A Quick Update

People ask me how I’m doing. You know what? I’m not even keeping track anymore. I’m to busy living life and all that crap. But people seem to be curious. I checked out my blog stats for the first time in a month this morning and found I’m getting almost as many hits for ‘knee replacement pain’ as I am for ‘My Jiu Jitsu Sucks’. I guess that necessitates a quick update.

So, um, let’s see. I can run now. Just a month ago I couldn’t even fathom that. I guess that means I won’t be so much fodder when the impending zombie apocalypse occurs. I can do squats with light weight now. I still have acute pain in the patella region and a little in my femur while performing them but it’s now a sort of good pain. It lets me know things are working. I’m nowhere near where I was pre surgery in regards to strength but that will come. My mobility has also improved, but I still have to be very cognizant of not only what I’m doing, but how. But I can catch glimpses of life with no pain and a fully functioning joint. I think the full view is not that far off.

And get this: I went to Jiu Jitsu class last Monday. I didn’t spar or really drill all that much; just rolled really light with my Professor and a couple people I trust implicitly. But… I have to say my knee did not like shrimping at all. Starting from the knees is definitely out as I can’t take the direct contact quite yet. And keeping full or half guard, even when rolling slowly and lightly, is an adventure. But I stayed for the entire class.

And I’ll be back tonight too. I’m thinking I’ll go once a week the rest of this month and next and try to increase that to two sessions after that. I don’t expect to spar and really don’t expect to drill all that much. Rather, I’m going to come in and go through the warm-ups and probably just do some mobility drills. And there might be a really light roll or two. We’ll see. I’m not going to push it.

But man was it ever nice to put on the gi again, see my teammates, and do what I could.

I still have pain where the new knee meets bone but the good days far outweigh the bad. It comes mostly from the lack of strength in my stabilizing muscles. The joint itself is still taking the full brunt of stability. Strength is coming, though. There have been a few days without the sharp, acute pain, and one or two where there was nothing but a distant, dull ache. And it’s very nice not sounding like a popcorn machine when traversing stairs…

Other than that, I’m not quite sure what else there is to say about the knee these days. It still lets me know it’s there. It still lets me know I’m not quite where I want to be. I’m no longer seeing stars from trying to do something as simple as getting the mail, so there’s that.

I spend more time showing off the scar than I do thinking about, or dealing with, the pain.

I kind of like being a cyborg.

And I have a question to ask those of you who still drop by from time to time. Should I start this thing back up? The blog I mean. I still get a fair amount of people checking out old stuff and still receive the odd comment on something I posted months and months ago, so it’s got me wondering if I still have anything to say and if there’s anyone who still wants to hear it.

And if I do, I promise to keep the “Ow. My knee hurts. This sucks ass” kind of posts to the absolute minimum.

Regardless, I’m good. I’m getting better. And I’m not just seeing light at the end of the tunnel; I can feel the warmth from it.

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Chicks Dig Scars

Oh, hi! First let me apologize for being so silent. Second, let me explain. I thought about blogging the entire recovery process from my knee replacement surgery start to finish. I couldn’t do it. To be completely blunt, my first couple of weeks did not go well. Blogging about it just let me marinate in the negative and I couldn’t have that.

During the first week of post-op, I was in a perpetual state of being pissed off. The Pain. The almost unbearable pressure and stiffness in my leg. The worry. The inability to do jack shit. It started eating away at me and swirled around in my head like some big, dark cloud.

I found myself spiraling down into that same hole that almost buried me after I got smeared by that drunk driver. I know how my head works, and I also knew that it is just natural to be all down in the early stages of recovery, but it was startling how quickly I got to that point.

I didn’t stay there long. It wasn’t fun. Any kind of writing I did do just turned into a 7,500 word pity party. So I didn’t do much in the way of writing.

But now that I’m a little less than four months post-operative, I have made the giant leap from focusing on surgical recovery and into building function – real, no compromise function – to last the rest of my life. Hitting a bunch of milestones last week, along with a nice comment from The Patient Grappler, , got me thinking. So I thought I would try and breathe a little life into this thing. Hopefully, I have a few interesting things to catch up with.

Looking at it as a whole, my post surgical recovery went well. I was a model patient. I got bored of that pretty quickly and became The Super Patient. I used my walker once and once only. Catching my reflection in the sliding glass door as I shuffled to the crapper using that goddam walker was all it took to say “never again”. I chucked the cane into the attic on day eleven. Once the swelling went down enough to, you know, actually move my knee, I dove into therapy head first. And from there I did extra reps, time, and weight on my own.

I say the first few weeks did not go well for two reasons: 1.) I stopped taking the narcotics prescribed to me and 2.) My original physical therapist and I had a very mutual hate for each other.

I’m a happy drunk but a very mean junkie. Barbiturates and opiates turn me into a vile, mean person and I was not going to subject my family to 16+ weeks of that. It’s hard to explain but taking poppy-based pain medication is a true Jeckyl/Hyde thing for me. So I weaned myself off the smack after one cycle. All this did was allow the pain curve to catch up and pass me. I was in so much pain during therapy that I couldn’t truly push myself into recovery. I ended up getting another post-op doctor, as my original one refused to entertain anything but opiates for pain relief, and the new guy came up with a cocktail of natural and synthetic pain medications that did the trick without making me all psychotic and strung out. Once I got control of my pain management, it allowed me to push hard and fast into recovery.

My physical therapist; what can I say? Have you ever seen someone who you don’t know, have never spoken with or even know a thing about, but their very existence makes you want to walk up and just smack the shit out them? That’s how I felt about my first therapist. And the feeling was mutual on her part. This woman came to my home every day for three hours and basically knee-barred me for 2 hours, and then heel hooked me for the last one. And during this process she’d say things like “Aw, big man’s knee hurts?” She motivated through shaming and belittling. Add in the fact that she never called me by name (only by “big man”), was insulting to my family, and I actually regressed in my recovery, and I can’t tell you the satisfaction I got by loudly and publicly firing her after a couple weeks of that b.s.

Her replacement was awesome. She is/was all business, doesn’t really care about forging a personal relationship, and places her patient’s recovery above all else. Her first order of business was to attack the inflammation and stiffness. Within three days of her working with me I could bend and extend my leg fully on my own, although incredibly painfully and slowly. On the sixth day working with her I actually walked around the block (albeit with a lot of support from my daughter) later that evening. Baby steps.

A large part of therapy involves a passive motion machine. It is basically the same device used for interrogations during the Spanish Inquisition but has been updated with an electric motor and integrated circuitry. It just churns your leg through its full range of motion over and over and over. With my first therapist, I could never make it past an hour in this thing without ripping out the power cord. With the new girl, I actually sleep through the night in this thing as it just chugs along.

Knees

And before you knew it I was off and (figuratively) running.

There have been noticeable improvements and positive changes on a daily basis. Perhaps the biggest happened towards the end of week 5. I stopped taking the narcotics again. My wife took over as my pusher, and she had been secretly curbing back my dosage and before you knew it I was taking nothing but the occasional NSAID and that’s it. I was pain med free and moving around quite nicely on day 37 post-op. Two weeks after that I was released to out-patient physical therapy which I still attend three times a week.

This past Monday I saw my ortho, who said I’m so far ahead on the recovery curve that he doesn’t want to see me again for another 3 months. The device in my leg has been fully assimilated. I am it and it is me.

Knees

I’m always amazed at the length of the tibial and femoral posts on this device when I see the x-rays. My doc has told me more than once that I’ll never forget that this is an artificial knee. But I know he chose this particular design due to the fact it has the lowest rate for “adjustments” on patients twenty years my junior who define themselves as ‘athletes’ or ‘very active’. That’s cool with me. And to be honest, I really don’t want to know about the “device” in the first place. It’s my knee, not a device.

And the best part of this whole experience?

I have this TOTALLY BITCHIN’ SCAR!

Knees

The only thing that is really holding me back is that the muscle groups in my leg are nearly useless. With the device I have, the surgeons are forced to cut the quadriceps in half and detach the hamstring and calf muscle groups in order to have unencumbered access to the joint. In a word, it totally discombobulates everything and the muscle memory dies. I’ve had to learn how to walk again, although that came back relatively quickly.

It’s the lack of strength. The neural pathways are gone, I have to recreate them. And it’s a total bitch just trying to contract the quadriceps let alone trying to get the leg to work as one harmonious unit. I can’t do any kind of work with any significant weight yet, and have to be very careful just doing body-weight squats. But it’s coming. Just a tiny little bit every day, but it’s coming.

I don’t doubt that I will get on the mats again. I understand that my improvement is up to me. I understand that there might be some unforeseen problems along the way. I’m already past the pain, the nonexistent movement, the reliance on everybody. This 18-inch incision still talks to me every day. But it’s ok This too shall pass.

Before I ever had the surgery, I already regretted it.

In reality, I was scared shitless about losing my way of life as a husband, father, friend, athlete, and Jiu Jitsuka.

I have no regrets.

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Holding It In

“Stop… Please stop… Debbie… Stop. STOP!! You are causing me so much pain that it’s all I can do to keep from pissing all over myself.”

I didn’t, but I did yell out more than once. My physical therapist is on a mission. And part of that mission involves her knee-barring me every 20 seconds for half an hour. Other parts involve a heel hook that Palhares would be envious of. And once this woman has satisfied her sadism, there’s a few hours in the passive motion machine to look forward too. I’m beginning to think I might not make it out alive.

In the week following surgery, I devoured any and all information I could find on how to make knee replacement recovery as successful – and quick – as humanly possible. One of the recurring themes you’ll find is to ingest as much pain medication as you can stomach prior to physical therapy for the first month or so. It made sense at the time.

However, I’ve been completely off the smack for close to a week now. I’m a happy drunk but a very mean junkie. Opiates cause an abrupt Jekyll / Hyde transformation in me and I just become an evil, whiny bastard. I don’t like the person I turn into while riding the snake.

So I’ve settled on just a handful of NSAIDs prior to therapy and an extensive icing regimen afterwards. It’s been working ok I guess, but today I had nothing in my system. And as a full, complete night’s sleep is impossible I find myself nodding off frequently throughout the day. Because of that I missed taking a few. I was actually asleep when Deb showed up to the house.

And if there was ever a day when I needed something in my system… today was it.

It was the first day where I couldn’t just ignore her. The first day I couldn’t stare at a picture on the wall, or find a happy place and wait for it to be over. No amount of volume on the iPod was going to let me escape this particular session. I actually had spots dancing in front of my eyes at times because I’d either forgotten to breathe or just simply couldn’t.

She was so intent on finally getting me past a 90-degree bend that she nearly fell off her stupid stool. Twice.

I figured out very quickly that at this point in time there is no way I can hurt myself enough to bring this knee back from the dead on my own. I sort of knew that going in, but it has taken this sadistic sociopath to make me realize that post-op recovery is a team effort.

She seemingly has no empathy. She takes no prisoners. She’s killing me. She puts every fiber of her being into bending and twisting and stretching my leg into another time zone. And damn her, she knows I can take it.

I clench my fists. I set my jaw. I hold my breath and tense my core.

And I try not to piss myself.

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Under Construction

Closed

Gentlemen, we can rebuild him. We have the technology. We have the capability to build the world’s first bionic man.

I wonder if I’ll make that MYANG-YANG-YANG-YANG sound going for an elevator sweep when this is all said and done?

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The Decision

For most of my adult life, I have been in pain.

I’ve spent decades ignoring pain.  One tends to do that after resigning to the fact that it will probably be with you for the rest of your life.  You learn to live with it, learn the little tricks to minimize it, and learn to live in a quasi sort of denial.  It becomes your normal.

But now that I’ve seen the awful truth in black and white so to speak, and felt the nauseating pain of bone on bone while just trying to sit up in bed, I can no longer deny the fact that my natural knee and what functionality I can get out of it is not long for this world.

Knees

Seeing that X-Ray and the associated MRI has erased any and all pretensions on my part that my knee as-is can be saved.  What little cartilage I did have is gone, pulverized into jelly.  What connective tissue was there now has the structural integrity of balsa wood.  As far as I’m concerned this is a done deal.  There are no more options.  Let’s do it now and be done with it.

So, around this time tomorrow, the docs are going to cut the whole thing out and discard it like some used-up ball joint out of an old Dodge.  And in its place they’ll weld in the titanium equivalent of double A-arms and coil-over shocks.

So I sit here wondering what it’s going to be like living without pain in this knee.  I have no concept of it.  After a lifetime of athletic activity and other more grievous insults to this joint, I was under the assumption that after reaching a certain age constant pain was just going to be part of the deal.  After talking with a few of the folks here on the orthopedics floor, and those in physical rehab, I was very, very wrong in that assumption.

I’m finally recognizing the pain.  I’m giving into it.  That doesn’t mean I’m suffering.  It simply means I’m finally truly listening to it.

And this is as good a time as any for us to say our goodbyes.

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Tapping Out… Again

Where have I been, you ask?  OK, maybe you haven’t been asking…

It’s said a picture is worth a thousand words, so maybe this will explain it.

Ouch.

Ouch.

Ok, so maybe that doesn’t explain everything, so here’s the back-story.

The Wife and I have been avid – some might say rabid – white water rafting & kayaking aficionados for over thirty years now.  In other words, we’re River Rats.  As of this writing we have rafted or kayaked white water in 12 different countries on four different continents.  Yeah, maybe rabid is the best descriptor after all.

When we first married, we didn’t have a pot to piss in.  Wanting to make what meager honeymoon I could afford be a memorable one, I finally decided that white water rafting would fit the bill perfectly.  It fed our love of the outdoors, was just a day’s drive away at the time, and was something we had never done before.  New beginnings and all that crap, you know.

Best of all it was cheap.  Dirt Cheap.

So we spent the first week of our married life in an angry, churning maelstrom by day, and our nights in the splendor of the West VirginiaMountains doing what newlyweds do.  And actually, that’s a pretty accurate description of the last 30+ years of our lives, minus the mountains…

And since then we have returned each year (except during pregnancies and what not) to the Gauley River to take in the natural splendor, raft and kayak the best white water in the country, and do what newlyw… you get the idea…

This place speaks to my soul.

This place speaks to my soul.

Scouting out the attack.

Scouting out the attack.

For those of you that aren’t familiar with it, the Gauley River is a dam-controlled watershed in the mountains of West Virginia.  Ten months out of the year the river offers the perfect conditions to learn how to raft and/or kayak what could only be generously considered white water.  It’s meandering, calm, and relatively peaceful.

But for a six-week period each fall, the state opens up the dam every weekend to flush out sedimentation (and promote tourism) and the Gauley River is absolutely transformed.  The 12-mile long Upper Section of the Gauley suddenly has 40 named rapids – and a named rapid is a notorious rapid – including six Class V rapids.  For the uninitiated a Class V is sometimes called a Devil’s Maytag.   Right at the mid-point of the Upper Gauley there’s a 14-ft waterfall.  For those six weeks the river easily falls into Top 3 in The World for white water.  And in the White Water community, a trip down the Gauley during the fall run is a badge of honor.  The Wife and I have done it twenty-seven times.

The way I describe it to people is try to imagine a wet, wild, incredibly visceral roller coaster ride that lasts for half a day.  It’s something that you will never forget. And if you ever decide to go, nobody does the all-inclusive trips better than A.C.E. Adventure.

Hey! Take my pic! I'm going for an ender!!!!

Hey! Take my pic! I’m going for an ender!!!!

Hey! Look at me! Look at me!!!!

Hey! Look at me! Look at me!!!!

Hey! Look at meEARGHAABLARFLE!! *cough*

Hey! Look at meEARGHAABLARFLE!! *cough*

So, you’ve probably guessed what happened by now, right?  You’re thinking I got ejected and caught a boulder or something with my leg, or maybe got it trapped under something?  Injuries of any kind are very rare in rafting & kayaking, but you would be completely justified in making that assumption.

And you’d be completely wrong.

So, this ruggedly handsome river rat, always conscious of his surroundings,  reflexes and balance honed and amplified by years of Brazilian Jiu Jitsu… tripped on a stupid branch after taking a family picture and ended up trying to drive his knee through a half exposed rock on the ground.

The pic in question.  That's the Future Son-In-Law and his Ridiculously Over-sized Head, The Wife, and Female Spawn #1.

The pic in question. That’s the Future Son-In-Law and his Ridiculously Over-sized Head, The Wife, and Female Spawn #1.

After the 2-hour drive back down the mountain and to the nearest town that had, you know, an actual hospital with running water and electricity, the attending physician said it was a one-in-a-million fall.  My knee hit that rock at precisely the correct angle, and with just enough force, to completely explode the joint.  Seriously, my knee just came apart; bone, muscle, tendons, and ligaments all disassociated themselves from one another and went in different directions.

Amazingly enough… nothing seems to be actually torn other than at the connective tissue at the bone.  Or more accurately, no tearing can presently be seen.  Both the interior and anterior collateral ligaments separated from the bone on both ends and ended up somewhere in my calf by the time I got to the hospital.  My ACL is beyond strained, completely detached from my femur but still attached to my tibia, but looks to be otherwise intact.  It looks like a fruit roll-up that has sat in some soccer mom’s purse for the last three years, but seems to be in one tear free piece.

I used to have one of these...

I used to have one of these…

However, I split my patella (kneecap) right down the middle and have several significant greenstick fractures at the top of the tibia and fibula and one “somewhat concerning” (the doc’s words, not mine) greenstick fracture running laterally along the bottom of my femur… and my tibial plateau is sliced to ribbons.  Probably the thing that’s concerning the doc the most at this point is that my patellofemoral groove is no longer a groove.  It’s no longer anything really, not that they can see, other than an angry, mangled mass of cartilage.  Same goes for my lateral meniscus.  If I could stand I would be grinding bone on bone.  As of this writing the internal/external swelling is too severe to complete an adequate assessment of the damage.  Like I said, my knee literally exploded.

So, I have this stupid fixator thing screwed into my bones just to keep everything from moving around until the internal swelling recedes enough to ascertain the true, overall damage.  There is so much inflammation in my knee that even an MRI can’t clearly make out what’s going on in there.  The docs say it will be a few days more until they can produce digital imaging that is “not masked by inflammation”.

And once that happens, I need to seriously start thinking about a total knee replacement.  The docs are thinking I may be able to recover depending on the true damage without it, albeit much slower, but they and The Wife are pressuring hard for me just to have the surgery.

I’m not so sure, and nowhere near convinced.

Way back when on my thirtieth birthday, I had complete ACL/MCL reconstructions in both knees due in part to a very recklessly spent youth, and in part because the first job I had out of college had ‘destroy your knees almost beyond repair’ in its official description.  The ligaments currently floating around in my knees are not my own.  People used to joke that I probably received the inner workings of some executed serial killer’s knees and that they would eventually betray and kill me while I was doing burpees or something.  They weren’t all that far off.

My hope with this prior reconstruction was that I’d return to pre-surgery levels of mobility and a return to those activities I used to love to do.  And to a certain extent it worked.  I had the freedom to do what I wanted.  But in reality, it only allowed me the freedom to do what I wanted within the confines of my tolerance for pain.

If I wanted too, I could play a pick-up game of hoops, hike through the parks, run the dogs to death, pretty much whatever I wanted to do.  One out of three times I didn’t, because I knew the day after would be hell no matter what precautions I took beforehand.  Any activity that required repeatedly placing weight/pressure on the knee and bending it for an extended time on a “bad day” would require a post-activity cocktail of ice, elevation, ibuprofen, and bourbon.

And if I go through with the knee replacement the prospects get that much worse.  I won’t ever play that pick-up game of hoops, or run the dogs into the dirt… ever again (so I’ve been told, anyway).  Jiu Jitsu is still very much up in the air.

See, even though the purpose of the joint replacement is to negate the eventual osteoarthritic pain, the replacement is not considered a lifetime device, or even a “cure”.  People that go through knee replacement surgery are strongly cautioned against any activity that could damage the device, or even cause the need for a surgical “adjustment”.  Over the course of a person’s life you could be looking at just having to get the device adjusted two, maybe three times, just due to usage and the natural changes in your body.

Does this look even remotely natural to you? Me either...

Does this look even remotely natural to you? Me either…

I am intensely worried about the potential affect to my quality of life and the time required getting back to full function.  No, scratch that.  I’m intensely worried about the medical definition of full function with the knee replacement because as it stands now, it does not meet my definition at all.  I worry less about pain management.  I’ve dealt with that before.

And so now I lay here trapped in a hospital bed trying to rationalize getting the surgery or not getting the surgery.  Right now this is a procedure that just seems wrong, unnatural, and all that.

I think what is giving me pause is this:  The surgery is not a fix, it’s simply a change.  And once it’s done, there’s no turning back.

And as stupid as it might sound, the thing that is absolutely killing me is that my time on the mats might be done.  Jiu Jitsu has given me so much: belief in my failing joints, gave me physical fitness and health back, instilled confidence along with an overall sense of self.  The art has given me more than I can put into words, actually.

But, at least for the foreseeable future, my time on the mats is done.  I’m not sure that fact has sunken in yet.  I’m sure, as the weeks slow down into days, the days into hours, and the hours into excruciating minutes of boredom, that fact will be laid bare.  The Wife just says I’m being stupid, and that all I should be thinking about is recovering.  But… she admitted the other night how she knows how important it is to me, the good it’s done not only for me, but for everything really.

I think the fact that I have no real control over anything right now is making the acceptance of “no rolling” that much easier to take.  Right now, I have two options. Nix the replacement surgery other than having the knee reconstructed, wear a fixator for 2-3 months, and then endure a few months of intense physical rehab.  Or, get the knee replacement and be, for all intents and purposes, completely off my feet for an unknown amount of time, follow that up with 2-3 months of post-op recovery, and then follow that up with another few months of physical rehab.

With the first, I’ll be back to being able to do what I want to do within reason, but again within the confines of my tolerance for pain.  With the second, I’ll have no pain but will be very limited in what I can do.

 I am dissatisfied with either option.

So, now you know where I’ve been, and probably have a good idea of where I’ll be for the foreseeable future.  Blogging will probably be light as the pain meds are strong enough to put Keith Richards down and out, but I’ll check in from time to time and, of course, check in on those blogs I read every day.

Take care, I’m tapping out.

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Train for Yourself

Even after a short hiatus I’ve always found returning to Jiu Jitsu to be, shall we say, challenging. Sure, we’ve all taken little breaks here and there, mandatory ones around the holidays, stuff like that. But even coming back after a week involving presents, turkey, and/or lots of laying around has not presented as big a challenge to me as last night did.

Three days ago I was completely cleared of my staph infection after almost a month of reevaluations, tests, changes in dosage, and outright head scratching. Last night was my first night back training. During my time off the mats I did nothing but try to keep myself upright when the situation called for it. Let’s just say my first night back was extra-crispy and leave it at that… for now.

Over the years, I’ve seen lots and lots of people get extremely discouraged on their return to training and then quit. They couldn’t keep up anymore. Their peers rapidly improved in their absence. There are myriad reasons, some valid and some not, but it happens. In fact, the main reason I abruptly ended my ‘career’ in body building was nothing more than not having time to properly train, eat, and all of the other stuff you have to do to be even a little competitive in that world and still keep the other 27 plates I had spinning up in the air. At the time, real life was just getting in the way. Because of my lack of time for dedicated training, my body – and even more devastatingly, my ego – took a massive hit. I used it as an excuse to throw all of my work away. It happens to everyone to some degree at some point in their life. Priorities shift and change.

And I think the best part of going through all that is that it prepared me very well for my mindset in Brazilian Jiu Jitsu. It wasn’t always so, but now my expectations have a lot less to do with ego –what others think of me- and way more to do with my own personal progression –what I think about myself. I don’t have to be tapping out punk-ass bitches left and right. Winning is not a priority. All I have to do is train, and right now, that’s enough.

Some classes, I’m handing out kicked ass on a silver platter with a nice side of smack talk. Some classes, I’m eating my own weight in Humble Pie. But, I’m always progressing.

This all came to a head for me last night. I was dead on my feet, easily shut down and completely gassed. Did I learn anything last night? Yes, yes I did. I learned that I have a reserve of guts and will power previously unknown. I don’t really think I learned much in the way of BJJ, but I learned volumes about myself.

So, to finally get to the point, my advice is this: Train for yourself and yourself alone. You don’t have to be Galvao or Cornelius or Almeida. Just show up and give it your all, all the time. You may progress fast or at a snail’s pace… but it’s still progress. You gain nothing if you don’t. Do it for yourself. For me, that’s the key to sticking with it.

And as a total aside, The Wife and I are heading to our (almost) yearly pilgrimage to the Gauley River for the best white water in the world for a long, well-deserved weekend. Posting and all that will be nonexistent. You’ve been warned.

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