Knee Replacement # 2

My left knee replacement went so well I decided to have my right knee done. Other reasons:

• Under my current health insurance plan I had virtually no "out of pocket costs" with my knee replacement or a shoulder surgery in 2004. Since my health insurance is through one of our insurance companies group plan who our office won't do business with much longer It made sense to "gitrdone" now instead of later.
• I saw the amounts that hospitals billed my insurance company versus what got paid. I figured neither one was real happy about the relationship. Sure enough my insurance company and the hospital/doctors are currently arguing about continuing the contract beyond July 01. My surgery is scheduled for June 26 and has been "approved" so this procedure is "covered".
• I had 2 ugly looking knee joints with both legs bowled outward. Now my replaced knee is almost normal sized and straight. So even though my right knee is not nearly as painful as the left before surgery I'm ready to replace it too.

I was suppose to donate 2 units of blood before surgery. When I went to donate the first unit my hematocrit level was 32. Normally it should be over 38, so the Red Cross took one unit, but told me that would lower my level to a point where it would not be possible to donate a second unit in time. Called doctor's office and they OKd one unit.

I prepared by cycling a century on Saturday, 25 miles on Sunday and walking 2 miles to Piedmont Hospital. The actual surgery took 87 minutes (I got that from the Doctor afterward) and I was in my room by 11:00. Just like my other joint replacements I had an epidural injection instead of general anesthesia, but this time I actually talked to the Doctor during surgery. They had put up a screen so I couldn't see my knee, and I asked if they had started--they had because I could hear the tool background noise and was aware my leg was being manipulated. I felt no pain what so ever.

Post--op pain in my knee was minimal as the epidural remained in place overnight. When Doctor Wilkes visited on Tuesday he told me the incision was longer than the last one and he cut into my quadriceps to get a large spur above my kneecap. He thought recovery would be similar to last time barring any complications. I made plans to go home on Wednesday. However, nurses/staff seemed to be taking a lot more vital signs and blood samples. They mentioned my blood levels were low and on Tuesday afternoon they gave my donated unit back. It only takes a few minutes to donate, but it takes a couple hours to return it. On Tuesday night/Wednesday morning the drainage system started to leak at my knee which slowed drainage. I was concerned because I was draining a fair volume and last time my leg swelled a lot the day after discharge and I was trying to prevent that from re occurring.

On Wednesday Doctor Wilkes removed the drainage tube and changed the bandage. We discussed my low blood counts--still way too low even after transfusion-- and he agreed to call my primary doctor (Marshall Levine) to check this out further. Fortunately this did not prevent my discharge and I was home by 11:30. I got a CPM machine and spent the the day icing and moving the joint. The technician told me not to set the machine beyond 90 degrees until the first set of staples are removed. Dr. Levine called and we set an appointment for Friday. He was concerned because of the contract dispute between Piedmont and BCBS (GA). Dr Levine called Monday to confirm my red blood count was low--everything else normal. However, since the Blue cross contract expired July 01 he could not refer me to a blood specialist. I wound up with a new primary care doctor with a referral to follow (see a future post on medical care/insurance). New doctor referred me to someone at Emory and they couldn't see me until September.

13 days post--op I still have a fair amount of swelling and discomfort. This surgery was definitely more than minimally invasive. Incision was 8 inches (left knee was 5) and the doctor had to cut my quadriceps to remove all the spurs. It was harder to do rehab and I had to leave work early to ice my leg. Therapist thinks it looks great and considering what they did he's probably right. I still thought I could get back on the road before August 01.

07/16/06 Got on a stationary bike today--one day ahead of previous knee replacement.

07/26/06 Post--op visit. Things looked good although swelling still an issue. Had to undergo an ultra sound at Emory to confirm no blood clots. That was my last visit to the surgeon. I didn't go back because I knew the knee was doing fine.

07/29/06 Back on the road again. One day sooner than last time and a few more miles. I did 27 miles in just over 2 hours. The initial 18 miles were done in 80 minutes. I felt good enough to do some more riding but as I continued cycling I had to slow down. Probably pushed it a little bit but it felt so, so good to be riding on the road again. It hurt so good!!

Blue Cross and Piedmont worked things out and I was able to return to my primary care doctor who got me to a hematologist in August. Diagnosis was anemia with no real idea why. I went on a high iron dose and scheduled a possible bone marrow biopsy in a month.

During August I continued physical therapy and did 11 road rides, most between 25--30 miles. On 08/27 I rode in north GA and went 55 miles. The first 30 were pretty easy but once I got to the last gap climb (Neels) I was tired. I limped up the 3 mile climb suffering a lot--normally this was an easy climb, but not today. It was partly my knee not being used to doubling my mileage and partly the anemia.

I continued increasing my cycling and therapy during September. When I went back to my hematologist he decided not to do the bone marrow biopsy because my counts and profile were improving. That probably meant my anemia was the result of iron deficiency because of the 2 knee surgeries. That also meant I got a little extra exercise walking 2 miles to his office since I wouldn't be able to drive after the biopsy. So I just walked back home after stopping for a huge breakfast since I had to fast.

My major recovery goal was to complete the 6 Gap Century on 09/24. I rode the back 3 gaps one week before the event and knew that while I might be able to complete 6 Gap I would pay a huge price. So I did the 3 Gap. It rained through entire ride but I felt pretty good. I was sure my anemia was disappearing because I could ride faster with less effort and do harder intervals without fading.

I continued weight lifting and riding through October. In early November the hematologist said all my counts were completely normal. The final diagnosis was anemia due to iron deficiency as the result of 2 surgeries and blood donations. I wasn't surprised because I could feel a big difference in my fitness level compared to earlier in the year.

On 11/18/06 I did El Tour de Tucson--my first century after the second knee replacement. It was almost effortless. I rode with team mates and helped pull several pace lines and individuals during the ride. The only mishap was a flat tire at mile 90. I've participated in this event 7 times but always as a coach helping and looking after my team. Someday I want to do this ride on my own to see how well I could do.

So 2006 (my 60th) was a good year. Back in 2005 I had planned to achieve some mile stone like 60 centuries, 6 or maybe 10 six gap centuries, etc. I wound up with only 4 centuries in 2006. But I have 2 new knees, improved range of motion, straight legs and no health issues that I'm aware of. I'll settle for that and plan some goals for future years. One goal is no more orthopedic surgeries--10 in one life time is already way too many!

Back to the Future--Marriage

Like anyone who's lived 60 years I've had my share of success and failure. One area where I failed consistently was marriage. Here's my perspective on how I screwed up. As a "boomer" I hit my sexual stride in the 1960's (after birth control--way before Aids). I was like a kid in a candy store with a free pass--unlimited opportunities--no reason to make any commitment. So I dated lots of girls/women never feeling any reason to settle down--there were too many choices. I probably dated several potential mates that would have been a better choice than the 2 women I did marry. By better choice I mean someone I could have stayed connected to for a life time.

I met my first wife in 1973 at a company softball game. Her name was/is Pam Riccio and the night I met her I ended up in bed with somebody else. That's how the relationships were for me--connect with someone, get a phone number, disconnect, wind up with someone else, follow up, date 2, 3, 4 people, be non-committal, lose them, find others, etc etc. I was also not any good at breaking up--once things got tense I would just distance myself until she/they disappeared.

I dated Pam and several other women almost 3 years. Then I was transferred to Los Angeles in 1976. I cared deeply about Pam, but I wanted to live the LA experience. The LA experience for me was going there on a business trip a few years before and getting laid by 3 different women in 5 days. So I moved to LA and found almost every woman I dated was sexually available but pretty shallow compared to Pam and others I had dated.

I invited Pam to visit me in California, things went well, and I proposed. Pam was athletic, loved the same activities I did and seemed ready to start a life with me. But once the honeymoon was over, she encountered job problems, missed NJ, etc. I did my best to reach out, but I was the typical guy--tell me what the problem is and I'll tell you how to fix it--without realizing she didn't want me to solve the problem--she wanted me to "listen". We moved to Connecticut in 1978 because she wanted to be closer to her family--and it was a good promotion for me, but once there all she talked about was how much she missed California. Sex between us just disappeared (both of us wound up getting it through affairs) but we hung together until 1981 when she moved back to California for a job. The reality was she was attracted to someone out there and I had an affair going so it was fairly easy to get divorced. Just like my previous relationships.

My second wife was an affair I started in Connecticut as Pam was leaving. Back then I prided myself as a person who didn't make the same mistake twice. But I got involved with someone who had the same qualities as Pam. We got married and managed to last 7 years but it was the the same thing all over again. Only difference was this time I was completely faithful while she had multiple affairs. Bottom line for me was I married almost the exact same personality twice--and reacted the same way when issues arose. I tried a lot harder to keep the marriage together during those issues, but finally decided she wasn't worth the effort.

So I've been divorced over 16 years. I've had no contact with my second wife, but talk to Pam a few times a year. We both admit we didn't give our relationship a full effort. If I could turn back the clock I would have worked much harder to preserve that marriage--after all it was the first time I pledged "until death us due part". But I doubt that Pam or anyone could tolerate me. I'm a hard person for any woman to get super close to--I have lots of friends, but still wonder if I can ever forge a long term relationship with a woman.

The other day I called Pam. We had exchanged messages a few times but had not talked in a while. That day (November 28) would have been our 30th wedding anniversary. We have become comrades over the phone, but right now we both seem too caught up in doing what we each want or have to do in our own lives to have much of a chance to really connect with anyone on a long term relationship.

Iraq--Updated Opinion

Over a year ago I offered my opinion on Iraq and referenced an article in the Wall Street Journal. Now the quagmire seems deeper than ever. When I re-read last year's article it sounds very rah-rah and too optimistic.

We still haven't done what I believe we should have done last year--set clear objectives and
benchmarks, and get out of there. I'm unhappy that our leaders are still struggling with this. I'm not an expert--but here are my observations:

1. Our leaders wrestle with the same issue that existed 3 years ago: How does a western culture understand how all the sub cultures over there think compared to us? The more we try to instill a democracy, the more resentment we create towards America
2. Our leaders comprare the war against terrorists to enemies we faced WW I & II. Terrorists are splintered--many times divided among themselves so they are not an evil empire or the axis. They are cells which need to be dealt with on a micro basis, not a macro basis. We should deal with terrorists like Israel did at those involved in the Munich Olympics. Most every one who masterminded Munich were dead 1 year after the attack. Look how long it's taken us to respond to attacks against us.
3. So far we've spent $600 billion in Iraq. That's $20,000 for every person in Iraq. What might have happened if we handed every Iraq citizen half that amount? We probably could have turned Saddam into a westerner for a lot less. What's the per capita cost for each American? Answer: $2,000/person. And not measurable to the families of the 3,000 who have given the ultimate sacrafice. What would have happened if we offered $10 million to each US citizen willing to go and stay until there was stabilility? We could have sent a lot more people and still have money to back them up. Any way you look at it, war is more efficient if the folks waging it are motivated.
4. Military action to resolve issues like the ones we face in Iraq almost never the right answer. Military action works when someone threatens our boundaries. Pearl Harbor is a prime example--but look at how many lives were sacraficed to acheive victory.
5. We need strategies that turn over authority to local governments officials then withdraw--at least military wise. We can't eliminate terrorists by occupying the middle east, and neither can we control or protect our perceived dependence on their oil.

Shane/Connections

Today Jack Palance died. He played a gun fighter in the movie Shane. Palance was the last surviving actor from that movie. Shane is one of my favorites for many reasons: cinematography, plot, etc. But my fondest memory was going to see this movie with my father. He took me to many movies in the 1950's, Ben Hur, The 10 Commandments, 20,000 Leagues Under the Sea, Giant, and others. It was one of those rituals I thoroughly enjoyed.

But of all the movies I went to with my father, Shane stuck with me. Almost anytime I see it's on TV I watch whenever possible. I can outline the plot and scenes from memory. My father died in 1962. Then the actors from the movie began departing: Alan Ladd in 1964, Van Heflin in 1971, Brandon de Wilde in 1972, Jean Arthur in 1991 and director George Stevens in 1975, over the years everyone except Jack Palance. As long as he was around I felt a connection to my past, and my father. So another connection is gone.

But at least one more remains. During a recent visit with my cousin Chris and brother Mark, I discovered that a first cousin of my father lives in Enterprise Al. Her name is Isabel Byers and she lived with my father and grand parents for 10 years (1918-1928). Since I know virtually nothing about that period of my father's (and grand parent's) lives I need to visit with her. Since she is only 230 miles away and is 92 I'd better not wait too long.

The Anti-Incumbent Vote

I just voted and for the first time ever I did not vote for a single incumbent. I spent extra time writing my name in for every position held by an incumbent running unopposed--and there were a lot on my ballot. In races where there were choices I usually voted libertarian if there was one. Otherwise my attitude is "it's time for a change!"

Why not run for elected office myself? Political campaigning is a nasty, expensive negative campaign. The only thing worse would be dealing with the political machinations dealing making earmarking and pork barreling that goes on between elected officials. Besides I want less government in my life, not more.

But I resolve to spend even more time focused on what my local elected officials are doing on a day-today-basis, because that's where most of us fall down as citizens. We worry about and debate the big picture--which we can't do much to change--and don't spend enough time following the local things that affect us.

Last week I discovered the city of Atlanta had embarked on a "traffic calming" project on 3 roads in the Garden Hills area. This is an expensive construction project to slow down speeding cars, but it accomplishes this in part by taking away space for cyclists. It happened because the residents were focused and insistent along with the fact no one else paid any attention.

Citizens can have an effect on things like this only if they remain vigilant about local government.

09/11--My Perspective

Today's the 5th anniversary of 09/11. Certainly a monumental date in American history but maybe not the most tragic. America lost over 618,000 during the Civil War. 418,000 during WW II including 2500 on 12/07/1941. Vietnam, WW I, Korea and other conflicts have taken their toll. We lose 40--45,000 every year in auto accidents. What differentiates 09/11 is it happened in the space of a few hours on American soil, involved Americans who were simply going about normal activities, and was extensively covered as it unfolded.

What does 09/11 mean to me? It means life is uncertain. I will die someday. I could die any day. I could die riding my bike, crossing the street, from cancer or as someone once said "being a health nut lying in bed, dying of nothing". I hope it's not anytime soon. I spend more time making each and every day a quality day for me (and the people I interact with). As the World Trade Center buildings were constructed I was in the subway below them 5 days a week. I probably was in one of the towers visiting clients or friends 50 times. All of those happened before the age of terrorism. But shit happens all the time, everyday, to everyone. I've been in the insurance business my entire adult life. Insurance is about managing risk by transferring the uncertainty of loss to someone else for a price. When it comes to terrorism there is really nothing an individual can do to manage the risk they face. And no matter what our government and military do a Pearl Harbor, 09/11 or another terrorist attack will probably happen again.

So you know what? 09/11/01 is a day when a lot of people who didn't deserve to die did. And that's like most any other day.

Tour de France

I spent 3 weeks in July glued to coverage of this event. I've followed the tour for the last 20 years since an American (Greg Lemond) won the tour for the first time. Lance Armstrong's dominance, the internet, and OLN TV have made it much easier to follow the race. This year was special because there was no clear favorite, daily coverage really showed a lot of different tactics and strategy employed by teams and individual riders, and the outcome remained in doubt until the end.

I was hoping Floyd Landis would win. He's a talented cyclist with a great work ethic, and he's racing at a world class level while facing a hip replacement. I never had the talent of Floyd at any point in my life, but I do know what it's like to ride (and live) with a degenerative joint. In fact I have a lot more experience with that than Floyd or most active recreational athletes. So I about died when Floyd cracked in Stage 16 and was overjoyed when he came back so strong the very next day. I compared Floyd's x rays to my own and was preparing to write about the similarities and differences between Floyd's condition and my own--along with our mutual lifelong absolute love of cycling

This week the shit hit the fan when the "A" sample test administered after Stage 17 showed an unusually high level of testosterone. I had several reactions:

• Anyone who pulled off the ride Floyd did when the whole peleton knew that was his plan has to have a lot of testosterone.
• Why testosterone? It doesn't do that much to boost a cyclist's immediate performance and is easily detectable in drug screens.
• Does a certain testosterone level mean automatic disqualification or are there explanations for a spike like this? Surely it's a spike since Floyd was tested 6 other times during the tour and numerous times throughout 2006 without any consequences.
• Why can cycling officials announce "A" sample results and immediately suspend a rider without corroborating evidence from the "B" sample? Answer here is simple--it's Europe, not America.
• Floyd's press conference today sounded like Tyler Hamilton's rhetoric after he was suspended. I wanted to believe Tyler but the final evidence vs his defense was overwhelming (in my opinion). I hope Floyd's situation turns out different cause I really, really want to believe he won because he was the best cyclist.
• Compared to other sports cycling seems to be doing more to prevent illegal drugs. Given that why would Floyd risk it--stage winners are always tested that day and the only way he could claw his way back into contention was to win that day by as much time as possible

Strange developments so we'll have to wait and watch.

Knee Replacement

After 40+ years of living with an arthritis left knee I will have replacement surgery on 11/28/05. I thought it would be therapeutic for me--and educational for others--to keep a journal. I've had 8 prior orthopedic surgeries and most of them have not gone completely according to plan. That's the main reason I have put this particular surgery off as long as possible.

Background
I first injured my knee in September, 1963 during football practice while living in Johnstown. I was on the punting team with outside left responsibility. The player returning the punt came towards my side of the field and I had a clear shot at tackling him because I had out run Gary Peeler (our starting quarterback) who was responsible for blocking me to the center of the field. He clipped me from behind and it was the most pain I had ever experienced in my life (at the time). Although I tried to keep playing over the next few weeks my knee kept locking up and swelling like a grape fruit. As I returned home to Danville I was facing surgery to repair a torn meniscus on 11/22/63 (day JFK assassinated). Despite rehab efforts my knee never completely recovered and over the next 6 years it kept flaring up. It did get me a draft deferment (1-Y) but in 1969 a NYC doctor in suggested another operation to "clean out debris". That was the accepted medical procedure; in retrospect it was a bad choice. The more times you operate and open up a joint the better chance for arthritis to occur. I remember the surgeon's negative comments after surgery; with the Vietnam War raging and a temporary physical deferment I asked about my chances of being drafted. His reply: "If the Russians attack NYC you may be drafted to collect tolls on the Triboro Bridge".

Over the next 13 years I had 4 more surgeries (right knee, 2 operations on big right toe, and a tendon transfer on left ring finger). All of them had complications and after the finger surgery I vowed my next surgery would be an autopsy. I kept that promise for almost 20 years but a degenerative left hip wore me down and I had it replaced in 2000. That operation compared to all the others was successful in that it relieved intense pain and let me resume life except for tennis and running. I asked the doctor about knee replacement but his recommendation was the pain wasn't bad enough yet.

In November 2002 I slipped on some wet stairs and injured my right shoulder. Nothing broken or separated so I lived with discomfort until an MRI revealed rotator cuff damage. I had that operated on in November, 2004 and like many of my other surgeries it didn't go completely the way I expected. It took a year to rehab that shoulder. The most positive aspect of my shoulder surgery is I am more adept using my left arm for throwing.

Decision Time
The bottom line as far as my left knee was concerned: as long as I could cycle I really didn't consider replacement surgery. Things started to change earlier in 2005. During century rides in Tahoe and Cartersville I experienced a lot of pain and swelling after about 60--70 miles. If I stopped riding for even a few minutes it was very hard to bend my knee enough to turn the pedals. I went to the doctor who had repaired my shoulder and he confirmed the only alternative was replacement or live with it. I decided to see how training went the rest of the season. My knee wasn't too bad at the Covington century in August. On Sunday September 18 I was riding and did a series of hard intervals. As I finished the last one I felt a sharp pain in my knee and had to ride very slowly the rest of the ride. Most of the time whatever pain I experienced subsided within a day or two. This time was different. Everytime I tried to ride it felt like stones were in my joint and then marked with an ice pick.

On September 23 I got a cortisone injection and scheduled surgery for November 28, the week after Tour de Tucson. Between then and November 1, managed to ride about 20 times never more than 25 miles. The cortisone didn't work and I was suppose to ride and coach 25 cyclists through a 111 mile Tour de Tucson. On November 5 I borrowed a hand cycle to use during a group training ride. I quickly realized that compared to legs, using the smaller muscles of the arms requires a lot of training time which I don't have. I could not ride fast enough to keep up especially on hills. The next day I rode 30 miles on my regular bike and while my knee stiffened up afterwards the ride wasn't as painful as previous rides.

11/08/05
Pre-op physical starting at Dr Wilkes office followed by a visit to Piedmont hospital. Doctor impressed by slow heart beat & lungs. I asked him when he thought I could ride a bike on the road. He said 8 weeks as long I was prepared to go slow. I told him that 8 weeks is right around my 60th birthday and I'm determined to achieve that goal.

11/09/05
I elected to donate my own blood so today was the deposit of unit 1. I get called constantly to donate blood because I have B+ and the Red Cross is across the street from my office. When you donate blood for your own surgery, if you don't need it, the blood can not be given to anyone else. It appears that's because they don't ask the litany of questions they do when blood is donated for the general population. Based on my experience it seems like some blood units go to waste when not needed during the surgical process. Wonder what could be done to change that?

11/14/05
Another weekend with no cycling except to teach an effective cycling class for Atlanta Bicycle Campaign (about 6 miles total). Today I donated my second unit of blood. I raised the question about giving un-used blood back for general donation. The answer was a bunch of jibberish, and does revolve around the fact they don't do the same tests or ask all the questions they do when the donation is for the general population. If the blood shortage is as advertised, the Red Cross should figure out a procedure for using this blood if I don't need it.

11/17--20 Tour de Tucson
As I left for Tucson my knee felt very stiff and wouldn't bend beyond about 80 degrees. Not the kind of flexibility needed to cycle 109 miles. However, when we picked up bikes at the convention center Thursday afternoon I rode the 2 miles back to the hotel without much pain or trouble. I debated with myself whether to start with the team and ride as far as I could or drive the course and then ride the final miles with them. I decided to start since that's the only way I could ride with everyone for a while.

The race started promptly at 7:00 am and we were across the line within 3 minutes. I cruised to the first river crossing at about 17 mph without any problem--knee felt OK. After the crossing I formed a pace line with 4 team mates. We were rolling along fine and after a pull I dropped to the back of the line. Within minutes I felt a dull pain which quickly got razor sharp. I slowed down and watched the pace line roll away. I tried riding about 3 more miles but knew the ride was over for me. I hitched a ride with a team mate's wife and mother-in-law and got to the 54 and 104 mile marks to cheer the team. I was happy everyone finished safely, but I was ready to check into the hospital that day to get the surgery over with.

11/27/05
I had planned a bike ride today and invited folks to join me. As I drove to the start it was chilly and drizzly. Even though my bike was pristinely clean I was looking forward to riding. About 6 other folks showed up wondering if we were actually going to ride in what looked like deteriorating conditions. I had no doubt, got everything ready and got on my bike to warm up in the parking lot--as I turned the left crank and straightened my knee it felt like I had been shot. Then the shock of not being able to turn the crank swept over me like a huge wave. I couldn't believe how painfully impossible it felt to bend--and then straighten my knee. The ride was over after 2 laps around the lot. My friends were glad because it meant we could go somewhere warm and eat lunch. I on the other hand wanted desperately to ride since it could be months before I could ride again.

Why did that happen? The only explanation I can think of was I had gone off all medication 5 days before in anticipation of surgery. Without meds to mask the pain it manifested itself and yanked me off the bike. We did go eat but since I was off alcohol as well it didn't taste as good as it would have otherwise. I was very moved by the folks who came out especially since they all said, "We didn't come to ride, we came to see and support you."

11/28/05 Surgery Day
I left my house at 5:00 am and walked 2 miles to Piedmont Hospital. It was actually a better exercise experience than cycling to the hospital because walking that fairly short distance allowed me reflect on what was going to happen. I did not have to inconvenience anyone to pick up my bike. Also the roads were damp which meant I won't have to clean my bike. Pre-op goes exactly as outlined in all the pamphlets except they "shave" my knee area even though I had already shaved the entire leg and they insert an IV in my left wrist without shaving a single hair. They never put the IV in the same place and they never "pre-shave" wherever it's placed.

Promptly at 7:30 I'm rolled into the OR; the next thing I know it's 9:45 and I'm being rolled out of OR following surgery. So my initial goal is achieved--I wake up. I doze off and wake up in the recovery room at 9:55. When asked how I feel, I reply, "I'm ready to go to my room". That doesn't happen until 11:00 probably because my room isn't ready for check in. I phoned my office and a few friends around 11:30, Don Schaet and Stephanie Thomas dropped by but despite my "I feel good" exterior demeanor I was still pretty out of sorts. Tried to read but could not concentrate, always felt like I had to urinate, but with 3 tubes in different body parts I couldn't get out of bed very easily. I was glad one of them was not a catheter, so I made extensive use of the bed side urinal.

11/29/05
I did get out of bed yesterday because I got out of bed the same day with hip replacement. Physical Therapist came by this morning and she was barely out of school. Besides very basic exercises in bed and the continuous passive movement machine (CPM) her plan was to have me walk to the hall and back--my idea was a lap around the ward. When I suggested we try stairs she looked pretty overwhelmed and suggested we wait until tomorrow (when another therapist would be coming).

11/30/05
Discharge day--I hope. Dr Wilkes came by and said I could go home as long as the therapist OKed it. I confirmed that he did not have to see me again and he said if the therapist passes me the nurse will call his office and he would discharge me over the phone. With that incentive in place I made sure I would perform well enough. I did and they let me go. The most painful moment was when they took out the IV on my unshaven wrist. It also bled profusely because of the blood thinners. By the time I got home I was whipped and the rest of the day was mostly nap time.

I did the rehab exercises faithfully. Left knee felt weak but I had no arthritic pain. My right knee seemed more painful than my left as I did the same exercises on both knees. Sometimes while walking and climbing stairs my right knee felt worse and more unstable than my left.

12/11/05
Today's PT session was hard. I had to pull my knee back as far as I could then he would push about 5 degrees further and hold it for 30 seconds. Then I had to attempt to straighten it while he held it in the bent position. later this morning a nurse came by and removed the remaining staples (had more seepage than before). Knee felt good during the day but swelled in the evening.

12/14/05
PT this morning was also hard. We pushed knee to 110 degrees. During the day it got very stiff and I could hardly bend it or walk with a normal gait.

12/16/05
During the night I had lots of pain mainly in my right knee. Felt extremely stiff all over. Took a pain pill for first time in a long time. Result: slight pain relief and instant constipation.

12/19/05
Back on a bike!! 2 sets of 10 minutes on stationary recumbent bike. Knee stiff but worked. Pain level about 0.5 on scale of 1--10. Enough said.

01/01/06
Today I rode my bike on the road 20 miles. Started at Silk Sheets route with a few riders planning on a 50 mile ride. They pulled me to the 8 mile mark and I told them to go on as I needed to limit my ride. Hit the 10 mile mark and thought about doing a slightly longer route but decided not to. Good thing because at the 15 mile mark my knee and body started telling me 20 was going to be enough. But it was great to be back on the road!!

During January I road 11 times for a total of about 175 miles. For some reason I didn't log February March results. April and May I rode about 15 times each month and logged almost 70 hours and nearly 900 miles. I had no arthritic pain in my replaced knee, but I seemed to run out of energy fairly quickly whenever I tried intervals and/or other hard riding.

I was invited to take a stress test by a company who wanted me to market their test to riders I coach. I took the test on March 13 . Initial test results measuring VO2 max, power, anaerobic thresh hold etc seemed fine. Afew days later their cardiologist called and said I needed to see a cardiologist as the EKG showed signs of ischemia, a lessening of blood supply to heart muscles under intense exercise. Dr. Levine (my primary care doctor) thought it was a false positive, but since it needed to be checked out I took a thallium nuclear stress test on March 31. Results according to Dr. Levine were "completely normal" and showed no blockages whatsoever.

06/04/06
I did the Tahoe century with my team. It's my first century since last August. I felt good, primarll
y supported my team and didn't push too hard. Time on the bike was 8 hours.

The following week I did another century in North Carolina and on June 24 did the Cartersville century. Both times around 7.5 hours--not great but pretty good considering how quickly I came back from the surgery.

Now it's time to move on to knee replacement #2!!

My Father's Birthday

Today would be my father's 100th birthday. He probably would not be alive since none of my relatives have made the century mark yet. Unfortunately he died in 1962 at the age of 56--nearly 44 years ago. If he had not smoked, I'm pretty sure he would have lived longer. His father and mother lived to 77 and 83, and his sister lived into her early 90's.

I've mentioned him in earlier posts. I only lived with him 16 years which is about 25% of my life. He was always an adult while I was only a child. I wish I could have known him after I grew up. He was a loner--friendly to everyone but never seemed too close to anyone. My aunt (Peg) described him as somewhat of a stuffed shirt. I remember that he had very few arguments with my mother. The only one I recall was when one he bought a set of encyclopedias without consulting her. I suspect they had others since my father was Presbyterian and my mother was Catholic, and she insisted that my brother and I be raised Catholic and go to Catholic school. He felt the public schools in Danville were more established, but if they argued over this or anything else I never saw it.

He came into the world as cars and planes were evolving. He was a pharmacist back in the days when they mixed compounds to fill prescriptions. I don't think he ever made over $10,000 a year, and often told me that his role as a druggist had changed during his career. He spent more time managing a retail operation instead of being a pharmacist. He died before computers and ipods became the norm. In fact air conditioning wasn't that wide spread. Today pharmacists are one of the hottest and best paying jobs in America.

His name was Frank Byerly Fleming, Jr. He was born and raised in Shippensburg, PA. He lived in a residence above the family drug store, graduated from Philadelphia College of Pharmacy & Science, and joined his father in the family business. He met my mother as he went overseas during WW II, and married her upon his return. In looking back over his family records it looks like the Flemings were staunch Presbyterians. He never went to church and would dismiss it by saying he was a "northern Presbyterian".

The family drug store had been sold during the war so he went to work for Peoples Drug Stores. We wound up in Danville, VA where he spent the rest of his life. In an earlier post I mentioned the one on one talks we frequently had after dinner in his bed room. My other favorite memory with him was going swimming at Luna Lake and later Glen Oaks Country Club. He was fairly active, walking to work sometimes, swimming and playing volleyball at the YMCA. Like most adults of his generation he smoked (unfiltered Camels). I remember he opened each pack by slicing it down the middle of one side with his fingernail. I also remember he could wrap a package tighter and more professionally than any gift wrapper in a department store.

I also remember he died from lung cancer over a 6 month time period without ever really saying goodbye. The last time I saw him in the hospital, his final words were "Just give me some more prendisone and I'll be fine." Spoken like a true pharmacist who never really let anyone get too close. He did have a profound effect on my mother. From the journal she kept from 1938--48 it's obvious she adored him despite whatever faults he had. She never really recovered from his death, so her many talents atrophied over time.

So how am I like him--how am I different? I am not very religious despite being raised a Catholic. Perhaps we both got too much religion in our youth. He was an honest, hard working man of morals. He had lots of friends but never seemed really attached to anyone except my mother. He did not have a temper which I seem to have (from my mother's side no doubt), although I am much better at controlling it than I used to be. He was handy with tools and could figure things out especially anything that interested him. He obviously had a talent for chemistry which was an absolute mystery for me--and the main reason I never became a pharmacist or doctor.

"Happy Birthday, Father (I never called him Dad). Thanks for bringing me into the world and getting me started on the journey of life. I just wish you could have spent more of it with me."

Mexican Standoff

Lots of discussion these days about immigration and compromise. Today my dog Greta & I performed our own version. Greta gets focused on chasing a tennis ball. We play this game every day. I throw the ball, she brings it back and drops it at my feet. A while ago I was sitting at the top of my stairs and Greta was standing at the bottom with the ball. She kept dropping the ball and barking at me to come down and throw it again. I kept imploring her to bring the ball up the stairs. We both wanted the game to continue but neither one would give in.

We don't want illegal immigration but we want and need cheap labor. Mexicans see economic opportunities here but many can't get here legally. So we sit on opposite sides barking at each other without compromise or resolution.

The game has been going on for years. I personally don't understand the big concern about illegal immigration. It happens, it will continue no matter what we do. Some of them will live underground, some of them will assimilate themselves into our culture. Virtually none of them will blow up chemical facilities, pilot planes into buildings, or commit any terrorist acts. It just isn't that big a deal.

So Greta, why won't you bring the ball up the stairs?