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."