pool, orthos

I've settled on a short simple interval set.  I can be in and out of the pool in about 15 min, and I can do it everyday if I want.  Using watch is inaccurate for HR but I'll post it anyway.

Pool laps  6x50yd w/ ~1:10 rest - 40.3, 45.9, 45.2, 46.3, 49.2, 50

Max HR - 154 

          HR avg - 128 

HR< 128 - 5:09

HR 128-144 - 6:49

HR 145-152 - 1:15

Not exactly 'running the engine hot' like the anaerobic power of track sprinting... more like a zone 2-3 workout.  

At least I'm not heavy - 141. 3 lbs after workout.

About undertaking this surgery, I'm thinking it's going to be a helluva miserable inconvenience. Crutches to early/mid March.  With my time off and spring break, I'll only have to endure 3 weeks or so of crutches at work.  I'm going to follow Dr. LaPrade's more conservative protocol of 6 weeks non-weight since it worked before.  I asked Justin about it, he said I'm more than welcome to follow a more conservative protocol but he says 50% weight bearing ok.  I asked him why, and he said, 'because my stitches are strong.'  Not worried about the stitches breaking, but what they're holding.  Curiously, his radial tear protocol is more like LaPrade's, 6 weeks, no weight.  So, since I do have a radial tear, that's what I'll follow.  LaPrade's decision to not treat this doesn't bode well for my chances for a complete fix.  He saw the risk and chances of success, and at this stage of his career at age 67, didn't want to deal with it.  Justin however, I feel is at the top of game, only 50, and willing to take on the tough cases.  

surgery

Dr. Justin scheduled me for surgery in 2 weeks, 1/30.  My meeting with him was OK.  He described my injury as a oblique root tear along with other parts of the meniscus.  He noted some wear already on surfaces and couldn't be certain the level of repair he could accomplish 'til he got in there'.  I wouldn't say he was brazenly optimistic, nor roundly pessimistic.  Perhaps a bit aloof.  I do like him, trust him, I like what I've seen from his staff, his prompt scheduling, and his willingness to work with my insurance company to reduce my out of pocket expenses.  He did push the BMAC stem cell treatment which I declined (because I don't think it really works that well and is expensive) and like last time, opted for PRP only.   He also mentioned the MISHA knee device, an internal prosthetic, but I'm pretty opposed to that at this point since it is so new, only FDA approved 4/23.  It would be last resort before a knee replacement.  

The logistical issues involved with doing this in LA, in the W. Hollywood area, are formidable.   I know it will not be at all like it was in Vail at Steadman.  It's basically check in, surgery, and adios.  No PT meetings, just bye-bye.   Followup via zoom.  His post op protocol is far less conservative than LaPrade's.  I'll be flying in Wed, surgery Thurs, home on Friday.  At least I won't need to drive.  One of the worst parts is finding someone to check me out.  They will not release me alone to an Uber.  Roya found someone through her caregiver network that I could hire for $150 to check me out and drive me to the hotel, will be worth it, LA during rush hour.  Good, so I don't have to drive in LA.  I'll checking out of the hotel to the airport shuttle only about 15 hrs after I return to my hotel after surgery.  I'll be glad to get home.  

I remember the trip to Vail, this same time of year, 6 yrs ago, it was truly epic 

 

short intervals in pool

At the pool again today, I tried a short interval workout.  50s.  Found that my bicep heart monitor does not work in the pool swim setting, and when it's activated using another mode, like track or gym cardio, it doesn't consistently connect.  So I use the watch, inaccurate HR but it measures distance and strokes quite well.  I'm not going to put absolute data for this workout but I did 6x50yd w/ 1min rest in 40-48 sec.  Pretty slow considering DIII college swimmers cover this distance in 21-22 sec, with a turn, but they also start from a starting platform.  

Tomorrow is my consult with Dr. S.  I'm really quite nervous about it.  I'm happy to see the fires in LA have spared his office and hospital, Cedars-Sinai.   Still no significant pain in the knee.  Looking back, I think I was biking up the mountain just days, maybe even the next day, after the Oct. '18 meniscus tear.  I think pain is not an adequate indicator of the severity of knee injury.  Meniscus injuries seem to have a great variability in treatment, but it seems to me, to achieve a higher level of athletic function, requires a higher level of treatment expertise.  

Pool

Pool opened today and I was there.  I had the place to myself.    Don't yet know how to structure my workouts so I tried to do something similar to what I do on the track.  I tried intervals of 100m, then a few 50m at the end.  Didn't swim much, 450m I think.  Didn't want to do a lot because it's a new thing.  Probably get sore in the lats.   I did 3x100m and 3x50m.  At the end of my 3rd 100m interval, I did just hit a max HR of 170 for a second.  My HR sensor was not connecting well with my watch so I don't have good HR data.  If I'm reading this right, my best 100m pace was about 1:21 sec,  slowest 1:45 sec.   I'm going to do this more often and see if I can get a routine going.  Don't enjoy it that much because it's upper body oriented, but it's better than nothing.  

Another CVD prognosticator

Another study.  Another possible risk factor indicator:  Triglyceride/HDL ratio.  Here is the study issue paraphrased:

Low-density lipoprotein cholesterol (LDL-C) has been cited as the main responsible factor in CVD. Nonetheless, even when LDL-C is well regulated, mainly with statin therapy, a residual risk for CVD still occurs, and it is attributable to other lipid components, namely triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). Increased TG and decreased HDL-C levels have been associated with metabolic syndrome (MetS) and CVD, and their ratio, TG/HDL-C, has been proposed as a novel biomarker for predicting the risk of both clinical entities... Inflammation plays a crucial role in the pathogenesis of cardiovascular disease (CVD), as it has been linked with both the initiation and progression of atherosclerosis. HDL-C has been linked to cardioprotective effects via its antioxidant and anti-inflammatory properties.

The above paper cites numerous studies showing the relationship between the TriG/HDL ratio and CVD.  

Looking back at my previous test results, when my LDL reached it's highest, 203 (on the egg diet in '21), my HDL also reached it's highest, 59, while my TriG were low, 73.  That gave me a TriG/ HDL ratio of 1.24. Best it had ever been.  Then 4 months later, I congratulated myself for lowering my LDL to 105.  But, my TriG/HDL ratio actually increased quite a lot:  117/44 = 2.70.   Not terrible, but significantly worse.  

As I had discussed in a previous post, the other metric that serves as a prognosticator for both CVD and stroke is the apolipoprotein B1/A ratio discussed in detail in this study.

possible Drs appointment cancellation/ postponement

Who could have thought my Drs appointment next week with Dr. Saliman on my knee would be affected by an out of control wildfire?  Are you kidding me?  My MRI disc was supposed to arrive Monday but tracking says it's delayed "by weather conditions" although it is in LA.  

Dr. Saliman's office on Sunset Blvd is literally one block away from a level 2 fire evacuation zone.  Level 2 means "get ready."  Level 3 means "go."  

I've been waiting for this appt for 2 weeks but some people in LA have obviously far more serious problems.   Assuming I get a meniscus repair, it will take 18 mo to get back to elite level.  Really not even enough time to get ready for '26 if my surgery is delayed much past Feb or March.  

We're about 36 hrs away from a major winter storm, and for here in the deep south, a "major winter storm" means more than 3-4" of snow.   And, due to gross incompetence at the Chattanooga Capitol Toyota dealer's repair shop, I will be without my 4x4.  After a month and 3 different diagnoses, I was told the truck needed a new transmission and transfer case for $9000.   I called BS, took it to the local transmission shop and it was what I originally thought and told them from day 1.... an electrical short in the wiring.  Cost for a new wiring harness installed:  less than $600.   Unbelievable!

Totally sedentary except for my daily 20 pullups, ab wheel, pushups, and bicycle crunches with ankle weights.   My V02 max is gone.   Pool opens Monday.  

MRI with contrast 2/19

2/6/19 just after my previous knee surgery I went to the ER with a heaviness in my chest, I was worried about a pulmonary embolism or clot.   After D-dimer tested high they recommended a CT chest scan with contrast.  I went down to the hospital and picked up the report and disc of that test today.  The report was very detailed and basically said the word 'normal' about 10x in regard to my heart and coronary arteries.  No mention of blockages.  Not really very informative.  FWIW...  

CV Study - dietary LDL / carb intake

This is an odd one.   Purely an anecdotal case study, but references a cohort study on a subclass of individuals who are “Lean Mass Hyper-Responders” (LMHR):  

A recent cohort study of 548 persons on carbohydrate-restricted diets (CRDs) revealed inverse associations between triglyceride/HDL-C ratio (TG/HDL-C) and LDL-C change, and between BMI and LDL-C change, on CRD. This means leaner persons with lower TG/HDL-C ratios generally exhibit larger increases in LDL-C on CRD. Individuals with a particularly pronounced high LDL-C, high HDL-C, low TG ratio are termed "Lean Mass Hyper-Responders." This report provides a clinical vignette of a patient who exhibits the Lean Mass Hyper-Responder phenotype, with LDL-C as high as 545 mg/dl, despite normal pre-CRD LDL-C of 95 mg/dl and consuming a CRD with a high unsaturated/saturated fat ratio. Coronary CT angiography conducted after 2.5 years of extremely elevated LDL-C reveals no detectable plaque development.

This seems to correspond to the time when I was on the zero carb 'egg diet'. Although I didn't exactly meet the criteria for this phenotype -  LDL-C ≥ 200, HDL-C ≥ 80, and TG ≤ 70 mg/dl, I was close:

March '21 - mean body weight about 138.5 lbs, likely about 9-10% body fat, LDL - 203, HDL -59, TriG - 71.   Never had my HDL been that high at the same time my TriG were that low.   My Trig/HDL was never better.  

The case study "LM" was only in his 20s, but after having a LDL reading as high as 545, after two+ yrs on the diet, angiography showed he had accumulated zero plaque or heart disease.  

Back to square one.  It's all very individual and complex.