Daddy Gets a New Knee

It's been coming on for several years, and in the summer of 2016, it came to a head while hiking in Shenandoah National Park.  I quit denying it and finally admitted to myself that something was terribly wrong with my right knee.   I would frequently experience significant and persistent pain on the inside of my right knee, particularly while hiking.  Ironically, it never hurt during or after playing pickleball, which I was doing 4-6 days a week.

Finally in October 2017 I visited a local orthopedic surgeon (let's call him Surgeon #1).  He took X-rays and determined I had osteoarthritis on the inside (medial compartment) of my right knee. Images showed no soft tissue in that area: bone on bone.  OUCH!  On that visit my knee was quite swollen, and he extracted a ton of fluid.  He also gave me a shot of cortisone.  The cortisone didn't really help much and drove my blood glucose through the roof for several weeks.  It was obvious that steroid therapy was not a viable solution.  Several weeks later he prescribed an orthopedic brace designed to put pressure on the outside of the knee to reduce pressure on the inside of my knee and provide separation between the bones on that side.  I began wearing the brace while playing pickleball, hiking, extended walking, mowing, etc.  It was uncomfortable, but fairly effective.

Pre-op front view

Pre-op side view

A few weeks after getting my brace Dorcas and I attended a presentation about knee surgery, with specific emphasis on the Mako Robotic Arm Assisted Technology.  The presenter (let's call him Surgeon #2) uses this technology in full and partial knee replacements as a tool to aid in the precision of the cuts and alignment of the replacement components.  We were impressed with both the surgeon and the technology.  I asked a lot of questions during the presentation and also afterwards one-on-one with the surgeon.   It was clear that I could benefit with knee replacement surgery.

Among other things knee surgery is just majorly inconvenient.  Recovery from knee surgery is fairly difficult, relative to many other joint replacements.  Recovery and rehabilitation usually takes about 8 weeks.  When do Dorcas and I have 8 weeks to set aside without sacrificing our extensive travel schedule, not to mention my year-round pickleball habit?  Finally, in late June, just before leaving for our Summer Rockies trip I met again with Surgeon #1, and scheduled surgery for September 24, the week after we returned from our summer trip.  That would leave about 8 weeks to recuperate before departing about Thanksgiving for our Florida winter home.

While on our trip I began having second thoughts about the surgery.  Surgeon #1 proposed complete replacement of the knee vs unilateral or partial replacement, and didn't use the Mako robotic arm. We never even discussed partial replacement even though the right compartment of my knee appeared to be healthy.  We learned during the presentation the year before that the trauma and recovery from a partial replacement were significantly less than that for a full replacement.  I sent Surgeon #1 a message asking 1) Why he recommended a full vs partial replacement and 2) What were the clinical benefits of Mako robotic assisted surgery vs conventional surgery.  His response follows:

"Unfortunately, I am not able to fully address this matter via email. Please contact the office and schedule an appointment at your earliest convenience."

Well that's a kick in the butt. We wouldn't be home until a week before the scheduled surgery (9/24).  Another appointment would likely mean a significant delay for the surgery, probably delaying our scheduled Florida departure. And why couldn't he answer my questions?  I had seen Surgeon #1 twice, and he had taken x-rays both times.  He had scheduled the surgery, so he should have valid reasons for his diagnosis and recommendations.  Why couldn't he explain his reasons?  At this point I had started to doubt my decision to go with Surgeon #1.  Surgeon #1 also happens to be significantly younger and less experienced than Surgeon #2.

OK, we had 3 options: 1) schedule another appointment with Surgeon #1,  2) schedule an appointment for a 2nd opinion with Surgeon #2,  or 3) wait until after we leave for Florida and visit the Mayo Clinic in Jacksonville FL, where I am already a frequent customer.  Option 3 was not particularly desirable because I have already met my out-of-pocket expenses for 2018, and if I had surgery in 2018 it would be essentially at no cost to me.  Surgery at the Mayo Clinic would likely be in 2019.  I enter Medicare on January 1,  and have no clue what expenses I would incur under Medicare. Option 2 was not very desirable, because I had lost confidence in Surgeon #1 and hated to delay the surgery and our departure to Florida.

Consequently, I scheduled an appointment for a second opinion with Surgeon #2 for Sept 17, the first work day after we returned from our summer trip and 7 days before my scheduled surgery on Sept 24 with Surgeon #1.  Oh, did I mention that both Surgeons #1 and #2 are in the same practice?  Anyway, Surgeon #2 took additional x-rays, including images with lateral stress placed on my knee, which Surgeon #1 had not done.  He concluded that a complete replacement was not necessary or warranted.   It happened that he had just had a cancellation and could perform my surgery on Sept 25, the day after my scheduled surgery with Surgeon #1.  So, we can do a partial vs full replacement, we can use the Mako robot and the surgery would be only 1 day later than originally scheduled.  There was a caveat that if, after making the incision during surgery, he found additional damage that was not apparent in the images, he would perform a full replacement.   We have a go.  Surgeon #2 would make the arrangements for canceling the surgery by Surgeon #1.

Mako Robotic Arm

Click HERE or HERE to view videos that explain and illustrate the Mako Robotic Arm procedure.  

Click HERE to view a rather graphic and gruesome animation showing conventional knee replacement technique. 

During the week before surgery I had numerous pre-op calls and spent most of a day at the Novant Health Clemmons Medical Center, which is a new facility about 20 minutes from home and specializes in outpatient orthopedic surgery.  Among other things, they performed a CT scan of my leg that would provide a map for the Mako device.  Surgery was scheduled for 10:30 on the September 25th, and we arrived at the hospital about 8:00 for preparation. During pre-op I tried to change my mind and walk out, but Dorcas said it was too late.  Surgery started on time and took about 4 hours.  I was in the recovery room by about 2:30 and in a hospital room shortly thereafter.  By late afternoon I was making laps around the ward with the aid of a walker.  No moss on this stone!  Amazingly there was very little pain.  They told me they used a nerve blocking medication that would block the pain for about 2-3 days.  Dorcas stayed until after dinner, and then went home to take care of Matilda, who had spent a long day at home alone.  That night I couldn't sleep.  I spent the much of the night completing  the blog on our Boundary Waters trip.  Then from 3:00 to 5:00 am I watched a very interesting Ken Burns documentary on PBS "THE MAYO CLINIC: FAITH - HOPE - SCIENCE".  The film features interviews with patients including John McCain and the Dalai Lama, and tells the story of William Worrall Mayo, an English immigrant who began practicing medicine with his sons Will and Charlie in Rochester, Minnesota.

It's too late to turn back now!  Don't we need a hair net for my face?

Shaving the surgical site

The surgeon drew the cross hatches to make sure he properly aligned both sides of the incision before closing up

The day after surgery I continued to walk and spent much of my time in a recliner with my leg up and attached to the "Ice Man".  The Ice Man is essentially a cooler filled with ice and water that has insulated hoses conducting cold fluid to a plastic wrap around the knee.  The Ice Man is my friend, and I got to bring him home.  I met with some physical therapists, who made sure I could go to the toilet, put on my socks and negotiate stairs with a walker.

Ice Man cold therapy device

Shortly after noon they sent me home, slightly less than 24 hours after coming out of surgery.  By that evening I had abandoned my walker, finding it more of a hindrance than a help. I found I could move through the house quite well by steadying myself on furniture, walls and door frames.  When I went outside I used a hiking stick.

OUCH!  First physical therapy session 7 days after surgery

Post-op front view

Post-op side view

Matilda is one of my two best support people

So.... what happened?  How did this happen and why was this necessary?  Let's take a trip down memory lane.  

I have been at least 50 pounds overweight most of my adult life.  That obviously has to be tough on the knees. When I graduated from high school I was 5' 111/2" tall and weighed 185 pounds.  At the end of my first semester at college I had ballooned to 235 pounds. During my first marriage from about 1985 to 1993 I had another growth spurt and jumped to about 275 pounds.  After my diagnosis of diabetes and during my separation I dropped about 70 pounds and bottomed out at about 205.  Then I met Dorcas. In spite of her healthy eating, and trying to entice me to eat better (didn't work) my weight climbed to about 235 pounds and has been fairly constant since the late 90s.  Also I seem to have shrunk an inch or so to 5' 10".   It also probably didn't help that my right leg is one inch longer than my left.

Skinny Myron during senior year in high school in 1972

After I graduated from college and starting work in 1978, I discovered that I loved the outdoors and have led a fairly active outdoor lifestyle since then, enjoying hiking, backpacking, cycling, skiing, canoeing, and, since about 2006 when I retired, pickleball.  I'm sure all these activities contributed to the wear and tear that led to my osteoarthritis  Following are some archival photos of some activities.   

Backpacking at Mt Rogers in the winter

Backpacking at Mt. Rogers in the summer

I started paddling in about 1989 and joined a local whitewater paddling club.  To paddle serious whitewater one must kneel in the boat.  This kneeling causes stress on the knees and that too may have contributed to my osteoarthritis.

Bull Sluice on the Chattooga River

Following images show some backpacking trips. Always one to overpack, my pack usually weighed 60+ pounds. On a trip to the bottom the Grand Canyon my pack weighed over 80 pounds, mostly due to the need to carry extra water.

Don't look down!

Hoh Rain Forest Olympic National Park

Hoh Rain Forest Olympic National Park

Hoh Rain Forest Olympic National Park

Colorado Rockies

Colorado Rockies

Crossing a steep snowfield in the Colorado Rockies

The week after I retired in 2006 I flew to Colorado to meet my friends Andy and Christy.  That week we did a backpack trip and several day hikes, including to the summit 2 Colorado 14ers, Handies Peak (14,058') and Rio Grande Pyramid (13,827'). OK, Rio Grande Pyramid is not technically a 14er, but it's close, and it was a harder climb than Handies Peak, so I'm counting it.

Summit of Rio Grande Pyramid

Above the clouds in the Weminuche Wilderness in the Colorado Rockies

Since 1997 Dorcas and I have been venturing into the Boundary Waters Canoe Area Wilderness in northern Minnesota.  These trips involve a number of portages as we travel overland from lake to lake.   On each portage I carry a food pack that contain alls our food (and Matilda's) for about 14 days. The few times I have actually weighed the food pack it has been over 80 pounds.  I also carry a dry bag containing camera, GPS, binoculars and miscellaneous other gear. That bag weighs 10 pounds or so.  Hello knees!

On the second trip across the same portage I carry the boat and a net backpack containing PFDs, tarp, chairs, sandals, ropes, drinking water and other miscellaneous gear.  That's another 20 pounds or so on top of the 55 pound boat.

During many canoe trips we find it necessary to drag the boats over trees and log jams.  On day trips with empty boats, that's not too hard, providing you don't fall off the log.  But on camping trips where the boat is weighted down with days of camping gear and food, it is much more difficult and strenuous stressing the back and knees.

Dragging a canoe across a downed tree.  Megan, Wayne's granddaughter, is now married and has a son.

So that's the back story.  At the time of this post it has been 3 weeks since surgery, and things are going extremely well. The pain now is practically nonexistent, and I am walking normally and negotiating stairs easily.  I had my first post operative followup yesterday and both the orthopedic PA and my physical therapist say I am doing great.  I have a range-of-motion of over 130 degrees. They gave me the green light to drive, and in fact to do whatever I feel like doing, including cycling and pickleball.  I will probably start going to the Y next week and using the machines and maybe even try to play a little pickleball.

All in all, while not particularly fun, it has been a fairly positive experience. 

The Great Rocky Mountain Adventure 2018 Wrap-Up

When we took out at Lake One we were pleased to find the Honda as we left it. That's always a big concern when we park for 2 weeks at a remote canoe put-in.  After loading up all our gear, Matilda would not come to the car and "Load Up" (her command for getting into the car, boat, motor home, golf cart, etc).  She sat down and planted her elf next to another group of paddlers loading up.  This is very unusual for her; she always wants to be the first one into the car and into the boat.  I think she had so much fun she just didn't want to go home.

Our craving for a dairy product was so strong we drove straight to Ely, driving past Fall Lake Campground, where the coach is parked (skipping hot showers, clean clothes and cold beer) and made a bee-line to the Dairy Queen. There we shared a tall cold smooth milkshake, and I splurged on a greasy double bacon cheeseburger.  Out of respect for the other customers, who were likely freshly bathed and wearing clean clothes, we ate outdoors. We are filthy, but we are considerate. 

Site 42 at Fall Lake Campground

When we finally got back to Fall Lake the coach was fine and in the same the condition as when we left it.  Again that's always a worry and a relief.  We have always parked it there in the paved, lighted parking lot, close to the campground office, and have never had a problem (knock on wood!). Fall Lake is probably the safest place of the hundred or so BWCAW access points to park a vehicle. We had a reservation for site 18, which is a nice spacious pull-through site, but we had stayed on that site before and knew we could not get a satellite signal on that site.  Being in the wilderness and unconnected for 2 weeks, we were starved for news and entertainment. We were also aware of Hurricane Florence bearing down on North Carolina and wanted to follow its progress.  Consequently, TV reception was important for us, and there is no over-the air signal reception near Ely.  The camp host told us that site 42 had good satellite reception and was vacant. Site 42 is a bit cramped and not nearly as nice as site 18, but we made the change, and I think it was a good decision.   Normally, after taking out of the wilderness, we go into town for a nice sit-down dinner.  But after hot showers, cold adult beverages and a big late lunch at DQ, we were content to stay home and eat something simple. 

There are Paul Bunyans all over Minnesota 

We saw a pair of swans on a creek near Ely

A load of new We-no-nah canoes arriving at Piragis Northwoods Company

On the day after we took out of the wilderness a storm came through Ely.

Strange weather indeed

We had registered for three nights at Fall Lake Campground, intending to depart on Friday, which would allow only 3 driving days to travel almost 1400 miles and arrive home on Sunday.  That's pretty ambitious when traveling in a motor home.  Considering the approaching hurricane and the fact that I had a doctor's appointment on Monday morning, we made a decision to leave Ely a day earlier than planned and allow ourselves an extra day to get home.  It was a tough decision (we love Ely), but it was the smart thing to do. We did take time to catch breakfast at Britton's Cafe, our favorite breakfast joint in Ely, on our way out of town.

There is a steep grade as we drop into downtown Duluth

On our drive this day we faced a stiff 20 mph headwind with the occasional side gust.  Driving was tedious and stressful.  I invited Dorcas to spend some white-knuckle time behind the wheel, but she politely declined.  We made 400 miles before spending the night at the Ho-Chunk Casino in Baraboo Wisconsin.

Camp Ho-Chunk in Baraboo.

On the next day the winds had diminished considerably and the driving was a whole lot easier.  We made 460 miles before stopping for the night in Columbus IN.  I was willing and able to drive a little farther, but Dorcas had already picked our Walmart, and she could not be swayed.

Camp Wally World in Columbus IN

On Saturday we got off to a relatively early start and continued east and south. Our plan was to spend the night at Tamarack, a regional crafts, arts and conference center, in Beckley WV.  Tamarack allows overnight RV parking and is a frequent and favorite stop for us.  However, I was on a roll; the weather was good, we were listening to a good audio book and the driving was easy.  When we got to Beckley we decided to just keep on keeping on for another 3 hours and be home.  The first waves of rain from Hurricane Florence were expected to hit Winston-Salem Saturday night, and if we drove on Sunday it would be windy and wet.  That's no fun in a motor home.  We arrived home at 6:30, before dark and before the rain.  Twenty minutes later, the bottom dropped out of the skies, and it rained hard for the next 2 days. Our timing could not have been better.  On Saturday we made 522 miles, one of our longest driving days ever.

The capitol building in Charleston WV

This image shows every location where we spent the night on the trip.  This information  can also be viewed on the "Where the Heck Are We?" tab on the left side near the top of the blog page, which also lists the dates and locations of each camp.

On this adventure, we were away 77 nights, drove 5930 miles and burned 702 gallons of diesel.  Fuel mileage suffers significantly in Colorado mountains and with interstate headwinds. We often get closer to 9-9.5 mpg.

Above is a photo of the trip summary data from our SilverLeaf engine monitoring system.

GPS trace of our Great Rocky Mountain Summer Adventure 2018

It was a great trip but it's good to be home for a while. Dorcas and I both have a number of doctor appointments coming up, and I have knee replacement surgery scheduled for next week.

As a parting note please enjoy this song by John Williamson, a popular Australian folk singer.  Dorcas and I can really identify with the lyrics and consider it our anthem.  Click HERE to listen to "Old Farts in Caravan Parks".  In case you didn't know, "Caravan" is Aussie-speak for RV or camper trailer.

Stay tuned for my next post which will describe my recent knee replacement surgery.  Spoiler alert: all is well so far!

Life is still good.

Another Great Boundary Waters Adventure

I think we have finally done it.  We didn't mean to do it, but it just happened. We seem to have set an all time world record for the easiest trip ever done into the Boundary Waters Canoe Area Wilderness.  Dorcas and I have gone into the Boundary Waters every year except one since we met in 1997.  Back then we were young and strong and healthy and foolish and did pretty ambitious trips with lots of paddling and lots of portaging.  Now we are weak and lame and pitiful and over the last few years we have made our trips increasingly easier.  But at least we're still going into the wilderness, and we hope to continue to go for some years to come.

Our route showing camps and day trips

Ultimately we only made two camps, 3 nights at Camp 1 on Lake One and 10 nights at Camp 2 on Lake Three.  All paddling, travel and day trips, totaled 25.69 miles.

The traditional put-in selfie

Matilda can't wait to get on the water at the put-in at Lake One

This year we put in at Lake One on August 29, which is about 20 miles east of Ely, with the intention of exploring the so-called "Number Lakes": Lakes One, Two, Three and Four.  We paddled only about 1.5 miles from the put-in before finding a nice secluded camp site in a cove on Lake One.  We made camp and ended up staying at Camp 1 for three nights.  This allowed us to lighten our food load a bit before portaging into Lake Two.

Myron's view of the world

Relaxing at Camp 1 on Lake One

For the first day or two we typically try to eat some fresh food since we know we will be eating dried fare for the next 2 weeks.  We usually have some steak for the first dinner and eggs and bacon for the first breakfast.

We had fried steak and onions for our first dinner

Dusk at Camp 1

Wildlife seen at Camp 1 included this walrus.  Use your imagination. 

Fishing was good for the whole trip.  I caught fish every time we went out.  Dorcas caught fish every time she dropped a line, which was rare.  Dorcas doesn't really care much for fishing.

A nice 3.3 lb small mouth

Sunset at Camp 1

Matilda is ready to leave Camp 1

On day 4 we did a 30 rod and 40 rod portage to get into Lake Two. A rod is an archaic unit of length still used in the BWCAW, and equals 16.5 feet.  The portages were pretty easy with good footing and minimal elevation gain.  From Lake Two, Lakes Three and Four can be entered without additional portaging.  We looked for a camp site on Lake Two, but every one we checked was filled, likely due to the Labor Day holiday. We were becoming worried about finding a site when we found an inviting vacant camp on Lake Three.

At the portage

Relaxing at Camp 2

Our camp was very near the opening from Lake Two to Lake Three.  Consequently it was a busy area, and we watched a lot of boats go by every day. 

Chipmunks were frequent visitors to the hearth

Common merganser

The weather was generally very good.  The temperatures ranged from highs in the 70s to lows in the 50s.  One cool morning the low was 41 degrees.  It was very nice fall weather.  We did have one day where it rained off and on most of the day.  Otherwise it was mostly fair.

Enjoying time under the rain shelter

Lunch stop on a day trip

When I took this photo I thought it was a common merganser, but now I'm not so sure.  Any guesses out there?

Dorcas likes to sleep in

Matilda likes to sleep in too

Dorcas "Hollywood"

A calm evening

Dorcas enjoys her hammock time

We stayed 10 nights at Camp 2, a personal record.  We spent a lot of time reading and watching the other boaters pass by.  Some days we paddled and fished.  Life is good on the lake.

A nice 8 pound Northern pike

We caught a lot of fish, but only kept this one. This 8 pound Northern was more than enough for a fish fry.

YUM!!!!

What are you looking at?

Matilda isn't allowed in the tent, but on this stormy morning she pushed the boundary

A brace of mergansers

Pancakes and fried summer sausage is a breakfast staple

A bit of hearth still life

A red squirrel gathering pine cones for the winter

When we spent the night at the Sierra Trading Post store in Cheyenne WY, we found this gizmo.  It is a telescoping stick to hold a sugar cone that can be filled with mini-marshmallows and chocolate chips; a new twist on smores.  It made really tasty smores, but it took a long time to heat and the top 1/3 of the cone never did melt.  The jury is still out on this device. 

Dusk at Camp 2

A raft of mergansers

Landing an 8 pound Northern and getting him on the stringer without a landing net can be quite an adventure.  Often blood is spilled, and it is not only the fish's blood.  These guys have teeth like an alligator and know how to use them.

I wanted to hike the Pow Wow Trail and count the fallen trees, but Dorcas said no

A sincere wood pile

Occasionally while camping in the Boundary Waters we will see the aurora borealis (northern lights). During the latter part of our trip we had a new moon, and when I got up for a nature call about 4:00 am we got a good look at the show.  Having a weak bladder is no blessing, but it does get me up and I can look for the lights.

Another nice smallmouth

On our next to last night in camp we had some excitement.  Just before midnight we heard a commotion just outside the tent. Matilda was agitated and snarling, and it sounded like something was coming down the tree just feet from the tent.  At first we thought it might be a raccoon, but I'm not even sure they have raccoons in northern Minnesota.  Naturally, being curious and foolish, I got up to investigate.  I shined my light around the tent and up into the closest trees, but I didn't see or hear anything there.  Then I heard a faint sound behind me and turned to find a large black bear rooting in our fire place.  I put a light on him from about 20 feet away.  He never looked at me but turned and ambled very slowly out of our camp and into the woods.  We learned the next day that this bear had also visited the next campsite over, a few hundred yards away.  There had been campers there who had not secured their food, and the bear had shredded their food pack and taken off with their grub.  I was hoping he would come back the next night, and I was ready to take his picture, but we never saw him again.  DANG!

We stayed on Camp 2 for 10 nights, partly because we were afraid if we moved we would not find another good site, particularly after watching all the other boats paddling into Lake Three and Lake Four.  But the real reason was that we were just plain sorry and had no real motivation to move.  We had a great site with a good view and plenty of firewood, so we just stayed put.  When we finally did depart for the take-out, the wind came with 15-20 mph gusts, making our paddle out a little exciting.  As usual, our first stop back in Ely would be at the Dairy Queen for a tall cool milkshake.

A good time was had by all.  Life is still good. 

Stay tuned for our next post which will be a wrap-up report on our Great Rocky Mountain Adventure Summer 2018.