PDY

I’ve mentioned my knee several times before… and today was just yet another beautiful day in the Virginia mountains, making my way towards Lynchburg. It was beautiful, not unlike most of the last 70+ days. The pictures can tell that story, and I will tell the story of the knee, my knee, that made this all possible.

There are several things that have enabled this walk, and several that have facilitated its execution. I’ve mentioned a couple of technologies upon which I’ve relied, such as Google maps and hotels.com. I’ve talked about shoes, clothes, backpacks - all those facilitated my walk, but one event which happened almost 10 years ago enabled this walk, and that is my total knee replacement (TKR). Without it, none of this could have happened. It was part and parcel of the original idea, but far more important, it has allowed me to walk almost 1,300 miles thus far on this trip and many thousands more before I left Austin.

If you’re young and think nothing will ever happen to your knees, you can skip this entire thing and come back tomorrow, unless it could help someone you know. If you’re middle aged with sore knees, you might consider reading, especially if you’re on the fence about knee replacement surgery. If you’ve already had a knee replacement, I hope it has been as successful as mine and you’ve been pain free and active, keyword, active, since yours was replaced.

It all started in late summer of 1978. I was a junior in high school, it was a Thursday, the penultimate day of hell-week, a dreaded week for all aspiring high school football players back then, a week when you try to make up for all the training you didn’t do in the summer. I wish I could say some all-star all star linebacker hit me as I caught the game winning touchdown pass against Carmel High, but it wasn’t quite that cool. Instead, during a (stupid) drill that had us run backwards, my cleat caught a divot, twisted my leg, and being tired from a week of hell, my quads gave out and all the weight concentrated on the inside of my knee, successfully tearing my medial meniscus.

That was then. You got hurt, you walked back to the gym. Gym in this case was about half a mile away, and it took me a while. It hurt like hell, and I was alone, but that’s what we did. By the time I got back, my knee was huge, and coaches decided I best have it checked out, so off to CHOMP I went… Community Hospital of the Monterey Peninsula. There it was determined, using plain x-ray, that my medial meniscus was indeed torn. How they knew that I’m not quite sure, being soft tissue, and x-ray showing primarily bone tissue. Back then, Computed Tomography (CT) was still in its early stages, not as widely used as it is today, and MRI was even greener. At the time, the “cure” for a torn meniscus was surgical removal of the entire thing -there were no attempts at surgically repairing. So I left CHOMP in a brace and crutches, and a date for surgery the following week.

Medial menisectomy was performed, successful, and after a night or two at the hospital, headed back to the dorms where I lived. I spent the first six weeks of my junior year on crutches and my brace, and, of course, didn’t play football for the Pirates that year.

The knee story goes on, but that last paragraph was interrupted by a very deep sleep, some breakfast and what turned out to be a great walk between Lynchburg and Amherst, both in Virginia, Since I’m on the subject of the walk, I’ll get back to the knee in a second. This walk was one of those that got off slow, plodding along, attitude neutral, tending to not so good. Then I got yet another lesson - you think I’d know by now.

I’ve always believed in signs, though I take them with a grain of salt sometimes, but there are some that are very subtle, others pretty far fetched, and then the slap-your-face-and-quit-being-a-baby-and-change-your-attitude signs. Today was one of those. After dragging myself through Lynchburg, I came up on the south edge of Madison Heights. There was a crew of about 15 men cutting the grass, edging, trimming trees, right along the highway. As I got closer, I noticed that they weren’t wearing normal work clothes under their safety vests. Instead, they were all in prison or jail assigned orange and white striped uniforms. Even closer, and I noticed all of their ankles were shackled, and I can’t help but believe they were instructed to not look up or at anyone. Up on top of the hill were three wardens keeping a very close eye. And here I was, walking completely free, no more than 20 feet from where they working, It didn’t take long for attitude to change, my step to pick up, Took a few deep breaths and had a great 13 more miles that day, in contrast to the first eight, which weren’t being appreciated. Good day.

So back to my knee. Little by little it got stronger, and with youth on my side, I was walking fairly well within a couple of months, and I resumed a normal life. I didn’t really make any changes to my activities, played polo that year, and then came back to play football my senior year, why, I really don’t know, even 40 years later, but I played football for the Pirates. We had fun, had a good season, and I suppose it’s something I had to do. I don’t regret it, but it probably wasn’t the best thing I could have done for my knee.

Things were all well for a couple of years, riding a lot of horses and being very active, until the knee started hurting again. This time I damaged my lateral meniscus, and being the early 1980’s, removal was still treatment of choice, so back to CHOMP I went for my lateral menisectomy, Both this one and the prior were full incisions. Today they would probably have used arthroscopes and minimally invasive techniques. Regardless, no problems, quick recovery of youth and normal life ensued in a couple of months.

All was well for a while, but the pain came back within a couple of years, and through friends, I ended up at the Sports Medicine Department at the Palo Alto Medical Clinic, where Dr. Behling and Associates were at the forefront of sports medicine, using arthroscopes to do things never before possible. It was all very cutting edge technology, and Dr. Behling did my third surgery, arthroscopically. Instead of months of rehab, I bounced back in about three weeks, after a patellar scrape and a lateral release. After that, and a pair of small interventions, it was relatively smooth sailing for about twenty five years.

For most of those years, I was very active, riding horses, running, walking, played some tennis, golf, whatever, but my knee was always something I had to manage, mostly with ice. After overdoing it, which was often, I would typically spend a couple of sore days, then do it all over again. My pain levels got worse over time, so I quit the tennis, and turned to walking. Walking didn’t hurt, made me feel great, and was my main form of exercise. But after a few years, the knee started to hurt again, pretty much constantly, and quite a bit, so I went to see an orthopedic specialist in San Antonio, who immediately suggested a total knee replacement based on my x-rays. The knee looked pretty bad on film, and I started contemplating the replacement. I was 45 at the time.

A couple of months later, I ran into my friend Dr, Harris at a bar mitzvah. I had met him several years prior, first as a customer of mine, when he purchased a computed radiography system from me for his office. I had seen him a couple of times for medical reasons, my knee and shoulder, and mentioned to him that I was contemplating a knee replacement. All he asked was that I come see him before making any decisions. So I did, and he urged, and convinced me, to postpone the replacement as long as possible, given my age. I kept walking, sometimes with a customized brace, and used and melted a lot of ice! I stayed away from painkillers as best I could, right up until the last few months.

One summer evening, back in 2009, I was walking on a great walking path that surrounds Rice University, right next to the Houston Medical Center. I’ve always liked that walk, having done it dozens of times while on business trips. I was about a mile and a half from my parked car, and very suddenly, I took my last good step. Pain was unbearable and it took me more than an hour to get back to the car. I sensed replacement was inevitable at that point, so it was back to Dr. Harris. Indeed, it was time. At that point, I could only bend my knee about 40 degrees, couldn’t go up stairs normally, and had quite limited mobility.

Given schedules and conflicts, we scheduled the surgery for early December. In retrospect, I probably shouldn’t have waited from July until December to get the knee replaced, as my quads deteriorated significantly over those months and lost a lot of strength. If there is one thing that will help you overcome a knee replacement it is strong upper leg muscles, the quadriceps being key. Given my own pain, I really couldn’t keep them strong. And, I had to take a lot of medicine, Vicodin specifically. I loved it - it took away my pain. Fortunately, when I didn’t need it for pain, it was over and I haven’t taken one since. All this was exactly ten years ago, and not as much was known about opiates and their devastating addiction effects. For me they served a great purpose. I took them only as needed, and the only pleasure, which I admit was wonderful, was being out of pain. It is unfortunate these medicines have been misused, over prescribed or stolen but, fortunately, their abuse is being addressed and changes are being implemented in regulatory and industry circles. That is a whole other story.

December 3, 2009. Replacement day. Early arrival to the hospital, all the pre-stuff, a little sedative, nice warm blankets, all good. Dr. Harris arrives, asks a few routine questions, and then he notices a tiny little skin cut on what would be the incision line. It was no more than a millimeter in size, but he put his pen down and told me to reschedule. I thought he was kidding until he was gone. The reason had to do with the possibility of infection, ever-present in the small cut though it was healing naturally. So back home it was. Had a couple of breakfast tacos and a day long, sedative induced nap, which made for a nice day.

December 23, 2009. Real replacement day. I had an uneventful and successful surgery, up and painful walking the next morning. The best Christmas present ever was my release from the hospital on the 25th. Happy to be home, and bound and determined to get rid of the walker - made me feel old, although I decorated with Christmas lights, so I was walking with a cane only within a week. Six weeks of physical therapy ensued, and Justin and his team were amazing. My leg was getting stronger by the day, and the pain was lessening as well,

However, after a couple of months, the pain was still there, and I had what is known as an “extensor lag” that wasn’t improving. This was the first time Dr. Harris had seen a case like this, and he went to great lengths to determine the cause, including a lot of peer review. It’s a long story, but it turned out my body had created a fibrous tissue connection from medial tibia to lateral femur, impeding free movement of the patella. A couple of months later, a quick 30 minute arthroscopic surgery to remove tissue and a little clean up, and I walked out of the hospital that afternoon. Things got better immediately. I kept doing my rehab, and was pain free within a couple of months.

So, if you’re still with me and wondering why I wrote all this, it is simply in hope that it help someone along the way. At some point of your life, your knees are going to hurt. All the basketball and football back in our invincible days will eventually catch up. And the pain will come for many different reasons, but millions of us will be looking at the possibility of a knee replacement at some point. Total knee replacements have become quite commonplace, and there have been great strides (pun intended!) in the technology of the replacement devices as well. Mine is a ten year old model, holding up pretty well I must say. Make sure you have the right surgeon and ask a lot of questions. Try to be as strong as you can be before your surgery. Even though it may hurt, do everything you can to strengthen your quads pre-surgery. And keep your expectations in check. It is going to hurt, and you’ll have to work at overcoming it. But once you do, I think you’ll agree with me it was well worth the trouble.

I am very grateful for this knee, for without it, none of this would have been possible. Thanks always to the researchers, designers, manufacturers, Dr, Harris and staff, the nurses. Especially now, thank you. You’ve all had a little something to do with this little walk to the park.

So there you have it. I have written this in lieu of sitting around a table with a bunch of old friends talking about our respective surgeries. Please, If you ever hear me describing mine, just shut me up, you don’t even have to be nice about it. I don’t mind hearing about yours, but please don’t let me bore you with mine (as I just did :-).