RE post operation thread + updates + auto refractometer

Posted , 11 users are following.

1- Cornea related stuff

So last time after the LE (near IOL eye) was done my wife ended up with corneal erosion in the line of sight = very blurry vision.

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On the post OP day the normal steroid drops were stopped for 2-3 days and repair lubricating gels were given. After 3 days Dexa free steroid drops were then started. Wife had fully blurry vision for 6 days and then the cornea healed and she finally had super sharp near vision in the LE!

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Now for the RE, the surgeon used the strategy of using loads of vitamin A gel after he closed the wound and disinfected it properly. No steroid drops for the 1st day. Today was post OP check and he found 2-3 small dry dots on the cornea even though the eye was swimming in lubricant Vitamin A gel. No full erosion/patches on the cornea like last time but still enough to cause some blurriness.

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Now he is 99.99% sure as to what was happening as my wife never had dry eye issues coming into both operations.

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My wife's cornea seems to react to Betadine (the iodine containing disinfectant used for eye surgeries etc, there are no alternatives to it and it HAS to be used during surgery).

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The last time when LE was operated, Betadine must have caused some damage to the cornea. Then when the strong steroid drops were used on top, the damage was made lot worse and resulted in my wife suffering severe burning pain and longer blurry vision. So if wife had taken steroid drops like last time, the RE would again have had more pronounced corneal erosion like the LE.

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Doc has told us to take Vitamin A gel on it's own for one more day (nothing else) and then start with Dexa free Steroid drops from tomorrow. He wants the cornea to heal bit more. We have to go back on Tuesday for follow up check with one of his assistant like last time, just to be safe (he is away operating). He is sure that she will see super sharp like the left eye.

2- Current "visual quality" status of RE (far eye)-

Yesterday wife was seeing blurry post OP (normal). This morning she started seeing 90% sharp. It is improving all the time. The 2-3 dry spots on the cornea + only one day since OP + very thick layer of Vitamin A gel= 10% blurriness in the RE (last time at same post 1 day, LE was 90% blurry).

We had 1 hour walk on the way back from the surgeon today, aim was to provide more visual data to the brain so that it could kick start the software upgrade process.

Wife started crying during the walk because she was able to see everything so much brighter, clearer and colourful. With RE only she can see my eyes from 40cm away. Car number plates she could read very well 30m away. Company signs 40-70meter away. She could recognize people from far away which she has not been able to do for last 4 months.

Hope all goes well and she gets to 100% sharpness.

3- Eye measurement conundrum (RE and LE)

LE was targeted for -1.25 and RE for -0.25

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RE readings 1 day post OP are meaningless but auto refractometer says...

1 day later= +0.25

Now the confusing part! LE was operated 4 weeks ago.

3 day later = -2.75

7 days later = -1.50

4 weeks later = -2.00 wtf ???????

We checked the measurement printouts when we left the clinic, on seeing -2.00 we went back and luckily the surgeon was outside to collect the next patient, so we quickly grabbed him and asked him about it. He said don't worry as auto refractometer are not accurate specially post OP.

**Note- ** The sharpest focus point for LE has not changed since day 7. We have measured it 2-3 times daily. It has stayed exactly same since day 7 at average distance of 45-47cm. If anything it has moved away couple of cms and not closer. On day 3 it was around 30cm.

Both eyes are working together well already for my wife. So I am not sure if there is really a difference of 2.25 diopters between both eyes!

How will we get absolute accurate measurements in the future? Via Keratometer?

Conclusion

We are cautiously optimistic and happy. Wife sees super sharp near and far vision is improving 10 times faster than LE was. Combined vision is very good too!

STAY TUNED!!!! Free Cataract roller coaster ride!!!!!

3 likes, 63 replies

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  • Posted

    Glad to hear she is recovering more quickly after this surgery and her vision is good! Regarding autorefractor, on day one postop of my exchange, dr saw me looking at the autorefractor numbers and said "ignore them - they will change".

    Regarding her first eye, has she had the phoropter measurement (which is better 1 or 2)? It is my understanding that the autorefractor is an estimate and the phoropter is the more accurate. I had 2 measurements at 2 places 4 days apart. Autorefractor for LE measured .75 at the first visit and .25 at the second visit. Phoropter measured .5 at both visits.

    • Posted

      Hi Deb,

      I am looking at the printout and all the post OP readings are from "Auto-Refractometer" ONLY.

      I have one NON- Auto-refractometer reading but that is pre operation so meaningless. It was taken using- Tomey Corporation-2000 OPT-TOPO. I think it is called the BIOMETER.

      On Tuesday I will ask for a non Auto-refractometer reading.

      Just now doing tests with wife....

      She can read computer screen with her RE (far eye) at 75cm too!!!!!!! The further she goes it obviously gets better.

      She can read computer screen with her LE only at 70cm too!!!!!

      Both eyes combining together at all distances quiet well! In Dr Zeiss we trust so I am gonna cautiously wait and see!

    • Posted

      has she had the phoropter measurement

      I don't know why I did not Google phoropter image before 😃 That thing looks full Robocop lol

      No, we definitely don't have any reading from such device post OP.

      I think our private opthomologist might have used that device when she first diagnosed cataract. If yes then it was more covered in plastic. Maybe she used a digital/auto-phoropter.

      image

  • Posted

    That's great news! Congratulation!

    • Posted

      That's great news! Congratulation!

      Hey Mak, not counting the chickens yet! Long way to go but thankful to our Dr Zeiss as it seems he did the best he could do. Just hoping for a good final outcome.

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      My biggest fear while waiting for my wife was split capsule!!!!!!!! I have read that for younger patients it is imperative to make sure that the capsule stays intact. Any other fixation might work but it is just not the same.

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      With Dr Zeiss it felt throughout that in case of issues he won't leave us hanging. He is very humble and zero arrogance! He repeatedly apologized to my wife because she suffered 6 days for the first eye. He also remarked that my wife not once moaned about anything and that she was one of the most calm patients he had operated on.

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      I know lot of people moan here about wanting to be glasses free (not blaming them) but our surgery was in a big clinic with multiple departments, people come there for all kinds of diseases. Our waiting room was next to the cancer ward. Seeing young patients getting chemo puts things in perspective. We should all be super thankful to have vision, with or without glasses!!!!!!!

      .

      The other thing I can't wrap my head around is people who split their chest open by choice for cosmetic breast implants! It is a free world I guess so...

  • Posted

    Well, you wife have better far vision at her "90%" than I will ever get, so to me it sounds like a success 😃

    Sounds a bit odd with those measurements, but what matters is the outcome in real life, and if the eyes are already working together now, it will be even better within the next 6 month.

    I really mean it, forget those measurements, you don´t want to mess with something that works that well anyway.

    So to me it sounds like a very good result, that she can enjoy the rest of her life 😃

    Does she have a soft spot with both eyes somewhere around 1m?

    I don´t think so, and if not, she have got max from this surgery!

    Frustrating she needs to go through these post op problems, but you have been there before, in one week things will be a lot different, and everything will be going in the right direction 😃

    • Posted

      Agree with Danish - what counts is what real life situation is. If eyes working together - great sign. If she had a decent range of vision all the better. The IOL until it adheres to tissue will shift back and forth - ignore it all as there really is nothing anyone can do. Big reason why one should never risk purposely targeting too big a difference between eyes.

      Sounds like recovery will be better than last time. Happy for her.

      The hardest part is behind you best is yet to come

    • Posted

      Does she have a soft spot with both eyes somewhere around 1m?

      @ Viking,

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      She just woke up so first thing I asked her to do with her thick gel covered eye is some tests lol

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      With right far eye alone she sees me kind of sharp from 65cm/25in, she said- "not too bad" and then starts getting sharper to what we think is infinity. No moon to look at but buildings 3-4km away. So definitely sharp at 1m/39in.

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      With left near eye alone she sees sharp between 40cm/16in to 52cm/20in . Very usable sharp from 52cm/20in to 72cm/28in....@ 1m/39in she sees my face reasonably good. Then less sharp but car number plate readable up to 3m with some blur. More larger stuff further away she can read too but with lot more blur.

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      With both eyes open she obviously see me sharp at 1m and every where else based on initial testing.

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      Viking, were you asking the above for intermediate vision?

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      DROPS ETC

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      So we finally started Dexa free steroid drops this morning! I was so nervous as no anti infection drops for last 2 days.

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      Now we will be taking only...

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      -Dexa free steroid drops for against infection and inflamation (3 x daily)

      -Visco tear gel for lubricating.

      -Vitamin A gel for lubrication and healing.

      -Lacri-Vision liquid drops for lubrication.

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      So no Yellox or Floxal anti infection drops this time (Dr Zeiss said better not). Speak on Tuesday when we see the other Doc. As steroid drops will stop after week two maybe they will ask us to continue with steroid drops or switch to one of the other anti infection drops i.e. Yellox.


      Crude Home depth/binocularity test

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      Both eyes open-

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      As I am paranoid about the eye measurement difference (if it truly is so). I thought of some self created tests.

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      TEST-1

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      I put my finger in front of her at various distances and angles. Then like the movie E.T she had to touch it with her finger tips. I did the test with one finger and multiple fingers. She had to match her fingers to mine and then touch my finger tips in one attempt. I did it on both sides of her central nose plane.

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      image

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      TEST-2

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      I made her kick a stationary Lacrosse ball with both feet. Then I kicked the ball towards her and she had to kick back the moving ball in first attempt. Tried it multiple times.

      Both test she passed with 100% result.

      Not sure if it means anything but passing it is better than failing I guess 😃

      image

    • Posted

      Hi Sue,

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      Thanks. Yes let us see what the final situation is. When she looks at the Jager eye test chart with each eye on it's own then she sees that the text is slightly smaller in size with the right far eye compared to the left near eye. That is normal with mini or full monovision I think. The difference in text/image size is obviously proportional to the difference in diopter between the two eyes.

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      She does not notice this difference in size when she looks at non text stuff with one eye at a time.

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      Fortunately with both eyes open she sees one single sharp combined image. She can read J1 sharp with left eye only and J1 sharp with both eyes open too.

      image

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    • Posted

      Yes, I was curious about the gap between the two lenses, but you see, she have no gap in vision between the two lenses, so she have got absolutely max from that surgery, you could not ask for more.

      To read that well, and have full covered vision from reading distance to far distance is a very good result, most people would take that any day 😃

    • Posted

      Wife had breakfast and then slept another 6 hours straight! She feels bit weak from the semi anesthesia that was put in her body + because of woman stuff....

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      Ok so she can read 20/25 test chart now with no errors. Then when she saw the 20/20 line, she said "Oh no!" but then proceeded to read the line with 2 mistakes only (6 out of 8 correct).

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      The right eye when looking straight down has slight blur compared to when looking straight in front (at exact same distance). I think the 2-3 spots that are on the cornea must be coming into play when she looks down or could be just due to lack of full cornea healing.

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      Time for 2nd steroid drop!

    • Posted

      Another thing, it does seem that the right eye must be the dominant eye if everything is working ok.

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      So our and Dr Zeiss's educated guess was correct! Now if we had gone with Dr Rockstar, the left non-dominant eye would have been set for far!!!!

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      And then if the diopter difference would have turned out big then there would have definitely been a potential of huge issues. Although Dr.Rockstar said that it would not matter as both eyes are similar and healthy.

    • Posted

      Nice Injinji toe socks.I use toe shoes for exercise.

    • Posted

      That image was from Google to give you idea of the ball size 😃

      I used to wear Injinji socks while trail running. Last time I used it was for a 50km mountain run 😃 Quit running 5 months ago, injuries started pilling up.

      Now just normal non running gym fitness.

    • Posted

      I don't run either. But really like toe shoes for gym fitness. Your toes are meant to move independently and that can't happen in "regular" shoes. Allowing toe to move independently strengthens the small muscles in your foot and legs.

    • Posted

      I read your post wrong. Did not realize that you wear toe shoes to go with the toe socks 😃

      I was thinking toe socks only as lot of trail runner wear them for ultras to avoid blisters forming between the toes 😃

      Some people wear those toe shoes in my wife's Pilates and Power Yoga classes too. Most of us do it bare foot though.

      I assume you do weight training with them or for other stuff?

    • Posted

      I dont understand this chart. Is this supposed to represent near vision or normal 20/20? But at 14 inches? My IOl was set for near but feel it isnt what I expected or want tho I can see see line no1 , .37 at 14 inches. Does that mean near sight? I can't (yet, hopefully) read close up as in labels or books or ingredients on bottle etc. I am using my LE unoperated eye to do that. This makes me very cautious about doing the other eye.

      Thanks for the info and good luck in continued recovery.

    • Posted

      Hi Ara,

      The chart that I have posted here is not the real/actual size chart. I will send you the PDF link via PM. You have to test the printed version and not on the screen.

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      It needs to be printed at 100% without any scaling. So your printer should not scale it up or down, it should be 1:1.

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      Then you just hold it exactly 14 inches from your eyes and try reading from J11 and make your way towards J1. The chart stays at 14 inches throughout.

    • Posted

      Ara, it is to check how good your near sight is. I have PMed you the chart...

      Jaeger Eye Chart

      DIRECTIONS FOR USE

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      The Jaeger eye chart (or Jaeger card) is used to test and document near visual acuity at a normal reading distance.

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      Refractive errors and conditions that cause blurry reading vision include astigmatism, hyperopia (farsightedness) and

      presbyopia (loss of near focusing ability after age 40).

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      If you typically wear eyeglasses or contact lenses full-time, you should wear them during the test.

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      1. Hold the test card 14 inches from the eyes. Use a tape measure to verify this distance.
      2. The card should be illuminated with lighting typical of that used for comfortable reading.
      3. Testing usually is performed with both eyes open; but if a significant difference between the two eyes is suspected,

        cover one eye and test each eye separately.

      4. Go to the smallest block of text you feel you can see without squinting, and read that passage aloud.
      5. Then try reading the next smaller block of text. (Remember: no squinting!)
      6. Continue reading successively smaller blocks of print until you reach a size that is not legible.
      7. Record the “J” value of the smallest block of text you can read (example: “J1”).

        .

        DISCLAIMER:

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        Eye charts measure only visual acuity, which is just one component of good vision. They cannot determine if your eyes

        are “working overtime” (needing to focus more than normal, which can lead to headaches and eye strain). Nor can they

        determine if your eyes work properly as a team for clear, comfortable binocular vision and accurate depth perception.

        Eye charts also cannot detect serious eye problems such as glaucoma or early diabetic retinopathy that could lead to

        serious vision impairment and even blindness.

        Only a comprehensive eye exam performed by a licensed optometrist or ophthalmologist can determine if your eyes

        are healthy and you are seeing as clearly and comfortably as possible.

    • Posted

      i read your other post. -1.5 is more of intermediate than near. you would get some near with -1.5 but it will again be a bit offset with the toric correction. your near may still get better so good luck.

    • Posted

      thanks for posting the home test results. reading j1 sharp with the j1 eye is fantastic so she got near without compromising too much far. that is great news. maybe i missed this but how much can she read with the right (distance) eye on the near chart? glad she is doing well. good luck with the healing.

    • Posted

      Soks, I agree. I do read the smallest line on the chart but I cant read the ingredients on a shampoo bottle or vitamin bottle that I could pre surgery but Im waiting another week to see what changes. I think people have different degrees of nearsightedness and different expectations.

    • Posted

      "I think people have different degrees of nearsightedness and different expectations" -- i agree. the shampoo or medicine bottle lines are j1+. i think its better to be in cataract position when you have naturally lost the near already. then its always an improvement.

    • Posted

      To get the chart, Google-

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      "Jaeger Eye Chart - All About Vision" you will find a PDF link.

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      Ok here goes Soks...talking about the Jaeger near eye test chart. All of which should be read at 36cm/14inches according to the instructions.

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      WITH NEAR LE ONLY

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      With near eye she can read J1 at 36cm but at 40cm she can read it lot faster.

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      WITH FAR RE ONLY

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      At 36cm with far eye she reads J7.

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      She can read upto J3 if she moves the card to 50cm but not sharp like with the near eye!

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      WITH BOTH EYES

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      She can obviously read all of them comfortably at 36cm.

    • Posted

      Ara, did you read the smallest line (J1) at 14 inches distance or did you read it at 5-6 inches like you read your books? For the test to be accurate it has to be read at 14 inches distance.

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      Anyway in real life you don't really need more that newspaper text size for comfortable living. J1 is just a nice bonus to have.

    • Posted

      thanks for sharing. very much appreciated.

    • Posted

      for the test i did it at the 14 inch. Until these threads i had no idea that is considered near sighted. Pre cataract surgery i was fine seeing as close as a few inches from my eyes. Without your post and explanation, i thought id lost my near vision. Now i have to accept that Ive lost my concept of near vision. Game changer.

    • Posted

      Ara,

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      Sorry, I am not up to date on your case as I have been busy with my wife's eyes. So looks like one of your eye is already done.

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      Why is it a game changer regarding not being able to read ultra super close? Normal people don't read books at 5 inches distance. The world around us does nit take place at 5 inches distance. Even if that was your reality until now.

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      With your new IOL are you able to read? Which is your sharpest distance.

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      If you can read well with your new eye without having to stretch or over stretch your arms then you are already winning!!!!!

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      Enjoy your new sight as alternative would have been blindness.

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      Use logic to target your next eye and not emotions 😃

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      We and most importantly the your surgeon is here/there to help and guide you.

    • Posted

      P. S-By the way when I said "normal people" in the previous post, I did not mean that you were not normal 😃

      I hope you understood the general sentiment behind my point.

    • Posted

      Off Topic, but yes I use toe shoes for weight training and general agility exercise (like High intensity Interval Training). For Yoga, bare feet.

      The big name in toe shoes is Vibram five fingers. Adidas did a huge launch of their version a few years ago, but it didn't take off for Adidas.If you search "Mark Vestegen adipure trainer" you can find lots of promotional material from a top US trainer who was part of the launch and explains the benefits of exercising with toe shoes.

    • Posted

      Off topic too - I like to run (half marathons but maybe a full in my future). Those Vibram five fingers are they good for people with fallen arches? I gave to wear orthotics in my running shoes. Wondering if these accommodate othotics or if they are constructed in such a way they provide support for arches that need support?

    • Posted

      Sue.An , (Off Topic). I first learned about two things from an very athletic guy who used to report to me. The two things are Five Finger toe shoes, and other is Muscle Activation Technique (MAT)

      He was always very athletic, but had worn custom orthotic inserts since he was a child. He grew tired of having to deal with orthotics, and say a master level MAT expert who activated muscles that weren't firing. He kept working with the MAT master and worked his way to using Five Finger toe shoes.

      Five Finger shoes provide absolute zero support and they fit snug like a sock, so no inserts.

      If you do interest search, you can find lots of info on MAT. They say Peyton Manning credits MAT with saving his career, and was one reason why he went to Denver (because the top MAT expert is in Denver).Not sure if there are any MAT experts where you are. There was also an article in the Globe a few years ago.

      And lots of info on orthotics as well. many experts think they are a good temporary solution, but don't help long-term.

      I've seen a MAT expert maybe twice in 10 years. Had plantar fasciitis many years ago, but have had zero foot issues since I transitioned to five finger shoes.

      For running (which I don't do much of), you need to change your stride (barefoot running style), and ease into it.

    • Posted

      More off topic on MAT.

      Article from Globe and Mail from a few years ago is "How correcting muscle imbalances can heal injuries and make you a better runner".

      MAT site lets you search for practitioners, but I would suggest only see "master" level experts. As someone who just dabbles in MAT isn't really going to do anything special. But a master level expert can really help. You would be surprised at how many professional athletes use MAT.

    • Posted

      Appreciate all this. Will look into this more. Most if my life have worn orthotics (custom made). They do help - even with walking. My daughter born with fallen arches too but I had custom made orthotics and had specific exercises for her by mason's hospital in Montreal and she developed an arch throw growing years and doesn't have the issue. Wish that info was shared with my parents way back when.

    • Posted

      Generally speaking shoe inserts are bad idea unless you have difference in leg length. Strengthening your feet muscle etc is the better option.

      .

      Regarding marathon or longer distance, my advice is that it probably does more long term damage to the body than it is worth. Great for the ego but if your bio mechanics are not good to excellent then it will hit you like a brick in the long term. Stick with half marathons as it is a good middle ground. Although running flat marathons on roads is not ideal for the joints. Although 1 marathon would be ok if it is part of your bucket list and you are not going in with any medical conditions.

      .

      That said there is nothing like running 50km up and down mountains in one go. Actually there is, running 100km up and down mountains lol Unfortunately 50km was the limit for my bio mechanics as building up training for my a 100km resulted in me quiting running all together due to too many injuries from previous years pilling up and getting chronic (ITBS, Achilles, Knee Plica, Hip pain...etc etc). I had to decide to risk long term damage + not being able to run + not being able to train in the gym VS continuing to train in the gym but giving up running.

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      I decided to quit running and just when I was busy feeling sorry for myself, my wife got hit with cataract. In a way that put things in perspective and I could handle the psychological impact of quitting running.

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      Some of my injuries were self inflicted. Like running 20-30kms and then straight away spending 3 hrs in the gym. Climbing up and down 15 story building 10 times on tired legs etc etc!!!!

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      Not gonna lie but I miss running uphill in the mountain 25-30kms in -4°c freezing conditions all alone just for fun!!!!! 😦

    • Posted

      Every time I see someone running I feel envious. There is just something about pushing yourself and that rush crossing a finish line - especially in the fall. Love fall temperatures and our pretty fall leaves changing color to keep me company when running. Our summers are too warm for long runs. I had to stop due to cataracts - took a fall. I really don't want an injury that has long term consequences so likely never do the full marathon. We have some great trails around here so starting to like hiking.

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