Moving To Hawaii

The PRP/Synvisc procedure was today.  All things considered, the procedure went very smoothly.  So now I am staring down the barrel of two days of hard down time.  I'm nine hours into it and already feeling like I'm imprisoned.  Riot and escape attempt to follow.  Stay tuned.

The morning started off very rocky.  Frustration was already thick because the wife refused to let me drive myself to and from the doctor's office.  My Army of One mentality and refusing to let her "take care of me" are sore points.  So we compromised by agreeing to allow her to drop me off on her way to work and then having my mother-in-law pick me up after the procedure was over.  We were out the door on time (a miracle in-and-of itself) and went through McDonald's drive-thru so that I could put something on my stomach before the appointment.  Interestingly enough the medical staff at the doctor's office suggested this as they said that many people become light-headed or pass out during the injection.  The majority, they said, were men.  Although I had no fear that I would swoon, I do have a very delicate image to maintain.

In the drive-thru I realized that I did not have the check book.  As this was a pay-to-play, out-of-pocket procedure, I would need it.  Then the rush back to the house to get the check book, which was never found.  We write checks for so few things that keeping up with its location is far from a priority.  Luckily I did locate a temporary check for the right account and back out the door I went; now running behind.  My frustration level was high.  Very high.  I didn't like the idea of being chauffeured like an invalid.  I didn't like not being at the wheel to cut through traffic like a trained stunt-car driver.  I didn't like the idea of having the mother-in-law come to pick me up, again like an invalid.  I sure as hell didn't like the idea of being bullied into any of this dependency BS, but there I was.  I am now, however, contemplating writing a book titled "Army of One: The Low Stess Life of Operating Independently".  Watch for it.  It will be a best-seller.

Where did everybody go?

I arrived at the doctor's office a few minutes late and walked into the reception area.  The first thing that I noticed was that the waiting room was vacant.  This is one of the best orthopedic and sports medicine practices in the the region.  The office is always crowded.  For it to be empty was a little disconcerting.  Or maybe they were afraid that the One Man would have a negative experience and for safety they had cancelled their morning appointments.  The latter makes me smile, therefore I'll stay with that assertion.

After the nurse drew my blood (which we now know contains magical healing properties) and took it to be spun in the centrifuge, the doctor came in to prep my knee.  I will say that the prep for the injection was the toughest part of the entire procedure.  Lots of sprays and needles to "numb" the injection site before he inserted a very LARGE gauge needle into the joint itself to aspirate fluid from the knee.  I was surprised when he was able to do so.  The knee hadn't seemed swollen or aching at all this morning.  But draw fluid from the joint he did.  That was the only part of the procedure that produced any sharp pain (no pun intended).  The injection of the PRP (3 1/2 cc), Synvisc (48 mg), and Kenalog (40 mg) was relatively painless - only a sensation of pressure - and very quick.

The highlight of the post-procedure was sitting outside the hospital and talking with a homeless man from Paducah, KY while I waited for my mother-in-law to pick me up.  He approached and introduced himself, showing me his ID as though he felt compelled to prove the name he had given me.  I showed him my ID which totally threw off his OODA loop.  Although I'm sure the original intent was to ask me for money, he seemed all too eager to put distance between himself and I after I gave him directions to the local shelter that was only a block or so away.  Maybe he didn't get the memo that everyone else around the doctor's office had received.

Why, yes, those are Balega socks.

So here I am locked down for three days of rest, ice, and Advil.  Luckily I still have the AirCast Cryo/Cuff from my surgery years ago.  Always knew it would come in handy again.  Days four and five are suppose to be light activity days - biking, elliptical - but no running until day seven.  That is a little different (more prolonged) than what I was initially told, but I will give the doctor the benefit of the doubt and err on the side of caution.

In the mean time I have set up camp on the the couch with the intention of getting caught up on work.  Instead, I've found myself watching episodes of Magnum P.I. on Netflix.  Which has me thinking: if you are going to police - or be a P.I. even - why not do it somewhere with palm trees?  So I have decided that as soon as day seven comes I'm packing up and moving to Hawaii.  I just need a cool Hawaiian shirt, a Ferrari, and a wealthy benefactor who'll let me stay in the guest house on their private estate.  That should be easy enough.  Oh, and I'll have to grow an awesome mustache too.  Better get started on that right now...

Check out that stylin' mustache!

The (not so) Bionic Man

Not just tallking about my personality.

The follow up appointment with the orthopedic surgeon to receive the results of my MRI was two days ago.  The meniscus isn't torn and the joint is intact.  Very good news to hear.  So much so that I had the surgeon repeat it three times just to make sure that my selective hearing power wasn't activated, or that I wasn't unintentionally "re-authoring" the facts (as my wife and I accuse each other of doing ever-so-often).  But the surgeons stuck to their guns: no meniscus tear.

Because of the residual chronic pain in my knee the doctor suggested that I might benefit from Platelet Rich Plasma therapy.  An experimental procedure (so deemed because of the lack of solid data from clinical studies) in which the doctors will draw my blood then spin it in centrifuges, then inject the separated plasma and platelets into the knee along with the drug Synvisc.  Theoretically the platelets in my blood will release growth factors that will initiate a healing and regenerative response in the bone and tissue in my knee.  Cool, huh?  The best thing is that I now know my blood has magical healing properties!  Who knew?  That automatically triples my awesome factor.  You can read more about PRP at the Scientific American page or at the all-knowing Wikipedia.

The down sides to the PRP treatment are a) as with any injection the potential for infection, b) the possibility that I will derive no benefit from the treatment at all (studies have shown inconsistent results - although I attribute this largely to a person's overall awesome score, so I should be just fine), and c) the $1000.00 out of pocket cost.  PRP, being an experimental therapy, is not covered by insurance.  I will also be "down" for about three to five days following the injection.  Doc says biking or swimming should be fine on day three or four and a return to normal activities on day five or six.  He is confident that this will give me the ability to return to all my normal high speed activities with no pain in the knee.  Considering that he was right about the meniscus tear, I'll give him the benefit of the doubt on this one.

So until the procedure next week, I have been given clearance to do what I like, provided that I can tolerate the discomfort in my knee. Yesterday I ran three and a half miles at a leisurely ten minute per mile pace.  There was little pain in the knee during the run, but it was sore the rest of the day.  This morning I put in around four miles at a mind-numbingly slow pace and so far the ache is minimal.  The plan is to get in my regular workouts between now and the procedure next week and to slowly return to my normal training after Labor Day.  I have committed to running with a team on September 29th at the Tap N Run and am already registered for the LSC Half Marathon on November 3rd.  After the PRP that gives me just under eight weeks to train for the half and I'm not confident enough in my base at this point to have much hope for an improvement over last year's performance.  But, hey!  If what the doctor says is right, then in the words of Oscar Goldman, I will be "better than (I) was before.  Better.  Stronger.  Faster."

   What I'm hoping for.   

The Good, The Bad, and The Ugly

The last two weeks the One Man has been away for an intense instructor's course for work.  I had the opportunity to hang out with a group of really great guys who are all very high speed and some of the best at what they do at their respective places of employment.  At first I had thought that this was going to be a great little get away from the daily stress of work and home, and while I certainly did have an awesome time doing cool tough guy stuff, I quickly discovered that the days and nights were filled with unique stresses of the training accompanied by what seemed like endless exhaustion.  Therefore, all the many things that I thought that I would accomplish while away just never happened: no catching up on leisure reading, no organizing or catching up on paperwork, no reflective meditation, and certainly no sleeping in.  Bummer.

Scary! Consider yourself warned.

While on my two week non-sabbatical a lot of things happened - some good, some not-so-good, and some down right ugly.  To attempt to detail every minutiae would consume more time than I have and would most certainly bore you, gentle reader, to tears.  Therefore we shall hit the highlights as I see them.  First...

The Good

Two weeks away!  No office.  No paperwork.  No case files.  No micromanaging administrators who make up for their lack of being operational bad-asses by simply being pricks.  This in and of itself was worth the price of admission.

Awesome company!  Did I mention that I hung out with some really awesome high speed guys?  Because I did.  The instructors were great, experienced guys who really knew their stuff and those who made up the training class were some of the best guys in the business.  Not a single ego on display and even when I can't remember times where I have been more exhausted/miserable, I also can't remember a time when I have laughed so much.

Taste the rainbow!

Shooting guns!  Lots of guns.  Big guns!  Small guns!  Future guns!  Old guns!  Stupid guns!  Unacceptable! (Warning - Do not click the link if you are easily offended - it is an inside joke from the last two weeks).  I put more rounds down-range in the last two weeks than my entire agency fired in training in the last five years.  And while I'm trying to make that sound like an exaggeration, I'm suddenly struck by the fact that in reality it probably isn't.

A small section of the firearms training complex.

Reaching the point of failure!  I know that doesn't exactly sound like a good thing, but in this context it actually is.  Travis Haley, formerly of Magpul Dynamics, said, "Amateurs train until they get it right.  Professionals train until they get it wrong."  The idea is that as professionals we must push the envelope in training so that when things start to come apart and what can go wrong does then as professionals we know where the limits are; we improve by adapting and overcoming those limitations and failure points.

Looking very dapper during a lull in the action.

I can honestly say that I came away from the last two weeks with a better understanding of myself and my capabilities on an operational level.  I found areas that I know I will need to work hard to improve, but I also surprisingly discovered that I could do some things that I hadn't really thought possible.

Some nice runs!  There is a one mile long mulch track that sits behind the Bizzack Law Enforcement Training Complex on the campus of Eastern Kentucky University.  The track has some very nice climbs and in the August heat is just challenging enough to make you really work.  In addition to the law enforcement basic training classes that run this track, you will also see Eastern's cross country team out on the track as well.

It has been quite a few years since I was first introduced to this track and quite honestly at the time I had no interest in running what-so-ever.  My memories of the mulch track were not pleasant.  Prior to going through basic I had never been much of a fan of running at all, mainly due to reoccurring shin splints.  Just before entering basic the problem of running was further compounded by extensive knee surgery that made any type of running feel like a spike being driven through the bottom of my femur.  If you had told me back then that I would be a runner today or that I would eventually run marathons then I would have politely smiled and quietly written you off as a complete flake.  However, that is a chapter that I have long since closed.

Mulch track at Bizzack Law Enforcement Training Complex.

I had several opportunities to run the mulch track during my stay the first week, and I took advantage of them.  I can certainly say that it was cathartic to get out and tackle the course with the confidence and desire of a runner.  There is something to be said for wanting to do a thing versus being forced to do it.

The Bad

Heat and humidity.  Not everything was sunshine and rainbows the last two weeks.  Many days it rained.  Not a lot, but just enough to make things damp and miserable at times.  It also increased the humidity which was a treat (note sarcasm).  At times the humidity was so thick that you could actually see bullets trace through the air.  It also made it feel like a sauna.  Running and gunning wearing a bunch of gear really brought on the sweat.

Kentucky River.  Stench directly proportionate to the heat.

The stink.  The training site was also situated on the Kentucky River.  I have no idea if it was the river itself or something in our immediate area, but the stench of the river was enough to make you want to wretch.  While the scenery was beautiful, the hotter the day became the greater the smell emanating from the area of the river.  This wasn't the smell of some rotting carcass that one might encounter out in the wild but the full blown aroma of a well used latrine.  Someone had mentioned that it was ballistic gelatin, used in the testing of terminal ballistics, that had been used a few weeks before our arrival and that someone had dumped near the river's edge (Don't fret, hippies, it is biodegradable).  Whatever it was/is it made training with chem/gas masks on a virtual treat.

Busting my ass!

Ripping my pants.  Ten minutes into day three of training and the first thing I do is get into a nice low position to fire my weapon and I hear the unmistakable sound of tearing fabric and feel the pleasant breeze of instant additional ventilation.  Granted I had worn a pair of three or four year old 5.11 tactical pants for a reason: they were old.  But having the ass rip out of your pants with no immediate change available simply sucked.  No one laughed of course, this was about pushing yourself and your equipment to failure and clothing is equipment.

I did buy a new pair of 5.11 Taclite Pro pants the next day and they were awesome.  But I did wind up tearing part of the knee on those as well the next week.  Mine wasn't the only set of pants to rip during the two week training.  There were multiple other busted and ripped seats and one set of pants that burst along the entire length of one guy's quad.  So while I may not have been the only one, I did get to lead the way!

The cat barn.  This really doesn't qualify as bad, maybe just creepy.  And creepy only because I read Haruki Murakami's 1Q84 which contains the short story Town of Cats, a story about a man who becomes lost in a mysterious town inhabited only by cats with no way to return to his own world.  Every morning along the road that lead to the training facility I passed an old barn outside of which several cats would congregate.  Each time I saw the cats I immediately thought of Murakami's story.

Town of Cats!

The Ugly

And then there are just things that are so bad that they are just plain ugly.  Injuries are one of those things.

Makeshift ice rig for the knee.

In a series of events last weekend that were so stupid that I refuse to detail them here, I injured my knee, my hand and my wrist.  I knew the knee was bad because when I landed on it I felt a sharp pain in the lateral portion of the joint that persisted.  My wrist and  knuckles also swelled somewhat but that felt more like bruising.  Since I was out and about I had to perform some field first aid which included going to the local Stop and Rob, otherwise known as a convenience store, and buying a bag of ice and some Zip Lock bags.  I made due with icing the the afflicted areas with this method which actually worked quite well.

One for the hand and wrist.

The timing, of course, couldn't have been worse.  It was dead in the middle of the training course and being sidelined by injuries to two critical components wasn't an option.  So I did what any tough guy would do - I sucked it up and kept moving.

In 2005 I was injured in a training accident and had a complete ACL reconstruction with repair to both medial and lateral menisci.  They also had to graft a piece back onto my femur which had been chipped.  The road back from that injury was a very long and painful one that included a lot of hard work.  Luckily for me I still had some of the equipment that I used in that recovery process - a Cryo Cuff and a sport brace.  I used the Cryo Cuff religiously and strapped the brace on for the second week of training.

There was some minor pain during any quick lateral movements (which occurred with frequency), but otherwise the brace really seemed to keep the knee stable.  Other than sounding like a loosely put together robot when I walked or ran, the injury didn't inhibit my ability to operate and I was able to complete the training successfully.  But I knew I had dealt some damage to the joint and I made an appointment with the orthopedic group that has put me back together on more than one occasion.

"He's more machine now than man."

The ortho doc is hoping for bone marrow effusion (fancy term for a "bone bruise") where the shock to the joint literally caused the bones of the joint to collide and bruise.  However, there has been pain and pressure in the back of my knee and I know from experience that is indicative of a meniscus injury.  This, as they say, isn't my first rodeo.

Yesterday I had what felt like my millionth MRI.  I've lived a very active life that has often resulted in injury.  I've joked that I have been exposed to so many X-rays, various other radiation, and strong magnetic fields that I should have had superpowers by now.  The radiologist laughed at my chart and asked if I wanted to just run the MRI machine on my own while she went to lunch - I had been there so often.  We even skipped all of the usual checklists and worked together like two people who had been performing the same job together for years.  I was in and out in record time.  Combine that with the fact that the office staff at the orthopedic surgeons office greeted me with hugs like old friends and perhaps it might be time to begin rethinking my "high speed" lifestyle.  But then, where is the adventure in that?  I will receive the results of the MRI on Tuesday and, although I am not hopeful, I would love to be proven wrong about my self-diagnosis.

So for now I can still get my morning weight lifting in, but my cardio will have to rely on the stationary bike; a prospect that I am none-too-thrilled about.  I miss the run.  Something that I never thought I would find myself saying or fearing.  Running has become important to me on a level that only other runners can understand.  Having that taken away, for any duration, is a terrifying prospect.  Of course I can remember the injury in 2005.  I can remember thinking that all of my high speed antics had come to an end and how, in my mind in those first few days, that everything that had made me me, had suddenly been lost.  But that feeling also steeled my resolve and I came back not only better, but in a higher gear.

While I will admit to being a bit more judicious this time around, I have the confidence that the end result will be the same.  In many ways it is like the last two weeks of training: pushing to the point of failure to understand just where the failure points are - where does the weakness lie and how do we strengthen those areas so that the points of failure become fewer and more distant.  Maybe this is a lesson for life as well.  As someone else quite bluntly stated this past week when speaking about having the proper resolve, "If you quit, you die."