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