Hip Arthrogram MRI

This is a shoulder joint. I show it only to demonstrate the
size of the needle, which is comparable to the needle I saw
on my x-ray. I couldn't find a hip image of similar quality.

My first words of advice to anyone who is scheduled for a hip arthrogram MRI are: don't read blog posts about hip arthrogram MRIs. I understand this is a counterproductive thing to write, given the title of this post, but. I had one done today, and I made the mistake of reading online about the procedure yesterday. As a result of my reading, I was somewhat terrified at the apparent prospect of terrible pain, both during and after.

Perhaps I had an exceptional experience, and perhaps an exceptional doctor, but I doubt it. That's not to say that the staff at Humber River Hospital in north Toronto weren't excellent - they were. But I am not certain how one procedure could vary so much from one location to another.

The procedure goes as follows. First your hip is swabbed with iodine and another sterilizing solution. Then, you have an x-ray of your hip done. Then the doctor (in my case, Dr. Anthony Mascia, brisk, efficient and energetic) injects a freezing agent, then the contrast media (guided by the x-ray) - the contrast solution is, as he described it, 99% water and 1% gadolinium. I had a glimpse of the x-ray, and then two reactions - 1. wow, that is a long needle and 2. my hip looks so, well, normal (sigh). It felt like it took all of two minutes, and I really do think that's all the time it took.

Then, I was wheeled off to MRI. Wheeled, not because I couldn't walk, which I could have, I felt numb-ish, but not unstable, but because if I had walked, apparently the contrast media would have leaked out (their words) of the joint and thereby would not have been as contrast-y (my word) for the MRI.

In the MRI room, I laid down on the table, had my feet taped together so my legs wouldn't move out of position, and then the chunka chunka chunka of the MRI began. Which was astoundingly loud, even with earplugs in. The tech, on a speaker directly above my head, would check in occasionally to see how I was faring, and to tell me that the next segment of imaging would be so-and-so minutes, and then I was done. About 15 minutes, I think.

Off the table I went, then got changed, and then out into the world. My partner Stewart was there to drive me home, which was lovely, but I'm quite sure I could have easily driven myself. And now, here I sit, typing this post, with a slight ache in my hip joint, but nothing terrible. I am a bit tired, because I didn't sleep well (anxious) last night, but other than that, quite fine.

Again, perhaps my experience was exceptional. I found an abstract of a report done on reaction to the contrast media, and was granted access to read the first two pages, on page two there is a conclusion: "severe adverse reactions from intravascular administration of iodinated contrast are seen in approximately 0.26 to 3% of cases." It goes on, a bit, and the curious can read it at the URL indicated above.

Next, I wonder what the MRI will show.

MRI Arthrogram. Plus, movement = happiness.

Near Driftwood Cove. Just one of many beautiful stops on the trail.

At last. The longish and winding-ish road of the story of my leg has led to the place I'd wished to be from the start - at an MRI. But, an MRI with a twist!

When I went to the doctor this most recent time (a couple of weeks ago now), he was more puzzled than ever. The numbness and 'humming' in my foot, the full feeling in my calf, the leg/glute pain already described all added up to what seemed to be a confusing problem to him. "The hip is very complicated," said he, "we're learning new things about it all the time." I can only imagine this is true of any part of the human body. Anyway. Since the xray told him nothing, and the ultrasound told him nothing, but I continued to tell him that there is a very real problem with this dumb ole leg of mine, he has now ordered the test mentioned in the title of this post: MRI Arthrogram. Wherein, I learned, a contrast media called gadolinium (which sounds cheerful, somehow) is injected into one's hip, to enhance the visualization of joint structures (phrasing from the rather useful Center for Diagnostic Imaging).

Unfortunately, the test won't be done until December 13. Which feels a bit like forever from now. But then, while this is a vexing problem, this leg thing, it makes sense that there are probably people who have much more dire pains and injuries who should take precedence. Plus, sigh, I've waited this long.

Moving on - literally - a week of exercise at the end of August while on vacation in the Bruce Peninsula proved, once again, that for me, movement is happiness. Even on a 20 kilometre hike on the most rugged of terrain (from Cyprus Lake to Tobermory on the Bruce Trail), and many many hours of awesome mountain bike riding, and some spectacular swimming in the beautiful waters of Georgian Bay, my leg didn't bother me nearly as much as it can after a couple of hours at the desk. Sheesh. Perhaps I should figure out a way to make money hiking.

Chronic pain.

Tara Stiles doing 'pigeon pose'.
Still from her youtube video.

I have been going a little bit crazy lately with this leg of mine. Despite what genuinely seemed like real progress over the winter months and into the early spring, I have lately felt as though there has been a reversal of progress in healing. I can ride my bike. I can go to the gym and work out. But I also have pain in my leg, from hip to foot, regularly and relentlessly. It strikes most fiercely when I spend a long design day at the computer. I get an awful 'full' feeling in my calf (like the skin can't contain the stuff inside), and a binding in my knee, and sometimes, the scariest tingling feeling in my foot. When I lie down at night, I feel a weird hum (best word I can think of to describe) in my right foot, and fierce aching in my whole leg. This all despite best efforts to stretch my legs and hip flexors (yoga's pigeon pose) is superb for this, and (as discussed in previous posts) lots of work in hip/core/glute/quad strengthening/stablizing (deadlifts, squats, split squats and lunges, among others).

And yet, the physical part is only part of the problem.

I have also been hamstrung (useful term, that) in the realm of medicine. I was scheduled, July 27, for a deep tissue ultrasound, as mentioned, and then possibly a cortisone shot, depending on the results of the ultrasound. I was assured by my sports medicine doctor that "[the cortisone shot] would put out the fire" and that I would be thereby relieved of pain. Excited, I was. And yet, when I arrived at Humber River Hospital, on July 27, prepared and energized to find some answers to this ongoing and vexing problem, I found I had been mis-scheduled – nearly blithely trotted into the xray department for a contrast/xray guided cortisone shot (sans ultrasound), when I asked the question, "what about this part on the requisition which reads 'ultrasound assessment, cortisone if necessary' "? This, plainly written, even though by a doctor. The response from the tech, bless her, was chagrin, and a "the charge nurse books these, it does seem wrong, I'll have to check it out"...but still, obvious screw-up. So, I waited, and then had an ultrasound done (but not done by Dr. Mascia, as expected), and no cortisone shot. A week of waiting for results ensued, no word from the sports medicine doctor, and my call last Wednesday (August 8) to their offices yielded a startlingly unsympathetic (I don't even know what to call her) person who, when I asked to speak to the doctor, said, "I'll see if he has time."

Exciting times, today, then - when, to my surprise, a voicemail from their offices today said the doctor doesn't want to speak to me, he wants to see me, on Monday (!) (a somewhat amazing difference, in terms of scheduling, from the 3 months I waited to see him last time). Either the ultrasound has shown something, and there's a course of treatment on the horizon, or, the ultrasound has shown nothing, and the next step is an MRI. One way or the other, I just hope there's some kind of answer pending.

Chronic pain is confounding. In a way, you get so used to it that you sort of dismiss it as a natural state of your life. But it's not a natural state. It really shouldn't be that when you lie down to go to sleep at night that your first thought is either a) "did I take an ibuprofen so I can sleep?" or b) "holy crap, my leg hurts - and what's that weird hum in my foot". The other confounding part of chronic pain is that one does get tired of being a one-note song, always complaining about the same thing. I sometimes feel helpless in the grip of this stupid leg of mine, which feels, often, almost disconnected from me - 'you are not my leg, you vexing thing you' - we are ever at odds, it seems.

This has been a long post. But it's been a while. In my renewed attack on solving the mystery, I have an appointment with my GP on Friday, the sports med guy on Monday (surprise!), and a physiotherapist on Tuesday.  I will have some things to report - even if no thing (per se) in the days to come.

Back to biking: so far, so good.

Mono Cliffs PP - beautiful views, fun trails.

So it's begun. I have been able to ride my bike many times, since my last post, without too much pain. Truth: there are some times when my knee gets a bit sore, and I feel that weird tightening up my leg into my hip, but not so much that I feel the need to stop riding.

What has made the difference this year? Certainly the effort made at strengthening my hip flexors and leg muscles (particularly the good ole glutes). The work done with Steve Neal, I think, was vital - and if it wasn't for the need to purchase a new furnace ($: sigh), I would definitely still be doing (ahem, could afford) those awesomely fun workouts. But, interestingly, it's not as though I've had setbacks since stopping those workouts just about a month ago now. I make sure to not ride too long (so far, not over an hour). I make sure to moderate, if I can, my effort while I'm riding - which can be tough, when having trail fun. And I've been keeping up with weight training twice a week - doing deadlifts and squats and lunges and glute bridges and so on - and thereby staying strong for time spent in the saddle.

In more good news, I've also begun to run again. Short runs (nothing over 5K), and at an easy pace. Sticking to trail helps a lot, and again, not enough credit can be given to the strength work done since February.

Still haven't had the ultrasound/cortisone treatment that was prescribed when I went to Collingwood Sports Medicine - I did follow up with a phone call, thinking I had missed something, but they reiterated that they would call me when the appointment had been set up. Hm.

Next steps (pardon the pun): picking a goal for late summer, both for riding and for running. And maybe, the Stomp the Quarry run (I think the 5K) on July 28 as an interim effort. We'll see!

Patience.

I was an impromptu fitness model once.
This is my leg before it started misbehaving.

It's tough to be patient. Even when it's been  proven that impatience is detrimental to healing, and, in truth, detrimental to just about anything in life, it's still not an easily natural human trait to be genuinely patient. 

Certainly I learned the hardest of ways that I had to be patient, with this stupid leg problem of mine, what with all the times I would get it so far toward better, and then screw up all that progress by doing something boneheaded like a long trail ride with competitive friends. It is a bit ridiculous, despite all that, that even now, while I know slow and careful is the best way to go toward healing, I still get astonishingly jealous of someone who says 'I was out for 3 hours yesterday on trail with my buddy so-and-so'. You know, considering that a long trail ride would just set me RIGHT BACK where I was before I started all this good healing work?

On the healing note - my leg continues to respond positively to strength training. I have yet to hear when the ultrasound with Dr. Mascia will occur. This is on the list of things to do. Along with (ha) being patient. A funny thing to put on a list of 'to-dos'.

Iliopsoas bursitis. Or, the thing that happens to my leg.

Image is from hipflexor.org, which also contains lots of useful information
  about hip stretches, strengthening and prevention of hip flexor injuries.

After another visit to Collingwood Sports Medicine, I finally have a more certain diagnosis of what the heck is going on with my leg: iliopsoas bursitis. This was well explained by Dr. John Bowman - essentially, the iliopsoas muscle group is the strongest of the hip flexors, it's vital for standing, sitting, walking, running, and in my case, pretty darned important for cycling, too - particularly in mountain biking where there is a lot of standing in the pedals and maneuvering around the saddle. Generally, iliopsoas injuries are caused by overuse/overtraining - which would be accurate for me, as, when this injury occurred, I was trail running, mountain biking, weight training and doing a lot of plyometrics - some weeks adding up to nine workouts/week. 

So what happens, as a rule, with me, is that I'll do one of the sports I love, sometimes have pain in the hip during, and then often or always in my hip, glute, outer quads, knee, and sometimes all the way down to my ankle the next day. So, I'll take that day off, see if I'm pain-free the next day, if I am, go for a ride/run/workout/whatever, and then repeat the cycle. The pain part of the whole deal is the result of the bursa becoming aggravated and inflamed and then sending its consequences down my leg. 

Since I've started my new workout regime, which, as mentioned, involves much in the way of hip strength/stabilization exercises - and stretching - the time from aggravation (pain onset) to resolution (pain mostly to completely gone) has shortened considerably. Where before it could take a few days for my leg to stop hurting, now it's usually on the order of 24 hours. This, obviously, is progress. 

Next steps for my hip? Well, first an ultrasound, to have a look at the bursa. I await an appointment at the Humber River Hospital, with Dr. Anthony Mascia - here is an interesting article about him and the treatment of a patient's chronic pain. Next, possibly a cortisone shot, depending on the extent of inflammation. And following that, I am told, disciplined adherence to exercises to keep my hips and core strong and resilient. 

It is pretty amazing, to have a name to put to this remarkably annoying chronic pain of mine. Also, nice to have an enemy to put forces decisively against. Rawr.

First ride of the year. Also, first ride in 3 years without pain.

On Sunday, I went for a bike ride. And it was awesome. It was very short - perhaps 30 minutes. It was mostly gravel trail, with a bit of single-track and some nice rooty climbing, so it was super easy. But it was perfect. Perfect because my leg didn't hurt within five minutes (which is its usual habit) and even perfect-er because it didn't hurt after 30 minutes, or the next day either.  It truly was the first ride I have had in three years that didn't hurt in any way. Which, on Sunday, was nearly tear-inducing - but ended up being beer-inducing, which is to say, I celebrated  in the sunshine with a cold bottle of, well, beer. 

And, even better, on Monday morning, I had a great workout, which involved split squats and glute bridges and hamstring curls and other exercises which would have ordinarily caused serious leg complaints following a ride (or run) - but didn't - which was cause for more celebration. This time without beer (workday, after all).

I am hopeful. 

I am, actually, more than hopeful. I am energized. I am totally thrilled to have found a way back into biking - which I really must credit to the workouts designed by Steve Neal. His insistence on perfect form and on developing genuine core and hip stability seem to have made all the difference. 

And so today I am going for (oh me oh my) another bike ride. Similar to Sunday's ride (in fact, probably identical). My toes are crossed that it will be another pain-free ride.

This one's for my dad.

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I was thinking a lot about my dad yesterday. This is because yesterday was the three year anniversary of his death. He died at age 64, from cancer, at Southlake Hospital in Newmarket. This year was the first year I was able to think about that time without being overcome with abstracted grief.  The kind of sadness and grief that made me, on the first year anniversary of his death, reverse my wee VW – at reasonable speed – into the back of a sturdy (and enormous) pickup truck. I was certain that I had checked and double-checked to make sure there was nothing behind me, but I was, more or less, blinded by sadness. One smashed taillight (mine) and dented rear-hatch (also mine) later, I realized it was probably not safe for me to be driving on that day. (There was no damage to the pickup truck that I could see. He or she never responded to my apologetic note, either, so I assumed my assessment was accurate.)

My dad was so proud of me, and he told me often. He was proud of me for getting my university degree, for finding a career that gave me both creative and monetary satisfaction, and for my general independence. But he was also so proud of me for being athletic. I was born quite premature, and the doctors (so my dad told me) said that even if I survived brain-intact, I would never be able to achieve physically.  Something about my lungs and their less-than-optimal functioning.  So he was always so thrilled to hear about how much I loved running and cycling, and would make a point of telling me that that I was never supposed to be good at either of those things.

I miss you Dad. Just so you know, I am working hard to get back on my bike. I’m keeping busy with working out, just to make sure these lungs of mine stay in shape for the moment my leg is ready to bike again.

Deadlifts, resistance bands and BOSU balls.

Because reading about workouts is boring, but mountain
biking is always fun. Plus, it IS the point of this blog.

Okay, so the Functional Movement Screen showed me to be ‘hypermobile’ and ‘lacking in strength’ – to which I said ‘bah!’ – as I may be particularly bendy but I would never say that I am not strong. Anyway. After a bit of back and forth in which I challenged the above assessment, I warily signed up for a session with Steve Neal, along with my good buddy Jodi.

And I know it’s super boring to read about other people’s workouts, so I won’t get into too much detail about the ins and outs of this one. There were (yep) deadlifts, resistance bands and BOSU balls, and a nifty ankle strength exercise and some neat kettle bell stuff and overall about 25% new-to-me stuff which was great. The rest of the workout was stuff I’ve done before, which was also pretty great – primarily because Steve is a real stickler for proper form and, it seems, for drilling the idea into your head that just because you’re doing, say, a deadlift  - doesn’t mean you’re only using your legs for proper form, you’re also using your core AND your cardiovascular system. This applied to (honest to god) every exercise we did. We paid a lot of attention to breathing. Which sounds sorta dopey, but I really was made to feel very conscious of taking a deep breath at the start of the exercise, and releasing it as I progressed through, particularly in the deadlift, where apparently it’s going to come in real handy when the weights get heavier and heavier. Woot.

The good news is, apparently I don’t lack strength after all. Or at least it didn’t seem so to me. I’ll have to ask Steve when I see him again on Thursday. And woohoo, in the even more good news department, so far, my leg doesn’t hurt any more than it usually does (which is always a teensy tiny little bit). Which is, you know, nice.

I love exercise. My leg – not so much.

Spin class - this time, it didn't hurt.
Next time, who knows?

Yup. That’s the totally ickily bummer thing about having such a bad old leg. It hurts - sometimes during exercise. Almost always after. Which, well, sucks.

I use exercise like a stress-relieving drug. I know now, after years and years, that exercise is the one thing certain to put me into a better frame of mind, no matter the circumstance. When my dad was sick and dying of cancer in palliative care, I am quite certain that exercise kept me from spiraling into despair. When I went through major life change after that, exercise kept me sane. Even now, when things are calm and settled – life still has its crappy moments, and exercise is still the thing I like to use to feel better. 

So when it just so happens that most forms of exercise that involve LEGS (sigh) tend to aggravate my right hip/thigh/knee – sometimes to the point of limping pain after, it can be a crazy upsetting, not to mention a real crap shoot trying to figure out what to do to get a workout fix.

This is all perfectly frustrating, too, as I’ve now gotten into a pattern, wherein I will get back into the gym (for example) for a good four weeks of strength training and lung/heart conditioning, with just twinges of pain. And then whoosh, all of a sudden, my leg will freak out, and then I limp around for a week, which seems to negate the four weeks previous, whereupon, at the end of the limping week, my leg seems okay, and then I tentatively get back into some sort of pattern, only to have it disrupted again. Profoundly annoying.

Anyway. I called Collingwood Sports Medicine to find out next steps, now that they have received the results of my x-ray, and I have an appointment booked for the end of February, prior to the as-yet-unscheduled MRI.

And next week, I will be doing something called a Functional Movement Screen with Steve Neal at his Crossfit Gym here in Orangeville. Steve did an awesome bike fit for me years ago, which resulted in instant and remarkable climbing improvement (it also improved just about every other darn thing I did on my bike). He’s also a great mountain bike coach, so I am really looking forward to hearing his impressions of how this leg of mine is working/not working.

What the dog did. 120 lbs of canine enthusiasm.

To give you an idea of how big Jake is, compared
to me: Yup. We're just about the same size.

Meet Jake, the world’s best dog. Well. He's the best dog in the world most of the time, anyway.

So, we’ve talked about how I hurt my leg originally. Then came the two subsequent injuries, about a year and then six months after that – both thanks to Jake.

Jake has a thing for squirrels. And we, every day, put three paw stamps on the daily walk sheet of his life. These walks generally take place in the park that is directly behind our house. About 100 metres from the back gate of our yard, there is a nice stand of rather mature maple trees. Squirrels love these trees. And, every day, the moment Jake’s nose goes beyond the back gate, he is in super-dog-squirrel-hunter mode. I know this, so he doesn’t get to have room on his flexi-lead until I too have scanned the landscape for squirrels. But there was this one day (there’s always that one day) when I wasn’t paying attention so much, and Jake shot out of the gate in pursuit of a squirrel, right to the end of the 16 feet his leash would allow, which was, naturally, about 200 feet short of where the squirrel was (sigh). He yanked me off my feet, quite thoroughly, and of course I went over on my RIGHT ankle. More sighing.

So that hurt a bunch, and ended up being a minor sprain. Which added to the whole right leg problem, now extending down into my ankle.

The next incident was much the same, except Jake spied not a squirrel, but rather a most unusual dog – a German Shepherd Corgi cross (honestly, the oddest looking dog I have ever seen) – I am pretty sure Jake didn’t actually perceive it as a dog, which led to his great excitement to get closer and check it out. The problem this time was much the same as the squirrel incident, except I managed to start running with Jake, but just couldn’t quite get the big guy under control, and tripped. On the same right ankle. Sprain. Again.

The whole point of the ‘what the dog did’ story is that my right leg has really suffered its fair share of injury over these three years. I’m sure these two incidents have helped create this everlasting inability to keep it stable. The good news is, my ankle doesn’t hurt anymore – but that took a really long time.

And Jake is getting a lot more mellow about squirrels, and we haven’t seen that odd-lookin’ dog. Just don’t lets talk about groundhogs, and we’ll just pretend that I have Jake under control all the time.

Woof.

The hip x-ray. Super procrastinator strikes!

Hip x-ray from Wheeless' Textbook of Orthopaedics

Hmm. Okay, so when I went see Dr. John Bowman, a sports medicine doctor at Collingwood Sports Medicine back in October of 2011, he twisted my leg every which way to examine it and try and figure out where the stupid thing (not his words, obviously) was injured. All of this pushing and pulling led to pained groans from me, and looks of contemplation from him, and then eventually concluded with the acknowledgement that ‘there’s definitely something wrong with your hip’. Which wasn’t so, well, boneheaded (you know, from a doctor) as it seemed – basically, it seemed to me, he was saying ‘it’s not your knee, it’s not the leg muscles, and it’s not the IT band, per se, it’s your hip’. Sooooo he said the only way to really figure out what was going on was to get an MRI done. And before he could get the MRI ordered, he’d have to take a look at an x-ray.

Which I stupidly didn’t do. Yes. I put it off and it put it off and put it off.

You see, I would have gotten the x-ray done, but I had to get home first and get some work done (see about me: self-employed), and then I had to get more work done over the next few days, which led to the next few weeks and then for a while it seemed like my leg wasn’t bothered any more (which had way more to do with me not doing very much with it than it not being injured any more) and then all of a sudden it was more than a year later and I still hadn’t gotten the stupid x-ray done and I was having just as much trouble as ever with it. SIGH.

So ahem. I got in touch with the sports medicine office, and they re-sent the requisition for the x-ray. A week before Christmas. Which meant I didn’t actually get the x-ray done until January 3. But I did get it done. One year and two months after it was originally requisitioned.

Now, it’s waiting time – waiting for an MRI appointment. But, I’m like, a professional at waiting now. So no worries.

My stupid hip. My stupid 41 year-old hip.

Biking in Colorado, October 2009 -
a miraculous week of pain-free riding.

About three and a half years ago, in July 2009, I had a huge spasm of pain while trail running. I was about 6K into an 8K run, when – I have no other way to describe it – my right hip freaked out.

I hadn’t fallen, I hadn’t tripped, it was just a sudden – surge of pain, which stopped me utterly. As was my way back then, I gave it a minute or two of walk time, and then started running again. Which hurt, but wasn’t impossible – it was limpy sort of running, but it got the job done.

When I got home, I did what I usually did after a hot July run. I jumped into my cold, river-fed pond. Which, looking back, was probably a good thing to have done, a great way to keep the leg and hip mobile (through swimming) while icing it (the pond generally didn’t get above 60 degrees F – which, granted, isn’t precisely icy, but is certainly cold enough – the equivalent of a cold bath, really).

The rest of that day involved only super tentative movements, as it was clear my leg wasn’t working as it should.

The next day I could hardly walk.

It was impossible to pull my leg forward, almost as though I had no muscles in and around the hip/hip flexor area. I had definitely injured my hip, and the injury caused a lot of collateral damage. In this whole process, my IT band had also become injured, which meant that my knee also fell victim to this wretched injury.

And so began a very long process of foolishness.

Hindsight tells me I have certainly not treated this problem with the respect it deserves, as I have, since then, more or less had to give up my two favourite sports – running and mountain biking. Both sports cause a cascading series of problems with my leg – first a pain at the front of the hip, mid-hip-flexor region, then pain radiates into the deep middle of the glute, and then this weird tightening feeling happens, where it’s as though an elastic is being tightened from my hip to my knee, which then tightens - like crazy - around my knee. Sort of like a knee boa constrictor or something. In the moment, the pain’s never so much that I have to stop doing what I’m doing because it hurts too much. But the next day is usually a limper, sometimes so bad that, say, if I’m grocery shopping, it’s been nice to use the cart as a crutch. Sigh. So, even though I can get through a 5K run, or an hour mountain bike ride without trouble (more or less) – the next day – or two or three days – can be kinda excruciating.

The foolishness is that I thought it was the sort of problem that would just go away. I saw an Active Release chiropractor, who helped somewhat in the acute phase of the injury – she certainly kept me moving. But it took me two years to go to a sports medicine doctor, and even then, I neglected to get the hip x-rays required for assessment before I could be booked for what he diagnosed as a very necessary MRI.

I miss my bike. I miss running. Heck, I miss the associated chocolate. So, my goal for the next six months is to get back into the sports I love. To be precise: I want to be able to run without pain the next day, and I want to be able to ride without pain the next day.  I’m thinking accountability will be the way to keep me on track with this set of goals, so here we are in blog land.

I welcome comments, tips, feedback and suggestions. I’ll share with you the process that I’m going to go through, and hopefully you can share with me any useful thoughts you have as I go along. Not-so-useful but funny and/or encouraging comments are equally welcome, too.