had for years but was able to manage through more rigorous exercise regimens than I’m not capable of doing right now.

I won’t go into details of my back problem but the treatment prescribed by the back doctor was for me to have an ESI (epidural steroidal injection) near the L2-5 lumbar region. The doctor who would give the injection was not the back doctor but another physician who specializes in such a procedure.

As he was taking my medical history prior to the injection, the conversation naturally turned to my unfortunate BQTR. He was very interested in this, never have seen a patient with the bilateral rupture. He knew it was a rare medical event and explored it with me at length. When I indicated that the slow healing process was a bit frustrating, he offered a perspective that immediately made sense to me. It was something no other doctor has mentioned as a possible reason for the long rehabilitation period.

This young doctor, who graduated from medical school in Germany, postulated that the tearing of the tendons and subsequent repair would, quite naturally, result in many nerves and blood vessels being severed. Every attempt would be made during surgery to re-connect the larger vessels and nerves but it would be difficult to re-join every single one.  OK, I’m thinking to myself, that makes sense but so what?

The so what part is what really seemed like an epiphany to me. The doctor said that nerves are what stimulate muscle. He said that even the most highly conditioned muscles would quickly atrophy without nerve stimulation. Thus, the nerves that could not be reattached would result in muscle atrophy – and this could be significant relative to the amount of nerve damage. While this “disorganization,” as he put it would explain muscle loss, the good news is that the nerves will eventually re-organize and will, in time, finally start to stimulate new muscle fibers as new nerve pathways are formed. All of this, of course, takes time relative to such a catastrophic injury.

Viola! I now realize that this is why there is always forward progress, be it ever so slow, but why strength is taking so long to return. The nerves are getting re-organized and muscle tissue is starting to respond to the new nerve pathways that are sending their wake-up calls. This explanation seems so obvious, Jim, I can’t believe I didn’t think of it. Does it make sense to you?

This conversation took place about ten days ago. Call it what you will – coincidence, power of suggestion, of whatever – but I had a dream last night that I suddenly felt as if I could run. In the dream, I could actually feel my legs giving my brain the message they were finally ready.  Well, this morning as I was walking the dog, I decided to test the dream and started out with a few tentative steps and slowly moved to what amounted to an “old man” trot – probably a 13 minute pace. I could actually walk faster but the important point is that I felt like I could withstand the force of the push-off. I did this for about 25 yards and then walked for a 100 yards and tried it again. I felt less timid and more confident each time I did this – about six times in all.

So, I guess you could say that I took my first baby running steps on the long road to recovery. If knowledge is power, then the doctor’s lesson was the wind beneath my wings. Maybe it was just time for me to venture forward but I think there was some serendipity in my steps. Now I can’t wait for Wednesday!  Hey, gotta have a day of rest. Give me a break!  J

Jim

6-12-07 I had some firsts last week, so time for another entry, even though they are getting farther and farther apart.  I played in a hickory golf tournament for four days last week at the oldest golf course in the USA, at Oakhurst Links in White Sulphur Springs, WV.  It's a very hilly course, and I signed up for the more benign tournament in the valley not thinking I could go up and down so much.  But when we got there, I played a practice round with my friends from Ohio and with a little help going down the very steep zig-zagging hill on #5, I was able to negotiate 4 nines over the two days.  While waiting for one tee off, I was able to sit cross legged on the grass, first time I could really do that.  Felt good, although still very tight in the knees.  And then the day before I'd left, something fell under my desk and I was able, gingerly, to kneel down on carpet over concrete, something I was very unwilling to do until that moment.  SO, kneeling for the first time (still didn't feel great, but tolerable), and sitting cross legged... and after walking that 1884 golf course, I felt much more energetic than before on our walk this morning, and finished the four miles in good shape, first time for that, as I'm usually quite bushed by the end.  We observed a taekwondo dojang in full practice in Lewisburg, WV, and I was energized to do more.  This was full contact, which we don't do, but it was fun to watch and think about getting more regular in the months to come. 
7-1-07 July already.  I started doing taekwondo without braces on about two weeks ago.  Then had to travel for consulting, so not regular as I'd like to be.  I'm being very careful now... as my instructor(s) advise me that this is the danger time--don't try to do too much.  My consulting travel plays havoc with my exercise, TKD, and workouts AND eating resolve.  I played golf this morning and had a nice 76, so that was rewarding.  I can kneel for brief periods on carpet and a sheepskin, so like Jim Falvo (see his Amazing Story above at the bottom), I'm slowly getting ROM back.  Tomorrow is ten months post event to the day.  Seems like a lifetime.  Jogged a little on our four mile walk today with the wife and two adult children.  She says, "NO!"  Now, I just need to sew my lips together. 
8-31-07 I had a good workout at taekwondo yesterday, had lost five pounds, and that made a big difference.  Still using my neoprene knee sleeves during workouts and 3 Advils.  All in all, legs are going pretty well.  They still occasionally feel like cardboard across my knees, and sometimes, weird poppings, or "catches".  I'm still not "up" to jogging or jumping in TKD, but can play golf, walk four miles, go up and down stairs (maybe 75% of former speed and ease there), and can get in and out of the sports car. 

Here's a comment from Jim Falvo that really resonates with me.  He's responding to a fellow athlete on the Quad Rupture-related IRL: 

I understand the need to compare progress because Jim and I were always checking on each other. But now that so much time has passed – Jim coming up on his one year anniversary and me exactly 17 months to the day of the injury – I’ve concluded that the rehabilitative process will move forward when the body is ready and not a minute sooner despite our efforts. I used to marvel at Jim’s aggressive approach to getting back to normal and wondered why I was apparently lagging.
   After some time and some reading, I concluded that Jim’s injury was probably not exactly like mine and our body chemistries were probably not identical either. Our physical therapy regimens were unlikely to be the same and our work schedules would also place different stresses on our bodies.  While I enjoyed reading about Jim’s progress and actually used some of his findings to try new approaches to recovery, I gradually began accepting the fact that my outcomes could not be compared to Jim’s because our circumstances would prevent precise comparisons. Not that we should give up learning from each other, mind you, but Jim’s biological clock has a different ticker than mine. I’m just a slow healer, I guess.
   One thing I learned from my trip where I went six days with little exercise – my legs actually got stronger than any previous six day period where I faithfully exercised. Perhaps a period of active rest is needed every so often. Maybe the upcoming Labor Day gives us a good excuse to sip some suds, grab a hot dog, and sit back and relax. All work and no play can wait for another day.

9-10-07 52 weeks ago, I was lying in my hospital bed in my living room, waiting for surgery.  The accident was on 9/2, and surgery was on 9/12.  So this week a year ago, I was lying in bed, realizing that minute by minute "things" were going backwards, not forwards. This weekend, I played golf, worked in the garage, wrote 10 hours on my book, and went to two hours of taekwondo.  My hip joints are hurting a little, and I don't have the spring and jump I used to have, but I'm functioning.  I can walk, go up and down stairs, and generally function well.  It's a milestone...  I'm grateful to Jim Falvo for all his support over the past year.  And to my lovely angel wife, Susan.  We're moving forward.  It's been a very challenging year.  We've had family problems, health problems, house problems, AND it's a new year!!  I've met about a dozen people world wide who have had similar accidents, and we've shared notes and insights.  Silver linings in dark clouds.  Life is good.
9-19-07 It's a beautiful fall day here, clear, sunny, low humidity, 70*, and today I will go to my 1,000th class in taekwondo.  That's a big anniversary for me, something I wasn't sure I'd ever get to.  I would have been a black belt a year ago if not for the legs, had my letter inviting to test.  Master Kwon is coming next month, so I'm hoping for then.  In the meantime, Susan had a new insight from a personal trainer today at the gym.  He noticed that my wife's and daughter's ilial tibia (IT) bands (outside of the thigh) were very tight to the point of pulling the kneecaps out of place.  He speculated to her that this was might have caused my quad tendon ruptures.  A YEAR later and a new theory bubbles up.  She speculated that while we do a lot of balancing and kicking in TKD, perhaps not enough stretching so that the outside of the thigh might be over tight and a major contributor to the rupture.  He also said that a way of relaxing the pressure on the IT band was to strengthen the core since with a weak core, the legs try to do more to support the body.  I'll have to check with Jim Falvo and the other bi-lateral quad rupture buddies I've met over the last year to see if they also had very tight IT bands.  It's a good day.  I hope all is well with you.  Jim Falvo didn't think there was a strong connection here...and my daughter's trainer is concerned she'll tear her quad tendons if she doesn't loosen them up. 
9-22-07 Another beautiful fall day here in Charlottesville, played golf, and had a very intense taekwondo class (#1001) that was exhausting but exhilarating.  We were supposed to to a lot of spinning and jumping, but I just did the spinning without the jumping.  Discretion is the better part of valor.  AND the knees didn't hurt afterward, although I was loaded up on Aleve.  We'll see how they feel tomorrow.  I started my hickory golf season again, playing them this morning prepping for a tournament in November.  It's a different game with hickories.  Okay.. the knees are feeling good today, Aleve assisted.
9/29/07 The School had a charity 5K run this morning, kind of a section competition on participation, Susie and Caleigh and I went.  They were both really sick with a flu/chest bug so they walked with me and my walking sticks.  About a mile from the end, they started pulling away, so I began to jog a little, and they kept going, and I was trying to catch them, so I ended up jogging with my walking sticks the last 7/8 of a mile.  The most I'd jogged prior was 20 steps.  So THAT was a big jump forward.  Afterward, my legs were a little wobbly, but okay.  I was going to go to taekwondo but thought better of it.  So, another milestone, jogging for a while.  Probably not so good on my hip joints at this stage, but who knows?  I've felt really intellectually stimulated lately, finished the fourth edition of my book with eight new chapters, developing five new technical notes or instruments.  If only my body would keep up!  But all in all, life is good! 
8-)
10/28/07 This has been a very big week for me.  I went to the Middle East for the first time, working in Bahrain, and visiting Dubai and Abu Dhabi.  I received a permanent research chair at the University.  And this morning, I tested for black belt in taekwondo and passed.  Grand Master Kwon was kind and allowed mostly hand techniques, but all in all, the test included breaking seven boards.  That's all the good news.  The bad news is that on one of the break, and outside jakusudo with my left hand, I re-aggravated a torn left shoulder rotator cuff and will now likely have to have surgery on it to repair.  That will mean I've got "zipper scars" on all four corners!!  That said, it's been a great week.  A year ago, I was scheduled to test and couldn't because of the accident.  It's a very big deal for me to finally be able to test and pass after ten years of study and practice/training.  The test involved three simulated free fighting maneuvers across an open space with a break at the end of each.  Then a tight "power test" with a punch in front, an elbow behind, and a two-board break to the floor on the floor.  My shoulder is killing me... but I go to sleep tonight a happy man. 
10/31/07 HALLOWEEN!  My wife is in Mexico celebrating the Day of the Dead.  A little scary for Spanish 101, don't you think?

Here's a note from Brian in Quebec:  "I just checked back to your BLOG for an update and thought I should send an update on my case. My fall was January 4, my operation on both quadriceps was January 6, The left quadriceps was totally detached and the right one partially ripped. In hospital and rehabilitation unit till March 1st.  Back at work on April 1st.           Physiotherapy 2 days a week in the pool at my hospital followed by stretching with electronic stimulation up until October 1.  About the start of October my wife and I went to see my orthopaedic surgeon. I wasn't happy enough with my progress and she wanted to know if I was working hard enough. I was kind of shocked at his replies. He specializes in knees and is known as one of the best in the Province of Quebec and has seen only three cases of bilateral rupture in his 15 years of practice. He said I was working very hard and had already made more progress than he had expected at the time of the operation. At the same time the hospital decided that my continuing progress was not enough to merit ongoing physiotherapy. They said I could still make improvements but that I should do it on my own.  I still need crutches to get up and down stairs in my home but walk everywhere else without help, and try not to avoid stairs. I manage to drive my two dogs to a nearby dog run and walk with them (probably not more than 500 meters). The last hospital tests had me walking only about 1300 feet in the 6 minute time period.  The shock of being told I won't get back to full normal has spurred me to push a bit harder. I have joined my civic indoor pool and have been going 4 times per week, doing about 90% of the exercises I was doing in physiotherapy. I don't know if the knees are any stronger/better but the impact on my overall health and attitude is great. I feel much better after the pool.            About a year before my accident my MD had warned me that I was very close to being a diabetic. I smartened up and with diet and activity lost 30 pounds and brought the diabetes under control (1 glucophase pill each morning). Over the past six months with lack of activity my weight has gone back up and the diabetes problems are coming back. So the physical exercise in the pool helps for the blood sugar as well. Your progress and activity has encouraged me to press on. Please keep up the occasional updates.

11/29/07 My new quad-tendon-rupture friends keep reminding me to add more data here... I keep thinking this chapter of my life might be over... but then something else comes along.  I had an arthrogram and MRI on my left shoulder two days ago.  An arthrogram is where they inject a dye into your shoulder socket under pressure and then X-ray it to see if it leaks out of the socket into the surrounding area indicating a rotator cuff tear.  I say "pressure"... they say it should feel like an elephant is sitting on your shoulder.  I've had my right shoulder repaired and they said the same thing then.  Both times, I felt no pressure at all.  And both times, the X-rays showed why.  On this one, the radiologist showed me, there were three or more large billowing clouds extending out from the shoulder indicating in his words, "large tears."  My orthopedist on the physical exam said that my shoulder was too strong to have tears in it.  But I felt differently.  He said that he'd only seen one other person, a tennis player who'd had similarly severe tears and not indicated or "presented" on physical exam.  The billows were large and clear, though... so it looks like I'll have to have it repaired sometime early in the year.  I can't do it now and still go on our planned vacation in December.  SO, soon I'll have zippers on all four corners.  Dang.  I know this drill, though, so it won't be so unsettling, I hope, as the knees were.

My knees are doing okay.. about 80% I guess... perhaps as good as they'll get, I don't know.  I still don't kneel easily, but can if I have to get at something... but very gingerly.  Up and down stairs is okay.  I don't run or jump yet.  Sometimes, I still feel the repair cords to my kneecaps and sometimes they still feel like cardboard, but mostly getting along okay.  I won't do any tolyo-chagi's (round house kicks) for fear of the repairs snapping.  But pandae-chagis (heel kicks) are okay. 

So, life goes on.  Enjoy every day.  I strive to remember how I want to feel every day (light, unhurried and engaged) and to organize to make that happen.  When I do, things go better.  I'm fighting a sinus infection now, but that too shall pass.  If it's not one thing, it's another.  Best wishes to you all, especially those of you who've had knee tendon repairs.  Here's to walking well and walking tall.  Cheers.  Jim

12/11/07 This was/is a disturbing/confusing day.  As you saw above, I've had some shoulder problems.  My orthopedist said it wasn't likely a torn rotator since I could raise my arm and had good strength.  It hurt though, so I got the MRI.  And was referred to another guy.  This morning this new guy said it was inoperable.  DANG, what???  The rotator cuff had a very large tear, 3.8 cms across, 2 inches deep, supraspinatus was atrophied, scarred, and adhered to the scapula not likely it could be pulled together.  He referred me to another man in Richmond, so now I've got to go down there to see if it can be fixed at all.  The bicep tendon was not partially torn, but completely.  But there's two of them apparently and the other one is still attached.  The torn labrum (0-ring to the glenoid socket) is a "minor" thing.  So I've got a 2" x 2" hole in my rotator cuff and he says it's been there for a while so I should have demanded an MRI on the left one when we fixed the right one, five years ago.  DANG! 

But my eldest daughter invited me to lunch today to talk about her new job and her new 401K plan and we talked for a while and then SHE paid for the lunch.  Wow.  That's a first.  She's growing up!!  And my second daughter announced she's going back to school.  Wow.  What a confusing day.   

  I met with the specialist in Richmond today.  He says the rotator cuff tear is inoperable in the sense that the odds of improvement are at best 50-50%.  He divided the discussion into two categories:  functionality and pain.  As for functionality, we can do three things:  operate to repair, operate to salvage, and do nothing.  The first means opening it up, releasing the adhesions to the scapula and then trying to stretch the atrophied, now fatty tissue infiltrated (irreversibly) muscle across the gap.  The odds of doing that, he said are at best 50-50.  "Salvage" means transplanting some muscle from one part of the body to the shoulder and the odds of that "holding" he things are very low.  Functionality, he says, is good.  (after physical exam, can you move this, bend that, push here, push there).  The danger of the first two is that surgery might make things worse functionally.  The second piece is pain.  I have constantly, daily pain.  He recommended there cortisone to see if that lessens the pain.  You can only have up to three cortisone shots in any one joint.  They may not work at all or may work for up to two years.  So... I agreed to a shot and a reappointment in five weeks to see if it's helping.  The next step in that process might be arthroscopic surgery to clean up the edges, reduce some of the scraping and popping, and maybe get a closer look at the supraspinatus to see if it's as bad as it appears on the MRI and X-rays and Arthrogram.  The good news he said is that my force coupling muscles on the front and back seem to be strong and good, so they've compensated pretty well.
1-21-08

There are four tendons apparently that connect the muscles on the torso to the arm, two in the back (shoulder blade), one in front and one on the top.  These tendons spread out to form a sheet like covering of the shallow shoulder ball joint.  The one on the top, the supraspinatus (one of the SSIT muscles) is the ruptured one.  He thinks it was done maybe ten years ago (!).  May have been when I tried to change the lug nut on my car and couldn't get it to release and heard a pop in my shoulder.  It would have been a legitimate debate, he said, back then, whether to operate or not.  The "conservative" approach of rehabbing it was reasonable.  At any rate, it cannot be stretched back across at this point. 

SO, it looks like I'm going to be a one-and-a-half-armed hombre from now on.  I have to be careful not to do things that hurt the shoulder.  So I'm backing way off in taekwondo, only doing certain things with my left shoulder and none of them fast.  When I do that, it really hurts, but if I go slow on that side, I can do some of the moves. 

And I can still play golf.  I want to protect that for sure.  But knock on wood, if my shoulder goes, I guess I can learn to golf one handed.  Would rather not.  If the shoulder goes, then maybe then I can try the 50-50 stuff. 

Anyway, not a happy day in getting this news.  I'm faced now with a new chapter in life...  I can walk though.  Can swing a golf club.  Can type.  Not so easy to erase the chalkboard or write on it.  We'll see how that goes.  My wife still loves me.  My kids still love me.  My dog still tolerates me. 

1-30-08

Jim Falvo responds to "how's it going?"  Good hearing from you. Jim and I have taken a well-deserved hiatus from our formerly prolific postings. As you can read on Jim’s blog, he’s having some shoulder problems but he’s a tough warrior who’ll make the necessary adjustments.  I’m now 22.5 months post op and can report steady progress each and every day. I honestly think there’s no limit as long as we’re patient. I say this because only three months ago, I still had great difficulty going up stairs and could not go down except by using a handrail. Whether coincidental or not, when I started doing deep knee squats in November by hanging onto the bar of the lat pull-down weight machine (and using just enough weight to keep the bend from being intolerable), I started to get the sensation that I could ambulate stairs and push-off while jogging.

I decide to enter a 5K race on Thanksgiving to see if I could break 30 minutes. I did a 30:10 but without a great deal of oxygen debt. Keep in mind I was used to running these events in the 22-23 minute range with little oxygen depravation. I was not sore in the knees or quads – in fact, I actually felt stronger after the race. This led me to believe that the circulation in the tendons is so poor that any vigorous exercise is probably beneficial, just as long as it’s only once a week until the body gets used to it.

As for tennis, I think you’ll recall that my one-year anniversary date was when I attempted to hit some tennis balls but left the court petrified after only three hits (see Jim’s blog).  Around June or July (15-16 months post-op, I tried hitting against the wall and experienced the same symptoms that you report, Chris, include one leg being stronger than the other (but the other being more flexible). By August I was hitting against my ball machine but the mobility was limited to two steps for forehands and backhands.

We suddenly got some warmer weather in December and January and I noticed that my mobility had increased quite a lot when hitting against the machine. I could cover half the court on either side of the center mark as long as I set the timing of the machine to a slow feed rate. I also started to really trying to stretch my quads by squatting down on my knees as if I was in the garden. This continues to be my attempt to stretch scar tissue that may have formed at the surgical site. My wife tells me that when I squat, my butt is still about four inches above my heels…although it feels like my butt is down as far as it will go….as if it’s touching my heels (but it’s not).

This all being said, what it boils down to is to faithfully persist in an relentless, controlled attack to counter this condition. I now give myself more freedom to be moderately aggressive than I did before…but that’s because I’m getting bio-feedback that it’s time to press a little harder. One thing I guarantee you: I will NEVER push like I did when I was healthy. In other words, push to improve, yes, but know your limits and remember that you don’t want a repeat of the past. It’s just not worth it. The goal is to return to a reasonably active lifestyle where enjoyment of living rather than the thrill of competition is the desired outcome.  One day at a time…--Jim Falvo

JGC:  Hmmm. I can cross my legs, but not for long.  Sometimes it feels like just the sutures in there, but my quads are definitely building back up since going back to taekwondo.  But as I noted above, my shoulder is permanently messed up.  I love taekwondo but every time I go now, I feel more and more limited.  I feel like my body is breaking down around me, but my mind is more active than ever.  Dang.  I haven't gone back to jogging like Jim F. has.  I like to walk, and use the treadmill or the elliptical.  I, too, try to get some exercise daily.  I see people sitting on their knees and bending back in taekwondo and I cringe.  Now I can't even do pushups with this shoulder.  DANG.  BUT, never, never, never, never give up!

2-16-08

UPDATE FROM JIM FALVO:  My big news is that I’ve had a breakthrough – literally – in my rehab from the BQTR that happened nearly two years ago (March 2006).  I’m undergoing a new regimen of physical therapy that involves breaking-down scar tissue adhesions that had formed on the upper leg muscles, not only near the surgery site near the knee cap, but in large areas above that where blood had pooled and remained undisturbed when my legs were locked in braces for eight weeks.

 As the therapist rubs-out the scar tissue (adhesions), I’m experiencing less and less pain during the therapeutic process and less pain as I exercise. He’s also helping me build-back the strength and range-of-motion I once had in the quads but couldn’t develop because of the scar tissue retarding muscle movement and growth.  In just two weeks, I’ve gone from 125 degrees of flexion in my quads to nearly normal 135 degrees.  I’m now much more confident going down steps. I can run easier and faster but still haven’t tried tennis because the weather has been nasty here in Oklahoma.   As for the rehab, you might want to consider a therapist who will do deep tissue massage on your entire upper legs. I only wish that I had known about the build-up of scar tissue 18 months ago.

3/12/08

FROM JIM FALVO in Oklahoma:  Hi Jim and to all fellow BQTR’ers. Tonight is the two year anniversary of my BQTR (bilateral quadriceps tendon rupture).  Last year at this time, I marked the occasion by attempting to hit tennis balls after having been away from the courts for one year. As noted in the 3-18-07 posting on Jim’s blog, I was terrified to attempt hitting and quickly left the court after only three swings.  Tonight’s 2nd anniversary finds me going onto the courts and confidently stroking shots. Thanks to the efforts of those who’ve been there for me, I’m able to enjoy the art of hitting a tennis ball once again. Although I doubt if I’ll ever feel comfortable with competitive tennis again, it’s nice to have the opportunity to enjoy something I love after losing it and not knowing if I’d ever play again.  My goal is to celebrate my next anniversary with the spring back in my legs and able to demonstrate the agility I once possessed. No matter the eventual outcome of my efforts, I am grateful for the opportunity that this injury has given me to see how lucky I am and what really matters in life. What really matters is to celebrate each day as a gift from our Creator and to make the most of our life as our gift to Him.   Blessings, Jim

 

4-4-08 What a treat!  Jim Falvo and I finally got to meet today!  After two years of emailing, telephoning, and teleconferencing, we got to greet, hug, and cry a little.  He was in Virginia and was kind enough to drive to Charlottesville.  We had a lovely lunch and rapid fire conversation about our injuries, recoveries, and plans for the rest of life.  My Susan was there, but Jim's Kris was working in Texas.  We talked about possible triggers or contributors to our injuries (diet sodas?  too much exercise?  old age?  statins?  all of the above?  none of the above?) and generally basked in the shared sense of experience that led to our brotherhood.  Here are a couple of photos to commemorate the experience.  (Notice the nice example of a Porsche 9 series in the background!)

In the meantime, my shoulder still hurts like crazy.  I did meet with a new orthopedic surgeon here at UVA who specializes in shoulders, and he says, "I think I can fix that."  We have more MRI's scheduled on the latest equipment and then I'll find out if I have to live with this for the duration or whether I can hope for pain free, functioning shoulders.

Our Grand Master in Taekwondo was here two weeks ago and was watching me do my forms with one arm.  He asked me to do my high form (#14) with one arm.  Then he asked me to do a break I'd never done before.  It was an extension of my first dan test in that he set up one board in front, one in back, and then three on a 12" tower on the floor.  (These are all 1x12x12 pine boards.) I'd never broken three boards before.  I tried it once with a pandae kick, but was unsuccessful.  So, I'm thinking, there goes my other arm.  The front middle punch broke, the back elbow strike broke, and then the down punch broke all three boards on the first try, splinters flying everywhichway.  So successful... but my hand swelled up majorly.  To be expected.  But two weeks later, still swollen and at a certain spot, a sharp, thin, harsh pain--telltale of the other times I've broken bones.  I haven't had it X-rayed yet, but am sure there's a chip or something in there. 

Life goes on!  My mind is as active as ever, working on three books this year, several cases, loving my teaching, and enjoying all except the challenges of the daily 5-6/10 shoulder pain and not being able to use my left arm in training.  I can play golf, albeit with a 3/4 swing, so all is not lost.  AND I can get a good workout with my one armed taekwondo "weird" form.  I love the way taekwondo makes me feel, during and after.  Better posture, stronger, more flexible, etc.  (See my note on the taekwondo link on my home page if you want more on that.) 

 

 

 

 

 

 

 

 


 

 

 

4-5-08 Here's a note from a new colleague, Terry: When I emailed you back about some of my medical and physical history, I forgot to mention that the temperature was in the 20 degree range with ice and snow all around when the injury occurred.  I wonder if the cold could have affected my tendons?  Did any of my physical or medical history have anything in common with any other BQR that you have come across? 

My surgeries were 6 weeks ago today.  I refer to your and Jim C's blog almost daily for knowledge and time frames.  It's been slow, but I am seeing improvement and every little progress I make is so great!  I sent for information and a video on the Total Gym and it looks like an ideal machine for rehab.  It said to wait 6 months post op.  That seems kind of long.

and Jim Falvo's response:  I know where you’re coming from – wanting to know why and, specifically, could the cold weather been a contributory factor. To answer your question, I really don’t know and have seen nothing in the literature that would specifically point toward your physical and medical history to explain your BQTR.   Like you, Terry, I remain curious about the reason for the rupture but I’m far enough along now to realize that the answer will probably remain a mystery. One would probably need to conduct controlled medical experiments and/or take extraordinary time to do a thorough review of the literature to formulate a plausible hypothesis.  I’ve found it more productive to accept that it did happen and move on from there. 

As for the Total Gym’s literature recommending that you wait six months, I would seriously considering doubling that amount of time. All health care pros that I’ve encountered say that soft tissue takes 12-13 weeks to heal. I didn’t start using weight machines that approximate what the Total Gym does until about 20 months post-op and found that such exercises helped me make significant progress. Thus, I’d suggest not being overly concerned about waiting too long for fear of premature stress on healing tissue.

 As for going to your doctor with a full set of questions, See below what I wrote-down to ask my surgeon (not for posting). Sadly, these doctors are so over-worked and/or fearful of lawsuits that I doubt if s/he’ll answer any of your questions “for the record” so to speak. I hope you have better luck than I did with my follow-up visits which were encouraging (“Keep up the good work” or “This takes time to heal”) but were very brief. They simply have too much on the plate…at least what I’ve experienced.  Here’s my list of questions, none of which were answered in writing: 

  1. What was the nature of my injury on each leg? By this I mean, where did the tendon tear occur and how much damage was there? I’m interested in knowing whether the tendons tore off my patella and/or how they shredded, if at all. I’m also interested in knowing the repair procedure. In other words, if the tendons were shredded, what approximate length of tissue needed to be debrided on each leg?  And since you have indicated that the tendons needed to be anchored to my patella, was that because they tore-off or needed to be reinforced?
  1. Assuming the tendons were torn and debrided, approximately how many inches of tendon tissue were lost?
  1. If the repaired tendons were shorter after surgery, can they eventually be elongated through time and PT?
  1. What is the weak point in the surgical sites – tendons or quad muscles – that seems to be preventing a more rapid build-up of upper leg strength? In other words, must the tendon tissue be healed sufficiently before they will allow muscle tissue to build?
  1. Does the bilateral quad tendon injury dramatically slow the healing process compared to someone with a single quad tendon tear? I ask this because a member of the YMCA who tore one quad tendon last November (four months before my injury) was able to start playing basketball in July.

In preparation for my next appointment, I am still having some issues that I hope can be resolved in the coming months. They are: 

  1. I am challenged when going up stairs. I have pain as if my knees were arthritic. Ascending takes great amount of effort as if my quad muscles are very, very tired. Using a handrail facilitates the ascent and provides security. Going down stairs is more painful and absolutely cannot be done unless there’s a handrail to grasp onto and, even then, it’s very scary because I could fall forward without the handrail. Even negotiating 2-3 inch steps at someone’s house presents a challenge for me.
  1. Getting down on the floor to do sit-ups or push-ups requires careful attention to avoid putting weight directly on my knees. Rising back up is very challenging since I need to assume a push-up position and then rise into an inverted-V and then walk my legs forward until I can push off my quads to rise up. In other words, my quad strength is not sufficient to simply rise up in a normal fashion. Similarly, if an item such as a pen rolls under a desk, it is difficult for me to retrieve it without using the above procedure.
  1. Despite intense efforts to strengthen my core, my back remains very painful, especially upon rising from bed in the morning where I cannot stand on my own without support of a walker until I’ve been on my feet for about ten minutes. Even if I merely lie down for about five minutes, the same pain is present although it can be resolved within a few minutes upon simply moving about very carefully.

 Hope this helps!

6-11-08 I had surgery on my left rotator cuff on Thursday, June 5th.  It lasted five hours.  I felt nauseous for several hours after "waking" up which I guess was something of a concern.  They were able to pull one side of the RC up and over, but the top portion didn't go, so they sewed some cadaver re-constituted material to my supraspinatus and then pulled it down over the RC tear (5-6 cms) and tacked it onto the humerus.  Last weekend was horrible.  They'd done a nerve block and that was uncomfortable until late that night and then I kept trying to find the right mix of pain pills to control it so I could sleep.  Percocet didn't phase it neither did single Vicodin's.  I finally found a mixture that numbed the pain enough to sleep.  I hope there weren't side effect/consequences... but they got me through it.  I continued to have some deep congestion in my lungs every morning.  Over the past six days the pain has gradually diminished.  I got a haircut on Monday for my first outing.  Then a teaching meeting on Tuesday for first trip back to school.  And last night, first time flipping pages with my left hand.  And last night, my first twitch during the night that hurt.  I'm typing slowly now, resting my left arm on the armrest.  I'm a mess.  My body keeps breaking down.  Dang.  Missed the National Hickory Championship last week.  Tanner said the rough was horrible, unplayable.  And it was HOT.  Okay... tired, some lunch and a nap are in order.
6-24-08 19 days after shoulder surgery, I went on a 2 mile walk this morning.  I'm surprised at how much effort it takes to heal 1/10 of your body.  The doctor said he didn't want me to use the arm at all for six weeks, so no typing, no one handed golf, nothing that overuses the right arm because it also stresses the left shoulder.  That means I over did the first five days.  But I don't think anything has come unglued.  I did meet a friend of former varsity football player who said that he had gone back after three weeks following shoulder surgery and eventually the repair did not take.  I don't want that to happen.  So now I have scars on all four corners of my torso, but I had a good night's sleep last night, and the 2 mile walk really helped my spirits.  Best wishes to all of you who are struggling with similar issues.
9-8-08

Today was a big day… my physical therapist put a golf club in my hand and asked me to make ten verrrrrrrry slow full swings.  He wanted to see my range of motion and assess the pain.  I had some pain here and there, but TODAY I got to make 30 sloooooooow swings, 3 sets of ten, AND do 3 sets of ten taekwondo blocks.  They really do ask you what you want to do and then try to get you there.  Very exciting as I haven’t been able to make that motion for about six months now.  I’d been playing with a 10% swing the last couple of months.  I’m very excited about this.  And spent another hour in the gym working out.  Feeling full of it today.  There’s a long way to go, (e.g. putting a 12” ball on the wall and “writing” the alphabet with a straight left arm pushing on the ball was exhausting in my shoulder) but I can feel and see the progress now. 

AND this is approximately my two year anniversary of the bi-lateral quad tendon tear.  So two years later---still not jogging, but walking actively, and hoping to get back to taekwondo soon.  Scars are benign now.  Still some pops and crackles now and then, still don't like to cross my legs for too long, and still don't like/do anything that involves kneeling. 

10-6-08

I had my last orthopedics check up today, four months post surgery, and the instructions are no taekwondo for at least another month, only short chips in golf for at least another month, no golf tournaments in November, only full swing after December 5th, and in the meantime work hard on the exterior rotator cuff strength.  (elbows at sides, arms 90* out in front, rotating outward against pressure/rubber bands.).   Dang.  Well, it was all good, very little to no pain, still that little slippery eel feeling now and then (the GRAFT?), but weak and a bit painful on the external rotation.  SO, no hickory golf tournament in November, and no taekwondo for another month.  BUT, things are on track, range of motion is very good, no more follow up visits necessary, just gradually continuing to strengthen the shoulder muscles (supraspinatus, infraspinatus, teres major, teres minor, subscapularis, biceps, triceps, deltoids, trapezius)  Whew.  It takes an hour to work them all.  So that’s where the rehab is.  It’s been a long slow process.  I feel like I’ve lost the last two years.  But it’s a beautiful day outside.  Susan and I walked four miles this morning, and it was gorgeous.  SO…. ambling along. 

12-15-08 A lot has happened in the last two months.  First the global economy collapsed, and then I went past my six month shoulder surgery anniversary which meant I could play golf and do taekwondo.  The weather hasn't cooperated, but I have been back, gingerly, to TKD.  What a wonderful workout.  And I've found I can kneel on my knees now, too, something that is new, so even two years later, they're improving.  I'm frustrated about my lack of weight control, though.  One of "us", Michael, wrote though with this great story.  Check this out.

"I haven't seen any of your comments on the blog for a while. Hope everything is going well for you. An update on my case is that I think I've "fully" recovered ( that is, I don't think I'll ever get any better )......still, the right leg just doesn't feel like my left one, but I can do the same amount of exercise with it, and the range of motion is like the left one too. So, I shouldn't complain. I don't do any martial arts, or other things that require quick movements and changes of direction ( like tennis, snowskiing, etc ) and will try to not create opportunity for missteps or falls . I can still hunt, play golf, lift weights, jog , row, and swim, and in general I do much more activity than many of our peers who haven't had the trauma to their legs as we did...................so,it's all good!

You may remember that I had an extended bout of atrial-fib about a year and a 1/2 ago, and that also has not recurred, but I'm on several drugs to help maintain the heart rate, and rhythm which , since I don't like to take pills, I've tried to get my cardiologist's blessing to wean off of them........................but he doesn't think I should ( of course he's used to dealing with guys who are "old men" at 67...........not 67 year old youngsters like me, so I'll keep working on him to relent )

Finally, in spite of my having been a glutton for my whole life, I decided to see if I could improve my blood lipid numbers, and the result have been amazing. Before the change in eating habits, my total cholesterol was 239 ( it has always been around there ) and LDL was 142. Now , 4 months later, total is 140, and LDL is 72 , and HDL of 56 . This has happened after adopting the vegan lifestyle ( not as a concern about animal cruelty, but purely as a biochemical experiment on myself ) I know you were on Vytorin before your mishap, and you wonder of the statins might have been part of the cause of your injury............regardless, you'll be interested to learn of my very good results with this dietary change . The best part is, that I can indulge my inner glutton by eating huge amounts of food, and feeling great. Also, as a unintended side effect, I've lost 33 pounds ( from 213 to 180 ) I'm 6ft 3inches , and last weighed 180 back as an undergrad at Duke.....................................so, that's pretty cool too.

1-8-09 I've been to three taekwondo classes this week, going carefully and slowly, but really enjoying the exercise again.  And played my second round of golf with no adverse affects.  I'm doing 30-40 pull downs and 20-30 rows on the Total Gym at level 3, and it feels like my shoulders are getting stronger.  I've also graduated from the yellow to red and now to the blue bands doing my rotator cuff outward rotations.  The surgeon said my shoulder graft would gradually increase in strength (if I was faithful in rehab--I am) for a year, so five months to go there.  I've also noticed that for the first time since knee surgery, I'm able to kneel on the pads at taekwondo now, so my knees are getting stronger, too.  SO, I can play golf and train TKD again.  Life is getting better as long as I don't look at my 401-K.

Update from Jim Falvo: 
     As you know, my third year anniversary is coming up in March. I’m amazed that the legs seem capable of doing more but, yet, I still feel like they’re stiff and lack strength. You know that I’ve been teaching tennis part-time since moving to Texas last summer. When I noticed my mobility increasing, I also started running again with Kris. Although my pace was never faster than 10 minutes per mile, I had increased my distance to eight miles but started notice a popping sound coming from the right knee. My primary care doc ordered a MRI and it showed tendon tissue fully intact. That was a relief. The popping was simply chrondomalacia patella or “runner’s knee” where the shock-absorbing cartilage under the kneecap starts to wear-out. BTW, the MRI shows the repair site quite well. There’s about a half-dozen tiny metal clamps still in there, probably to stop blood flow. The chord they used to join the separated tendons isn’t visible but the scar tissue (or whatever) shows where the chord was threaded. I’m sure that tissue has surrounded the chord by now. It’s interesting.  
     Anyway, I started a regimen of physical therapy to further strengthen quad muscles and stretch them, too. The past month of 2-a-days has helped and I’m seriously thinking of starting to train for a marathon. I’ve run 9 of the 12 I’ve finished in under four hours.  My goal would be to walk-run and finish under five hours which would be about 11:17 pace.  I got this idea when I saw people finishing the Tulsa Marathon in November and the Dallas Whiterock last month. Some of the runners were crossing the finish line with physical challenges that looked more daunting than ours. I got to thinking that doing this would be a big step forward, more in terms of psychologically than physically. I’ll keep you posted because this won’t be easy.  I’m targeting the Oklahoma City Marathon in late April.

And here's a report from a "new brother:"  
     September 1st 2004
the decision of front flip or back flip changed my life. Board was stiff and although I had done back flips without any problem, I decided to go front. Stiff board, no problem, I'll just really get a good bounce. Well as my 6 foot 5 inch 270 lb body went as hard as it could on the board, it just came right back up as I was still going down increasing the pressure by who knows how much ? Pop, right leg, pop, left leg. Collapse in pool in so much pain I almost couldn't feel it ! Operation the next day, home a few days after that.  
     October 22nd
, know that something isn't right but they said I could walk without crutch in 8 weeks. Re injure both, surgery the next day. Wow, this is fun ! As I go to bed my first night home, I listen to a commercial for a asthma med I take that say's " may delay healing after surgery, consult your physician ". Call my surgeon the next day and he agrees I shouldn't be taking that but of course that is the primary doctors responsibility. You know how many times I had to tell everyone from EMT, to Emergency Room Attending to Nurses, to well anyone else that asked what meds I took ?  Would be nice if anyone of them would actually have an action plan for a response, but I digress.  Sad day, my then 5 year old son crying and getting upset with me when I attended his Christmas Party at school. I'm sure there was just shame, and  anger, and not understanding why his dad was in these straight leg cast and crutches.
     Best exercise:
Ping Pong, Sitting and light bouncing on Exercise ball, Just walking, resting.

     Best Advice:
Learn what is important in your life. Don't sweat the small stuff. After something like this, not much else is hard. The Physical Therapist have no idea what you are going through so trust your instincts and err on the side of caution. Your legs will come back. It's been a little over 3 years and mine still surprise me by improving even now.  Things I miss, although I never was much of a runner sprinting would feel great ! 
I don't know why I chose to look up bi lateral quad tonight,  but glad I did.  

2-12-09 Here's a story from another new BLQR "brother." 

My name is JB, and I am a member of the bilateral quadricep club. I started reading your blog while I was recuperating. My story:

On October 12, 2007 I was going down the stairs to my basement office when I hooked my toe on the next to last step. A split second and twin pops later, my knees were on the floor with my toes still on the step. I am a big man, 6-4 @ 340#. I wasn't exactly in pain, but my legs would not move correctly. I wondered if I had broken both femurs. My daughter called 911 and I was transported to the hospital...3 blocks away. After a great deal of dithering in the ER with a couple of doctors who didn't have a clue, a third doctor arrived and figured out that I had torn some tendons or ligaments. I was admitted, and one of the local orthopedes checked me out after he was out of surgery and determined I had completely ruptured both quads. He repaired me the first thing the next morning, and I spent the next 43 days with my legs in braces locked at 180 degrees and instructions to not attempt to bear weight. On the Monday following Thanksgiving Day, he released me to begin therapy (home visitations, since to get in and out of my house requires multiple sets of stairs).  Prior to my injury, I was very active. I owned a mail order iris and daylily nursery, and had just finished the last of the outdoor work for the season. I also lifted wieghts and worked out on an elliptical trainer 3 times a week. I am sure that had some effect on the recovery, since I achieved a 125 degree knee bend within 3 weeks and was climbing stairs by Christmas day. I put my cane in the closet by mid-January 2008, and have not looked back. I still get some mild swelling if I overdo things, and am a bit stiff the first thing in the morning. I do not kneel (except briefly) yet, but that seems to be getting better all the time. I would say that there was some discomfort, but I did not have a great deal of pain during the recovery or rehab, and for that I feel truly fortunate. I was 47 at the time of the injury.

 The thing that prompted me to finally drop you a note is a curious set of coincidences. I understand from what I have gleaned from the internet and anecdotal information that bilateral quad ruptures are on the whole very rare, with something like only 50 cases reported in medical literature since 1950. My surgeon never stated this statistic, but he said he only had knowledge of 3 occurrences including me. I live in Middletown, Ohio...a town of about 50,000 located between Cincinnati and Dayton. One of the three was also from the immediate area, and my surgeon was his surgeon as well. His injury was about 1-1/2 years prior to mine. Imagine my surprise to pick up the newspaper a couple of weeks ago to see that a Middletown firefighter had stumbled over and uncharged fire hose last fall and ruptured both quad tendons. Three bilateral quads in a 10 mile radius within 2-1/2 years. Makes you wonder....

 Anyway, I am glad you seem to have come out on the other side of your injuries, and I hope you continue to improve. Thanks for sharing your story, it was comforting to know that others who had gone through what I was then experiencing were having successful recoveries

Other than being overweight, I am as healthy as the proverbial horse. My cholesterol is excellent, as are my triglycerides. I have borderline high blood pressure and the only meds I am/was on are a mild anti-hypertensive and Nexxium. I also had knees that were healthy...no arthritis, no signs of declining muscle mass. As a matter of fact, two days before my injury was workout day, and I leg pressed 2 x 25 reps @ 400# followed by 30 minutes on the elliptical trainer. This had been the routine for about a year. I did kneel quite a bit working in the garden and would find my legs stiff after kneeling for 30-40 minutes, but again this was normal routine and I am in my late forties. A bit of stiffness is sort of expected. As to why it happened? My house is 89 years old, the steps were uneven and small, my feet are big and I was talking to my daughter and not payiny attention. A sports physics expert calculated that the sudden compression associated with this kind of fall magnifies your mass 6-8 times your body weight, so if you call it 7x, I come out with about 2400 pounds exerted on my poor quad tendons.

 I have noticed that the treatment varies depending on the doctor. I also understand there are other variables as to size, physical condition, health and age. This makes it difficult to say which treatment is better. From my understanding of anatomy and physiology the route my surgeon took makes the most sense to me. His opinion is that the quad tendons are slow healing with a poor blood supply, and only sewn back together with a metallic suture which could pull out if stressed too much/too early. His solution was to immobilize the legs and not allow any stress during the initial six weeks of healing, then to slowly and steadily increase flexion. For his two cases it has worked out the same way with little pain and near-complete recovery. I should note that both his patients were similar in age and health and the surgery was nearly immediate. It also was helpful to have a great support system...my wife is an angel also, as well as my daughter. I daresay it was harder for them than for me.

7-6-09 Ahh, the challenges keep on coming.  I had a little heart attack last Tuesday while walking with my wife.  No chest pain, just a bit light headed and strong nausea.  At the ER, they said my triponin (heart damage enzyme indicator) which should be .01 was .42 and my d-dimers (clot indicators) were elevated.  The nuclear infusion test thogh was negative, and the next day, the sonargram was normal and the heart cath showed only minor bumps so they, again (had this six years ago, too), did NOT insert any stents.  So, some rest, letting the femoral artery plug heal (they used a little titanium plug--better than the natural plug last time), and then back to "normal."  But we don't know what caused it.  Maybe a combination of airline travel all day Sunday coming home from the West, taekwondo at noon on Monday, then 18 holes of golf walking 2/3 of it were "set up" contributors?  Perhaps a little clot, heart aggravated by pushing against it, clot dissolved...  leaving me with a little "achy" feeling in the chest.  Or maybe it's just more esophageal lesions?  GERD?  Again?  Who knows?  Enjoy every day. 
2-11-11 I HATE to note that Thursday, 2-10, after teaching I was climbing a flight of stairs and my left knee collapsed, locked up, spasmed, something.  It hurt like crazy.  9 on the scale.  I hobbled home.  Couldn't sleep that night for the pain.  My doctor gave me some muscle relaxers, pain meds, and steroids for inflammation and the next day, I'm feeling much better.  I still feel like something snapped, so next week we'll check with the orthopedist to see if any ligaments or tendons were involved.  DANG.  Maybe it was because I'd played golf on vacation for three days straight, 36  a day.  ??  Maybe.  I had my annual physical recently and cholesterol was 146 (with 20 mg of Crestor daily).  I still need to lose 40#s, but am feeling active and energetic except for my knee now.  Still doing taekwondo 3-5 times a week, still playing golf, and still have lots of things to do in life.  I hate these joint things!  DO NOT want more surgery.  But with the meds, feeling mellow tonight.  And went to TKD in my old brace today.  Limited movements, but still a good workout.  I hate/hated those braces.  See above.  But it allowed me to "workout" today. MAYBE it was just an IT band or back-knee muscle spasm?  I hope. 
6-4-2014 I received a new notice from another "brother" in BLQTR's.  Here's his story.  WOW.  Glad I wasn't in that hospital!
12-15-2015 Life continues apace.  I took up swimming about three months ago on the advice of a good friend.  I lost 20 pounds so far, my BP is 103/66, Resting pulse 64, and my blood numbers are better than ever over the last 20 years:  Total cholesterol 117 and 43/66  HDL/LDL.  A1C at 5.9.  I'm  a new believer especially since it's easier on the knees and hips.  Then I had a hard baseball pain in my chest while doing my crawl laps; it went away when I did my recovery laps.  Went to see the doctor and he said, whoa!  Called my cardiologist.  Two days later I'm in the OR with a catheter up my right arm.  They found the Left Anterior Descending artery LAD was 95% blocked.  Doc said I would not have made it if I'd had an infarc on the golf course or in the pool.  It's the "widowmaker."  They inserted a stent 3 x 22 mm and then all hell broke loose.  I suddenly felt awful, and I hear the MD shouting "100 cc of this!  50 cc of that!  Another 50 cc of that!"  Apparently, I caused a big furor and almost bit it.  About five minutes of total body pain and discomfort, but the Resident brought me back.  So my PCP, Cardiologist and the Cath Team saved my life twice in one day.  Whew.  All of which would not have happened had I not had a check-up on my back scheduled.  In May, my wife took me down the Colorado River through the Grand Canyon.  In one stretch, Upset Rapids, I got majorly Upset, went upside down and did a WWE pile driver on my head on an aluminum catwalk.  My neck hurt for two months and my pelvis hurt for six.  I think it jammed my sacrum down (well, up since I was upside down) and jammed all of the facets in the sacro-iliac joints.  Two months of PT later, I'm mostly okay, but still get nerve tingling across my pelvis and down my legs.  The knees are doing fine.  I teach TKD once a week and do my 16 forms 3-4 times a week.  Walking nine holes is a challenge, but I can do that.  Swimming 2,000 yards has become "normal" now and doesn't stress my joints.
12-15-15 New BLQTR brothers keep writing.  Here's one:

Jim,  I have been reading your blog for the last couple of weeks on and off and finally got to the end or to the point of writing.  I am another unlucky person who has/or is going through what we who’ve been through this is going through.

My story began 2-10-14 while working part time at a local Elementary school during lunch(I live in California in the Bay Area).  I tripped transitioning from the tan bark area of the playground to the asphalt falling with all my forward force landing on both knees, while lying there on my back unable to move either leg and knowing something bad had just happened. I didn’t hear any pops probably because the stuff in both hands and arms came flying out when I fell. To make things worse when I tripped I fractured my left ankle as well as the complete Bi-lateral quadriceps tendon rupture, while lying there in excruciating pain the custodian came out with the wheelchair from the office and tried to help me get up, that wasn’t going to happen, finally someone called 911 and the fire truck EMTs and Ambulance got there they wanted to cut my brand new jeans off my legs and I told them “No” we can take them off once I’m in the Ambulance all the while they were working on me getting ready to put me in the ambulance, they got the gurney out and were lifting me onto the gurney when one of the EMTs thought to have me try to stand to get the rest of the way on the gurney well one of the Firemen noticed I was going down unable to support myself and grabbed me by the back of the jeans and pulled me onto the gurney thus saving me from falling to the ground again.

Once I got to the ER I was somewhat of a spectacle in the fact that none of the ER Doctors had seen this injury before and they took turns poking their heads in to look at the big divots above my knee caps where the Quad Tendons should have been, I was taken to X-ray to get pictures of my knees and while in X-ray I noticed my left ankle swelled up like a balloon so they took a couple of pictures of the ankle to find it fractured as well, next I was taken to have an MRI of my legs to verify it was a Quad tendon tear (one of the ER Doctors) thought it was a patellar tendon tear.

I had surgery the next day by the same Orthopedic Surgeon who had fixed my left shoulder rotator cuff tear, and SLAP repair a few years prior and who also had done a right shoulder arthroscopy thinking it was another rotator cuff tear only to find the shoulder joint needs to be replaced at some point in time. I was kept in the hospital until Valentine’s day 2014 which was also a Friday night when two young “skinny” women Ambulance/ Transport drivers showed up to transfer me to the Skilled Nursing Facility associated with the hospital (all the time I was afraid these two young women were going to drop me).

I spent the next two months at the SNF with both legs in immobilizers and my left ankle in a cast, I was told by the Physical Therapists fortunately I had such good upper body strength because that’s how I had to learn to get in and out of bed into and out of the wheelchair, legs straight and no weight bearing.  I was released one week short of two months to come home to a waiting hospital bed, commode, shower chair, walker etc.  I had visiting Nurses PT and OT coming to the house until I was able to go to outpatient PT. The therapists I was assigned did a good job but they had no idea what I was going through as far as limited Range of Motion, Strength etc. (not to mention they are probably 30 years +/- younger than I) they kept saying I should be able to squat to the floor along with other unrealistic movements.

It has been one and a half years since my injury, my non-weight bearing ROM is excellent but weight bearing ROM is limited to approx. 45 degrees squatting, no kneeling, no climbing, walking on uneven surfaces hurts, as well as doing any kind of stepping up or down off curbs or the planter box in my garden, walking down the driveway or any kind of incline, going up is not as difficult or painful but going down is terrible. I am able to walk a couple of miles with the aid of a cane for support (especially when walking the dog).

I guess if there is any benefit to this whole ordeal, is the fact that I was at work when I fell and worker’s comp. is/has covered all the medical expenses, unfortunately they have forced me into obtaining an attorney to get what I feel I deserve for future medical treatment etc. The Surgeon feels I will have some type of Permanent Disability with the need for possible future surgeries, so here I am going on two years since date of injury and still in moderate to severe pain with trouble sleeping and just trying to live life the best I can with my limitations. TS

12-15-15 Here's another story.  Thanks to all-you-all who share and allow us all to learn from each experience.

     I had my surgery on Monday and I am doing alright so far; less pain and mostly stopped pain meds, mostly gotten past some post surgery constipation and urinary retention issues, and beginning to get around the house in my outsized straight legged wheelchair.  I remember how hard my 2004 single legged quad rupture seemed at the time, but I sure wish that now I had a leg to stand on.  It should get better as I begin to put weight on over the next couple weeks.

      My injury simply followed stumbling over some uneven soil in our front yard. I was varnishing a trellis on my wife's and my 29th wedding anniversary and eager to get the job done so we could go celebrate.  Five days of working on a trellis was a lot and I was tired and trying to move fast and I think that led to the stumble.  As I was losing my balance, with knees hyper flexed,  I heard two disgusting cracking sounds coming from my knees and I went down hard. I knew I couldn't bear weight even without trying, and got ambulanced to the local ER where the doc told me that X-ray showed no fracture, and their policy was that only fractures get surgical treatment.  He told me to call my PCP "if it's not better in a week."  I spent most of the next week trying to get into an ortho office, or obtain an MRI, to no avail. Ten days after the injury my family and I ultimately staged a sit in at an MRI office and the manager relented and agreed to come in early the next morning to do the imaging.  When the radiologist saw the image I spoke by phone to an orthopodmthe same day and scheduled surgery.  

      I have first PT tomorrow after having some inpatient PT the day of surgery.  My wife is taking two weeks off work and my older daughter is also helping quite a lot. I had just retired from working as a psychotherapist for a county mental health clinic and Was supposed to have begun a new half time job Monday.  Life pitches some interesting balls. 

     I tore my quad tendons in the most mundane way: I stumbled, while walking in my front yard, carrying a paintbrush while varnishing a trellis on a beautiful Sunday afternoon.

      If it had been just a few days later I would have had a more dramatic story as my wife, our 23 year old daughter, and I were planning to go backpacking for four days in the Trinity Alps Wilderness here in northwestern California.  But I'm happy to have escaped the drama of a possible helicopter rescue and put my family through even more stress than they've already faced.  

     I saw my surgeon today, six weeks and two days post-surgery.  I'm progressing okay, can bend both knees to 90 degrees and I tool around the house using a wheeled walker, but I had hoped to be out of braces by now and find that I'm clearly not strong enough for that yet.  My right knee, which suffered a quad rupture in 2004 in a high impact bicycle accident, remains quite swollen and definitely lagging behind the left in recovery.  My surgeon reports that she found "tendonosis," not tendonitis, and she explained that it appeared calcified and "degenerated" in parts and "with a flap of dead tissue," and not simply inflamed as with tendonitis.  But she remains optimistic that the repair will remain sound, although she says "It won't be better than before, that much we can be sure of." 

     One thing I'm happy that she did at surgery time was start me on Enoxaparin, an injectible anticoagulant.  At first I was not happy to be giving myself a shot each day.  But reading entries from others in your blog, and on other sites, I see that many bilateral quad rupture guys suffered deep vein thrombosis or worse, pulmonary emboli (as Jim Falvo did), and I read an orthopedic study reporting on a large group of inpatient surgery patients, both male and female, who had "lower limb surgeries."  Nearly half of them developed DVTs after surgery, although quite a few of those were asymptomatic and detected only by ultrasound, but still likely dangerous if they traveled to the lungs or brain or kidneys. As much as I've suffered through this ordeal, I would not want to face a risk of dying from it!

    I'm glad you're hanging in there, and it's clear you're been an inspiring online presence to a lot of guys facing horrible injuries.  PC

Jan 8, 2016 Here's an update from one of our "brothers." 

Nearly two months after my previous report to you, and 14 weeks post-surgery, I have experienced a lot of improvement and I'm feeling more optimistic.  I'm continuing in physical therapy and I've found that indispensable; the homework exercises not only strengthened me but they helped me keep my sanity during the dark days early on, and the staff always encouraged me.  Now I walk pretty well without any assistance, but for walking any distance at all I use trekking poles.  Today I walked one mile in our neighborhood, which is hilly, so I get some up and down practice.  Just tackling our steep driveway is a workout, but it feels good to get it after so much time relatively immobile.  I've been going to the gym to use a stationary bike, up to nearly an hour at a time, broken into intervals of ten minutes.  At each break I stand and stretch and make sure I haven't biked my legs into oblivion.  I also have been adjusting the seat as close as I can tolerate it toward the pedals, just for a minute or so, to increase my flexion.  But I'm at about 130 degrees on both legs so I'm not really having to do that anymore.   

 

Other than building up my endurance and strength, the major hurdle now is walking on irregular ground in winter's dark and rainy conditions.  I'm blind in one eye so I have poor depth perception and my useful eye has little night vision.  So when we've gone to holiday events I've been completely fine with friends supporting both my shoulders and basically carrying me to the car.  My surgeon says that many repeat ruptures occur at the three to four month period, right where I'm at.  I don't think I, or my family, could handle repeating these past few months of pain and disability. 

Jan 19, 2016

My name is Steven Gartner and I am 45 years old and I live in Bremerton Washington with my two amazing Taiwan mountain dogs. I have been very active all my life, but unfortunately I have been very injury prone most of my life as well. Being so very active all my life and having such a diverse interest in so many activities is the reason why I have gotten injured so many times.  

I am part of the Ruptured Quadriceps Tendon Club. I not only had to endure a full quad tendon rupture to my right leg back in 2007 while jet skiing, no I decided to go all the way and suffer a bilateral tendon rupture (as you did) in January of 2013 while snow skiing. Needless to say, the last injury was ever so devastating to me initially as I knew what was in store in terms of recovery and rehab. Having dealt with one quad rupture was bad enough, dealing with both legs is a quite different story which I know you are all too familiar with. 

I initially wanted to document my experience for the first injury I dealt with much like you did, but life got in the way and I forgot about it. The second time it happened I was all gung ho to document and create an online blog, which I have, but again life took over and it was swept under the carpet. But no more. I have recently completed the bulk of my online site but have much more content to add.

Since your story inspired me so I wanted to include you on my site and I hope that you are ok with it. Also if you wouldn't mind adding my story to your site I would be so ever grateful. I have dubbed you the 'Quad-Father' :-) since at the time when I first was researching this injury the only story I found with was yours and by the looks of your site and by talking with others, your name was always the first to come up when they did their online searches about Quad Tendon Rupture.

 Here is the link to my website:    http://www.quadtendontear.com/

March 8, 2016 I'm a tv news anchor in Texas and I've been reading and re-reading your blog with vigor.  I'm a 50 year old bodybuilder and on Feb 1 was doing squats in the gym and boom. I tore both quad ligaments.[sic: tendons] The next day had surgery and just got home from rehab hospital a few days ago. I'm unable to return to work. Can't really walk comfortably yet without my walker. This is week five post op. Good thing is I cherish the small victories Bending my legs to 90 and walking unassisted in my home with braces. Your blog inspires me and thank you for sharing. This is not easy.
March 29, 2016 Dang!  Felt something pop in my left elbow during taekwondo demonstration two weeks ago in Florida.  Just had MRI and today the follow-up consult.  Distal bicep tendon now ruptured.  Gradually, tendon by tendon, I'm breaking down!  Shoot!  Have to decide whether to have surgery now or not.  Apparently, one can do okay without bicep, brachialis is mostly for flexing, but bicep does mostly supination.  Fibber McGee!
4-4-16 Still on the fence about elbow surgery--orthopedist called today after conferring with my cardiologist and suggested that the risks have gone up by needing uninterrputed blood thinners.  So in his words, "a long run for a short slide" meaning increase in functioinality would be minimal over what I have now.  Anyway, I have a Bi-lateral Quad Tendon Facebook page/group.  Bi-Lateral Quad Tendon Rupture Friends if you want to join and share notes with others.  Just ask to join if you have had BLQTR's.
5/20/16 WHOA!  I was answering two other fellows who had just had BLTR's and my wife came home and said "CIPRO!"  What?  Her masseuse said there was a big class action suit about the relationship between CIPRO and tendonitis and ruptures.  I looked.  http://www.webmd.com/osteoarthritis/news/20080708/fda-warning-cipro-may-rupture-tendons
http://www.webmd.com/osteoarthritis/news/20080708/fda-warning-cipro-may-rupture-tendons
  SO, now I have to do some more investigation.  But wow if that's it, I took CIPRO several times over the years for various infections.  NEWS!  Going to check it out more.  DID ANY OF YOU TAKE CIPRO?
9/5/2016

Here's a note/update from one of our "brothers:"
I hope you are doing well and still able to keep doing your favorite things!
Just wanted to let you and your blog-readers know that, 364 days after my injury, I continue to improve, though my quad ruptures remain ever-present in my mind.

Valerie and I backpacked last week in the Trinity Alps Wilderness.  I expected this would be a big challenge but I've been doing a lot of preparation for it with my workouts.  We had planned an easy, short hike to a relatively high-elevation lake, but due to a cold front moving in went for a lower elevation (read: warmer) canyon that was a significantly harder hike.  With packs heavier than they should have been, we made it to our destination, about five miles in.  I was tired.  We had a beautiful campsite on a bluff above Canyon Creek and the next day planned a day hike to an upcanyon subalpine lake.  I found I was able to make it almost, but not quite all the way, before my legs felt completely spent.  My wife could have made it on up by herself but chose to return to camp with me where we had an evening of beautiful stargazing.  We hiked out the next day and on the steep parts of the trail I worried that my jelly-like quads would fail on me; they didn't, and we made it home just fine.  

Hiking and backpacking have been parts of my life since I was a young boy and it was a relief to know that, even if slowly, and arduously, I can still enjoy being in the wilderness after this injury.

 Pat Carr
GOOD FOR YOU PAT!  Keep it up!

9/5/2016 I didn't have the detached bicep surgery; taking blook thinners for the inserted stent last fall makes it too dangerous.  BUT, I am still doing Taekwondo, golfing, and don't feel much different except for a floppy left bicep.  Not too manly!  And Life is Good.  Take care of your tendons y'all.
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