Do Kegels Work

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Heavy Leaker
Regular Member


Date Joined Feb 2010
Total Posts : 63
   Posted 2/10/2010 6:04 PM (GMT -6)   
I am 3 & 1/2 months post robotic surgery.  I was very, very lucky in the ED department with my first erection 18 days after surgery which I attribute to my surgeon's skills.  However, I am very incontinent using 5 to 8 pads a  day.  I can retain my urine while sitting or lying down but once I am up it's a constant drip.  My question is, do kegels work?  I have done them on & off but am so discouraged that I have not been doing them religiously.  I have read that at 6 months post surgery, men who did kegels & those that didn't have about the same incontinence rates. 
 
So, you guys with leaking problems like me, are you doing your kegels religiously & for the guys who are continent, did any of you regain continence without kegels?  Alao, I am open to all suggestions to improve my incontinece.
4 biopsies over 4 years starting in 2006, 4th biopsy showed 5% of one core Gleason 3+3=6.  PSA in 2005 6.0, rose to PSA 18 shortly before surgery.  Chose surgery over radiation due to conflicts in PSA versus biopsies.  PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09  T2B Tumor 30% of prostate  involving left & right lobes  NOMX Gleason 3+4=7  Urethral Resection margins &  resection surface clean Seminal vessicles clean.


profman
Regular Member


Date Joined Jan 2010
Total Posts : 55
   Posted 2/10/2010 6:11 PM (GMT -6)   
Hi - I can only describe my own experience, but once I scheduled the robotic surgery in early November (surgery was December 15) I religiously did kegels three times a day, sets of 10, holding for 10 seconds, and relaxing for 10 seconds. Once the catheter came out I started out as 1 pad per day, and now, 8 weeks later, can go padless, although there is an occasional leak. I don't know if the kegels helped or not, and I have not been as vigilant in doing kegels post-surgery. I must admit to shoveling snow the past two days, with minimal leakage as well. The ED, however, still remains, but is the next goal to reach.
Diagnosed 9/4/09, age 59
PSA 3.5, up from 1.8 year before
First biopsy showed 3/10 positive cores, Gleason 3+3, less than 10% involvement in all three cores, diagnosed as T2a
Doc and I decided on Active Surveillance, pending a confirmatory biopsy
Second biopsy showed 5/10 positive cores, Gleason 3+3, left side (4 postitive cores) had 40% involvement
RRP on 12/15/09
Home on 12/16/09
Failed cystogram on 12/23/09, catheter out on 12/29/09
Path report was all good news, Gleason 3+3, no margin involvement, no perineural involvement, everything clean other than core of prostate, tumor on both sides, but more prevalent on left side, 5% involvement, 42 gram organ
Within two days down to one pad a day, now continent except if I sleep more than four hours
Back to work 1/4/10
First PSA 1/28/10 - nondetectable, next scheduled June 2, 2010
ED present, although blood does flow after Viagra. working with pump now - still trying!


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 2/10/2010 6:20 PM (GMT -6)   
Many people say they do. From a logic point of view, we all know exercise is good for muscles, so it makes sense.

From an individual point of view, it is hard to prove. There are some variables here. How much urtethra did the surgeon cut out ? How were we built as far as prostate proximity to the bladder ? What kind of a job did the surgeon do sewing our urethra back to the bladder ? etc. etc.

From a technique point of view, are we doing them correctly ? Are doing them too much, tiring out our sphincter ? Are we doing them too little, not building up the muscle ? etc. stc.

I think we are foolish not to do them. Because we don't get lung cancer right away, does that prove smoking is not bad for us ? Kegals don't work instantly, but strengthening the pelvic floor has to be a positive thing.

It is easy to get discouraged (this is an 8 monther talking). You may elect to see a therapist who can measure your efforts and give you some pointers. My advice ( for what it's worth), is to continue kegaling, and goive it at least 6 months. Then perhaps you can cinclude it isn't going to work for you.

Good luck . Keep your head up about this. I know it is a bummer.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01


TheoTeacher
Regular Member


Date Joined Jul 2009
Total Posts : 47
   Posted 2/10/2010 6:31 PM (GMT -6)   
My vote - yes they help.  However, I also believe in the theory, it won't hurt you to do them so why not?  I started two sets of 40, 10 seconds on 10 seconds off, twice a day about two months before surgery.  I resumed same after the cath came out. (Found out later you can do them with the cath in.)  It's the PFM your building so it's important to keep up the building the muscle.  I still use a pad while at work. I'm a teacher and stand in front of the high school kids all day.  One leak would take year to live down!  But while at home, even when chopping logs or shovelling snow no pad and no leaks!
 
Good Luck!
Dad dx at 72 with Pca; RP at 73; Died 11/08 at 88 from Pca met.
3 Uncles have had Pca; 2 deceased from Pca met.
Me: Age 51: Joyfully Married; father of 7!
Routine Physical 11/07 PSA 1.73 DRE normal
Routine Physical 1/09 PSA 2.77 DRE abnormal.
1st Urologist visit 2/09 DRE normal, small - PSA 6.3!
Biopsy 3/17- St. Patty's Day! 3 of 12 cores positive with 5-8% Pca
3+3 Gleason; Visit Johns Hopkins 3/26/09 and decide for surgery.
Lapro RP 6/29/09; discharged 6/30/09
Cath out 7/9/09 Gleason unchanged 3+3;
"Larger amount of cancer" than expected.
Organ confined Pca, positive margin as "artifact" of surgery.
All other tissues clear.
7 wk psa 8/20/09 - 0.05
10/15/09 - 1 pad daily
ED - Still an issue! Cialise no help!
12/09 ED improving, Half mast works for me!
1 pad/day at work; pad free at home!
2/5/10 psa 0.01

"We walk by faith, not by sight."


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/10/2010 7:39 PM (GMT -6)   
I was not a doer of kegals. Tried them a few times, but was fully continent within a month of when my original catheter was removed. There are so many factors involved. My doctor feels they are over rated, and that many men go too nuts doing them, and in the end, its counterproductive, because they wear down the muscle tone throughout the day. Like very thing else with PC, there is no one way, or right or wrong way.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 2/10/2010 8:02 PM (GMT -6)   
Cleveland clinic claimed to have done research that had it down to doing them any less than 12 minutes apart caused the muscles to overtire. They have the patient get a kitchen timer, and every 12 minutes, you are to hold for 30 seconds, all day long. They claim average continence is 60 days.

Who the heck knows? I guess i always thought it would be stupid not to do them, and find out later they did help.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01


Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 665
   Posted 2/10/2010 8:19 PM (GMT -6)   
Heavy Leaker, I don't recall the details, but I had similar issues as you. The pads had to be replaced very often at first. I found that on days that I did a lot of Kegels, I leaked a lot more than on a day that I rested. However, I saw better overall progress (a day or a few after doing lots of exercises), so I believe that they helped. I also believe that most of my progress just came with time, and my progress came with plateaus, where I would make significant progress over days and then none for weeks. Hang in there, I'm betting it will gradually get better with time like mine did - at first I couldn't hold anything when I stood up, no matter how many kegels I did or did not do, but I seem to recall at 5-6 months I was fully continent. Everybody's different... but a lot of guys have mentioned about the plateaus, so don't get too discouraged.
Jeff
Gleason, 3+4; PSA, 7
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
cancer contained, no penetration, lymph nodes clear
PSA consistently <0.1 since surgery until Oct 09, 0.1; retested Oct 09, <0.1, Jan 10, 0.2; retest confirmed 0.2


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 662
   Posted 2/10/2010 8:37 PM (GMT -6)   

As related to me....not doing them had no effect. that is to say from what i had read, and from what i was able to discover for myself....running 6 miles 3 - 4 times a week would be my choice.  I was able to do this and walk 4 miles a day post-operatively. I did not do nor do I do.,,,kegs>>>>>>>>>>>I am Completely dry.


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate.  Negative surgical margins
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. No prostate extension
Post-op PSA 12/10/2009, Undetectable
12/12/2009, Pad Free and Started jogging.


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 2/10/2010 8:52 PM (GMT -6)   
Well, they certainly did not work for me. Unless I am lying down, I squirt whenever I do them. I can stand in from of the toilet and kegel till the cows come home but I still leak when I am vertical. Every day I try to hold an pucker but it just leaks out. Frustrating.
I'm telling you, "There's a hole in the bucket dear Liza, dear Liza. There's a hole in the bucket dear Liza a hole...."
Jeff

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 2/10/2010 11:49 PM (GMT -6)   
"kitchen timer, and every 12 minutes, you are to hold for 30 seconds, all day long"
Sounds like the plot from an episode of LOST.

Oh well, yes, I did see that at a certain point Kegels seem to hurt more than they help, so I backed off some. But I can't tell if the walking or the Kegels are helping, but between them, there is some progress.

My doc was insistent that I not do them with the catheter in.

MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 2/11/2010 8:06 AM (GMT -6)   
Initially I did them whenever I was either sitting watching TV or driving, so I did do them a lot

Walking also was a great help, in effect the mind does the kegels for you while walking and retrains itself to hold. When I did leak I NEVER leaked while I walked, it was usually when standing from a sitting position that caused the most likely leak

If you want to test out a Kegal to see if it works, squat down, do one and hold it, then stand back up, if you are dry it worked, try it again without doing the kegal, if you leaked the non-Kegal bend then you know the exercise is working in step one.

Doing this squat, kegal, stand routine was what I worked on most and was the last step in my being 100% continent
Stats:
Age: 52, PSA (2008)=1.9
Biopsy on 01/09/09, Gleason Score = 3+3
One (1) out of twelve (12) cores was positive, plus external nodule found
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Post Op Path 3+3
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, <0.01 - 3 months post-op
PSA 1/10 undetectable, <0.01 - 9 months post-op
Trimix provides 100% erectile function


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 2/11/2010 8:17 AM (GMT -6)   
Heavy Leaker said...
My question is, do kegels work?  I have done them on & off but am so discouraged that I have not been doing them religiously. 

The best answer for you is probably this:  If you don’t do them, then they don’t work.

Here’s some other relevant questions and answers pertaining to your posting:

  • Will Kegels guarantee you instant continence.  No.
  • After RP, do you need to use muscles in your pelvic floor that have been used less than before RP?  Yes.  Those muscles will be weak from lack of use.  Kegel exercises target strengthening those muscles.
  • If you don’t do Kegels, will you regain continence?  Yes (except for the small percentage of men that don’t regain complete continence irrespective of whether they do Kegel exercises or not, but have other issues.)
  • Do some doctors say Kegels don’t help?  Yes, because of the question/answer above.
  • Do some doctors say that doing Kegels correctly will hurt you?  No.  (Note, if anyone reading this has a doctor who has answered this question with a "Yes", then please do your PC brothers a favor by posting his name here on this site so that others can avoid making the same mistake you made by going to a stupid doctor.)
  • If you do Kegels, will you regain continence faster?  Yes; also see the next question.
  • Any peer-reviewed, medical journal published evidence that doing Kegels will result in me regaining continence faster?  Yes; here’s a good example:  http://www.ncbi.nlm.nih.gov/pubmed/16002204?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1
  • At 3 & ½ months after RP, aren’t most men continent?  No; there have been many studies done and can be easily found on via internet search, and the typical is that about half of men are continent at that point.
  • Is there a “right way” and a “wrong way” to do Kegels?  Yes.  Lots of good descriptions of the right & wrong ways are available.  If you didn’t get one from your doctor, here’s one:  http://www.healthboards.com/boards/showpost.php?p=4135151&postcount=3
  • Can doing Kegels a "wrong way" be harmful?  Yes, of course.  Doing just about any exercise wrong can be harmful.
  • Can I get a guarantee on when Kegels will work for me?  No
  • Will just reading about other people regaining continence faster by doing Kegels, while I continue to not religiously do Kegels myself, help me regain continence faster?  No.
  • Guaranteed?  No

t-dog
Regular Member


Date Joined Dec 2009
Total Posts : 154
   Posted 2/11/2010 10:23 AM (GMT -6)   
My guy recommends them but advises not to do them while peeing the way women do. He likes you to keep a good stream if you`ve got one going. As for me i`m doing them when i think about it but i`ve only lost a stress drop or two since they pulled the cath so i`m not sure i would know any big difference one way or the other. Tim
Dx at 50 in 12/09 Merry Christmas its cancer....
3 of 12 positive, right side only, psa at dx 2.6 free%14
gleason 3+3=6
routine physical, no symptoms
Da Vinci performed Feb 2k10 by Dr Marc Milsten [hes got mad skills]
99% continent from cath out, we`ll see about mr happy
path showed same gleeson with no other blips other than one slight margin, organ confined 20% right, 5%left, 34grams
 
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 2/11/2010 10:26 AM (GMT -6)   
Casey

Excellent kegal reply !
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01


Heavy Leaker
Regular Member


Date Joined Feb 2010
Total Posts : 63
   Posted 2/11/2010 4:11 PM (GMT -6)   
Casey59 said...
Heavy Leaker said...
My question is, do kegels work?  I have done them on & off but am so discouraged that I have not been doing them religiously. 

The best answer for you is probably this:  If you don’t do them, then they don’t work.

Here’s some other relevant questions and answers pertaining to your posting:

  • Will Kegels guarantee you instant continence.  No.
  • After RP, do you need to use muscles in your pelvic floor that have been used less than before RP?  Yes.  Those muscles will be weak from lack of use.  Kegel exercises target strengthening those muscles.
  • If you don’t do Kegels, will you regain continence?  Yes (except for the small percentage of men that don’t regain complete continence irrespective of whether they do Kegel exercises or not, but have other issues.)
  • Do some doctors say Kegels don’t help?  Yes, because of the question/answer above.
  • Do some doctors say that doing Kegels correctly will hurt you?  No.  (Note, if anyone reading this has a doctor who has answered this question with a "Yes", then please do your PC brothers a favor by posting his name here on this site so that others can avoid making the same mistake you made by going to a stupid doctor.)
  • If you do Kegels, will you regain continence faster?  Yes; also see the next question.
  • Any peer-reviewed, medical journal published evidence that doing Kegels will result in me regaining continence faster?  Yes; here’s a good example:  http://www.ncbi.nlm.nih.gov/pubmed/16002204?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1
  • At 3 & ½ months after RP, aren’t most men continent?  No; there have been many studies done and can be easily found on via internet search, and the typical is that about half of men are continent at that point.
  • Is there a “right way” and a “wrong way” to do Kegels?  Yes.  Lots of good descriptions of the right & wrong ways are available.  If you didn’t get one from your doctor, here’s one:  http://www.healthboards.com/boards/showpost.php?p=4135151&postcount=3
  • Can doing Kegels a "wrong way" be harmful?  Yes, of course.  Doing just about any exercise wrong can be harmful.
  • Can I get a guarantee on when Kegels will work for me?  No
  • Will just reading about other people regaining continence faster by doing Kegels, while I continue to not religiously do Kegels myself, help me regain continence faster?  No.
  • Guaranteed?  No

 

Casey,
 
Thanks for the answers & links.  However, I don't understand your next to last comment.  "Will just reading about other people regaining continence faster by doing Kegels, while I continue to not religiously do Kegels myself, help me regain continence faster?  No."  What do you mean by this?  It seems rather sarcastic.  I am willing to do whatever is necessary to regain continence.  My Dr. never told me how many Kegels to do or how to do them.   After 3 weeks of trying to do them properly, I went to Biofeedback sessions once or twice a week for 6 weeks.  At the first session I could only Kegel for about 2 seconds.  By the end I could do much better but I have seen no progress in regaining my continence.  For this reason, I have asked about Kegels effectiveness.  What number of kegels do you recommend & how mant sets of kegels per day should I do?  How will I know if the kegels are working or if time alone is helping?  My Dr. said "kegels might help".  I don't see that as positive direction.  I apologize to you if you were not trying to be sarcastic & I will definitely take your comments to heart in seeking a solution to my incontinence problems.  I certainly don't like using 5 to 8 pads a day.
4 biopsies over 4 years starting in 2006, 4th biopsy showed 5% of one core Gleason 3+3=6.  PSA in 2005 6.0, rose to PSA 18 shortly before surgery.  Chose surgery over radiation due to conflicts in PSA versus biopsies.  PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09  T2B Tumor 30% of prostate  involving left & right lobes  NOMX Gleason 3+4=7  Urethral Resection margins &  resection surface clean Seminal vessicles clean.


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 2/11/2010 4:49 PM (GMT -6)   
It's all simply a matter of time. 
 
Unless you are among the very small percentage who won't recover within a year, then it just takes time.  Doing Kegels regularly & correctly does reduce the time to continence recovery, but even if you don't do them you will (most probably) eventually regain continence.  While wearing pads is frustrating, I encourage that you channel your frustration energy into motivation to do the Kegels religiously rather than allow it to overwhelm you into lower levels of commitment...which is what you described is happening.
 
If your doctor hasn't provided you with materials & instructions for Kegels, there are other doctors who post very good instructions online.  Here's one which addresses all the questions you asked in your last posting:  http://www.urologyteam.com/female-urology/kegel-exercises    (don't be thrown off by the portion of the URL that says "female-urology"; it also addresses men's post-RP needs)
 
I've heard of one doctor who holds a 4-hour training session for all his RP patients on combined topics of pelvic floor rehabilitation treatment (Kegel exercises) and sexual function rehabilitation.  In my view, this is a best-in-class medical care.
 

Heavy Leaker
Regular Member


Date Joined Feb 2010
Total Posts : 63
   Posted 2/12/2010 6:30 AM (GMT -6)   
Casey59 said...
It's all simply a matter of time. 
 
Unless you are among the very small percentage who won't recover within a year, then it just takes time.  Doing Kegels regularly & correctly does reduce the time to continence recovery, but even if you don't do them you will (most probably) eventually regain continence.  While wearing pads is frustrating, I encourage that you channel your frustration energy into motivation to do the Kegels religiously rather than allow it to overwhelm you into lower levels of commitment...which is what you described is happening.
 
If your doctor hasn't provided you with materials & instructions for Kegels, there are other doctors who post very good instructions online.  Here's one which addresses all the questions you asked in your last posting:  http://www.urologyteam.com/female-urology/kegel-exercises    (don't be thrown off by the portion of the URL that says "female-urology"; it also addresses men's post-RP needs)
 
I've heard of one doctor who holds a 4-hour training session for all his RP patients on combined topics of pelvic floor rehabilitation treatment (Kegel exercises) and sexual function rehabilitation.  In my view, this is a best-in-class medical care.
 
Casey 59,
Again I thank you for your help.  I'm going to read that link right now.  Due to the comments from all of you guys, I am recommitting to the kegels& will keep you posted.
4 biopsies over 4 years starting in 2006, 4th biopsy showed 5% of one core Gleason 3+3=6.  PSA in 2005 6.0, rose to PSA 18 shortly before surgery.  Chose surgery over radiation due to conflicts in PSA versus biopsies.  PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09  T2B Tumor 30% of prostate  involving left & right lobes  NOMX Gleason 3+4=7  Urethral Resection margins &  resection surface clean Seminal vessicles clean.


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 2/12/2010 10:15 AM (GMT -6)   
Good luck, and stick with it. I hope my "tough love" wasn't too tough...wanted to help get you motivated. I think of these exercises as part of the post-surgery physical therapy. I've had other surgery in the distant past where I WISH I had remained committed to the difficult physical therapy throughout the recuperation period...I didn't, and I regret it to this day.
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