Sunday, April 7, 2013

My Least Favorite Questions

"Mountains are the means, the man is the end. The goal is not to reach the tops of mountains, but to improve the man." - Walter Bonatti
The last several weeks have been something of a drought creatively. I won't pretend to have found a century spring or the like, but I have discovered something like a dripping faucet that, drip-by-drip, will satiate for the time being.

Since my last post, "Disappointment, Resilience" x2, I have done my darnedest to keep resilience at the fore by taking positive steps towards healing. I immediately made an appointment with a physician's assistant (PA) at Missoula Bone and Joint to have a look at my knees. He said the pain I was experiencing in both knees was likely associated with pressure created from the rheumatoid arthritis. The PA went on to give me a shot of cortisone in each knee to ease the pressure and sent me on my way with a referral to a physical therapist. 

To physical therapy!

After a brief knee exam, the physical therapist asked me what has become my second-least favorite question (least favorite to come): "Have you tried biking?" My heart sank. Not because of any ill-will toward biking, but because I have so much love for bi-pedal locomotion. Ambling, hiking, sauntering, running, jogging, sprinting, strolling, loping, walking, sashaying, mountaineering, striding and straight-up walking: all of these forms of two-legged travel - even sashaying! - are near and dear to my heart and, given the ability, I would perform combinations of these movements every waking hour. 

Back to the exam… She went on to describe how biking is not only easier on the knee joints - something we all know!,  but in many ways, healthier for them. When activated, the synovial fluid - the lubricant in the knee - heats up and provides nourishment for the meniscus and various cartilage in and around the knee joint. Running, hiking and power walking, on the other hand, provide the additional element of downward force on the cartilage, tearing, grinding and outright destruction of the precious padding in an unhealthy knee. 

After describing the science of knee joint impact through competing dyads (running vs. walking, walking vs. biking), the physical therapist went on to explain the value of cross-training. She mentioned that two to three hikes a week is within the realm of what is reasonable given the amount of cartilage I have remaining in both knee joints. She then asked me what has become my least favorite question: "What are your exercise and physical goals?" The reason I dislike this question lies in the fact that my goals are always unreasonable. Examples of previous exercise and physical goals: win a marathon; place top-three in a 50-mile running race; 100 miles on a stationary bike in under four hours; run Pikes Peak round-trip in five to six hours; run a half-marathon in the morning and a 50k in the afternoon. The challenge, the chase, the insurmountable nature of the goal is exactly what makes it so tantalizing. It is in the pursuit of excellence that I feel most human, most alive. Invariably, when asked the question, I couch my reply, responding with what I think my rheumatologist, PA or physical therapist considers to be the upper limit of what is reasonable. In short, I lie. 

A few more minutes of discussing my ostensible goal - to hike 4-5 times a week, ha! - my reception to the news of biking began to warm, consequently changing my attitude and tone. I begin to ask the 'real' questions, the honest questions that reflected the reality of the condition of my knees and what lie in the realm of the reasonable. "Hiking two to three times a week, with days of biking in between to maintain your cardiovascular health will keep you fit", she said. Although I may not be a genius, I am not an idiot. I know these things she tells me! But how hard it is to accept hard truths, truths that we can intellectually acquiesce, repeat and believe! 

All right. So that is my story: I visited a PA, he gave me shots of cortisone; and then I visited a physical therapist and she asked me two of my least favorite questions. 

My honest answers the questions?

Have you tried biking? After a soul-searching chat with my buddy Dave over a cup of coffee, the idea of biking as a sport became real. I purchased a mountain bike last week and will begin supplementing my hikes and climbs with mountain biking.

What are your exercise and physical goals? At this stage, to climb Mount McKinley in 2014. All else is secondary. The goal of 500,000 feet and 100 summits of Mount Sentinel in 2013 is a means to an end (a means that will need to be amended to the realm of what is reasonable).

This week, I will be telling my physical therapist the truth. Her support, coaching and encouragement is only as good as my honesty. I am doing myself no favors by couching my dreams. If my goal is to make the unreasonable reasonable, the unreasonable must become reasonable. The unreasonable - the dreams! - must be shared with friends, family and, in this case, medical professionals that can provide proper nourishment for the mind, body and soul that can explain away the doubt. 

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