“Getting Back on the Horse”

Today was my first day without any physical restrictions after having a surgical procedure four weeks ago; luckily, I am fully recovered and the procedure was successful. This was not the case six weeks ago; I had actually undergone the same procedure in mid-November and was not given the clearest guidelines for what recovery should look like. As a result, the procedure was not successful and I had a second go-around at the end of December. The second time, before surgery I was told to plan on 7-10 days without strenuous activity, but at the 7-day mark the nurse practitioner told me since I was a “repeat offender,” I should count on four weeks instead! Not fun for a personal trainer and someone who likes to stay active. I did not, however, want to undergo the procedure a third time so I took an entire week off of work after surgery and did not exercise for three weeks afterwards–although walking was encouraged.

I did blog about my recovery from foot surgery a few years ago. In that post, I shared five important pieces of advice for “getting back on the horse.” 1. Listen to your doctor, but also listen to your body. (I knew within a few days that the procedure in November had not worked even when I was told to give it some more time.) 2. Go slow; after an absence from the gym, do not just jump in where you left off but ease back into it carefully. 3. Set goals and have a plan for how to get there; having this written out clearly will facilitate a safe return to exercise. 4. Do not get impatient or give up; everyone’s recovery time is different and it may take longer than expected or desired. 5. Do some research; the more you know about the recovery before the procedure, the more realistic you will be going into it.

This afternoon when I taught my on-line fitness class, I participated in the workout instead of just sitting in a chair and giving instructions. I planned a workout I knew I could handle and…so far, so good. Many people do ask, though, how much “damage” or regression occurs when we do not exercise…and how soon does it happen?

Cardiovascular capacity can be decreased within just a couple of weeks–even more quickly for those who are endurance athletes like long-distance runners or cyclists. Muscle strength that is recruited during resistance training begins to suffer after about 3-4 weeks. These are just estimates and the actual amount of time will vary due to the level of fitness before the break, how active a person remained during the break (bed-bound vs. walking), and the cause of the recess. Obviously, a person who has joint replacement may take much longer to recover fully as opposed to a person who has an appendectomy. Each person is different so, as noted above, listen to your body.

I am grateful to my doctor and the nurses for getting me hale and hearty. I am thankful that they were extra-demanding of me the second time around. It made the difference in a complete recovery–even if I was starting to get restless.

After a fitness break–due to health reasons, travel, etc.–it will take time to get back on that horse…but get back on that horse we must. The more we take care of ourselves, the less likely we will need to take those medical breaks in the first place.

Recovery Time

Sometimes less is more, and sometimes more is more. When it comes to fitness, both can be true.

When it comes to our workouts, more time spent on cardio exercises has a greater effect on the number of calories burnt, endurance, and circulatory and respiratory capacity. With regard to resistance training, the heavier the weight, the greater the number of reps and sets, the more likely muscle will be built. The more you do the, the more you accomplish. The Jewish sage Ben He-He said “the gain is in proportion to the effort,” and he had it right over two thousand years ago.

At the same time, there is such a thing as overtraining. Some people take “the more, the better” to mean that they should be working out seven-days-a-week, 365-days-a-year. Overtraining can cause all kinds of injuries that can set progress back. That is why recovery time is so important.

There are a number of factors to take into account when considering how long we should recover after a workout (or even after a specific exercise). When working with some of my clients I may alternate between a group of core, lower-body, and upper-body exercises to give the muscles an opportunity to recover before moving on to a second or third set; in other cases, when we are working the same set of muscles, we take a short break between sets. These all take place within one workout.

Between workouts, however, we must think about:

The intensity of the exercise. The more strenuous it is, the longer recovery will take. This could be anywhere from 24-48 (or even longer) between working specific muscle groups; less time may be necessary if the exercise is more moderate.
The type of exercise. For example, weight training usually requires more recovery time than cardio. Several sets of bench presses on Monday may necessitate waiting until Wednesday to do upper body resistance exercises, whereas a bike ride on Monday might easily be followed by a run or a hip-hop class on Tuesday.
Your fitness level. If you are just beginning, it is all the more important to allow for recovery; going from 0 to 60 in 5.4 seconds might be great for your car, but the effect on our bodies is dangerous. It is important to slowly build up weight, number of reps and sets, while including recovery time. On the other hand, those who are more fit may find that recovery times are faster.
Age. As we age, it takes longer to recover. This is not always the case, but in general it becomes more important to take rest between exercising muscle groups, as well as to have days with no exercise or light exercise.
How well you sleep. A good night’s sleep is key to a good workout. Some of us sleep better than others, but if you have had a particularly rough night or simply did not get in the requisite number of hours, a recovery day is a good idea, or at least aim for a less intense workout.
Stress. This seems like an odd thing to consider, but it can have several effects. Some of us, when we are stressed, have a tendency to work harder or at a faster pace because we are “wound up;” this can lead to overtraining, lack of attention to form, and even injury. Stress also saps our energy; we may think we have the power to do an exercise only to find that our strength is flagging.

We may worry that taking time off or resting is “cheating,” but it is an integral part of the process of staying healthy and boosting our levels of fitness. Recovery time allows muscles to build/rebuild and gives our metabolism a chance to adjust to activity. It is also key to preventing injuries due to overtraining. Regular allowances for recovery help ensure that we do not have to take an even longer time for recovery because we have “overdone it.” Anyone who has ever had a surgery due to an exercise injury knows just how far it can set us back.

Remember: Work hard. Rest hard.

Exercise before Surgery

Early last week, one of the regular participants in an on-line class that I teach had hip replacement surgery. I teach the class 3 times/week and she is almost always there unless she is traveling. Even in the weeks leading up to the surgery, she has been participating fully with a few modifications.

I checked in with her a few days after surgery to see how she was doing. She told me that the surgery went well–no surprises–and that the recovery had thus far been better than expected. She further explained to me that she had no doubt that all the workouts had prepared her body for a speedier and easier post-surgical experience. I have a friend who had a benign brain tumor removed over 20 years ago; he had a couple of months before the surgery date and he did his best to get in as much exercise as possible. He wanted to give himself the best chance for a successful recovery; there were unrelated complications after surgery and his strength helped keep him alive. He made a full recovery and continues to work out regularly.

These two anecdotal stories illustrate something that medical research has backed up. Study after study shows that the better shape you are in before surgery, the more likely you are to have an easier recovery with positive results. For those who exercise on a regular basis, there is no need to pile on more workouts; those who engage in physical activity regularly are likely to have greater strength and improved cardiovascular capacity to begin with. There is an indication, however, that those approaching surgery may want to shift to more HIIT workouts. HIIT stands for High Intensity Interval Training; it is exactly what it sounds like: periods of intense exercise interspersed with periods of moderate or light exercise. For more info on HIIT workouts you can look at my post from July 2019 and a follow-up from August 2021.

Followers of my blog know that I have undergone a few surgeries over the past years. I have been fortunate to recover to 100% with each one. It is not because of luck alone, but rather because I have prepared my body to be strong and resilient. It goes without saying that if you have been scheduled for surgery, you should talk with your doctor to see what they recommend or discourage before going under the knife (or laser). Hopefully a regular regime of exercise, proper rest, and good nutrition will–like an apple a day–keep the doctor away…but when surgery is called for, the better we go into it, the better we are likely to come out of it.

A Month After Donating a Kidney

Framed Embroidery Kidney Anatomy Art. Hand Embroidered.

On the one hand, it seems like the surgery just happened. On the other hand, it seems like it was ages ago. I will blame my confusion on the residual anesthesia still coursing through my body.

When I posted last about my kidney donation, I was still in what I refer to as “the rough period.” This recovery has been more difficult than I expected. I was told that the first few days would be tough; the day of surgery and the day after were a piece of cake since I was on a lot of pain medicine. The following day when I went home was a lot harder; the car ride home was torture!

I got a list of what I should expect after discharge from the hospital, but somehow I was still caught somewhat by surprise. There was a fair amount of discomfort. I lost a lot of weight (which I did not need to do). I began to feel like I had turned a corner until 10 days after surgery. After 2 weeks, I was back to training clients virtually–albeit with naps in between! After 3 weeks, I was training my in-home clients, and then a few days later I went back to teaching my fitness classes. The main thing now is that I still tire quite easily; as I indicated in my last post, I have really had to listen to my body and figure out what I can and cannot do. I do finally feel like myself again, though, and look forward to building up my strength and endurance.

Would I do this again? Absolutely not–I intend to keep the one kidney I have left! Did I think this was worthwhile? Absolutely yes! A couple of weeks ago, my wife and I had dinner with Phil and his wife; he is the guy for whom I donated, but was not the one to actually receive the kidney since we were not a match. It was great to see how well he is doing; unlike the donor, the recipient feels better almost immediately. Sometimes in life we wonder if we really make a difference. This time, I know that I did. It was also just amazing to have this connection with a stranger.

Next week, the Cleveland Clinic will be hosting a reunion for the 3 donors and 3 recipients in our “daisy chain.” This will be when I meet the guy who got the kidney I donated (I try not to call it “my kidney,” because now it is his). I am kind of nervous about it. I had gotten to know Phil through social media, but the recipient is really a total stranger. I hope it will be just as amazing to have a connection with him; we will see how it goes.

In the meantime, I have heard about three people I know who need kidneys. One is in the thick of finding a donor. It is refreshing to see the outpouring of concern, support and prayers on Facebook. Hopefully, it will translate into something more. Hopefully, someone will see it–just like I saw a post last year–and decide not to keep scrolling, or to just “like” the post, but actually take the first step to find out about donating.

Despite all the discomfort, I feel so grateful that I was able to do this. I am thankful that I did not wait until it was too late. I am proud that I have made my health and fitness a priority.

Thank you to my wife, my family, and my friends for all their support. Thanks to everyone at the Cleveland Clinic: my doctors, the kidney donor coordinators, the nurses, aides, phlebotomists, environmental services, and administrative staff. In my book, you are all heroes too!

24 Hours after Bicep Tendon Surgery

Yesterday I finally had my bicep tendon surgery. After 18 months of on and off physical therapy and 4 cortisone shots, this was the next step. As I wrote in a previous post, I see this procedure as regular maintenance–just as I would do for a car. As long as I take care of my body, I hope that it will last me a long time.

Over the next few weeks, I’ll talk to you about my progress so it might be of some use to others who may be in need of similar surgery.

On Wednesday, I got a phone call to arrive at the surgery center at 11 AM. I would estimate that surgery actually began around 12:30. Once the anesthesiologist got involved, there isn’t a whole lot that I remember. The last thing I can recall is getting some Versed, after which the doctor began to do an ultrasound of my neck to figure out the right spot in which to do the nerve block. I remember eating some graham crackers in recovery; I remember getting into a wheelchair to be wheeled out to the car; I have zero recollection of the ride home or how I changed into my pajamas or how I got into my bed… Which is, frankly, how I prefer it.

I will admit that I am not exactly sure what the procedure entailed. It is called bicep tenodesis. I tried to watch a video on YouTube, but after about 20 seconds, I decided it was probably a better idea to just let the doctor do his thing. What I do know is that my rotator cuff was in good condition and required no attention.

And now, the recovery. I have a sling that I have to wear for 2 weeks; on top of that sling is an ice pack that I will need to use for the next 24 hours or so. I have to wear compression hose for 2 weeks to prevent blood clots; let me assure you, it is quite a look. No shower until Sunday morning (ugh!). On Monday afternoon, I have physical therapy with my favorite therapist, Megan, at the Cleveland Clinic. Originally I thought I would be missing one week of work, although now it appears it could be 2 weeks. I won’t be able to do any lifting with that arm with anything heavier than a coffee cup for the next 6 weeks.

The real challenge is learning to do the things that are necessary for daily living with my left hand when I am righty. Believe it or not, I found a way to dictate text on my laptop and that is how I wrote this blog post.

Of course, this is not the best way to spend my summer, but I am confident that in the long run, the pain will be worth the gain. I would rather have this taken care of now so that I can continue to enjoy an active lifestyle and be the best personal trainer that I can be.

In the mean time, wishing everybody Shabbat Shalom, and a good weekend! I will keep you posted on my progress.

What I Hadn’t Counted on After Surgery

It has been 9 weeks since my surgeries on my leg and foot. The recovery has been more arduous and painful than I expected. And I have learned a lot.

It is only since I began physical therapy exercises a couple of weeks ago that i finally began to see progress in my mobility and levels of pain. As a personal trainer, I am on my feet a lot; after a month of putting no weight on my foot, the shock of doing that again was dramatic. After having been off pain medications, I went back on again for a short time. I’m still taking Ibuprofen and Tylenol–although a lot less now. It has only been in the last week that I finally have been able to go through a large part of the day without pain.

To those of you doing PT…listen to the instructions and do what you are told! It makes a difference. PTs are amazing skilled health professionals and I am really impressed with their ability to spot (diagnose) issues and recommend the appropriate exercises. I even “borrow” some of them for clients who have similar complaints.

Here is what I really did not expect. I put on quite a bit of weight–about a 5% gain. This is due to a number of issues. I was forced to be sedentary. Medications (especially pain meds) messed with my system. I did not eat as I normally did since I was sitting around with little to do but…snack. My exercise regimen was interrupted.

I have been trying for over 6 weeks to get back to my pre-surgery weight and really been finding it difficult. I finally turned to a subscription weight-loss app. Too soon to say if I am making progress, but the tracking of calories is scary as hell and definitely showing me where I am making mistakes. I will let you know if it works.

It is noteworthy that weight gain is quite common after many different kinds of surgery. It is also notable that few doctors warn their patients that this is a possibility and to prepare for it–physically and emotionally. I wish I had known; not that it would necessarily have made a difference, but I believe that knowledge is power.

My big takeaway? With regard to both the pain and weight gain after surgery, patience is required. Others who have had foot surgery have told me to not give up hope or get anxious; it takes a while for recovery. This is true of nearly any surgery. I now see a pain-free light at the end of the tunnel, but it took me longer to get here than I thought it would. With regard to the weight, I am also learning that what took 8 weeks to come on will not come off in 8 days. Slow and steady wins the race.

At some point, most of us will have to undergo some kind of surgery; in my experience, I never felt like I adequately understood what the recovery would be like (if we did, would we ever agree to the procedure?!?). If there is a next time, I will ask more questions, adjust my expectations, and remember that there is a reason why we are called patients!

The Mental Work of Working through Physical Recovery

It has been one week since my foot surgery and hopefully only another three until I can walk again.
The physical recovery has not been as difficult as dealing with emotional issues that come along with an injury/illness. The first few days after surgery were not that tough; the block on my lower leg meant that I did not feel anything below the knee–especially pain. Once that wore off, I began to feel the discomfort. I really wanted to avoid taking pain meds since I don’t like the side effects, so I’ve been icing and trying to take it easy with several doses of acetaminophen daily. Today I wanted to go to morning minyan (prayer services); I got up, showered, got dressed, but was in too much discomfort to go. Big bummer.

The past several days have been difficult since I am so accustomed to doing a lot of the work to prepare for Passover. For those unfamiliar, imagine two Thanksgiving Dinners two nights in a row, but having to start with all new ingredients. In the past, I did a huge amount of the work and my wife pitched in with some sides and desserts. We were so excited to be doing all the preparation for the Seders together this year, but it ended up being all her. I tried to help where I could, but I felt kind of useless.

That feeling was made worse when I started receiving all the emails from the gym that all my clients were being cancelled for the entire month. That is a tough situation for anyone, but when you are just starting out in the industry and trying to build your client base, it feels devastating (even if the real effect may be much less). Since I don’t know what my recovery will be like and whether I will ever be back to where I was nine months ago before the pain began, there is an added level of anxiety. Will I be able to get back to training as quickly as I want? Will I have restrictions? Can I be successful at this new endeavor in my life? All questions swirling in my head.

It is always nice to have an objective party to discuss these issues with, and I did that today. I have in my mind that these four weeks are just a total write-off, but I can use this time productively. I will spend the week studying and hopefully obtaining my Functional Aging Specialization. Getting ready for that basically requires me to sit on my butt and read…I think I can do that this week. I also have to take things one at a time; I think we can all sometimes get into a downward spiral and follow a rabbit hole into the worst-case scenarios. I have to stop myself and let things unfold as they do without getting ahead of myself.

What has surprised me is just how much this recovery from surgery is emotional as well as physical. I have to deal with not working out, which is my usual stress reliever. I have to consider the possibility that my body may not fully recover. I have to face the fact that I am aging; this doesn’t mean that I’m all washed up, but rather that I have to change my approach. Hopefully, that awareness will make me a better Personal Trainer in the long run–especially as I train those in my peer group.

Wishing everyone a Happy Passover, belated Happy Easter, and all the best in whatever you celebrate. I also celebrate the process of healing–physically and emotionally. But it is hard work!