Monday, December 17, 2012

Some worthwhile wisdom....

101 Simple Truths We Often Forget

by two different things,

It's not where we stand but in what direction we are moving.
Sometimes we find ourselves running in place, struggling to get ahead simply because we forget to address some of the simple truths that govern our potential to make progress.  So here's a quick reminder:
  1. The acquisition of knowledge doesn't mean you're growing.  Growing happens when what you know changes how you live.
  2. You can't have good ideas unless you're willing to generate a lot of bad ones.
  3. A good idea without action is worth nothing.
  4. Change is often resisted when it is needed the most.
  5. Discipline is choosing what you want most over what you want right now.  Read The 7 Habits of Highly Effective People.
  6. People seldom do things to the best of their ability.  They do things to the best of their willingness.
  7. You can't change other people; you can only offer guidance, and lead by example.
  8. Right now, there's a lot you don't know.  And if you never challenge your own beliefs, the list will never shrink.
  9. If you're talking to someone you don't know well, you may be talking to someone who knows way more about the topic of conversation than you do.
  10. The most common and harmful addiction in the world is the draw of comfort.
  11. Growth begins at the end of your comfort zone.  Stepping outside of your comfort zone will put things into perspective from an angle you can't grasp now.
  12. When you spend time worrying, you're simply using your imagination to create things you don't want.
  13. It's usually only as good or bad as you think it is.  Most of what we see is only what we think about what we see.
  14. Most of the bad things you worry about will never happen.  Most of the bad things that do happen will have never crossed your worried mind.
  15. Some circumstances are uncontrollable, but we can always decide how we react to those circumstances.
  16. Those who complain the most, accomplish the least.
  17. Whenever somebody discredits you, and tells you that you can't do something, keep in mind that they are speaking from within the boundaries of their own limitations.
  18. Every problem you have in your life right now is your responsibility, regardless of who initially caused it.
  19. It's not so much about finding opportunities as it is about creating them.
  20. Having a plan, even a flawed one at first, is better than no plan at all.
  21. Paving your own road is intelligent only if nobody has gone exactly where you are going.
  22. What you do every day matters more than what you do every once in a while.
  23. What you don't start today won't be finished by tomorrow.
  24. If you're waiting for the perfect conditions, ideas or plans to get started, you'll never achieve anything.
  25. Doing something and getting it wrong is at least ten times more productive than doing nothing.
  26. Putting something off makes it instantly harder and scarier.
  27. You cannot change what you refuse to confront.
  28. If you keep doing what you're doing, you'll keep getting what you're getting.
  29. The harder you work, the luckier you will become.
  30. Kindness and hard work together will always carry you farther than intelligence.
  31. Lots of successful people have failed as many times as they have succeeded.
  32. Failures are simply lessons that help you prepare for next time.
  33. Being successful is a journey, not a destination.
  34. To be successful does not mean you have to dominate others; it means you have to dominate your own potential.
  35. Your success isn't just about you.  It's about how you positively impact the lives around you.
  36. Being busy and being productive are two different things.
  37. Being happy and being successful are .
  38. You have every right to be happy, but it's up to YOU and only YOU to exercise that right.  Read Stumbling on Happiness.
  39. Everyone you meet is better than you at something.  We all have different strengths.  What worked for someone else might not work for you.
  40. When you're worried about what others think of you, you're really just worried about what you think of yourself.
  41. The bad news: nothing is permanent.  The good news: nothing is permanent.
  42. You don't have to settle.  It's simply a choice you make every day.  If you don't like your life, then it's time to start making changes and better choices.
  43. There's no such thing as 'risk free.'  Everything you do or don't do has an inherent risk.
  44. No matter how smart you are, you will make mistakes.
  45. Problems, when they arise, are rarely as painful and hurtful as the process of fearing them.
  46. Confusion isn't a bad thing.  It means you're growing and thinking.
  47. Just because you can doesn't mean you should.
  48. In the beginning, you need to say "yes" to a lot of things to discover and establish your goals.  Later on, you need to say "no" to a lot of things and concentrate on your goals.
  49. Even if it doesn't cost any money, it's not free if it takes up your time.
  50. No matter how you make a living or who you think you work for, you only work for one person, yourself.  The big question is:  What are you selling, and to whom?
  51. Money makes life easier only when it's yours free and clear.  The stress of financial debt can change a person.
  52. The fewer possessions you own, the more you will use and enjoy them.
  53. Life is not easy, especially when you plan on achieving something worthwhile.
  54. There is good reason why you should wake each morning and mindfully consider what and who you will give your day to:  Because unlike other things in life - love, money, respect, good health, hope, opportunities, and many more - time is the one thing you can never get back once it's gone.
  55. Cutting your losses is often better than the alternative.
  56. We sometimes do things that are permanently foolish just because we are temporarily upset.
  57. Screaming at people always makes things worse.
  58. Everyone likes a person who gets straight to the point.
  59. First impressions are oftentimes inaccurate judgments of a person's true character.
  60. When you're up, your friends know who you are.  When you're down, you know who your friends are.
  61. If someone wants you in their life, they'll make room for you.  You shouldn't have to fight for a spot.
  62. When someone truly loves you, they don't ever have to say a word.  You will be able to tell simply by the way they treat you over the long-term.
  63. We rarely lose friends, we usually just figure out who our real ones are.
  64. Just because one person doesn't seem to care for you, doesn't mean you should forget about everyone else who does.
  65. Family isn't always blood.  They're the people in your life who want you in theirs – the ones who would do anything to see you smile and who love you no matter what.
  66. Good looks attracts the eyes.  Personality attracts the heart.
  67. In human relationships, distance is not measured in miles but in affection.  Two people can be right next to each other, yet miles apart.
  68. Being nice to someone you dislike doesn't mean you're fake.  It means you're mature enough to control your emotions.
  69. If you aren't happy being single, you won't be happy in a relationship.  You have to create your own life first before you can share it with someone else.
  70. Whenever you hate someone or something, you are giving that person or thing a piece of your heart.  Read The Road Less Traveled.
  71. Life is too short to spend time with people who suck the happiness out of you.
  72. It's better to be alone than to be in bad company.
  73. Saying "no" to right people gives you the time and resources required to say "yes" to right opportunities.
  74. When you stop chasing the wrong things you give the right things a chance to catch you.
  75. You can raise the bar or you can wait for others to raise it.  Either way, it's getting raised.
  76. In life you get what you put in.  If you want love, give love.  If you want friends, be friendly.  If you want money, provide value.  It really is this simple.
  77. Cynicism might seem warranted at times, but it's never useful.
  78. Everyone dies, some sooner than later, and often unexpectedly.  To know this means you are alive, with a chance to make the time you have left count.
  79. You are in competition with one person and one person only – yourself.  You are competing to be the best you can be.
  80. Trying to be somebody you're not is a sure path to self-hate, and a waste of the person you are.
  81. It's better to be disliked for who you are than to be liked for who you are not.
  82. Giving up doesn't always mean you're weak, sometimes it means you are strong enough and smart enough to let go.
  83. Sometimes you need to distance yourself to see things clearly.
  84. You can't make the same exact mistake twice. The second time you make it, it's no longer a mistake, it's a choice.
  85. Not getting what you want is sometimes a wonderful stroke of luck.
  86. You never have to deal with more than one moment at a time.
  87. Many of the greatest lessons we learn in life we don't seek on purpose.
  88. You have to fight through some bad days to earn the best days of your life.
  89. A harsh fact of life:  Bad things do happen to good people.
  90. Regardless of the situation, the sun rises the next day and life goes on.
  91. You never know how strong you really are until being strong is the only choice you have.
  92. We end up regretting the things you did NOT do far more than the things you did.
  93. We meet no ordinary people in our lives.  If you give them a chance, everyone has something amazing to offer.
  94. Every passing face on the street represents a story every bit as compelling and complicated as yours.
  95. People are not as beautiful as they look, as they walk, or as they talk.  They are only as beautiful as they love, as they care, and as they share.
  96. Silence is often the loudest cry.  So pay attention to those you care about.
  97. Making one person smile can change the world.  Maybe not the whole world, but their world.
  98. Blowing out another's candle will not make yours shine brighter.
  99. No matter how many mistakes you make or how slow you progress, you are still way ahead of everyone who isn't trying.
  100. Things turn out best for people who make the best out of the way things turn out.
  101. Life is short.  If there was ever a moment to follow your passion and do something that matters to you, that moment is now.
Photo by: Alexander Steinhof
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Saturday, December 15, 2012

Parenting tips from Verlander's parents

Just passed a local bookstore hosting a book signing by Justin Verlander's parents. I wish I'd had time to stay a while to learn how to teach someone to throw 100mph and pick up Kate Upton.

Friday, November 09, 2012

2012 election reactions

  • Though I voted for Romney, I'm not upset that Obama won. Both candidates were going to continue busting our budgets and limiting our freedoms. It's just Romney was going to do it with slightly more palatable judicial appointments. This election COULD nudge Obama towards the center and towards compromise. This notion is contrary to all evidence, but one can hope.
  • What I am disappointed about is Elizabeth Warren winning in MA. I liked Scott Brown, and think that Warren is full of ignorant populist crap. I tremendously dislike any politician who is driven by their perception of changing the world to meet her view of what's fair, and sees economic division as the best means to enact their vision. She's the embodiment of the limousine liberal, and while good intentioned, doesn't have any idea of the negative consequences of the policies that she advocates. Yes, her financial regulation ideas SEEM to benefit the little guy, but they have unseen consequences, such as raised costs that reduce access.
  • I don't agree with all of the talk that the Republican party is now sunk by (pick one) demographics, a liberal tidal wave, national acceptance of liberal social policies, or that the party's policies are inherently bad/unpopular. Instead, I think this election is an indictment of Republican party leadership. The whole "next man up" approach to picking a candidate needs to change. Dole '96, McCain '08, and Romney '12 were all nominees mostly because they were next in line. Surprise - they all lost. Obama was eminently beatable, but next-man-up meant that the R's ran a guy who was both the Father of Obamacare and an evil rich white vulture capitalist. Result: Romney couldn't really campaign on health care, even if Obamacare is very unpopular, and Romney was an easy foil to the "ask a little more of the rich" angle. In retrospect, running a candidate with those qualities was flat-out stupid.
    • To support this point, I need to demonstrate that some other candidate would have done better than Romney. It certainly wouldn't have been any of the other announced Republican candidates (Perry, Santorum, Bachman, etc.), but I've got to believe someone (Mitch Daniels? Jeb Bush?) could have been a more effective candidate.
  • It still stuns me that Obama's campaign (basically) ran without touting their first term OR clearly stating what their plans were for their second term. (That's how bad of a choice Romney was, as a candidate.)
  • I now look forward to watching Obama reconcile his policies and tendencies with the looming economic realities. Some kind of dramatic change in economics is inevitable in the next four years. How will Obama balance his core interest groups (such as unions) with economic challenges such as unsustainable public pensions. 
  • If I were in charge of the R's, the first thing that I would do is make Paul Ryan the Speaker of the House. Boehner is the embodiment of all of the party's flaws: old, devoid of new ideas, combative, and definitely not new media savvy or telegenic. Ryan, on the other hand, is vibrant, constructive, and following the presidential election, better known than Boehner. (He's also known for being able to go toe-to-toe intellectually with Obama.

Saturday, November 03, 2012

Recent travels: Germany & Scotland

I just spent four of the last five weeks in Europe on business. The bulk of my time was scattered across Scotland, but I also had side trips to London & Cambridge in the UK, and Dusseldorf & Cologne in Germany. Here's a few highlights (click on any picture for a larger view):

Dusseldorf's "World's Longest Bar" in the Altstadt.

I was pleasantly surprised by Dusseldorf and Cologne. I had been told that these two Rhine cities were very industrial and very impersonal. Instead, I found them both to be very livable cities. They don't have high tourist appeal (they'll never be mistaken for Las Vegas, and Berlin and Munich have many more tourist sights), but I think you would be very happy to live in either city. Both cities are oriented towards the Rhine river, with nice promenades surrounded by bars and restaurants.

Speaking of bars, Dusseldorf has a collection of bars, clubs, and restaurants that they bill as the "World's Longest Bar"in the Altstadt. I had the good fortune of passing through the Old City on a Friday night, and I can say that it really might be true to its' name. 
Cologne's cathedral and bridge

Cologne had the same buzz in two separate areas, one with a view of the Rhine, but the real appeal of Cologne is the combination of the Dom (cathedral) and Hohenzollern Bridge, located next to each other.
Padlocks on the Hohenzollern Bridge, with the Dom and train station in the background

One neat thing about the Hohenzollern Bridge is the local tradition of couples in love placing a padlock on the bridge as a sign of commitment. There are literally thousands of padlocks everywhere you look.
While in Scotland, I had a spare weekend which is decided to split between the town of Pitlochry - a gateway to the Highlands - and Loch Ness.
Queen's View of Loch Tummel in Pitlochry, Scotland

Loch Tummel at sunset
Pitlochry is visually stunning. I rented a bicycle for a day to take in some of the scenery, pedaling among Blair Atholl castle, the Queen's View, and Loch Tummel.
Urquhart Castle on Loch Ness
I generally try to avoid obvious tourist traps, and on the bus ride to Loch Ness I was really kicking myself for making the effort to visit such an obvious tourist trap.

Loch Ness panorama

But once the Loch came in view, you could tell that there was something special. For one, it's a beautiful setting. For another, there is something about the water that really makes you think with each ripple that you might have just seen Nessie. I didn't manage to see him (or her), but it was still a worthwhile visit.

Friday, November 02, 2012

I'm voting for.......

Just for my own enjoyment, what follows are my thoughts about the 2012 Presidential election. I wrote a similar post about the 2008 election that you can read here.

2012 is yet another election where our two party system has delivered us two lame choices. One candidate was a 1-term governor of a nothing-special state and his most recent political accomplishment was coming in a distant second to John McCain in the 2008 Republican primaries. The other candidate’s performance as President has been so underwhelming that his campaign ads only come in two flavors: either “I’ve got a plan,” or “the other candidate is really bad, and he’ll do bad things to you.”

(Sorry, Mr. President. You lose the right to campaign on your plan for the future when you haven’t even had a budget passed in most of your term, even when your party controlled both houses of Congress. If you can’t get a budget passed through a Congress you control, why should I believe you will get a series of legislative initiatives through a divided Congress?)

We’ve got two really bad choices, making the election a choice of the lesser of two evils. (Seriously. I can understand if you want to vote for your candidate because he’s not the other guy, who is way worse. I cannot understand anyone, though, who thinks their candidate is actually doing a good job, or going to do a good job. Anyone who thinks Obama is an effective, positive leader has been asleep the last four years, and anyone who thinks Romney isn’t a neocon and a repeat of Bush #43 isn’t paying attention.)

But rather than pointing out each candidates’ flaws (which might take up all of the space on the internet, though I do recommend reading this), I’ll illustrate how I arrived at my choice by describing my ideal candidate, and picking the one that comes closest.

In my opinion, the ideal Presidential candidate is:

-Constructive, and practically principled. My ideal candidate holds clear positions, but is willing to work with, or to do the deal with the other party that gets 70% of what the leader wants, rather than viewing any compromise as a loss. My ideal candidate also doesn’t demonize the other party or any group on the other side of an issue.

-Extremely limited in the application of the US military.  My perfect candidate would get the US out of Afghanistan and Iraq, and reduce American military commitments around the globe. Why, for example, are there still ~100,000 US troops in Europe 23 years after the Cold War and 67 years after the end of WWII?

-Socially quiet. I’m interested in “hiring” a commander-in-chief to execute the policies to improve the country, not to be our conscience-in-chief. On most any social issue our country is split roughly 50/50 (example: abortion). For any President then, imposing social policies is inherently a losing proposition – half of the population is likely in violent disagreement to a given policy. Let social policies work through other channels – state legislatures, for example. (I realize the concept of the socially quiet candidate is a bit na├»ve, but a real leader knows that there are three ways to make change happen, and brute force (i.e. driving a social change through legislation) is the least effective.)

-Fiscally prudent. I still don’t understand why the most prosperous nation on the planet is also the biggest debtor on the planet.  A balanced budget (or something a few trillion dollars closer) should be a central tenet.

-Unequivocally for free trade.

-Against any internet regulation. 

-Consitutionally limited. Once – just once – I’d like to hear a candidate say that something is a problem best addressed by something other than the Federal government. One great place to start: education.

In short, my ideal candidate is a Jeffersonian Democrat. Too bad they went out of style in the Democratic party decades ago. (Jeffersonian Democrats might even be extinct – I can’t think of any Democrats who would qualify.)

Grading both Obama and Romney against my wish list is depressing. Romney comes out at a slight advantage, largely because in some dimensions he’s an unknown, whereas we know how bad Obama is in a given dimension.  

There is one person on the ballot who scores fairly well versus my criteria: Paul Ryan. He’s demonstrated that he’s practically principled in his legislative efforts with Sen. Wyden (D) in health care, he’s certainly fiscally prudent, a free trader, and many of his positions are driven by an interest in limited government. He also is NOT loud or widely known for his stance on social issues.

Unfortunately, though, Ryan is only one the ballot as VP, but I’ll credit Romney with a bit of Ryan’s halo.

Also on the subject of VP, Joe Biden to me is a walking disaster. I don’t agree with his policies, but I am even more alarmed by his utter lack of principles (remember his theft of Neil Kinnock’speeches?), impact (he's been a Senator or VP for the last 39 years - can you name one thing he's done?) or frankly brains. Where are the people who slammed Bush #43 for umm, stupidity, when Joe Biden is a heart beat away from the Presidency, and IMHO a bigger moron? (And a crook, if the stories I’ve heard are even half-true.)

So, comparing Obama and Romney gives a slight advantage to Romney, but mostly because of Paul Ryan.  Really, though, the Presidential candidate that I most connect with this year is Gary Johnson, the Libertarian candidate. Unfortunately, he has no chance of winning.

I’m certainly willing to cast my vote for a lost cause, but I live in Virginia – a swing state with a very tight race. It's a tight race in Virginia, with the leader changing daily. State polls show everything from a 5 point Romney lead to a 4 point Obama lead in Virginia, so the only conclusion that I can reach is that it is a very close race. I like the notion that I am going to cast the deciding vote.

The last presidential election was a choice between two mediocre candidates. This election is a contest to decide which Harvard grad will do the least bad job of running enormous deficits. Neither choice is appealing for that reason, and I’m not hopeful that much will change.

But it is very likely that the next four years will see multiple appointments to the Supreme Court, and the next President will have a chance to significantly alter the demeanor of the Court.

Obama has already appointed two Supreme Court Justices (Kagan and Sotomayor), neither is considered moderate. I’m not a legal scholar, but my views are best characterized as a conservative interpretation of the Constitution, with a limitation on government power and against judicial activism. (I’m a believer in the now-radical position that the legislative branch is responsible for writing the law, not the judicial branch.)

So, only because of the Supreme Court impact of this election and a small Paul Ryan halo, I tepidly endorse Mitt Romney for President. If he wins, though, I won’t be celebrating. Instead I’ll be laughing about how the most powerful man on the planet wears magic underwear.

(Polls here in Virginia open in four days, so there’s still time for you to change my mind – leave me a message to set me straight.)


Wednesday, October 31, 2012

How Hurricane Sandy Proves We Need To Cut The Defense Budget

Hurricane Sandy just tore up the Jersey Shore, an area I grew up in, and a place I hold dear. The hurricane also roughed up New York and Connecticut, and I hope that all affected by Sandy can bounce back quickly, and get abundant assistance to do so.

Except for the assistance coming from the US Navy in the form of three aircraft carriers on their way to New Jersey. These carriers are being sent to "provide landing platforms for Coast Guard, the National Guard and civilian agency helicopters if needed."

Nobody would object to more air support for recovery efforts - large parts of the Jersey Shore are cut off from land, and regular transport links including rail and road are submerged. But notice - the military isn't moving the carriers to provide the air support - just to provide the off-shore platforms.

What really is at play here is a quest by the US Navy for good PR and more funding. The US Navy's current tagline is "A global force for good," and the slogan is usually accompanied by footage of operations in response to the Indonesian Boxing Day tsunami. Such a good image is worth billions to the Navy - not just as measured in terms of goodwill, but in terms of funding.

I might not object to having an extra place for air support to land if it weren't for the fact that the affected areas are saturated with huuuge military bases like Dover AFB and Fort Dix-McGuire JFB. Also in easy range are Atlantic City airport, a huge FAA station, Willow Grove NAS, the Brooklyn Navy yard, Groton navy base, and several Coast Guard stations. The kicker is that one of the Navy's largest air stations (i.e. landing platform), Lakehurst NAS, which is now attached to Dix-McGuire is only 15 miles (5 minutes by helicopter)  from the most affected areas of the Jersey Shore. (If Lakehurst sounds familiar, it is the site of the Hindenburg blimp crash in the 1930s.)

Here's how close Lakehurst is to the Jersey Shore:

But in spite of the concentration of military assets, the Navy has dispatched 3 aircraft carriers. I could maybe understand one carrier, but the lesson that I take from the 3 carrier search for photo-ops isn't that we need more Navy for situations like Hurricane Sandy, but rather we've got too much Navy around if in spite of Navy deployments in the China Sea, the Persian Gulf, the coast of Somalia, and other regular stations we've still got 3 aircraft carriers to deploy to the Jersey Shore to complement enormous military assets already in place. This isn't the conclusion that the Navy wants you to reach, especially after some Navy scenes to be shown on TV, but I can't see it any other way, except to wonder if this is a decision driven by political optics rather than military budget optics.

Tuesday, October 23, 2012

Friday, October 05, 2012

I speak Gaelic? Who knew?

I snapped this picture while in Inverness, Scotland. I'm pretty sure the Gaelic on the windows of this McDonalds translates as "McDonald's Faulty Goo is Greasy and Makes Air Come Out Your A$$."

Monday, September 17, 2012

Carticel 1-year (+2 months)

I'm now 14 months post-ACI (Carticel implantation) in my left knee, and about 6 weeks removed from my 1-year check-in with my doctor. I've got mixed emotions and a mixed review to offer.

(btw: a recap of my prior posts on my knee surgery/Carticel experience can be found by clicking here.)

Compared to either pre-surgery, or this time last year (two months post-surgery), I'm in great shape. I rarely think about the condition of my knee during my daily activities. In contrast, climbing stairs was painful pre-surgery, and only occurred two months post-surgery if I scooted up stairs on my butt, and even then I would try this only a couple of times per week.

Also positive is the subtle progress in knee health that I've made since my last update 5 months ago. I'd describe improvements as slow and steady, as I don't notice changes week to week, but I do feel more capable every month. (Along with more "life" in my knee every month.) I've also had friends notice that I seem to be walking more smoothly even though I generally only grade myself as "not walking normally yet."

You may be sensing a "But.....," and you're right. Here's a few critical observations:

-While my knee function has mostly returned, there is still an element of wear and tear (or stamina) that is humbling. Example: football tailgating season has begun, and I can definitely say that tailgating for 1-2 hours, walking into a stadium, sitting for 3 hours, and post-game tailgating for an hour or so is tremendously exhausting on my knee. Once home from the tailgate, all I can do was curl up on the couch, and also take it easy the next day. Note: I don't experience pain during the football experience - there's just cumulative wear or knee exhaustion. The positive spin on this is that with no pain, I'm just pushing stamina boundaries, and my hope is that this issue will diminish in time. (Downside: it is less obvious to me when I have pushed too far.)

-In general, my surgically repaired knee doesn't have the same springiness that my "good" knee has.

-Prolonged periods in dress shoes really, really take a toll. In response, I've traded style for comfort in my dress shoes (no more hard soles for me), which has made for an improvement.

-I also sporadically experience very intense but momentary pain when I torque my knee. These outbursts are diminishing in frequency, I think, but I probably have one once every two weeks.

I'm also a bit peeved that my recovery isn't complete one year on. All of the Carticel literature suggests recovery in 12 months, and I was hoping that I could rejoin my adult baseball team this summer. However, when I went to my doc for my 1-year check-in, he cautioned me that Carticel recovery is really a 1-2 year activity. I swear that in all of my previous interactions with my doc he stressed the need for a full year for the new tissue to adhere and recover, with no mention of the possible need for a second year. The doc also kept in place some restrictions on my activities - I still can't stand up on my bike pedals, and I'm nowhere close to running any time soon.

The doc also suggested that I place more emphasis on diverse exercise. Prior to my check-in, I was regularly cycling 15-25 miles 3 or 4 days in a row. (Performance wasn't perfect - my best days were always the first of several in a row, and anything beyond 2 hours was labored.) I have since cut back cycling to every other day, and am rotating in other no-impact exercises - swimming and walking. The negative here is that cycling in the Blue Ridge Mountains in the fall is a fantastic experience, and there's been a few days where I'm sad to not be able to cycle due to my new exercise schedule.

(That said, I've still pedaled 1,500 miles this year.)

So, if you were to ask me if Carticel implantation has been a good move based on my current knee health, I'd say that my knee health is better than pre-surgery, but has not yet reached my goals or expectations one year post-surgery. I'm very hopeful though that my knee health will continue to improve. If so (and there is reason to believe in further improvement), I should be able to give a good review for Carticel.

Friday, August 31, 2012

We Want This Debate. We Will Win This Debate

But I've been consuming an excess amount of election punditry and thought that i'd clicked on some expert analysis of the convention when i came upon this transcript of Paul Ryan's convention speech. I was impressed by the tone and content, and thought that it was worth posting here for you to read.
I completely ignored the recent Republican party convention, figuring that it was one great big scripted commercial (as both parties' convention have largely become), and because I'm already turned off by the negative campaign rhetoric flooding the airwaves.

We Want This Debate. We Will Win This Debate

by Rep. Paul Ryan,
Paul Ryan today delivered remarks to the Republican National Convention in Tampa, Florida. The following remarks were prepared for delivery:
Mr. Chairman, delegates, and fellow citizens: I am honored by the support of this convention for vice president of the United States.
I accept the duty to help lead our nation out of a jobs crisis and back to prosperity – and I know we can do this.
I accept the calling of my generation to give our children the America that was given to us, with opportunity for the young and security for the old – and I know that we are ready.
Our nominee is sure ready. His whole life has prepared him for this moment – to meet serious challenges in a serious way, without excuses and idle words. After four years of getting the run-around, America needs a turnaround, and the man for the job is Governor Mitt Romney.
I'm the newcomer to the campaign, so let me share a first impression. I have never seen opponents so silent about their record, and so desperate to keep their power.
They've run out of ideas. Their moment came and went. Fear and division are all they've got left.
With all their attack ads, the president is just throwing away money – and he's pretty experienced at that. You see, some people can't be dragged down by the usual cheap tactics, because their ability, character, and plain decency are so obvious – and ladies and gentlemen, that is Mitt Romney.
For my part, your nomination is an unexpected turn. It certainly came as news to my family, and I'd like you to meet them: My wife Janna, our daughter Liza, and our boys Charlie and Sam.
The kids are happy to see their grandma, who lives in Florida. There she is – my Mom, Betty.
My Dad, a small-town lawyer, was also named Paul. Until we lost him when I was 16, he was a gentle presence in my life. I like to think he'd be proud of me and my sister and brothers, because I'm sure proud of him and of where I come from, Janesville, Wisconsin.
I live on the same block where I grew up. We belong to the same parish where I was baptized. Janesville is that kind of place.
The people of Wisconsin have been good to me. I've tried to live up to their trust. And now I ask those hardworking men and women, and millions like them across America, to join our cause and get this country working again.
When Governor Romney asked me to join the ticket, I said, "Let's get this done" – and that is exactly, what we're going to do.
President Barack Obama came to office during an economic crisis, as he has reminded us a time or two. Those were very tough days, and any fair measure of his record has to take that into account. My home state voted for President Obama. When he talked about change, many people liked the sound of it, especially in Janesville, where we were about to lose a major factory.
A lot of guys I went to high school with worked at that GM plant. Right there at that plant, candidate Obama said: "I believe that if our government is there to support you … this plant will be here for another hundred years." That's what he said in 2008.
Well, as it turned out, that plant didn't last another year. It is locked up and empty to this day. And that's how it is in so many towns today, where the recovery that was promised is nowhere in sight.
Right now, 23 million men and women are struggling to find work. Twenty-three million people, unemployed or underemployed. Nearly one in six Americans is living in poverty. Millions of young Americans have graduated from college during the Obama presidency, ready to use their gifts and get moving in life. Half of them can't find the work they studied for, or any work at all.
So here's the question: Without a change in leadership, why would the next four years be any different from the last four years?
The first troubling sign came with the stimulus. It was President Obama's first and best shot at fixing the economy, at a time when he got everything he wanted under one-party rule. It cost $831 billion – the largest one-time expenditure ever by our federal government.
It went to companies like Solyndra, with their gold-plated connections, subsidized jobs, and make-believe markets. The stimulus was a case of political patronage, corporate welfare, and cronyism at their worst. You, the working men and women of this country, were cut out of the deal.
What did the taxpayers get out of the Obama stimulus? More debt. That money wasn't just spent and wasted – it was borrowed, spent, and wasted.
Maybe the greatest waste of all was time. Here we were, faced with a massive job crisis – so deep that if everyone out of work stood in single file, that unemployment line would stretch the length of the entire American continent. You would think that any president, whatever his party, would make job creation, and nothing else, his first order of economic business.
But this president didn't do that. Instead, we got a long, divisive, all-or-nothing attempt to put the federal government in charge of health care.
Obamacare comes to more than two thousand pages of rules, mandates, taxes, fees, and fines that have no place in a free country.
The president has declared that the debate over government-controlled health care is over. That will come as news to the millions of Americans who will elect Mitt Romney so we can repeal Obamacare.
And the biggest, coldest power play of all in Obamacare came at the expense of the elderly.
You see, even with all the hidden taxes to pay for the health care takeover, even with new taxes on nearly a million small businesses, the planners in Washington still didn't have enough money. They needed more. They needed hundreds of billions more. So, they just took it all away from Medicare. Seven hundred and sixteen billion dollars, funneled out of Medicare by President Obama. An obligation we have to our parents and grandparents is being sacrificed, all to pay for a new entitlement we didn't even ask for. The greatest threat to Medicare is Obamacare, and we're going to stop it.
In Congress, when they take out the heavy books and wall charts about Medicare, my thoughts go back to a house on Garfield Street in Janesville. My wonderful grandma, Janet, had Alzheimer's and moved in with Mom and me. Though she felt lost at times, we did all the little things that made her feel loved.
We had help from Medicare, and it was there, just like it's there for my Mom today. Medicare is a promise, and we will honor it. A Romney-Ryan administration will protect and strengthen Medicare, for my Mom's generation, for my generation, and for my kids and yours.
So our opponents can consider themselves on notice. In this election, on this issue, the usual posturing on the Left isn't going to work. Mitt Romney and I know the difference between protecting a program, and raiding it. Ladies and gentlemen, our nation needs this debate. We want this debate. We will win this debate.
Obamacare, as much as anything else, explains why a presidency that began with such anticipation now comes to such a disappointing close.
It began with a financial crisis; it ends with a job crisis.
It began with a housing crisis they alone didn't cause; it ends with a housing crisis they didn't correct.
It began with a perfect Triple-A credit rating for the United States; it ends with a downgraded America.
It all started off with stirring speeches, Greek columns, the thrill of something new. Now all that's left is a presidency adrift, surviving on slogans that already seem tired, grasping at a moment that has already passed, like a ship trying to sail on yesterday's wind.
President Obama was asked not long ago to reflect on any mistakes he might have made. He said, well, "I haven't communicated enough." He said his job is to "tell a story to the American people" – as if that's the whole problem here? He needs to talk more, and we need to be better listeners?
Ladies and gentlemen, these past four years we have suffered no shortage of words in the White House. What's missing is leadership in the White House. And the story that Barack Obama does tell, forever shifting blame to the last administration, is getting old. The man assumed office almost four years ago – isn't it about time he assumed responsibility?
In this generation, a defining responsibility of government is to steer our nation clear of a debt crisis while there is still time. Back in 2008, candidate Obama called a $10 trillion national debt "unpatriotic" – serious talk from what looked to be a serious reformer.
Yet by his own decisions, President Obama has added more debt than any other president before him, and more than all the troubled governments of Europe combined. One president, one term, $5 trillion in new debt.
He created a bipartisan debt commission. They came back with an urgent report. He thanked them, sent them on their way, and then did exactly nothing.
Republicans stepped up with good-faith reforms and solutions equal to the problems. How did the president respond? By doing nothing – nothing except to dodge and demagogue the issue.
So here we are, $16 trillion in debt and still he does nothing. In Europe, massive debts have put entire governments at risk of collapse, and still he does nothing. And all we have heard from this president and his team are attacks on anyone who dares to point out the obvious.
They have no answer to this simple reality: We need to stop spending money we don't have.
My Dad used to say to me: "Son. You have a choice: You can be part of the problem, or you can be part of the solution." The present administration has made its choices. And Mitt Romney and I have made ours: Before the math and the momentum overwhelm us all, we are going to solve this nation's economic problems.
And I'm going to level with you: We don't have that much time. But if we are serious, and smart, and we lead, we can do this.
After four years of government trying to divide up the wealth, we will get America creating wealth again. With tax fairness and regulatory reform, we'll put government back on the side of the men and women who create jobs, and the men and women who need jobs.
My Mom started a small business, and I've seen what it takes. Mom was 50 when my Dad died. She got on a bus every weekday for years, and rode 40 miles each morning to Madison. She earned a new degree and learned new skills to start her small business. It wasn't just a new livelihood. It was a new life. And it transformed my Mom from a widow in grief to a small businesswoman whose happiness wasn't just in the past. Her work gave her hope. It made our family proud. And to this day, my Mom is my role model.
Behind every small business, there's a story worth knowing. All the corner shops in our towns and cities, the restaurants, cleaners, gyms, hair salons, hardware stores – these didn't come out of nowhere. A lot of heart goes into each one. And if small businesspeople say they made it on their own, all they are saying is that nobody else worked seven days a week in their place. Nobody showed up in their place to open the door at five in the morning. Nobody did their thinking, and worrying, and sweating for them. After all that work, and in a bad economy, it sure doesn't help to hear from their president that government gets the credit. What they deserve to hear is the truth: Yes, you did build that.
We have a plan for a stronger middle class, with the goal of generating 12 million new jobs over the next four years.
In a clean break from the Obama years, and frankly from the years before this president, we will keep federal spending at 20 percent of GDP, or less. That is enough. The choice is whether to put hard limits on economic growth, or hard limits on the size of government, and we choose to limit government.
I learned a good deal about economics, and about America, from the author of the Reagan tax reforms – the great Jack Kemp. What gave Jack that incredible enthusiasm was his belief in the possibilities of free people, in the power of free enterprise and strong communities to overcome poverty and despair. We need that same optimism right now.
And in our dealings with other nations, a Romney-Ryan administration will speak with confidence and clarity. Wherever men and women rise up for their own freedom, they will know that the American president is on their side. Instead of managing American decline, leaving allies to doubt us and adversaries to test us, we will act in the conviction that the United States is still the greatest force for peace and liberty that this world has ever known.
President Obama is the kind of politician who puts promises on the record, and then calls that the record. But we are four years into this presidency. The issue is not the economy as Barack Obama inherited it, not the economy as he envisions it, but this economy as we are living it.
College graduates should not have to live out their 20s in their childhood bedrooms, staring up at fading Obama posters and wondering when they can move out and get going with life. Everyone who feels stuck in the Obama economy is right to focus on the here and now. And I hope you understand this too, if you're feeling left out or passed by: You have not failed, your leaders have failed you.
None of us have to settle for the best this administration offers – a dull, adventureless journey from one entitlement to the next, a government-planned life, a country where everything is free but us.
Listen to the way we're spoken to already, as if everyone is stuck in some class or station in life, victims of circumstances beyond our control, with government there to help us cope with our fate.
It's the exact opposite of everything I learned growing up in Wisconsin, or at college in Ohio. When I was waiting tables, washing dishes, or mowing lawns for money, I never thought of myself as stuck in some station in life. I was on my own path, my own journey, an American journey where I could think for myself, decide for myself, define happiness for myself. That's what we do in this country. That's the American Dream. That's freedom, and I'll take it any day over the supervision and sanctimony of the central planners.
By themselves, the failures of one administration are not a mandate for a new administration. A challenger must stand on his own merits. He must be ready and worthy to serve in the office of president.
We're a full generation apart, Governor Romney and I. And, in some ways, we're a little different. There are the songs on his iPod, which I've heard on the campaign bus and on many hotel elevators. He actually urged me to play some of these songs at campaign rallies. I said, I hope it's not a deal-breaker Mitt, but my playlist starts with AC/DC, and ends with Zeppelin.
A generation apart. That makes us different, but not in any of the things that matter. Mitt Romney and I both grew up in the heartland, and we know what places like Wisconsin and Michigan look like when times are good, when people are working, when families are doing more than just getting by. And we both know it can be that way again.
We've had very different careers – mine mainly in public service, his mostly in the private sector. He helped start businesses and turn around failing ones. By the way, being successful in business – that's a good thing.
Mitt has not only succeeded, but succeeded where others could not. He turned around the Olympics at a time when a great institution was collapsing under the weight of bad management, overspending, and corruption – sounds familiar, doesn't it?
He was the Republican governor of a state where almost nine in ten legislators are Democrats, and yet he balanced the budget without raising taxes. Unemployment went down, household incomes went up, and Massachusetts, under Mitt Romney, saw its credit rating upgraded.
Mitt and I also go to different churches. But in any church, the best kind of preaching is done by example. And I've been watching that example. The man who will accept your nomination tomorrow is prayerful and faithful and honorable. Not only a defender of marriage, he offers an example of marriage at its best. Not only a fine businessman, he's a fine man, worthy of leading this optimistic and good-hearted country.
Our different faiths come together in the same moral creed. We believe that in every life there is goodness; for every person, there is hope. Each one of us was made for a reason, bearing the image and likeness of the Lord of Life.
We have responsibilities, one to another – we do not each face the world alone. And the greatest of all responsibilities, is that of the strong to protect the weak. The truest measure of any society is how it treats those who cannot defend or care for themselves.
Each of these great moral ideas is essential to democratic government – to the rule of law, to life in a humane and decent society. They are the moral creed of our country, as powerful in our time, as on the day of America's founding. They are self-evident and unchanging, and sometimes, even presidents need reminding, that our rights come from nature and God, not from government.
The founding generation secured those rights for us, and in every generation since, the best among us have defended our freedoms. They are protecting us right now. We honor them and all our veterans, and we thank them.
The right that makes all the difference now, is the right to choose our own leaders. And you are entitled to the clearest possible choice, because the time for choosing is drawing near. So here is our pledge.
We will not duck the tough issues, we will lead.
We will not spend four years blaming others, we will take responsibility.
We will not try to replace our founding principles, we will reapply our founding principles.
The work ahead will be hard. These times demand the best of us – all of us, but we can do this. Together, we can do this.
We can get this country working again. We can get this economy growing again. We can make the safety net safe again. We can do this.
Whatever your political party, let's come together for the sake of our country. Join Mitt Romney and me. Let's give this effort everything we have. Let's see this through all the way. Let's get this done.
Thank you, and God bless.

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Monday, August 20, 2012

Madrid: come hungry!

(click to enlarge - Plaza Mayor, Madrid , Spain)

I just spent a quick two days in Madrid on my way home from the UK. Here's some travel impressions:

-I can't believe that I took so long to get to Madrid. I've now been to 30 countries and just now got to the 3rd largest city in Europe (behind London & Paris.) It was definitely a mistake on my part. Madrid is waaaaay more interesting (and fun) than some of the 2nd tier cities that I've been to.

It did seem, though, that Madrid is a tiny bit off the beaten path. There are - for example - many more flights between the US and Paris or even Frankfurt than Madrid.

Also, Madrid lacks a signature event or icon. I had a great time in Madrid and really enjoyed the sights and the history, but there isn't a single prominent must-do/must-see, like the Eiffel Tower, Big Ben, or the Duomo.

Most memorable in Madrid's case is the food & drink, or perhaps lifestyle. Not only are tapas tasty, but it is an insight into Spaniards way of life.

2 things surprised me about Spanish food: 1) it wasn't spicy at all, and 2) it tended to be very basic. For example, 2 of the most common tapas are patatas bravas and albondigas, which are roasted potatoes with ketchup (more or less) and meatballs in tomato sauce. (Not a complaint - I enjoyed them both.)

So to experience Madrid, come hungry. (And be sure to visit the Mercado de San Miguel, which provided the single best hour of touring that I've ever experienced. It's a market/food court that offers the best of Spanish food in a very accessible way/)

It's true what they say about Europeans taking the whole month of August off - the town was fairly quiet and there was wide availability at restaurants and hotels. It's also true about the proclivity for siestas in the afternoon.

As for trip specifics, I stayed at the Hotel Tryp Diana, a 4* hotel near the airport. The hotel was decent, and a 7 minute walk to the Alameda Olmos Metro stop on the end of line 5. (Line 5 running through the heart of the tourist districts.) The hotel area is nearly 100% residential, though there are a few restaurants/pubs focused on the locals, including 2 located inside the hotel.

I wish I could have spent more time in Madrid, and I'll definitely put a higher priority on exploring the rest of Spain.

Saturday, August 18, 2012

Like Water for Climate

Want a dose of climate sanity? Read the latest from Danish economist Bjorn Lomborg. In essence, Lomborg proves again that weather does not equal climate.

Friday, July 13, 2012

Airbus A380 impressions

I'm mid-flight on a trans-Atlantic trip on an Air France A380. I've been curious for a few year to catch a ride on the new superjumbo and was really looking forward to this new experience.

How would I describe it in one word? Yawn. There's some minor improvements in amenities and overhead space. Also the cabin is quieter than most, but I otherwise found the flight experience underwhelming and a bit bumpier than hoped. (in fairness, it could just have been today's weather making the flight rocky for periods, but I thought such a big plane would suppress chop, but it seems the largeness of the plane might actually as a sail for wind forces.)

My main impression though is that such a large plane is a bad idea - today's pre-flight experience suggests that boarding complexity doesn't rise linearly with increased passenger count but rather arithmetically. Our boarding and pre-flight sucked - very long, slow lines in the terminal, clogged aisles on the plane, and a delayed departure, though I didn't notice anything to make today's boarding more complex than others.

I will definitely actively avoid the A380 if possible. On long trips, my preference would be:

1. Boeing 747 - still the best
2. Boeing 777
3. A380 - only beats the 767 because of it's higher speed.

I have a feeling that I'll rank the Boeing 787 in the top 2, once I get a chance to ride one.

It appears my lukewarm experience on the A380 is echoed by the airlines - A380 sales have stalled and are unlikely to produce enough orders to reach break even on the project.

Update: the rest of the flight tipped me from lukewarm to thumbs down, mostly because of the deplaning process. Boarding in Paris used 3 doors to the plane. At our destination (Washington Dulles), we used only 1 standard door to deplane. Being in row 47, approximately 469 people deplaned before I me, taking 20 minutes, and negating any speed advantage te A380 has over mid-sized planes.

Monday, July 09, 2012

Impressions of Belgium

Snack time at the Grand Place in Brussels, Belgium

I crammed a quick trip to Belgium in at the front of a business trip to the UK. (trip via extra-quick Eurostar service from London to Lille, France.) Here's a few impressions, as I take the sloooowwwww train from Brussels to Lille.....

-hard to believe that Belgium is <200 years old. The monarchy was founded in 1831 based on a displaced German prince. I'm also not sure if Belgium should exist today - there are 3 distinct parts to the country (Walloonia, Flanders, and the capital, Brussels) none of which make sense together.

-amazing contrast between the French and Flemish parts of Belgium. The Flemish part seemed happier, taller, and the people were less likely to smoke. The French part was more global - many more Arabs, Turks, and Africans, and seemingly a bit poorer, both in Brussels and beyond.

-all that talk about Belgian frites (fries)? They're really only notable for their ubiquity - they're served with EVERYTHING. Frying the chips twice makes them slightly different and arguably slightly better, but not much different. They're often topped with different sauces (I saw as many as 16 different sauces), which adds to the uniqueness. My new favorite is Andalucian sauce. I have no idea what it is besides orange colored and slightly spicy.

-speaking of food, I discovered that I could live on doner kebaps and pain au chocolat - yum! Belgian waffles and beers were less impressive. I'd say crepes>waffles. I also tried a Flemish specialty flammades carbonnade. It's basically beef stew, cooked in beer with sugar, minus veggies, but of course with frites.

-here's something weird: Belgium regulates when retailers can have sales. Apparently July 1-July 31 is the permitted month of sales. Every clothing store has this screaming I their window.

-both Ghent and Antwerp were worthwhile side trips - I enjoyed both even more than Brussels. Both are picturesque, with Ghent's canals making the town special, and Antwerp with a very nice old town center.

-I walked through the EU area and was surprised at the small footprint of the EU, though there was a great deal of construction underway. Turns out that Brussels is one of 3 EU capitals (along with Strasbourg and Luxembourg.) If the EU was a stock, I'd short it. It is cumbersome, dysfunctional, and probably irrelevant. I had a chuckle when I saw the message on the outside of a parliamentary building: "Towards a stronger economic union." How about better, instead of stronger?

Wednesday, April 25, 2012

Good short reads

I read way, way, way too many economics articles, but I am always looking for a prompt to help make the best decisions possible. (Economics isn't the study of money per se, but rather an explanation of decision making.)

What follows are a collection of mainstream articles by economists that really caught my eye this month.

First up: great tips from an economist on how to find great food when dining out. Tyler Cowen presents 6 ways that thinking like an economist will result in a better meal and a better deal.

Next: 25 great quotes from Thomas Sowell. A brilliant economist, Sowell is most known for making economics accessible and for challenging on economic grounds racial and political orthodoxy.

Then: Cowen on how America is changing and what it will mean for the next generation. If you read one economics article this month, read this one. His analysis is fundamentally econometric, but the real highlight are the distilled implications and strong, direct conclusions.

Finally, here's a cool graphic that sums up the case against the TSA:

TSA Waste
Created by:

Monday, April 23, 2012

Carticel patient Q&A

I've had two blog visitors in the last month who have had good questions about my A.C.I. surgery and experience with Carticel. I thought it would be useful to post their questions and my answers in the hope that they would be helpful for anyone else scheduled or considering surgery.

First up is a note from Kevin:

1. In reading through the recovery/rehabilitation guidelines, I'm not finding much instruction on when I could return to work at a desk job. I'm a consulting engineer and work primarily in a traditional office setting (can be sitting all day, if need be - not much walking). My boss has told me the company will be flexible with working from home or rearranging things at the office for me. When in your rehab did you feel you could sit at a desk for 8-9 hours a day?
2. Any problems with insurance?
3. What kind of activities did your doctor say you could expect to resume if all went according to plan with the ACI?
4. How many hours/day should be budgeted for rehab during the first 2 weeks? 6 weeks? 6 months?

Basically I would like to get as reasonably accurate of a picture as possible of what my rehab schedule will look like…….

My response:

- I found the carticel literature produced by Genzyme (the company that makes carticel) to be very helpful and pretty much spot on in all things. If you haven't received this stuff yet (I did, after my first consultation), I highly recommend you get it (and get multiple copies - your physical therapist and others will find it handy to read to.) I'm talking specifically about a green spiral-bound guide, and a small green pamphlet that is the summary of the green book.

-I found the recovery/PT to be pretty easy, as long as you stick to it. No particular exercise is too difficult, and no session was too tough. Adding up all of the movement exercises over an hour could leave you tired, but I always found it to be a good kind of tired. Sometime sore, but not in pain.

-I was really, really lucky to have a great support team. I moved back in with my parents for a month post-surgery, and friends and family were a HUGE help.

-if I could go back pre-surgery and do one thing it is to start a diet. Post-surgery you do a LOT of sitting around, and inevitably you put on some weight. A pre-surgery diet would not only make this a little easier to accept, but also lightens the load on your knee.

1. Ah, returning to 'regular' life. Here's one area where I found the guidance was a bit too optimistic. To answer your question directly: how long until you could sit in the office for 8-9 hours/day: I'd say 1 month. (But you can contribute well before then, working from home or half-days.) Here's why I say that:

I work a desk job too, and was told that I should expect to miss a full week of work, but after that, I could go back to working at my desk. Everyone's reaction to getting chopped open is a bit different, but I'd say that I didn't really get back to work for 2 weeks, and I'd say it was a month before I was good for anything but answering emails and other "light duties."

My implantation surgery was on a Thursday, and I expected to be back to reading emails and maybe joining teleconferences during the next week, with the expectation that I'd be back "in the office" the week after (i.e. 11 days post-surgery.)

Even with all the care that I was getting - getting driven around, etc., I was surprised by how draining the recovery was and how small things became big accomplishments - like taking a shower, or walking between bedroom and living room. (btw: you're going to live on 1 floor for about 2 months. Stairs just aren't worth it.)

The first month post-surgery is a blur to me now. I wasn't a vegetable, and certainly remember feeling like I was getting things done, but everything for the first month took 4X as a long as you'd expect - even simple things like reading a book. In the early days post-surgery, I'd fall asleep in the middle of a chapter in the middle of the day. This got better almost every day, but still, I was surprised how drained I was, every day.

btw: one piece of advice from my experience: get an iPad to keep you busy during the recovery.

I didn't do any work other than reading a few emails for the first full post-op week, and worked lightly from home in the second week. My third week was effectively all half-days. (Luckily this was vacation season in the summer.) It was only by week 3 when I could think better and focus.

As for the physical dimension, you'll be mobile pretty quickly (with a walker), and you could get back to your office quicker than I did. PT and doc check-ins won't really interrupt your work day, but don't underestimate how draining just getting from the parking lot to your office will be. Also: for the first month, your repaired leg will be in a locked brace running from ankle to thigh. It's not as bad as it sounds, but it has a few implications: 1) you'd definitely rather wear shorts during this time, 2) you can still get around with the brace on, but it is cumbersome and you learn real fast to minimize movement - no getting up to pick something off the printer ever half-hour.

The one thing that could keep you at home is the required time in the CPM machine. (CPM= continuous passive motion. It's a gizmo that just keeps lightly moving your leg, whether you are awake and watching TV, or sound asleep. It's not difficult, but the first week or two requires rotating 1 hour on/1hour off schedules. You really can't go back to work when you need to spend 4-8 hours a day in the CPM. Unfortunately, I can't recall if the CPM was only for 1 week, 2 weeks, or 3 weeks. I know we returned the machine to my doc at the 1 month check-in.

2. Insurance: I was really, really surprised by the insurance process. (I'm with Anthem Blue Cross/Blue Shield here in VA.) For starters, my doc's office took on the challenge of getting approval from my ins. company - I really had almost no interaction with the ins. company. There was a problem, though, in that we set a surgery date based on a regular turnaround time by the ins. company. My approval process went long, though. I was very nervous that this was a negative, but it ended up being a paperwork issue - my referring doc (my 1st orthopedist, who eventually referred me to the carticel doc) hadn't sent some particular info. One other tidbit to be aware of: I heard that insurance approval can sometimes be complicated by body weight. (i.e. insurance isn't going to pay to fix the knee of a 400-pounder), and that BMI (body mass indicator) is an important screening criteria with some companies.

The one negative in the pre-surgery process is that I never knew what my financial obligation was going to be - there aren't fixed prices for something like this. I had an idea of what the whole deal costs, and I thought that I'd owe 20% of it - which ended up being accurate - but NOONE could tell me this with enough certainty.

3. The expectations that you'll read about in the carticel literature are pretty accurate - no running or abrupt movements for a year. That said, I've been swimming, bicyling, and walking without difficulty for months now. I was swimming in month 3, and crutch-free at 4-months. Just in the last month (month 7) I've gone from thinking "just the thought of running is painful," to "yeah, I could see myself running in 3 months."

4. Rehab: actual daily demand is pretty light - like less than hour. My schedule was (roughly) go to a PT place every other day for about an hour. On the "off" days I did a series of leg lifts and other simple movement exercises which took less than a half-hour. Warning though: when you're only a week or two post-op, even these exercises will drain you pretty good. (the PT is a bit lighter for the first few weeks, concentrating on movement. Later, when building strength, you'll do the 1-hr PT period.)

I'm 8 months post-surgery, and I'm surprised to say that I'm still endurance-limited. I can do about an hour and half (max) of continuous activity (like biking) before needing a break for my knee. I'm told this is normal, and that over time this figure will rise, but that I shouldn't try to "power thru" my limits.

Kevin, I hope this helps. Please feel free to contact me with any additional questions or clarifications.



And the second note from Lisa:

How much help will I need the first week or two post-op? I live alone and some patients said I will need someone to stay with me 24 hrs a day for the first week or two and others said I wont need much help at all.

My other concern is how much Genzyme charges for cell growth. First I was told they accepted only what Aetna would pay and nothing from me, then they send me a letter that I am responsible for the balance. My issue is Carticel will not tell me how much they charge for the cell growth. Did you receive any invoices for your cell growth?

Thank you for sharing your experience,


My response:

The first week or two post-surgery is pretty slow - except for days where you have PT scheduled, all you really do is alternate between however you like to rest (TV, reading, bed, etc.) and sitting with your leg in a CPM machine. (You've heard about the CPM machine, right?) The days will fly by, as you'll find yourself randomly drifting off to sleep while reading or watching TV, which was good for me, and hopefully for you too.

PT days are straightforward too. Think of it as basically an hour of coached movement exercise - no weights, no machines.

I don't agree with the idea that you'll need help available 24/7, unless you have one of two challenges:

1) your house or apartment has stairs on the inside or outside, or

2) you don't prepare to live as smoothly and simply as possible for the 2-3 weeks post surgery.

Here's what I mean: stairs are very, very, bad, immediately post-surgery. They're difficult, draining, dangerous, daunting, and the devil, all rolled up in one. A simple flight of stairs up to an apartment, or to a second story bedroom is enough that you'll want to plan your days around your up/down trips. In addition to the challenge of the stairs, they can be very dangerous - you'll be on some kind of painkiller for ~2 weeks, and stairs + drugs don't mix well. I lived on one floor of my 2-story house for about 2 months post-surgery, with a few exceptions when I very slowly scooted up/down the stairs on my butt, and I'm glad that I did so.

Having someone around - even just a visitor every day or two - can really help out a lot with regards to stairs.

Prepping in advance of surgery can really reduce your interactions with stairs and make daily life post-surgery less demanding. Moving everything you need to one floor - or even one room would be a big help, as would doing all of the laundry, grocery shopping etc. in advance. Don't even dream of carrying a laundry basket for the first month post-surgery, and you definitely won't be pushing a grocery cart through a store. (I stocked up on shelvable foods (spaghetti, etc) and relied on friends to bring by things like milk, fresh veggies & takeout.)

Along the same lines of planning, for the first month or so you'll want to really coordinate your trips out - you wouldn't want to go to PT in the AM, then make another trip out in the afternoon to visit the drug store when you could combine these into 1 trip out, to minimize your work, and make the most of any friend who is escorting you that day.

(Oh, one other thought about having help and prepping: showers are a much, much bigger challenge than I expected. I'd try to have someone on call in the next room for your first couple of showers, and definitely prep your shower pre-surgery by finding a seat or stool to put in the shower. (I highly recommend a plastic lawn furniture chair.))

So, solo life immediately post-surgery is completely possible, just take it easy, listen to your body, and make sure your survival doesn't depend on anything that HAS to be done.

(While solo life is good, I really appreciated every visitor, sometimes off-loading stupid stuff on them ("Can you get my book?") but every little bit makes life easier post-surgery, and your friends want to help.)

As for finances, I can't give you a precise answer, but I'll tell you my experience. I had (and have) a very regular health insurance policy with our local Blue Cross. I too sweated pre-surgery as nobody could give me any exact financial answers, and I got letters from Genzyme and others that scared me - like the one that says "if you cancel the surgery once your cells are thawed (a day beforehand), you're going to pay for everything,even if there is no surgery."

Ultimately, the finances were a pleasant surprise. I'm pretty sure that the all-in, total of everything, cost for me was ~$64,000, but my insurance covered >90% of everything. I think the balance from Genzyme for growing up the cells that I had to pay was $963, and I had a couple assorted bills for everything that might have added up to another $2000 (anesthesia was one, follow-up doc visits was another - nothing too big on its' own.)

(PT was a separate issue - my insurance covered something like the first $750 in PT. My PT bill was much more than that, and I partially blame myself, because my PT folks were very adept at offering additional services to make a bit more money. I never realized that when they said "do you want knee mobs?" (manual massage of the knee) I was committing to an additional charge.....every time.)

Best of luck with your surgery!



I hope you find this helpful. As always, please feel free to send me an email through any of: my profile page, my Facebook link (lefthand column) or write questions in the comments section. To see all of my posts regarding my ACI/Carticel experience, click here or "Knee Surgery" in the label cloud to the right ---->

With my new friends on the Great Wall of China

With my new friends on the Great Wall of China
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"I do not choose to be a common man. It is my right to be uncommon -- if I can. I seek opportunity -- not security. I do not wish to be a kept citizen, humbled and dulled by having the state look after me. I wish to take the calculated risk; to dream and to build, to fail and to succeed. I refuse to barter incentive for a dole, I prefer the challenges of life to the guaranteed existence; the thrill of fulfillment to the stale calm of utopia. I will not trade freedom for beneficence, nor my dignity for a handout. I will never cower before any master, nor bend to any threat. It is my heritage to stand erect, proud, and unafraid, to think and act for myself, to enjoy the benefit of my creations, and to face the world boldly and say, "this I have done." All this is what it means to be an American." -- Anonymous