Recognizing limits and finding ways past them

by Aug 1, 2019

July is the month of my birth, and since I am around to celebrate it, I can admit that I am now the ripe old age of 61. It’s also the time when I sit down with my doctor for my annual checkup since it’s a convenient reminder that it needs to be done. And, I think, it makes a good time to do a quick status check here for those of you who care, and even more so for future me when he looks back on past years trying to figure out what the trend lines are.

In general, the news is good. At this age, honestly, it’s not whether or not there are bits of the body broken, but how you’re managing and working around the breakage. The basics: the sleep apnea (12 years now) is very well managed, and I just bought a new CPAP since the old one was going on 6 years old which is a nice upgrade. The diabetes (two months shy of ten years) is also well managed with an A1C of 7.3, which earns me gold stars on my forehead from him, but I’m always working on improving how I handle this, and I’m hoping next test to be closer to (or under) 7.

The arthritis and the knees — is a bit more complicated. It was in 2009 I stepped in a gopher hole while birding and tore up the left knee, went to the doctor to talk about getting it scoped and cleaned out, and found out it wasn’t that simple. Both knees have torn meniscus and arthritis and neither one can be worked on short of full replacement. I was told at that time to expect maybe 5 years and then have to consider full knee replacement and I was put on a large dose of Relafin to keep everything going as long as I could. About five years ago, I started the routine of cortisone shots in both knees to get the inflammation down and keep the pain at a minimum.

Around Christmas we switched out the Relafin for a newer drug, Meloxicam, and it was a relegation. The knees improved to the point where we’ve cancelled the cortisones shots indefinitely as unneeded, which, given my love of needles, makes me smile every time I think about it.

That’s the good news about the knees. The not as good news — one of my goals this year was to build up my fitness so I could reliably do a 3 mile hike, because for the last couple of years, my birding has been seriously limited by my ability to cover territory and I wanted to fix that.

Things have gotten better, but the legs have been slow to come around. It’s not the knees (although they can be stiff and sore at the end of a walk, and ice does wonders on them), but the legs overall. One of the drugs I’ve been taking causes edema — retaining water, especially in the legs — and the leg and foot swelling inhibits my interest and ability to walk distances; imagine hiking every day with 2 pound ankle weights on. It has other impacts, as well that may not be obvious: foot swelling causes your center of gravity to change a little, so I feel unstable on uneven grounds and the knees aren’t necessarily strong enough to support me trying to prevent a fall. This has limited me to paved or packed gravel paths. And carrying around that weight in the legs tires them, and when tired, you tend not to be as careful lifting and placing your feet and you become more likely to trip and fall. I’ve come close a couple of times, fortunately without incident (yet).

So that was the primary point of discussion with my doctor this trip, looking for options that might improve this. We ended up going with a change to one of the pills I take to one he thought might reduce this swelling. I’ve started it and seem to tolerate it well (the last time we tried something like this was the trigger for six months of emergency room visits while we waited for the liver to stop threatening to quit, so we’re a bit careful about tweaking what’s working).

So far, so good. Starting on day 2 I started to get rid of (cough) the excess water, to the tune of over five pounds so far. The swelling is mostly gone, the legs feel better and the knees feel a lot better, too. I’ve got a couple more days before we officially declare victory on this, but it seems this new pill is a winner.

I’ve long worried about and hated the idea of becoming the old fat guy in a scooter, but there have been times when it’s felt that this was inevitable, and that I should just give up and let it happen. I’ve always decided to not go without a fight, though, and I’ve used it as a motivation to keep trying to push forward.

If I look at a few key numbers, as of today my weight is 343; having finally broken past 350, and helped with this drug switch, I’m well on the way towards 340, which is awesome. That puts me at 13 pounds less than this time a year ago, and 11 pounds since Jan 1, which gives me 10+ pound losses for 4 of the last 6 years and puts me over 70 pounds total from my high and on track for 20-25 pounds for the year if I can keep it up.

A year ago, my max heart rate was about 140 and I could do moderate activity for about 30 minutes before hitting a wall. Today I find my max rate is closer to 155, and that moderate activity can go as long as 90 minutes before I feel like I should stop. I see that my pulse recovers faster, and than my heavy breathing stops sooner. my doctor loves the max rate number as an indicator of heart health, and I’m thrilled because I can accomplish more before I have to stop and rest, or to call it for the day.

That said, it still hasn’t translated into those hiking numbers I want, so I’ve been pondering how I can do what I want given what seems a set of limits I won’t be able to fix easily (or ever). And that led me to this week’s expedition.

I went and test-rode an e-bike. I’m thinking about it, but leaning towards buying it. I’ve had a number of friends buy one recently and they all rave about them. I’ve been hesitant about getting back on a bike because of my weight, but now that I’m down under 350 it’s easier than it was 50 pounds ago, but I still worry about the knees due to the peddling, even if it’s lower impact on the legs than walking is.

The e-bike offers an assist, and it offers a way home if I decide the legs have had it. It gives a safety margin that makes doing things feasible. I’d first looked at them about a year ago and realized I needed to get under 350 to have bikes that supported my weight properly (unless I wanted to ride a cargo bike. See “old fat guy in a scooter” for my thought on that idea). And I realize a lot of the paths I want to bird are bike friendly — not all of them, but an ebike would widen my birding range significantly in a lot of places I’m currently not able to explore.

And I can share the load with the motor, or I can let it haul me around, as I want and as me knees dictate what I’m capable of that day.

I will admit the first five minutes of the test ride was a bit of a horror show, but once I started getting the feel of being on a bike again, things smoothed out, and I really started to like it. I felt comfortable on it and it seems a reasonable option.

I made myself think about it for a few days, to make sure I was making the right choice, but right now, I still feel like it’s the answer to a few challenges I’ve been chasing, and so I think I’m going to pull the trigger. If so, we’ll talk about it more here down the road, as I dive into the idea of using an e-bike for accessible birding for people who can’t walk as much as they used to.

Since I seem to be bumping into a hard limit on what the legs will handle — I’m hoping the reduced swelling will push that limit out, but not depending on it — this seems an interesting option. And it sure would be fun to be able to hop on the bike and roll off to the coffee shop for a few hours to write rather than have to get in the car and drive there.

We’ll see. Nothing final, but it seems likely I’ll pull the trigger right now.