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Friday before the weekend I had a PT visit with Jacquie.  My appointments are always at 7:30am, and begin the same each time.  I head in and warm up for 5 minutes on the exercise bike, then stretch and use the foam rollers.  At some point in this process Jacquie appears and asks if things have gotten better / worse etc.  Usually I respond that things are more of the same, a good day here, a bad pain day there.  I think it threw her off that I said they’ve been fine.  I’ve been biking minimally, swimming regularly, and doing stretches and exercises daily.  That’s not to say that I think I’m all better, my knee still throbs a bit before I stretch, or when I’m going down stairs, but things seems to be normalizing at the level of activity that I’ve been maintaining for the past few weeks.

To celebrate this minor victory and enjoy the (relatively) warm and sunny afternoon on Sunday, I rode to the grocery store to pick up the week’s supplies.  The store is less than a mile away, so if things got bad, I could just walk it in a pinch. 

I made it to the store in no time, and continued on another mile just for the sake of it.  I remember why I am drawn to jogging and biking, but often have to force myself to go swimming.  I love that cold feeling in my lungs as I’m riding downhill, and the warmth of the sun.  I had to reason with myself for a mile before practicality won the conversation and I turned around.  I woke up and swam this morning without incedent or stiffness.  I’m very relieved and reinvigorated…I really needed this boost of confidence that I’m progressing, as well as the reminder of what I’m getting myself back into shape for.

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My second opinion doctor agreed with the first opinion.  That makes 3-2; 3 medical professions who think that the problem is solely weak quads and strained patella tendons / IT band vs 2 medical professions who think there is a small tear in my meniscus.  Good news?!  I guess we’ll just trudge along working on quad strengthening and loosing up some exhausted tissue in my legs.  As a part of this process, I’ll be receiving doses of dexamethasone via iontophoresis.  Don’t know what either of those things are?  That makes two of us, so let’s do some learning:

from the always accurate, never skewed Wikipedia:

Iontophoresis is a non-invasive method of propelling high concentrations of a charged substance, normally medication or bioactive agents, transdermally by repulsive electromotive force using a small electrical charge applied to an iontophoretic chamber containing a similarly charged active agent and its vehicle.

Still confused?

To clarify, one or two chambers are filled with a solution containing an active ingredient and its solvent, termed the vehicle. The positively charged chamber, termed the anode will repel a positively charged chemical, while the negatively charged chamber, termed the cathode, will repel a negatively charged chemical into the skin.

Ooooooooh, now it’s crystal clear.  What’s that you say?  You think that sounds a lot like a transdermal patch?  “Unlike transdermal patches, this method relies on active transportation within an electric field. In the presence of an electric field electromigration and electroosmosis are the dominant forces in mass transport”

So that’s ionto, the process, but what about Dexamethason,  the actual drug I’ll be receiving into my body via electrodes and wizardry?  Well, it’s an anti-inflammatory which packs 60 times the punch of a cortizone shot.  I’ll be attaching the negatively charged pad to my patella tendon, directly below my left knee, and the positive charge will be on a pad stuck to my left thigh.  This is, without a doubt,  the strangest thing I’ve ever had my body hooked up to, and it’s too soon to tell the breadth of the benefits yet.

Still curioius about dexamethason or iontophoresis?  (I know you are)  Turns out a Polish cross country skiier was disqualified and issued a 2 year suspension for her doping use of dexamethasone back in 2004.  Uhhh?

Into PT I walked today, proud to tell Jacquie the good news that the doctor had dismissed the notion that I had done some real damage, but rather than relief she seemed more upset. Adding a pinch of self-doubt to her diagnosis, she had one of the other therapists run a few diagnostic tests. After some pushing, pulling, squeezing, and bending he thinks I likely have a torn meniscus. Shit! I guess it’s just a lesson that I need to be a better patient and push for the MRI, question diagnose, and go with my gut.

So back I go to a specialist, Dr Evans to get a second opinion. My appointment is set for 3 weeks out, so I guess between now and then I’m just going to stick with the exercises etc. Oh and jump through more HMO hoops.

On the bright side, by the time I have my appointment with this second specialist, we’ll have a new president!

NO INTERNAL OR SERIOUS DAMAGE!!!!!

I had a great consult with the orthopedic surgeon/specialist today, and after some tests and X-Rays he doesn’t seem to think I’ve done any internal damage to my knees. As he put it, I’ve got some “tracking” issues, but recommended I keep working on PT exercises etc to strengthen my quads. Considering surgeons like to perform surgery, he didn’t push for an MRI or to schedule another exam to see about the need for it. This is totally encouraging to me since it basically means that as far as his business is concerned, I would be a waste of time.

I wish I could show you a model like he had, but basically by “tracking” he means that rather than severe damage to the tendon or cartilage, my quads are simply not strong enough and have gotten exhausted from the amount of stress I’ve been putting them under. Once the quads and hamstrings are exhausted, they don’t hold he patella tendon, (which connects the patella and the tibia) in place, allowing the patella to shift when carrying weight. Because of the way the bones and tendons are lined up, there is a naturally tendency for the tibia to shift laterally, and the quads aren’t strong enough to fight that normal shift.

It’s not really bad news yet, but it’s a precursor to bad news. Jacquie did some more tests today since some of my symptoms have been getting better, while some have been persisting and/or getting worse.  Turns out I need to go get an MRI to check for a meniscal tear.  She and I had talked about the possibility of a small tear in my meniscus last month, but after having made great progress on the patella tendinitis, the meniscal symptoms stand out even more.  I spent most of this morning on the phone finding an orthopedic surgeon who could see me in the near part of the near future (somehow I wrangled a 9am appointment on Monday) and jumping through hoops trying to get a referral in place.  After the jump I’ve included my progress report from Jacquie, which is full of medical shorthand, some of which makes logical sense, some of which does not.  Anyone out there able to read between the lines?

The good news…even if I do have a torn meniscus, bikers don’t get them, joggers do; and therefore biking is permissable during my recovery, but jogging will take some time to get back into.  Slow and steady wins the race.

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Thanks to my absent minded clumsiness I am forced to take the week off from biking. There is nothing more than a skinned knee, but every time I go up stairs or over-extend my right knee, I can feel (and see) the cuts open back up. Therefore, I have remanded myself to the T this week, which just so happens to be the first full spring week we’ve had this year. It hit 80* today, probably for the first time since August, and where was I? Looking quite sullen on the red line this morning as I gazed out the window at all the runners and cyclists on the Longfellow. It felt like when I was little and had put off my summer reading until the last week of vacation, and my mom forced me to stay inside to read The Delaney Sisters’ FIrst Hundred Years while my friends would come over to invite me to play baseball or to ride bikes to get Hodgie’s ice cream.

At least in the winter I would ride my trainer in the morning and watch the local news, which gave me a bit of satisfaction. Riding the T has reminded me of how much better I feel when I get to be outside for a bit on each end of my day, particularly this time of year as my bones are beginning to thaw. I guess I could ride my trainer very gently with a tight bandage on, right? Maybe I’ll just have another cookie instead.

towards the finish

What a great turn-out at the marathon today. I spent most of the afternoon along the race route at the final stretch towards the finish line. While I watched everyone run by-slowly, quickly, young, old-I was completely inspired to run someday. I once worried that my chance to run a marathon and qualify for Boston may have come and gone, but watching everyone today made me feel so young and hopeful. I have nothing but time to prepare for a marathon. I hope maybe I can figure out a way to balance training on my bike and apply that with running and qualify at the Bay State Marathon in the fall.

I was so inspired that I went out to run immediately after getting home. Excited by the marathon buzz throughout the city, I was making a great pace across the Longfellow bridge, and then experienced what I have always pictured in my worst fears…my right foot scraped along the barrier between the sidewalk and the road and I broke my fall against my right knee and right forearm along that very same barrier. I considered carrying on before I noticed that my knee and arm had immediately begun bleeding plenty. By the time I ran home my shirt, once white, had gotten plenty of pretty bright red accents, and my sock was painted with a similar motif. I spared you all the gory details, but after the jump you can see more marathon photos and the make-shift bandages roomie Lauren (a nurse, phew) and I made.

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What a great day to be in Boston. The sun is out, there’s a little chill, but barely a breeze through the city. I took the day off from work so I can be here to ride to Copley and watch the finish line this afternoon. All in all it’s quite a special day to be in Boston. There’s an energy in the air all weekend that is just infectious. It’s amazing to see a community come out by the thousands to support complete strangers running the race. It was three years ago on marathon Monday that I turned a corner in the way I live my life. I didn’t run anywhere near 26.2 miles, but I did run 3 miles for the first time, which was quite the accomplishment for me then, and it changed my life.

During the first winter months of ’05, I had started walking and jogging at the gym on a treadmill with varying success. Most days I would walk for 15 minutes, jog (quite slowly) for 5, and then walk for 15 minutes. That Patriots Day morning, my friend Amy called and asked if I wanted to get out and go for a run to the river. I was pretty self conscious about my running skills, especially on the one day of the year where the best runners in the world were in town. The sun was shining, and that energy helped me overcome my insecurities, so Amy and I took a casual jog to the Charles. From that day on, I refused to go back onto a treadmill, I began getting up before the sun to get out before work or school all summer, and as the winter approached I bought gloves, spandex, and a windbreaker so I could keep running outside in the ice and freezing cold. I was hooked. A slow 3 miles three days a week slowly turned into 5 days a week, and by the following summer, I was running 6 days and averaging 35 miles a week. By this point I had dropped from 240lbs to 170lbs.

I still run, but usually only on the weekends. My new job has put quite the constraints on my time, and I began biking to work last July so that I could at least get some exercise while getting to work, rather than getting up even earlier to run and then ride the T. Over the past year, my athletic association has shifted from being a runner who bikes to get to work/school to being a cyclist who runs in my free time on the weekends. I don’t spend as much time thinking about when it’s new sneaker time or what a new jogging route will be, instead I’ve begun researching bike maintainence and the growth of Boston into a stronger biking city. I hope that I can forever balance these two persons; each coming to the front at different times in my life as they have shifted over the past three years.

It was a balmy 38* when I left my apartment this afternoon to go for a run. I am by no means the most hardcore runner in town, but sometimes find myself almost all alone out there. The rain didn’t really start until a few miles into my run, but still I didn’t pass any joggers or bikes as I warmed up through the Public Garden. Usually in the weeks approaching the Boston Marathon, the sun starts to shine and the city falls back in love with the bike/footpath along the Charles, but It seems that the seasonal urban jogging community is still a bit shy. That said, I was quite happily surprised to pass more joggers than I could keep track of, and almost as many cyclists once I made it over the river into Cambridge.

As enthused as I am to have seen as many folks out enjoying the day as I did, I was made quite aware of how cold and dreary it was today compared to years past. I usually look forward to the deep down cleansing rain through April and May. I love the soaking rain, but as long as it’s warm(ish). There’s a lot of scientific reasoning that flies way over my head when it comes to global warming, but days like today make an extremely clear impression on me. It seems a bit counterintuitive that global warming would make spring colder, but with a little bit of research on wind patterns and glacial melting, April showers bringing May snowfalls seems far too plausible.