Plasma Rich Platelet injections

After making my way back to Vail to see my knee surgeon Dr. Steadman and waiting the customary 1.5 hours in his jampacked Waiting Room, I was ushered into Exam Room 1 by Chris, the nicest physician's assistant ever. Chris remembered me from my knee surgery last year and so I was lulled into a false sense of security and comfortably awaiting Steady(which is what the doctor is called by all his pro athlete patients, so what the heck I call him Steady too). Steady's tanned and smiling face soon appeared followed by one of his Fellows. Having had an MRI earlier Steady was armed with my full report and I happily hopped up on the exam table so he could examine my knee. After much discussion, contemplation and pressing on parts of my knee that made me groan in pain, Steady informed me that the patella tendon was inflamed and required PRP therapy. Great, I thought, a little ice and stretching and I'll be good to go. "What is PRP?," I inquired. To which the response was long and involved so I'll abbreviate for you dear reader; Plasma Rich Platelet therapy is a procedure where by blood is drawn from the patient, then spun in a centrifuge to separate the plasma rich platelets, and this plasma rich reduction is then re-injected into the injury site. The injury site is essentially duped into believing it has sustained another massive trauma and the plasma rich concoction then attacks the re-injured site and repairs the damaged cells. It is, as you can well imagine, seriously painful but holds the promise of long term non-surgical benefits. It would take 3-4 hours. Not wanting Steady to think less of me, I swallowed my fear and mild horror, smiled and said "Looks like I need to catch a later flight". Steady beamed with pride, his sparkling blue eyes conveying his happiness. I confessed to Chris that there may not be room on the later flight but sadly after enlisting the help of a friend and Steady's assistant Mona, my transport home on the later flight was confirmed.
That's when I met Brent, the physician's assistant for Dr. Karli who would be administering the PRP. Brent explained the procedure to me again but with great enthusiasm. Clearly the prospect of drawing my blood and re-injecting it was a good thing to Brent who is padding his resume before heading to Med School in the Fall. Brent also explained that after the procedure my knee would swell and that I was not to try and reduce the inflammation, so no ice or ibuprofen, although he would give me pain killers as it would hurt a lot for a week to 10 days. Brent said this entirely too matter-of-factly for my liking. Apparently it has to be inflamed so that the PRP will then find the injury and repair it with the regeneration of healthy cells. Sounded like a nightmare but a necessary one if I'm to return to normal activity. Brent drew an awful lot of blood, then placed it in the centrifuge which spun and spun until out came my separated plasma, platelets and blood. The plasma was bright yellow and thick.

Dr. Karli entered the room looking friendly and not a little handsome in his surgery scrubs. He explained how I had the same injury he had suffered from and was optimistic about the procedure. Note to self: beware anytime something is referred to as a "procedure". Dr. Karli positioned my knee atop a pillow so that it was bent at a gentle 35 degree angle and began marking my knee with little black x's, 4 in total and then another 4 x's along my IT Band, at the time that seemed innocuous. He then asked Brent to hand him something which turned out to be an enormous needle and asked me if I was ready. "You bet," was the best I could muster as I rested my head back between my cradled arms so I could dig my finger nails into my scalp without drawing attention. I simultaneously suck in my gut while reclining to appear as thin as possible for Dr. Karli as he proceeded. Brent stood by with a can of topical freezing agent which he sprayed on Dr. Karli's command and it was indeed freezing. Brent continued to spray and then I began to feel the bright pain of the needles as Dr. Karli liberally injected me with what was an internal freezing agent. Yes this was still just the warm up act. After my knee was frozen solid as a butterball turkey (or so I thought). WARNING: IF YOU ARE SQUEAMISH PLEASE STOP READING HERE AND SKIP DOWN TO THE NEXT PARAGRAPH, DAVID LAWEE THIS MEANS YOU. Dr. Karli then injected 4 needles with small catheters attached into each of the 4 x-marks, this was somewhere between very painful and excruciating, but I just dug my nails into my scalp and kept breathing. Once those were inserted, Brent handed Dr. Karli a long syringe filled with my Plasma Rich Platelets and Dr. Karli warned me at this point that the sensation I was about to experience would be like nothing I had felt before; this turned out to be a massive understatement. I craned my neck forward so that I could watch what was going on and saw Dr. Karli as he began to empty the PRP-filled syringe into the first catheter. I could feel immense pressure building in my knee (not a good pressure like a back rub) more like a sharp implement trying to pierce your muscle tissue, and then some of the PRP began to spout out of one of the other catheters. Brent wiped this up and both he and Dr. Karli assured me that this happens all the time. I kept digging my nails ever deeper into my scalp out of Dr. Karli's sight and upon finishing with the first catheter, Dr. Karli said to Brent, "Yup, she's tough." I was obviously overjoyed and filled with immense pride. It was at this point that Dr. Karli told me that he had done this exact procedure to himself just 12 months ago. I was duly impressed and countered with the tale of how my aesthetician does her own bikini waxing. This made both Brent and Karli take pause and concur that women were tougher and that no man would ever be able to do his own "manscaping". I'm sure he is right. 1 down 4 to go and that was just the patella tendon, we also had the 4 in the IT Band as well.
I hunkered down and we got through the rest of the procedure with only one audible articulation of pain that I just could not suppress. Dr. Karli assured me that I was tougher than most of the men he treated, especially the football players who are "babies when they see a needle." Brent concurred and we all had a controlled chuckle as the catheters were still inserted into my leg. Finally it was over, all the Plasma Rich Platelets had been re-injected into my tendon and IT Band and I was bandaged up. Dr. Karli wrote me a prescription for Vicadin which he assured me I would need over the next 24 hours. I thanked him warmly but he stopped me saying, "Thank me next time I see you when you are better." What a guy.
Brent helped me hobble down to the lobby where my driver was awaiting to take me back to Denver to catch my flight home. I shook Brent's hand and wished him luck with Med School, "you take care now" he said, and as I drove away I smiled and looked down at the knee which had already swollen to the size of a small grapefruit. "It's working," I thought, "come on platelets do your thing," and on we drove.

Bars, Balls and Bungees and 4 sad little dates

I decided to opt out of the morning bike ride today and so after Hilary headed off for the ride I lounged in bed a while and then joined Jana and Jill for breakfast. My Mexican food binge and DQ slip of the night before had me feeling guilty as though everyone in the dining room could still smell the sweet scent of the deep fryer on me. I ordered some steel cut oats and egg whites and topped it off with 4 sad looking pitted dates while my breakfast companions enjoyed bread and butter. Determined to work off the excess calories and gluten of the night before, I then headed to my first fitness class “World Beat” with Jana. The studio was well lit and teaming with eager Ranch guests determined to burn every last calorie possible. There were 3 different drummers stationed in the center of the room each equipped with some exotic form of percussion instrumentation which would soon assist in our ultimate sweaty demise. The instructor, a lean perky Chilean names Elisa with bright red lips and spandex covered hips that could move a nation to tears, stood before us welcoming us with a wide smile. The drumming began and Elisa’s hips took off like a rocket, I attempted to mimic her moves undulating my hips, whipping my arms around and shimmying about like a South American salsa goddess. Clearly I am a natural for World Beat I thought, relieved in fact, until I caught a glimpse of myself in the large and unforgiving floor to ceiling mirrors which covered all the walls. Could that clunky creature in the Lululemon capris and orange top be me? Surely there’s been some cosmic mistake or practical joke being played, I thought. But I shimmed to the right and the creature in the mirror jerked awkwardly in unison. I tried looking in the side mirror and sucking in my gut as best I could, but there was no escaping the reality, I was no Elisa. For the next 45 minutes I hopped and stomped and twirled with eyes affixed on Elisa trying to avoid the mirrors and my reflection at all cost. I have never sweat so much in my life, nor had as much fun making a pure dancing fool of myself. Jana and I even had a bonding moment where we got to dance together, two mildly uncoordinated middle aged euphoric white women in the land of Elisa and the World Beat drummers.
After a much needed 15 water break, we re-entered Gym 1 to try the next class called Bars, Balls and Bungees ADV (advanced). There were only 6 women in this class and they seemed far more lean and muscular than our World Beat sisters. We stood in a circle around a large pole to which was attached 6 sets of bungee cords with handles. Rick the instructor who resembled every Jewish boy I attended Bialik Hebrew Day School with told us to pick up a set of bungees and with one in each hand begin squatting rhythmically to the music which was now an old U2 song. He informed us we would be doing 5 minutes of each set before switching to the next exercise. Within 35 seconds my quads began to burn and I looked around at my compatriots to examine their facial expressions, all but one Amazonian woman with guns like Arnold, were sweating profusely and looking nervously around as well. Good, I thought, we’re all in this together. Needless to say, after World Beat my resistance was low and I had to struggle to make it through the entire class, inventing modifications to the torturous squats and medicine ball tosses to allow me to carry on. Thank god I have a bad knee that truly began to throb and so made the perfect excuse for my lower impact version of the endless jump squats. After the class I wished Jana a sweaty and breathless adieu and made for the L-pool where I promptly lay down and fell asleep.
Hilary returned in time for lunch and so we dined at the Double U Café, this time I opted for the mixed salad with grilled chicken, skipped the frozen chocolate covered banana and left hungry but proud at my restraint. Then it was on to the Metaphysical building for my Clairvoyant Reading followed by a 100 minute Thai Massage. I waited in the spa relaxation room for my Thai massage therapist to collect me but after 5 minutes had passed a kind attendant asked me what I had scheduled and informed me that Thai massage is given in the Life Enhancement building. I was so ashamed; I had made a classic newbie error. Every returning guest knows that all clothed massages are given in the Life Enhancement building. I solemnly trudge over to the L.E. Building and was greeted by my therapist who comforted me and told me that such errors happen all the time even to returning guest, which cheered me slightly. After 100 minutes of deep stretching massage I returned to my Casita where Hilary and I exchanged our tales of the day over our last bottle of chardonnay and some microwave popcorn.

We decided to invite Maria Bartiromo to join us at dinner if she was there, but alas she was nowhere to be seen in the dining room. We did however spy an extraordinarily fine looking new guest at the salad bar, he was some kind of professional athlete but neither of us could figure out which sport or who he was. He wore a pair of True Religion jeans and a shirt with the words "Look better naked," emblazoned across the back. "I'm sure you do," whispered Hilary to me, and no doubt she must be right.

Tomorrow will be our last day at the Ranch and I’ll be sad to say goodbye.

Hiking, acupuncture, fitness report and escape from the Ranch for dinner

This morning we slept in until 6:30am as our hike was not to depart until 7am. Once again we descended upon the Double U Café where Hilary enjoyed the fresh baked muffins and coffee while I tried gluten free toast with peanut butter and banana and some more organic decaf tea. I had a few dehydrated figs and apricots for good anti-oxidant measure and one unidentifiable dehydrated fruit sphere that we’ve decided was a small plum. We piled into the van with 10 other guests, mostly from New York and New Jersey, and headed for Bear Creek. We were each given a day pack containing not 1 but 2 water bottles, a small snack pack and a towel. While the others ripped open their snack packs to admire the contents, I was struck with sadness as mine was filled with nothing but contraband, I mean really a bagel for a snack, and pretzels, are they trying to kill me?? Who eats carbs these days anyway, it’s just so yesterday. Luckily there was a small container of pumpkin crunch and a hardboiled egg, without which I might have just gotten off the bus. We made it to the trail head and I grabbed my trusty hiking pole and joined the group as we ascended the mountain single file elephant style. The group quickly split into two sub-groups, Hilary and I were in the “fast” group and the remaining posers were in the “slower” group. Hilary was ahead of me, Mona from New Jersey (a retired radio station manager with an unforgiving son-in-law) was behind me and off we went. It was a beautiful day and we spotted some Ermets which look remarkably like ordinary squirrels to me but cause much joy when seen here by hikers due to their pointed ears and bird-like chirps. Half way up the 1000 foot climb the “slower group” split into two groups so that now the 3 hikers who should never have signed up for the level 3 hike in the first place could rest and allow the others to carry on upward. After an hour of climbing we reached the picnic spot which afforded beautiful vistas of the canyon and tucked into our snack boxes. Needless to say I was finished rather quickly while the others gorged on white flour bagels, Snyders pretzels and other toxic goodies. One woman in a thick New York accent and very attractive Marni sunglasses (“They’re pehr-scription, I do it awhll the time; bawuy the nicest glahssez I can fwind and just tell them to make the lenses fit.”) began asking us where we were from and what we do etc. Hilary asked where she lived and she said London, which had us perplexed. “22 yeez I ben there, fouwer kids, divohced and still love it they-ah.” I commented on how nice it was than even after living abroad for 22 years she still had her lovely New York accent. That didn’t go over so well, and for the remainder of the hike she (Bobbi is her name) made sure to pepper her speech with plenty of anglicisms like “grotty”, “smashing” and “brilliant” with a curbed accent to say the least.

We returned from the hike put on our swimsuits and cover-ups and headed for lunch at the Double U where we met up with Jana and Jill. I enjoyed my grass fed burger on gluten-free bread and my frozen banana again. Watching the others munch on lavosh crackers with their hummus was too dispiriting and so I left half my rice crackers and hummus on the table. I headed to the Health and Healing Center to meet Carol my naturopath and acupuncturist. After a brief discussion of my headaches, no doubt exacerbated by my new detoxification diet regimen which has clearly thrown my body into some sort of shock, I popped onto the table in my swim suit. Carol began to stick me with plenty of needles determined to alleviate my headache so that I will stick with the detox which she concurred was critical to my wellbeing. For those of you new to acupuncture, the needles are just a little poke and then the real fun comes when the acupuncturist twirls the needles in order to get the “chi” flowing. The more the chi is stuck the more twirling is required to stimulate the meridian where the chi is meant to flow and free it up. Suffice it to say there was a baton troop worth of twirling going on and I could feel the chi being freed up and beginning to flow through my body. Once I was sufficiently stuck with needles, Carol lowered the lights and left me in the room for 20 minutes to allow the energy healing to flow. She checked on me once to make sure I was warm enough (I was) and then came back at the very end to unstuck me and give me some recommended herbs and tinctures. Carol felt that I was a “complete pleasure” to work with because I had such incredible “energy” and “appreciation for Chinese medicine.” I don’t know about my chi, but the A-type overachiever in me was delighted and flowing.

I then met up with Hilary in the gift shop and will not provide details because both our husbands are likely to read this post and I feel the details of our purchases are best discussed in private. Suffice it to say, I saved a lot of money due to the incredible sale that was ongoing.

Next it was back to see Stephanie for my Metabolic Assessment read out. I’m sure it will come as no surprise to any of you that Stephanie felt I was a “pleasure to work with” and that my metabolism is one of my strongest assets that I should be careful not to damage by under eating. Clearly she has been spying on me at the Ranch during mealtime and wants to encourage me to eat my fill even if that means consuming 16 dates for dessert. The good news is that my cardiovascular fitness is at “performance level” which is generally for athletes according to Stephanie, and that I burn 2x the calories of the average woman my age when resting. I burn 2.51 calories per minute while the rest of the average 41 year olds only burn 1, hah 30 years of running, aerobics in the late 80’s and a little jazzercise around 1981-1982 pays off. Stephanie believes that with the new exercise regimen she has recommended, I should be able to further increase my VO2 max and (the following may not have been exactly Stephanie’s words but represent the gist of what she said), my resting heart rate to Lance Armstrong-like levels.

With my report in hand and glowing from my “performance” rating, I walked over to the Aquatics Center for my 5pm Watsu treatment. Susan greeted me warmly, her long gray hair in a bow-like knot at the very top of her head so that she resembled some sort of friendly alien. Susan asked if I had ever had the treatment before, to which I replied, “Oh yes, I always have a Watsu treatment when I visit the Ranch.” This is technically true as I had a Watsu the only other time I was here. Susan beamed her smile at me and told me that she knew she was in for a treat, and I had to agree as I am obviously a pleasure to work with. Susan used to be a mermaid at Wicchikissi Springs near Tampa, where she spent 15 years dazzling children watching from the underwater observation deck with her long flowing hair and mermaid tail. (you cannot make this stuff up) Susan lowered me into the 99 degree pool; wrapped floatation straps around my legs cradled me in her mermaid arms as she began the hypnotic silent underwater massage. An hour later we were done and Susan thanked me warmly and I thanked her, adding that she “..is still quite the mermaid.”

Now bathed and moisturized we headed off campus to a Mexican restaurant Hilary knows for Jill birthday dinner to feast on some ultra contraband margaritas and guacamole with corn chips; deep fried yes but gluten-free, hallelujah! We arrived at El Charo and instantly were dizzied by the aroma of fatty foods and promise of tequila. We were seated at a lovely table for four and before we even ordered our margaritas a basket of hot oily tortilla chips and salsa was placed on the table, this brought tears to my eyes. We tucked into the tortilla chips and savored the saltiness, washing it down with sips of margarita. After enjoying green chile corn tamales and carne secca with corn tortillas, we were serenaded by the wandering guitar player who sang a sweet rendition of happy birthday to Jill. We were stuffed but I had spotted a Dairy Queen on the drive back from the hike and mentioned it to my friends, and we all decided to find the Dairy Queen and enjoy ourselves. Hilary navigated and after only one seriously wrong turn we found ourselves at the intersection of Sabeno Canyon and Tanque Verde unsure of which way to go. My spidey sense was tingling and told me to turn right, so we proceeded in that direction and no more than 100 yards down the road we saw the gleaming red and white lights of the DQ sign. It was like a soft lit haze as we drove into the drive thru lane and approached the window. Our charming drive thru server, we named her Juanita, was clearly no stranger to the delicacies of the DQ herself and smiled broadly as we ordered our 2 vanilla cones dipped in chocolate and 2 hot fudge (full fat) sundaes. I exited the car to thank Juanita for her kindness and efficient service, which is when armed with my iPhone Jill snapped this lovely shot. Back in the safety of the car we devoured our desserts and in one fail swoop I consumed gluten, dairy and sugar. It was a major setback after days of obedient detoxification, but it was worth it! We drove back to the Ranch on our sugar highs and decided the DQ should be a monthly visit. Tomorrow I will return to my detox and purification rituals for mind and body but for tonight, just for one night, we were wild and free.

Biking, metabolic testing and "dessert"

Day 2 at the Ranch began with a 6am wake-up call in order to give us time to grab breakfast which for Hilary included blueberry muffins and coffee, while mine consisted of some steel cut oatmeal (gluten free), dehydrated figs and apricots and herbal tea before heading out on our 6:30am bike ride. It was a 12 mile ride with the first 6 being essentially uphill and tough. I saw a roadrunner on the side of the path, they are much smaller in real life than on the cartoon and more of a grayish beige color without the purple feather mane, but look exactly like the coyote’s nemesis in every other way. We reached the apex of the ride and waited for the other guests to make it up for quite a while. Finally the last rider (New York princess type) made it and we cheered her on. As soon as she dismounted she began to sob uncontrollably as one does after a marathon or childbirth. It was oddly touching and annoying at the same time. We made it back to the Ranch and Hilary and I lounged by the L-pool (not to be confused with the T-pool). We fell into a blissful post exercise haze which morphed into a mid-morning nap but were awakened by the grinding noise of the underwater treadmills some overly eager guests decided to use. It is rather strange to watch a 60-something year old woman in a wide brimmed hat and sunglasses walking briskly in place half submerged in the water.

We met our friends Jill and Jana for lunch at the Double U restaurant where everyone got to taste the gluten free crackers I was allotted with my tiny scoop of organic hummus, and unanimously agreed that they tasted like cardboard and needed salt. Jill suggested that I lick the crackers and then pour the salt on top so that the grains of salt would have a chance of adhering to the tasteless cracker. I’m not too proud and licked away as elegantly as possible. I had a small frozen banana on a stick for dessert enrobed in a thin layer of dark chocolate, that was the highlight.

Then it was off to the Exercise Physiology department to have my body composition testing done. Essentially you are hooked up to a bullet-proof vest looking contraption that holds various heart and oxygen monitors, and then a gas mask-like apparatus is put over your mouth and nose, and the physiologist then asks you to “breathe normally” as you run uphill on the treadmill. Like a blonde Darth Vader, I ascended the treadmill and rasped into the contraption as the incline increased steadily, all the while trying to respond chipperly to the Physiologist named Stephanie who was asking questions about the strain I was experiencing. I had to give her a number grading as the hill became steeper and my breathing heavier. The chart starts at 1 and ends at 20. After 11 minutes my heart rate was at 175 and I was clearly at a level 19, so the treadmill was stopped and Stephanie declared that I had done extremely well and unhooked me from the equipment leaving my mouth with the distinct lingering taste of Lysol.

I thanked Stephanie who I will be seeing again tomorrow for the read out of my stats, and made my way down to the spa for my 100 minute Ashiatsu treatment. Ashiatsu is a deep tissue massage performed by a therapist who stands on the massage table and hangs onto multiple poles affixed to the ceiling of the massage room for balance and support as she whisks up and down the table and my oil slicked body massaging with her feet and legs. My therapist, Dorothy, was fantastic. She commented on my strong "positive energy" which is a very high order of compliment at the Ranch and something you just can't fake.

A steam and a shower followed by some contraband Chardonnay with Hilary in the cassita, and then we were off to the dining room for dinner with Jill and Jana. Pea soup, rice noodles (about 6 in total) with grilled chicken in a peanut sauce, steamed sugar snap peas and some rice crackers were my feast. After spotting Maria Bartiromo at a table directly across from mine, she was very nice to all the wait staff and dined alone with her face illuminated by the blue glow of her Blackberry, it was time for dessert. My dinner companions all enjoyed vanilla ice cream with non-fat hot fudge sauce, but for dairy-free, sugar free, gluten-free Lorna, I was served a plate of 6 dates, 6 sad little pitted dates which I ate along with some mint tea all the while staring longingly at the ice cream and fat-free fudge.

And so to bed....