Knee Blog Index

Just some background about my situation:

● tore my ACL 7 years ago, doctor removed ACL but didn't reconstruct. I have no clue why he didn't reconstruct the ACL. Every doctor who has seen my knee afterwards has been puzzled.
● I went two more times to my doctor and another doctor to ask for an ACL reconstruction but they denied it because they said my knee was stable enough without it. And in Canada, the doctor is the gatekeeper--if they say "no", that means "no"
● since I didn't technically have to recover from the ACL removal bit, my experience might totally be different from someone who is getting the whole ACL removal and reconstruction done at once
● day-to-day life without an ACL was fine, knee buckled very rarely
● knee would "lock up" if jammed while straight-legged--I suspect because it separates. I think if I had focussed more on jumping during rehab, I might have been better at avoiding this
● gave up all sports after ACL tear, tried to get back into volleyball and badminton after a few years, but both times my knee painfully locked-up when landing a jump
● tried a second time to play vball with a C$1500 customized knee brace--knee locked up and separated on first jump
● was very active doing weights, yoga, p90x--more "controlled" activities 6x a week when accident happened
● I'm currently on business in Hong Kong, so all the prices of things are in HKD (1CDN = 7.4HKD)

091012: Massive Knee Injury 2009 Begins
091015: Playing the Insurance Game
091016: Counting Down to the Operation
091018: Timeline of the Operation
091019: Flex Bitch!
091016: Oh...My....God.....

Session 1: First Day of Physio
Session 2: Second Physio Session
Session 3: Lumpy Knee

Week 1: Getting Squirrely
Week 2: End of a Scary Month
Week 3: Getting Better
Week 4: Scar Mobilization and Dancing
Week 5: Feeling More Normal
Week 6: No More Crutches
Week 7: The Only Squat Toilet in All of Japan
Week 8: One Step Back, Two Steps Forward
Week 9:

091021: The Road to Recovery
091022: Cramps Suck
091026: Long Walk
091027: Overcoming Fear
091028: Why I Have No Feeling in My Shin
091030: Back and Forth Good, Sideways Bad
091108: Flying After Surgery


Knee Guru:
All things knee related from doctors and fellow knee-deficients.

ACL Tear Blog:
This guy got hurt about the same time as I did. His recovery plan seems quite different than mine, so it's interesting to compare our experiences.

Black Belt Mama:
This blog is for those people who like to read...a LOT. This girl describes every last gory detail. At some points, it reads more like a horror story than a blog. I'm glad I read this one AFTER my operation!

Oct 12 - Massive Knee Injury 2009 Begins

Last night I was walking on one of the overpasses in Central and in a freak accident, I misjudged a set of steps which caused my bad knee to lock up, and I stumbled and fell into a painful heap. I could hear things pulling and crunching as I fell.

Once I fell, I knew that my knee was fucked up. It was already relatively loose from having no ACL since it was removed 7 years ago. And the fall twisted and pulled my knee apart. I was on the ground rolled into a ball for a few minutes. After being painfully escorted back to my apartment, I propped my leg up and fell asleep.

Waking up throughout the night, I found that I had shooting pains in my bad left knee. Any motion I made shot pains through my leg. It massively sucked! So in the morning, I found some crutches and made my way to Asia Medical Specialists and saw Dr. CC Kong, a knee specialist with 20 years of experience.

After an MRI, Dr. Kong told me that I had a bucket handle tear in the lateral (outer) meniscus. The pieces were getting stuck in my knee which was causing the severe pain . He said that he wanted to operate as soon as possible as the meniscus would continue to deteriorate the longer I waited making it more difficult to repair.

So here I am lying on my bed trying to figure out my next steps. If there is a good side to this accident, it's that I'll get the ACL reconstruction that I was denied 3 times in Canada.

I dug more into this "double bundle" ACL reconstruction on the internet. It seems to be a relatively new procedure in the last couple of years. It's more complex but provides questionable improvement over the more common "single bundle" method. Plus, it's about 35% more expensive!

Single Bundle
Double Bundle
Surgeon             31,108              46,662 150%
Assist Surgeon             12,443              18,665 150%
Anaesthetist             10,369              15,554 150%
Hospital Fee             30,700              33,100 108%
TOTAL (HKD)             84,620            113,981 135%
CDN$             11,753              15,831

Add to these numbers the cost of the meniscus repair (another 35000HKD / C$5000), and....OUCH! With the high pricetag on this operation, my next step is to work on my insurers. I'm really bummed about all this...


crutch rental: $50 per week, 500 deposit
consultation: $980
MRI: $4800
- time to arrange MRI: 3 minutes
- time to arrange MRI in Canada: 3 months
surgery, acl double bundle reconstruct
- surgeon: $46000
- assistant surgeon: $18500
- anaethesiologist: $15500
- downgrade to single bundle: -33%
- upgrade to semi-private room: +50%
- upgrade to private room: +100%
surgery, meniscus repair
- surgeon: $21000
- assistant surgeon: $8000
- anaethesiologist: $7000
- upgrade to semi-private room: +50%
- upgrade to private room: +100%
Matilda Hospital charges incl 1 night stay
- ward: $33100
- downgrade to single bundle: -7%
- upgrade to semi-private room: +18%
- upgrade to private: +53%
TOTAL COST ward level: $150000
- equivalent to CDN $21000
- downgrade to single bundle: $120000

Oct 15 - Playing the Insurance Game

Growing up in Canada, I really have no concept about the cost of health care. When I get a boo boo, I just go to the doctor and get fixed up. I never see a bill. But this experience has really opened my eyes to how expensive it can get.

The past few days have been crazy. I have been spending my evenings talking to my insurers to see what they will cover for this operation. I thought that I would automatically be covered for this because if it happened in Canada, the doctor visits and operation would be covered by the government. Well, I've come to realize that unless you are basically about to die, the "emergency" insurance policy may not pay for anything. So if you ever get hurt, make sure you're not traveling!

I want to give big kudos to my underwriter and insurer Empire Life / Mondial Assistance. They have been extremely responsive and fair with their travel emergency coverage. They offered to fly me back first class to Canada to get the operation there. As a second option, a generous offer, they offered to pay for the operation in Hong Kong. Fucking AWESOME! Thank God someone at Mondial was feeling generous--I was on the verge of paying everything out-of-pocket when these guys came through for me.

My travel emergency policy under Travel Cuts Bon Voyage / ETFS Inc. was quite disappointing. Although they were responsive, they barely even recognized my injury as being an "emergency". Bitches. Don't pay attention to their definition of "emergency" on their website--they basically have an exclusion on any problem where you could, at some point in the future, return to your home country to get medical attention. So that's pretty much everything unless you're about to die.

So bottom line, when shopping for travel emergency insurance, make sure you understand the meaning of "emergency". If I knew this, I would have looked at other options--like expat insurance from Pacific Prime. In fact, I'm going to go there now...

One other interesting development was that the doctor reduced the total doctor fees by a whopping 50% after I told him I had no insurance and was going to pay out-of-pocket. He did this by dropping a second (hopefully redundant) surgeon from the quote. He also offered to do the double bundle for the same price as the single--maybe he's looking for more data points for one of his publications? Generous nonetheless.

That shows the pitfalls of dealing with private health care. They really are there to make massive profits. Maybe, I'll ask if they can give me a bottle of whisky instead of the anaesthetist!

Double Bundle
Surgeon              31,108
Assist Surgeon
Anaesthetist              15,554
Hospital Fee              33,100
Meniscus Repair              28,100
TOTAL            107,862
CDN$              14,980


Oct 16 - Counting Down to the Operation

It's pretty crazy if you think that I just hurt myself on Sunday and less than a week later, I'm going into a two hour operation to fix everything. I talked to a colleague in Canada whose wife tore her meniscus just recently. She is still waiting for the MRI and probably won't get it for another 3 months. And only after the MRI can she even look into booking an appointment for an operation.

To tell the truth, I actually feel a bit lucky to have this accident happen in Hong Kong. It finally allows me to finally get my ACL reconstructed. I am sure that my lack of ACL had a big part to do in this most recent injury. Although it only happens infrequently, my knee can lock up straight or buckle a bit at times. But this is the first time it's happened while I was going down stairs--a very inopportune moment. So it was really an accident that was waiting to happen. Luckily, it happened to me somewhere where I can do something about it.

So tomorrow is the operation. My knee is feeling okay--I can walk lightly on that leg now, but I can't straighten my leg completely without it feeling like it will buckle. I definitely cannot twist or move laterally without feeling instability and some pain. And there is soreness at the back of my knee when I am standing for longer than 10 or 15 minutes.


Oct 18 - Timeline of the Operation

6:00am Wake up and eat breakfast--I can't eat 6 hours before operation
10:45am Arrive at the Matilda Hospital. It's at the very top of the peak on the side away from Kowloon. It's an inconvenient place to put a hospital, but I get to see a view of the valleys and seasides. I make a mental note to explore that part of the island once I get better.
11:00am Fill in questionnaire and personal information with the nurse. Dr Kong comes in to see me and talk about the operation.
11:30am I'm taken to my room--a 3-person room. One guy in the room has something wrong with his hip, but my Cantonese isn't good enough to figure out the problem. The other bed is empty. I take a shower, washing with some red goop the nurse gave me.
1:10pm I'm wheeled into the operating room. I meet my anesthetist. He seems like a happy guy with an Aussie accent. We chat as he preps me for surgery.
1:15pm The anesthetist puts an IV in my arm. Starts pumping in the anesthetic. I feel a cold wave over the left side of my body. Then they put an oxygen mask on me. The first breath makes me feel light headed. I can't remember the second...
3:45pm I wake up with two nurses talking to me. I am groggy and they ask how much pain I feel on a scale of 1 to 10. It's about a six. I can feel the incisions throbbing in the front of my knee. They give me a shot of morphine. I'm wincing in pain as I'm wheeled back to my room.
4:00pm I'm back in my room. The pain is settling a bit, probably a 5 now. I fall in and out of sleep.
4:15pm Dr Kong comes into the room and tells me that the operation was successful. He harvested ligaments from my hamstring and used them to rebuild my ACL. He hands me a video on dvd and pictures. The pictures look pretty good. My leg is still numbed by local anesthetic down to the middle of my foot. Dr Kong tells me to start trying to straighten my leg and swivel my ankle.
6:00pm Eating a dinner ordered from their extensive menu. Hospital food isn't that bad after all! They remove the drip from my arm after shooting in some antibiotic and give me a couple of Panadol painkillers. There's pain the back of my leg. I can swivel my ankle with pain. I need to go pee really bad, but can't seem to do it--they've given me a little bottle to go in, but it's like my body forgot how to pee.
8:00pm HUGE relief...I can finally take a leak! Pain is down to about a 4.
10:00pm Pain is down to around 3 or 2. Pain behind leg is going away, but there's pain on the left side of my quad and the right side of my calf when pressed. I pass out watching the Miss Macau pageant with my ward neighbour. My leg is propped onto pillows.
8:00am Given 2 Panadol. My leg is still numb to mid calf. I can straighten my leg to about 160 degrees.
8:30am Dr Kong shows up and asks how I'm doing. I'm really impressed with the level of care Dr Kong is giving. I feel like he's actually concerned with my state and recovery. I didn't get this much attention in Canada when I had an operation done there.
9:00am Nurse comes in to remove the dressings. When the bandage comes off, I see they've shaved my leg--man I should do drag one day with legs like these! My knee smells funny. I see the 5 bandaged incisions on my knee--all at the front, 3 below the knee, two above. That's 2 more than my ACL removal operation. The incisions aren't bleeding anymore--the doctor sutured the wounds on the inside. The nurse puts a "tubigrip" tight elastic bandage around my knee.
9:30am A physiotherapist comes in and gives me my own set of crutches. She also gives me 4 exercises to work on during the next week. She shows me how to go up and down stairs with the crutches. Stairs freak me out.
12:00pm I get back to my apartment and just look at my leg. It's pretty unresponsive and very tight. It'll be a long recovery--but I think things will be okay.


Oct 19 - Flex Bitch!

My muscles have quickly forgotten how to keep doing what they were doing before the operation. I am working on my 4 lying-down exercises at home:

1. Flex and extend my foot while my leg is straight
2. Slide my leg up from a straightened position to a 90 degree angle and back
3. With leg straight, flex my quads to push my knee back and my foot up--to straighten my leg as much as possible
4. With leg straight, quad flexed, foot flexed, lift leg and lower back down

I need to do these each 10 times, 4 times per day. The most difficult exercise is the leg slide. I'm sitting here yelling at my knee "come on bitch, flex!". It's a bit strange when I have to concentrate so hard on doing something so "simple". It makes you realize how amazing the human body really is--everything is so complex that it becomes simple.

There isn't much painful pain. More like major tightness. The only pain happens if I accidentally flex my hamstring--then I pay the piper. I stopped taking the pain killers after the first day because there wasn't any constant pain. I'm still taking the anti-inflammatories though. I'm sleeping fine, both on my back and on the side away from my bad knee with a pillow propping up my leg.

One thing that I notice is that I've lost feeling in the front on my shins like it's still numb from the anesthetic. Strange.


Oct 20 - Oh....My.....God.....

I just watched the video of my operation. If you ever get an operation done make sure you ask for a video. Not only will you see exactly what is done, but it also gives the benefit of the Hawthorne Effect.

It's crazy watching the operation. It's like looking into a bloody fish tank filled with white and red seaweed. I can see him sucking out the blood from my leg. I can see him drilling into me and I'm yelling at him to stop, but he doesn't listen. I can even see him pull the camera out every once in a while and I see myself lying on the gurney. It's like I'm witnessing an out-of-body experience. In the end it looks like he ties up the double bundle with the same twine that my Dad used to prop up the plants in the living room...I hope it's not plant twine.

I can actually limp around without crutches today. But it's very jarring--so I'm sticking to the crutches until I can walk more smoothly. I left my apartment to get some food--using only one crutch. It wasn't too bad except for the few times that the muscles in my leg would suddenly tighten up and I would get a shot of pain. I also feel very uncomfortable if I stand still for a few seconds--it feels like blood is pooling in my foot and calf.

I'm still most sore on the left side of my quad and the right side of my calf. They feel like they're on the verge of cramping--I'm trying to massage it out.


Oct 21 - The Road to Recovery

I have been waking up pretty sore. Sore in my leg because it's tightened up over the night. And a bit sore in my back because I'm trying to sleep on my back all night. After a few minutes stretching everything out, I felt much better this morning. My knee is loosening up and feeling more stable day by day. I can walk okay today without crutches.

I've been doing my four exercises. They're not too bad--I think the hardest part is actually switching exercises because my muscles stay flexed for the last exercise. So it takes some concentration to relax and change to another motion.

I went to the gym and did some upper body stuff...felt tired and lightheaded afterwards. Actually, I've noticed that I'm pretty tired all the time right now. One sucky thing is that my right (good) knee is feeling sore now too. It must be because it has been doing so much work over the past week.

I just went through the recovery schedule the doctor gave me. Here's the pdf version for anyone who is interested. Basically here's the schedule:

Stage 1, Week 0 - 2: Learning to Walk
Stage 2, Week 2 - 6: Learning to Control Hamstrings and Quads
Stage 3, Week 6 - 12: Proprioception--Learning to Relate to the World
Stage 4, Month 2 - 5: Preparing to Return to Sports
Stage 5, Month 5 - 9: Return to Sport


Oct 22 - Cramps Suck

As the swelling is going down, it's actually getting harder to walk. I'm getting cramps in my calves, quads and hamstrings when I walk. I notice a bruise at the top of my calf now--I'm not sure if it was there before.

On the good side, I feel in better control of my knee and leg. I don't have to concentrate so much to do the 4 exercises. Tomorrow I start physio.


Oct 23 - First Day of Physio

I met with the Ice Queen today. And I'm not calling her that just because she iced my knee. She was pretty emotionless and was straight down to business. Needless to say, I booked another physio for next time--I need to feel that the other person really cares.

Anyways, she spent about a half hour with me, maybe even 20 minutes, it sure didn't seem very long. She went through my exercises with me--but pointed out that I wasn't straightening my leg to its fullest. It's actually difficult to realize that you're not straightened the leg completely without someone pointing it out. I also wasn't bending my leg enough when doing the leg slide. She basically told me to continue the four exercises I was given on day 2. But to push everything harder and she also suggested putting a rolled towel under my knee for the exercises which really forces me to flex my quads more. She also told me to focus on full leg extension--the bending will naturally come later as the swelling goes away.

She also said that the cramping was normal and that I needed to keep stretching. And she expected that I would get more bruises over the next few days as the fluids from my knee flush out into my calf and foot. I forgot to mention to her the loss of feeling along my time.

She looked at the bandages on my leg and said that I shouldn't change them for a while--once you expose your leg to air or water, you risk getting an infection. The girl after me had to get checked by the nurse because she had completely changed all her bandages.

I also bought a couple of ice packs because I have been a bit lax about icing my knee. She said I should ice my knee for 10 minutes 4 times a day.


1 session physio: $720
2 ice packs: $180

Oct 24 - Getting Squirrely

I must admit that I'm a bit frustrated today--I'm getting a bit squirrely staying in my apartment most of the day for the past 2 weeks. I didn't come all the way to Hong Kong to just get hurt and spend all my time recovering. How much TV and Youtube can I handle?! What a fucking drag. Totally sucks.

The worst time is first thing in the morning when I wake up. My leg is so tight. I do my exercises, then get up and I feel the blood rush to my calf and I feel like it's going to burst. My calf is looking like it's on the verge of becoming one giant bruise. On the other hand, my knee is starting to flush out a bit--I can start to see the outline of my kneecap once again.

The "teardrop" on my quad is completely gone--it's amazing how quickly the muscle deteriorates.

I walked around for about an hour today with one crutch--I can walk without crutches (albeit slowly), but I find that people are more careful around you if they see you have a crutch. And I'd like to have it available to smack down the person who knocks me off balance on the jam-packed streets of Hong Kong.

I still can't straighten my leg completely or lift it off the ground very high during my walking. Which makes it difficult to avoid a slight limp. And my quads, calves, and hip flexors are all cramping up. I now have a constant fear of sudden cramps. But I know I need to keep it up--I have to give my knee the best chance it has to recover. And that won't happen by coddling it.

I guess it's still only 1 week after the operation. I don't know why I expect to be further along than this. Recovery is recovery. I'm just frustrated looking out the window and seeing the world pass me by.



Oct 26 - Long Walk

I did good today. I was feeling a bit cooped up and got my crutch, put on my trusty tubigrip, and took to the streets. I walked a about 2 kilometres over an hour and a half (slowly!), from Fortress Hill to Quarry Bay MTR stations. I actually walked most of it without using the crutch--only when I was approached by a throng of people would I put down the crutch and look downtrodden so that people would walk around me. A crutch is a great signal to tell people to "Piss off!!".

I focussed on my gait. I'm still limping for sure--even when I focus really hard on it. I just can extend my leg out enough, I can't lift it enough to pull my foot back, and I can't do it all quickly enough to avoid the limp. Anyways, I'll keep working on it. I just had a few episodes where my knee had a wave of soreness or cramping. If I had found a taxi at those moments, I would have called it a day.

But I ended up making it to Fitness First. I just did a short ab workout. I also found I could actually do pushups just as long as I stayed balanced on my good foot. It's just hard to get face down on the ground in the first place.

Definitely the most active day I've had in weeks, and the knee feels fine.


DAY 10
Oct 27 - Overcoming Fear

I took the MTR back home yesterday--faced my fear of the super fast escalators. It's amazing how vividly my mind remembers things when there is pain involved. Since I had my ACL tear injury 7 years ago, I can recreate the moment playing volleyball that I landed off-kilter and heard my knee pop and was down on the ground just trying to push myself off the court. I can remember the pain, and I wince and shiver everytime I think about it. It's funny that I can't remember my first kiss, my favourite meals, my first dunk-a-dunk, but I can recreate the memory and emotions of my knees popping without any problems.

Now, I'm replaying the falling down the stairs incident in my head. And that memory is a bit more debilitating than the volleyball memory. I'm thinking, shit this could happen when I'm just walking down stairs! Sigh...

Today my knee wasn't so hot. Maybe I overdid it yesterday with the long walk? I walked a block to my gym and back and when I got home the back and outside edge of my knee were pulsing with soreness. I did my exercises, but took it down a notch because of the soreness. After icing my knee, the soreness went away.


DAY 11
Oct 28 - Why I Have No Feeling in My Shin

I'm starting to feel pain around the incision areas. Not all the time, just a few moments of burning that goes away after a few seconds.

I also happened to stumble upon the reason why I have no feeling in the skin on the left side of my shin. It looks like there's something called the saphenous nerve that controls the feeling to the skin in that area. This can get damaged when the doctor is harvesting the hamstring tendon. It sounded like a common occurrence--like 50% of the cases from one website I saw. One guy was describing the lack of sensation and numbness as being able to pluck the hair off his shin and not feeling a thing! I should try that! haha!

Anyways, I'll see if this improves over the next while. I guess it's not a huge deal--it's just weird. I just have a small patch, about a handspan, of numbness...some people have it all the way down to their ankles!

Other than that I think I'm feeling pretty good with my knee. Tomorrow I have another day of physio, so hopefully he'll do some measurements so I can get a better guage of how I'm progressing. From eyeballing it, I think my leg is pretty close to full extension, maybe a degree or two off. And it's getting easier to do the exercises--the leg slides still take some concentration and sometimes I feel a twang of something moving into place.


Oct 29 - Second Physio Session

I got a new physiotherapist today. Nice enough guy--pretty relaxed. It was his first time seeing a double bundle post-operation it seemed. He also has Canadian citizenship so we bonded over how long it takes to get an MRI in Canada.

He took off my bandages which were now stiff with dried blood. He said that it was okay to get my wounds wet now and to get fresh air on them. The three wounds on the outside of my leg are very small nicks. The two on the inside are longer horizontal cuts 2" and 3" long. He suggested applying some vitamin E lotion on them to reduce the scarring.

He measured my flexion and extension and said it wasn't too bad. I still need to work on getting full extension--I'm about 3 degrees short. He then gave me a couple of more exercises to work on until next week.

1. Standing on one foot with my bad leg and balancing
2. Riding a stationary bike with no tension for 10 minutes a day, increasing to 20 minutes twice a day

After the physio, my knee felt really good. A huge difference from first thing in the morning when I woke up all limpy and crampy. I don't think it's because my physiotherapist is a magician--it was probably that I got my knee active.


flexion: 103 degrees
extension: -3 degrees from straight, -5 without support, 2 degree lag
extension on good knee: +4 degrees

DAY 13
Oct 30 - Back and Forth Good, Sideways Bad

I went to the gym today and rode the stationary bike for 10 minutes. It started slow and tight, but got to 60 rpm by the end.

Afterwards, I went to do some walking practice and some ab work. While flipping over for the ab work, I tweaked my knee when my knee hung sideways for a second. It hurt, and it hurt to stand, and it hurt to walk, and it hurt for the rest of the day.'s so frustrating that I can get sudden pain if I make the wrong move. So from now on, I really need to control my leg when flipping over. I hope I didn't screw up the meniscus repair.

I also found that walking on even a slightly sloped service is a bit painful on my knee. I really need to watch the lateral pressure on my knee.


Oct 31 - End of a Scary Month

It's Halloween today. Instead of a night on the town, I'm at home watching the Simpsons Halloween Marathon. Just kill me now. I had to choose this over standing an hour in a 10-block line to join in the jam-packed jostling drunken crowd at Lan Kwai Fong. thanks. I can barely stand still for 5 minutes without my leg feeling like it's going to burst and even a slight stumble can spell trouble.

So two weeks ago I had my operation. How are things now? They're okay--slowly getting better.

1. I think my leg is pretty mobile now. I can walk without crutches and am just working on walking normally without a limp.
2. I've progressed to riding a stationary bike and balancing on my operated leg. The basic exercises are going well too.
3. No pain in normal circumstances. Cramping has reduced from the first week.
4. The stubble is slowly growing back on my leg and the gentle brush of fabric as I walk feels oh so good!

1. I still feel blood pooling in my calf and ankle when I stand for a few minutes or when I wake up from sleeping. Shin and ankle are sore from this.
2. Stairs and sloped surfaces are my nemesis.
3. I'm still basically house-ridden after 2 weeks. I can go out for dinner and drinks, but it's hard to stay comfortable the entire time.
4. Still sleeping a lot. I don't feel my normal pep.
5. If I have to watch that "Attention Must Be Paid" commercial one more time, I'm going to rip my eyes out!


Nov 5 - Lumpy Knee

I had another session with Tim. He said things were going well, there was no infections in the wounds. My knee is still puffy and warm so he told me to keep icing as much as possible. The puffiness is soft and pressing it seems to move it to the other side of my knee. My knee is a strangely lumpy mess.

I also told him that starting a couple of days ago I've had pain and tightness in my thigh and iliotibial band. Tim didn't seem too concerned by this. He said I could just massage it. He then measured my flexion and extension--I can extend my knee straight now, but my flexion seems unchanged. We also went on the bike for a few minutes where he said I should be going at about 90rpm--I was able to hit that speed after I gritted through the soreness at the back of my knee.

He walked me through a few more exercises to do over the next week:

1. Add a pillow or mat under my leg during the one leg close-eyed balance 3 to 5 times a day for 2-3 minutes
2. Increase range of motion by swinging leg over edge of bed and reducing the height of the stationary bike seat while cycling. Increase cycling to 40 minutes a day.
3. Slow controlled movement of knee along the plane of normal walking 15 minutes / day
4. Calf raises 3 sets of 20 / day -- since I can't exercise my quads or hamstrings yet, the calves are the only muscles I can get going now

Since I'll be away from Hong Kong for a little over a month, he also gave more exercises to do:

5. At 4 weeks, I can start doing hamstring strengthening in earnest. He gave me the hamstring kick and catch. Basically short small kicks while lying face down on the bed. Then I graduate to standing small short kicks. He stressed that I should take on hamstring exercises slowly and not to rush things as if I take it too hard I could strain my remaining tendons.
6. After the scabs come off, I need to start massage the wound to prevent it from sticking and causing stiffness. I can also start to swim with light kicks.


flexion: 103 degrees
extension: 0 degrees from straight, -2 without support, 2 degree lag

Nov 7 - Getting Better

I had an appointment with Dr Kong yesterday. He checked my knee and said everything was going well. I've noticed that my knee got significantly better this week. The cramping in my calf is gone, the bruising in my ankle and calf is subsiding, and I am feeling better walking.

I also went out to a bar for the first time since I've been injured. My friend said that the alchol would make me forget my knee. I told him that I didn't want to forget my knee bitch!! Anyways, I went out without a crutch for the first time and I became a bit paranoid, especially with the crowd. I did get a bit tipsy, had some fun and made it home without any casualties.

1. The pulsing pain of the blood pooling is going away. I can stand for a while without feeling it. But the circulation must still be bad because I'm getting a cankle after walking or sitting for a few hours.
2. Can walk up stairs now. Takes some effort to lift leg to stair height though. My PT seemed a bit dubious about taking stairs at this point, but gave in and said I should only do this when I have 50% of my weight on a crutch.
3. On the stationary bike 20 minutes at about 85 rpm now. My leg feels pretty good after cycling.
4. I'm starting to get over that emotional funk I've been in since this whole thing started a month ago. It hurts when you get knocked down from feeling on top of the world.

1. The painful area seems to keep changing week by week. My thigh and iliotibial band are sore as shit right now. Trying to massage it out, but it's painful.
2. My legs are still wasting away as I can't do any quad or hamstring exercises. It's amazing how long it takes to build muscle, yet within a very short time it can waste away. On the good side, my good leg is staying pretty fit from basically doing hundreds of single leg lifts every day.


DAY 22
Nov 8 - Flying After Surgery

When I saw Dr Kong a few days ago he said that I should be okay to fly. He just suggested that I keep my foot and calf actively moving so I don't develop any DVT blood clots and die. Great...

So the 2 hour flight (+1 hour delay on the tarmack) to Beijing went ok. The wounds on my knee were getting a bit sore and blood was pooling in my ankle eventhough I was constantly flexing my calf and foot. When I got up, my leg was a bit stiff, my limp was pronounced, and my shin and ankle were sore from the blood pooling.

When I got to my hotel, I went to the gym to do my stationary cycling. It was a bit crappy because every time I got to about 65 rpm, my thigh would cramp until I stopped. I kept repeating this about 4 times before I gave up. At least I got about 15 minutes of slow cycling in. Tomorrow is another day.


Nov 14 - Scar Mobilization and Dancing

A scab fell off my main incision at the beginning of this week and there was a tiny bit of fluid leaking out. I didn't think the wound had sealed fully yet--there seemed to be a bit of an open hole there. So I bandaged it up for a few days until a new scab formed over the hole. It's interesting--when I lightly rub along one side of that wound, I can clearly feel an electrical zap go across my shin. It actually feels pretty cool--on the bad side is that I get electrical zaps through my shin during the day when it rubs against my pant leg.

I've started to massage and mobilize the scars that have healed over to make sure that they don't attach themselves to the underlying tissue. This should keep the area looser. The main scar is definitely attaching because it doesn't move freely when I push it, but I can't do the mobilization until it has completely healed. The physio said we could still break down the scar attachment without any problems after another month.

I'm also rubbing some Body Body eye rescue serum onto the scar to reduce the scarring. I feel bad for women who have this operation--I'm sure I'll have significant visible scars from this.

1. The cramping in my thigh is going away and I think the muscle wasting has slowed to its natural turning point. It's also nice to be able to do the heel raises and work on my calves a bit.
2. Cycling is getting better, I can get up to 90rpm without too many complaints from my knee. I can get up to about 100rpm before my knee can't keep up. I'm doing about 20 minutes a day and my knee feels pretty good afterwards.
3. The cankle syndrome is disappearing. I can sit for a while without my ankles puffing up too much. But my knee still feels stiff when I first stand up.
4. I actually went dancing last night. Now mind you I'm more of a rave dancer than a come-on-baby-let's-do-the-twist guy, so it's probably wasn't that tough on my knee. I also had a few drinks in me--which although was probably a bad idea, it was the first time I forgot about my knee in a while. When I got home, my knee felt fine.

1. Any quick movements can fuck me up. I slipped a tiiiny bit when walking in from the snow, where my bad leg slipped forward and I felt pain in my hamstring. It went away pretty quick, but it scared the shit out of me. I feel very vulnerable.
2. I tried to do the kick-and-catch exercise lying on my front. Holy cats, I can barely kick let alone catch. I don't have total control over my leg and my hammies are weak.
3. I take back what I said last week about being able to climb up stairs. It hurts the front of my knee to lift it to stair height. Not doing it anymore. I've decided that I'm going to use one leg for stairs for the rest of my life.
4. Traveling in another country when you're disabled sucks.


Nov 21 - Feeling More Normal

Another week in the log book. Things are getting better--at the worst times my knee and hamstrings feels a bit tight. After a few minutes stretching it out, it feels pretty normal.

The proprioception exercise is still tough. I'm supposed to balance on my bad leg with my eyes closed. WTF? I can't even do that on my good leg! After 10 seconds at most, I'm done here.

1. The main incision has finally sealed as of today--scab fell off. Now I can start to massage it around a bit. It's pretty obvious that the scar has attached because it doesn't move freely. I'm actually not sure how I'm supposed to do the scar mobilization, I should have asked my PT before I left HK--so I'm just going to rub it around a bit every day.
2. Cycling is getting better. I've started to lower the seat to make my knee bend more and still going 90rpm. I'm guessing my flexion is now about 120 degrees. My extension is at least zero and maybe 1 degree of hyperextension.
3. I am doing the kick-and-catch exercise lying on my front. Still tough, but doing about 90 per day. I'm supposed to be doing more like 3 or 400. I tried to add about 2 pounds of weight (okay it's more like I was trying to do them while still under my warm bedsheets), and I felt pain in the front of my knee so I stopped. Calf raises getting easy.
4. There are short moments where my knee feels like a normal part of my body. It's not moaning for attention all the time. I walked around Shanghai today without a crutch for about 3 hours without any problems.

1. My leg under the knee gets flakey dry a few hours after putting lotion on. Especially the spot where I've lost feeling. The scars where I put the eye cream stay flake-free though. I guess eye cream does have something special in it--it's not just marketing!
3. I think I need to stand more. I was waiting an hour for a taxi and felt soreness in the back of my knee, I felt like I was standing on a wooden peg-leg. I did my mini-knee bends and it felt better. Have been a little lax on my mini knee bends, now I know why the physio suggest 15-20 minutes of it every day.


flexion: about 120 degrees
extension: about 1 degree hyperextend

Nov 28 - No More Crutches

Not much happening this week. I think I've gotten past those weeks where I make substantial gains. Now it's just slow and steady recovery. The hotel I'm staying at in Tokyo doesn't have a gym--so I'm out of luck for the stationary bike exercises. Grrr.

Scar mobilization is a bit painful. Maybe because I'm doing it wrong. I actually felt something rip under the scar like velcro while doing this earlier in the week--I think that's what's supposed to happen.

1. At the beginning of the week, my knee suddenly seemed to have a lot more mobility. On the sitting knee slides, I can get the same bend as my good knee.
2. I've stopped using the crutch when walking outside. I realized that I'm basically just carrying it around--I'm not using it at all. And I've gotten over the paranoia that other people will accidentally knock me over (even in jam-packed Tokyo). I've started to walk up low stairs with my bad knee.
3. Most of the swelling is gone. My knee is still a tiny bit puffy and there are lumps at the incision sites, but it's pretty much looking like a knee now. I'm realizing how boney my knees really are!

1. I have "shy actuary" syndrome where I am always looking at my feet when I'm walking. Need to learn to walk like a normal person again.
2. I tried to do some knee extensions with the gym machine (no weights) and found that it hurt the front of my knee, so I stopped. I will give up on these "open chain" exercises until my physio gives me the go ahead.
3. I'm getting pops and crunches from my knee during the standing quarter squats and when I straighten my leg to hyperextension. Rice Krispies anyone?


Dec 5 - The Only Squat Toilet in All of Japan

Akawesley vs. Insurers, Round 2: This week I got a "thick package" from Mondial Insurance. I told my friend back home to open it, hoping that it was full of 15,000 $1 bills. Unfortunately it was my original receipts back and a letter asking for a decline letter from my primary insurer, Global Excel. Fawk! Talk about frustrating! I'm dealing with both insurers, submitting exactly the same thing. And now everything will probably take another couple of months because I have to resubmit all my receipts to my primary insurer--they told me I need to do that just to get the decline letter. I guess I wouldn't complain so much if I wasn't....on the other side of the world. Bitches! Argh!

Yesterday, I did a day trip to Hakone. Lots of walking and climbing up and down big steps. I got to see the majestic Mt Fuji. Fantastic! But with an unbelievable stroke of bad luck, I had to use what must be the only squat toilet in all of Japan. Needless to say, I didn't squat--I just did the blind bomber thing. My aim wasn't too bad, just a few outliers.

In the evening I went out dancing at a club in Shinjuku for a couple of hours--a boy's gotta have some fun... But now today my knee is swollen and a bit sore. It hasn't been this swollen for a while and I can really feel the sponginess in my knee when I try to walk. I'll lay low today and let it drain.

1. The steps in Tokyo are perfect for rehabilitation. They are about half the height of normal steps. I've been going up and down them for the past week. I'm cheating a bit on going down stairs...I'm more like floating down on the balls of my feet.

1. There seems to be more pain in my knee this week. Maybe because I'm trying movements that I wasn't doing before. Maybe because I missed the stationary bike all week. My hotel has no gym. The pain is mainly some soreness at the two incisions on the front of my kneecap while walking or standing. It's also hurts a bit during my mini-squat exercise, especially when I press my knee back straight into standing position.
2. Ingrown hairs


Dec 12 - One Step Back, Two Steps Forward

Wow, the swelling from last weekend was pretty bad--it was like it was after the operation. I couldn't straighten my leg because of the swelling and I had to use my crutch again when I went to the airport with all my luggage. I was a bit worried I did something serious. It stayed pretty swollen until about Tuesday and didn't go down fully until around Friday.

But now that the swelling is gone, my knee feels pretty damn good. My ROM is back to what it was last week, probably a bit better. I still have a long way to go, but at least I can feel improvement from week to week.

I'm in Singapore now--last stop before I go back to Hong Kong tomorrow. I can finally get back into a regular routine! Yay!

1. I plan to get back into my workout schedule hard core next week. Actually about a year ago I started doing the P90X program. Awesome program! Finished my first round. And then in 2009, I did a few false starts on my second round. When I hurt my knee, I was a month into the P90X schedule. Time to try again!
2. Stairs are getting better. I'm always expecting some pain when going up or down stairs, but this week has been pretty painless. Although I have jammed my leg a couple of times while walking on uneven ground and that smarts.
3. I finally have another Physio session next week when I'm back in Hong Kong. I want to progress more and getting input from Tim will be great.

1. My new found ability to self-shock my shin has disappeared. Boo!
2. Itchiness! I had a couple of episodes this week where I had an annoying itch around my knee. Maybe it was a mosquito bite or something.
3. My friend invited me to the ZoukOut party in Singapore. 30,000 people dancing on the beach on Sentosa Island with international DJs. I had to decline. The thought of 30,000 people on the beach scares me right now. Actually, the thought of just walking on the beach scares me right now!


Dec 19 - Back to Physio

After looking forward to it for over a month, my physio appointment with Tim on Thursday was a bit of a dud. He basically told me to continue with my exercises, but with more vigour. I wished I could move into different territory, but he told me that I'm really not ready yet to get into more strenuous activity.

I also asked him about the scar mobilization. He pressed the scars over to one side and pointed out that they were kind of puckering up and not moving freely. So he began massaging the shit out of it, which hurt. He said I need to detach the sticky point--but said that there's a 6 month window after the operation when your body is in a rebuilding phase and the mobilization helps.

1. After my session with Tim, I did the kick and catch exercise differently. Instead of focusing on and tensing my knee during the kick, I focused on my foot and the actual kick itself. At first it felt a bit like my knee was getting pulled apart. But since I've changed the kick, my knee has felt looser afterwards.
2. I feel like my knee is capable of most movements now. Everything is feeling more natural and it's getting closer and closer to feeling like a normal knee.

1. Massaging hurts!
2. Since the swelling from last week went down I have having the same sort of pains from week 7 again when standing. And my knee seems to fight with itself when it's straightened--it gets wobbly. Not because it's unstable, but because my muscles are spasming a bit.
3. My knee is popping and crunching quite a bit during the mini knee bends. Tim listened closely to the sounds and said that it's coming from the joint itself. I asked if that was good or bad, and he said that it's not a big deal unless there's accompanying pain. I'm not sure if I believe him.


Dec 26 - Feeling a Bit Lopsided

The scars are still kinda scabbing up and falling off. I'm applying vitamin E lotion on the scars--they're pretty ugly. Definitely looks like a guy with a lop-sided smile.

1. I can flex and bend my knee in mid-air--it's difficult but not much pain. Before this, I was feeling a twinge whenever I tried it.
2. I've caught myself naturally running down steps and climbing up 2 steps at a time. Whoa horsey! I'm thinking this means I'm feeling more normal and I am starting to forget my knee situation.
3. Increased the tension on the stationary bike to 2. Just doing 90 rpm 20 minutes a day. My bad knee gets a bit sore with about 5 minutes left.

1. Massaging still hurts. Scars still seem stuck.
2. Leg is still weak. I want to progress to weights, but right now even that kick-and-catch exercise leaves my knee a bit sore, puffy, and a bit of pain on the outside of the knee when I walk. Standing leg curl is tough.
3. I swear my bad leg actually feels longer than my good leg when I'm standing. I don't know why. But it does. It's like I'm lopsided.


2010, Jan 2 - Making Peace

Happy New Year! I'm hoping this decade is easier on my knees than the last one! I went out with some friends to the crazy packed Lan Kwai Fong to bring in the new year. Actually, when we were walking there I passed by the "scene of the crime" where I had my fierce tumble. I was sad to see that it was still the couple of measily steps--what a joke...but I forgave the steps, made peace within myself, and now I can move on with my life. :P

1. It's great when you meet other people who have had knee operations as well. You can quickly bond with strangers over the experience.

1.There's still that pain every once in a while in the back outward side of my knee. Either a lingering soreness or a quick shot of pain after my exercises have weakened my leg.
2. Long workouts. I've progressed to doing two P90X workouts a week--lots of pull ups, push ups, and arms.Yoga, Plyo, Legs are not really possible at the moment, but I'm planning to add Kenpo to this week's round. But it ends up being an hour doing this workout, 15 minutes on abs, 20 minutes on the bike, and another 20 minutes doing my leg exercises. I am not a fan of 2 hour workouts.


Jan 9 - 3 Months Post Operation

I had my first physio session of the new year on Thursday. Unfortunately I was about 30 minutes late, and Tim wasn't too forgiving and just gave me a 15 minute quicky. It's kind of unfair that when he's 30 minutes late, there's no problem, but when I'm 30 minutes late, I lose my session. But I guess that's the same with any business.

The physio session held a bit of promise. I was much more capable with the exercises he gave me before. He gave me a new exercise to begin strengthening my quad which is still very weak. I just put a exercise ball behind my back and squat and stand. When I did it, I naturally shifted all my weight to my good knee. With some concentration, I evened out the weight and my left quad quivered. I could see the muscle squirming like worms as I konked out after about 10 reps.

But it's great that My PT basically gave me the go ahead to start working my quads lightly. This feels like a big step from being in a preservation state in the previous weeks.

I should also mention that I've started taking my protein powder again. It was really because I'm trying to get back into the P90X workout thing. But it dawned on me that protein powder might be a good thing to take while trying to recover from this injury. Especially now as I try to build up my quads.

1. I get to start quad exercises. Woohoo! My bed leg is much thinner than my good leg. The thinness makes me realize that's how my leg will look like when I get old and frail. Ugh.
2. Standing leg curl is not too bad now during the kick and catch exercises. The tightness is gone. PT told me to kick harder, and wear shoes for extra weight. He also told me to stand on a pillow when doing the close-eyed one-leg balance. And to do the calf raises on the edge of a step to get more range of motion.
3. I had friends visiting me in Hong Kong this week and we did tons of walking, including a lot of stairs, and went dancing in the evening. It sounds reminiscent of week 7. The main difference is that although my knee was a bit sore by the end of the day, it didn't swell up for 3 days like last time. Progress!
4. Increased the tension on the stationary bike to 4, 90 rpm, 100 watts, 20 minutes a day. Now I'm starting to sweat.

1. Regarding that "dead" patch on my shin--I noticed it still has no feeling. Not a big deal--but I thought I'd give an upate.
2. Wow, it's been 3 months. I thought I'd be a lot further than this. I still haven't done any weights with my legs and I still sometimes feel discomfort when taking stairs or even just standing. I don't remember my first ACL removal operation taking this long to recover.


Jan 16 - Don't Watch Wipeout

My PT appointment with Tim this week was good. We went through my exercises and he said I was doing well. He even made me one-leg jump and land--I was a bit nervous to try it but I surprisingly did it without pain. So he upped the exercises. First, I'm adding a single leg balance on one of those half-ball thingys for 2 minutes at a time. And a single leg wall squat with the ball behind my back. Nooice!!

He asked me how I was doing going down stairs. I thought about it and said that I wasn't going down them normally. When lowering down the step with my bad leg, I really go on my toes on my bad leg and then drop down with my good leg. He said that he didn't expect me to be able to do stairs properly yet, but he said these new leg strengthening exercises will get me back to normal.

I also told him that my scar massage wasn't doing anything. The scars seem just as stuck as they were a month ago. He said it was a slow process and that I should keep massaging the shit out of them.

1. Added Kenpo and Yoga to my P90X workouts this week. I only finished about half an hour of the Yoga before giving up. But all the static lunge positions in yoga should be great to help build up strength and endurance.

1. I really hate the random uneven steps on the streets of Hong Kong. I think I'm naturally oblivious. In Canada, walking down a street and taking stairs is a totally separate experience. You don't do both at the same time. I know I sound like a suck, but it's surprisingly problematic. Am I the only person who gets fucked up with this in Hong Kong?!? Probably...haha!
2. I was watching the tv show Wipeout today. What is wrong with these people? Everytime someone bounces off the Big Balls or gets slammed in the face by a tilting platform, after I laugh hysterically at another's misfortune, I think "wow, I hope they didn't hurt their knees". I would suggest not watching Wipeout after an ACL injury.


Jan 23 - Starting Lunges

Single legs squats are a bit painful. When I get to about 110 degrees, it feels like the two scars at the front of my knee are getting pushed out, and I feel some pain. I worked through a set of 10 and then called it quits. Later in the week, I had my PT appointment and he told me that I should let up a bit if there's pain. We modified it so that I am basically back to doing single-leg quarter squats and just getting deeper as the pain lets up.

He also added lunges, 2 sets of 50 a day. These don't hurt as much as the standing wall squat. And to improve my balance more, he added tossing and catching a ball while I'm standing one-leg on the bosu.

So that's it. My last PT appointment before I head off on my world trip. I am a bit sad because it was nice to have a second opinion on my progress. For the next few months, I'll have to find my own path to recovery.

1. I see the muscle start to build back onto my leg. There's a slight outline of the "teardrop" muscle coming back.
4. Increased the tension on the stationary bike to 5, 90 rpm, 120 watts, 20 minutes a day.
3. I tried jogging and little jumps on the spot this week. I was a bit worried to try it at first, but my knee felt fine. My PT suggested that I shouldn't run very much until I get more leg strength.

1. I added the Legs & Back session from P90X to my workout--and planned to do all the exercises without any weights. I went through about 60% of the exercises before my knee was feeling too sore. Overall, probably about the 100 lunges that my PT recommended. That night my knee was sore and puffy, and I couldn't straighten it without some pain at the incisions. The entire next day there was some soreness left, but it wasn't too bad.


Jan 30 - Famous Knee Injuries

You are not alone:

Mary Pierce

Tomas Kopecky

Bode Miller
Downhill Skiing

Tom Brady

Michael Owen

Danny Manning

Andrew Flintoff

Tiger Woods


Akawesley vs. Insurers, Round 3: Called those bitches from Global Excel / Travelcuts to see why they're sitting on my claim for so long. I already know they're going to decline. They already know they're going to decline. We knew this 3 months ago and clarified it 2 months ago. Why does it take 6 weeks to send me the decline letter?! They said they just sent the decline letter "today". So I just magically called exactly the day they sent out the letter? Yeah right.

1. I should mention how my knee feels overall. It's pretty good day to day. There's clicking sometimes when I straighten my leg. There's some soreness sometimes when I'm just standing still, but walking is fine. There's still a little crunching noise when I'm moving my knee--probably not a good sign. My bad knee can bend as much as my good knee. I can squat on both legs to about 90 degrees. I can do little jumps. Jumping jacks. Kick. Sit cross-legged. I can almost sit on my knees, but I'm too afraid to put my full weight on it right now.

1. Wow, 100 lunges is a lot more than it seems. I've broken it down to 4 sets of 25. My leg is pretty weak and near the end, I find myself using inertia to pump myself back up from the lunges. Definitely not getting good form on these.


Feb 6 - End of This Blog

So I'm 4 months after the operation. I'll probably be ending the blog now. I feel like I'm well on the road to recovery. Hopefully, I'll get back into some sports later this year now that my ACL is intact. But I don't have any burning timelines to recover--I happy enough to have a good knee.

I left Hong Kong this week and started on my work leave. It's great that my knee recovered enough before I started my leave. I took my crutches to Ruttenjee Hospital and used my broken Cantonese to donate them to another unfortunate soul.

So my first stop is Bangkok--I'm meeting up with my sister to do some sunning in Phuket. Someone mentioned to me that I should cover up my scar if I get into the sun, otherwise it might darken permanently and become more visible once it finishes healing. It kind of makes sense since the skin is new and probably burns easily. So going out in the sun, I'm putting band-aids on the big scars.

1. Went swimming for the first time since my injury without any problems. Completed the entire P90X Yoga and P90X Legs routine without too many hiccups. This means my leg is getting stronger and the squats aren't as painful as before.


Apr 3 - Want to See the Numb Spot on My Leg?

I know I said I ended the blog, but just one more cool thing. I was walking around a park a couple of days ago and got eaten by the mosquitos. Ok, so a few of the bites just went a bit red like normal. One of the bites was in the patch of skin below my knee where I can't feel anything since the operation. The exact area of the numbness flared red from this one little mosquito bite. Actually the numbness probably extends another 1/2 inch outside this patch. Very cool and interesting!

numb patch after acl reconstruction


Aug 12 - Akawesley Vs Insurers Round 4, 5 and 6....

....winner: Akawesley!!

So what happened since February? I finally got the rejection letter from Global Excel, sent that to Mondial, got everything returned from Mondial saying that I had to submit the receipts myself to the Ontario Health Plan (OHIP), sent everything to OHIP, waited a month, got everything returned from OHIP saying that I filled the form incorrectly, sent everything back to OHIP, waited a month, got 5% paid by OHIP, they kept original receipts so I sent copies back to Mondial with the results of the OHIP review.

Then today...tadahhhh! Two cheques from Mondial. Cha-ching! I feel like I've won the lottery. Although I don't plan to play this lottery any more in the future!

% of Total
TOTAL COST               14,980               100%
Ontario Health                    733               5%
Mondial               11,699               78%
TOTAL REIMB'D               12,432              83%
Out of Pocket                 2,548               17%

My knee is pretty functional. It just creaky like an old rocking chair. I don't think I've been working it out as much as I should be. And every day I tell myself that I will do more. So that's happening slowly. Sometimes I can feel my leg muscles working hard to get up stairs, so it's still relatively weak.


see itinerary