Compared to What?

Perhaps the most consequential experience in my entire life was when I flunked my freshman year at St. Joseph's Academy for Boys in Westchester, Illinois.  I didn't pass one course.  Did no homework. Participated in no misbehavior.  I just showed up every day and ... read about the Holocaust and World War II.  Pictures.  Historical accounts.  Biographies and autobiographies.  

I simply could not accept that it happened.  

The Christian Brothers sent my parents a note in July of that year informing them that I would not be accepted back.  

So I started again as a freshman at Proviso East High School in September of 1961. Did high school on the `five year' plan.  Again, no misbehavior. Got passing grades and graduated in the bottom quarter of my class four years later.  

I still have no way to understand or conceive of the factory inspired murder of millions of people.  The families.  The energetic willingness of individuals eviscerating entire families, neighborhoods, towns and nations.  

This confusing awareness of the holocaust determined a life of consistent decisions to not participate, directly or indirectly, in violence, murder, war.  

I am now in my eighth decade, looking back.  Accepting and prizing my imperfections.  Quietly aware of my many failings.  In fact, having made a profession of embracing imperfection and a faith in stepping into the unknown.  

Compared to what?  Compared to what!!  

Today I learned that I will not have to have surgery to repair torn muscle and ligament in my leg.  I feel a literal `burden' of relief and ecstacy.  

And a guilt, if not actual `shame,' at the fact that I am happy about dodging this minor adversity.  Guilt when I compare my gentle life to the tragedy of others in enormous poverty, neglect, terror and violence.  I did nothing to deserve my good fortune.  An accident of birth.  And others have done nothing to deserve their misery and hopelessness.  

I'm still confused.  Palpable sense of helplessness.  

Setback and Blessing

Monday, September 10, was the four week milestone regarding the knee replacement surgery.  Good, but arduous and painful progress.  I was very pleased.  

That evening I slipped on a wet spot on our tile floor.  The left leg went out as I went down and the right leg (surgical knee) went under me.  I hyperflexed the right knee, resulting in a serious tear of the quadricep muscle at the knee.  Swollen, bruised and painful. 

A quick visit with the surgeon resulted in a very probable additional surgery at the knee to stitch the quadricep muscle back together.  Failing to do this the right leg will be impaired, not extending properly, weakening the entire leg.  

So, another surgery. 

After the surgery I'll have to wear a full leg immobilizer,i.e., something that will force the leg to NOT bend at the knee, allowing the quad muscle to grow back together again. THIS  is a full leg immobilizer.  For three months, 24/7.  

I'll be restricted to upper body work in order to maintain good fitness.  

Key to my upper body fitness regimen will be the Concept2 indoor rower.  Unfortunately I won't be able to move back and forward on the rolling seat.  But, I will be able to capture both aerobic and anaerobic cardiovascular exercise.  I've never had much upper body strength so this may be a blessing in disguise.  

Lemonade from lemons.  

Back In The Saddle

I made a personal commitment not to write much about the past year's struggle with the bum right knee until I concluded that the struggle was resolved.  Today was the first day I was on the open road since June 3.  (First Open Road Training in 3 Months)

For several years I'd feel a sore stiffness in the back of  my knee when I stopped and got off the bike.  Given that the soreness didn't increase or resolve I simply attributed it to chronic muscle soreness or tendonitis.  The soreness was not present while riding.  Only when getting off the bike.  After five or ten minutes the soreness `went away.'  

Then last October I began to experience an ache in the right knee while riding.  I found that it limited my pedalling, requiring me to stop riding or to coast for a while with my right leg outstretched to ease the ache.  Again, I attributed this to some tendonitis or muscle tear and continued training.  

Then in early November I participated in the 24 Hour World Time Trial Championship in Borrego Springs, Ca.  After about 6 hours of pretty flat riding the ache in the knee got to the point where I had to get off the bike, lay down in my van and elevate the leg. After 3 hours of this I got back on the bike and continued on to accumulate 252 miles.  Not my best but not my worst.

Over the successive months I employed all the usual conservative treatments for a torn tendon/ligament/muscle (Rest, Ice, Compression, Elevation).  To no avail.  The ache continued and became even worse.  

I then contacted two local orthopedists to get x-rays, an MRI and a corticosteroid shot.  And then I took two weeks off the bike, returning at a slow and measured (sedate) pace.  The ache was not present on long sections of flat road.  But as soon as I started climbing (3%+) it reappeared with a vengeance.

Both orthopedists counseled conservative treatments. When I related the extent of my already conservative treatments they both agreed that a total right knee replacement was in order.  

So, on August 13th I went under the knife.  Dr. Judah Pifer of Orthopedic Specialists of Central Arizona was the surgeon.  The surgery only took an hour and I was discharged after a one night stay at the Yavapai Regional Medical Center.  

The surgery was a snap.  Dr. Pifer and his surgical team did an excellent job.  The hospital staff were attentive, sensitive, caring and exceptionally capable.  

The next three weeks were absolute hell.  Which is what all TKR patients are told.  Very little pain in the knee when not moving.  The rehabilitation, however, requires aggressive bending (range of motion) of the knee so that scar tissue doesn't cause the knee to `freeze up' and not bend well.  

Daily bending exercises (flexion and extension) were painful to the extreme.  After half an hour to an hour of daily rehab exercises I was completely exhausted due to the pain.  The pain killer meds contain a narcotic that essentially paralyzes your colon, i.e., puts peristalsis to sleep.  Constipation.  Pain meds, anti inflammatory pills, etc .... too many (but necessary) pills.  

Sleeping more than an hour or two at a time was entirely out of the question.  And then .... more knee exercises.  More excruciating pain.  I became impatient, short-tempered and easy to anger after the second week.  

And then things began to turn around.  More mobility.  More range of motion.  I returned to work four to six hours a day for three days a week.  I could climb and descend stairs.  I could walk without a cane ... carefully and slowly.  

Sleep became less fitful and more satisfying.  I worked out on the Concept2 indoor rower and the stationary bike for 1.5 to 2 hours every day.  

TIPS IF YOU HAVE KNEE SURGERY:

1. Get ahead of certain constipation. You will be prescribed painkillers that contain opiods.  Opiods paralyze your bowel functions.  Take two stool softener pills for every painkiller you take.  If you fail to address this issue you will have one of the most excruciating memories of your lifetime.
2. Coffee.  If you are a regular coffee drinker you will probably go one or two days without a cup of coffee.  Two days after my surgery I had a terrible headache that I didn't realize until later was a caffeine headache.  I then had half a cup of coffee and the headache vanished in less than five minutes.
3. Sleep.  You will find your sleep massively disturbed.  Address this issue with your doctor well before the surgery.  Sleep deprivation makes your recovery immensely more unpleasant.  
4. Beware of false boosts of energy.  It happened to me.  Nine days after surgery I had an odd rebound experience where I felt I was `all better.' Very upbeat, lots of energy, effusive mood.  As a psychologist I can attribute this to a natural human response to trauma. Predictable and short-lived.  
5. Stamina.  Your stamina will be totally trashed.  I did not expect this and a very good friend of mine (psychologist - Thank you Marlin Hoover, PhD) explained that this is also a natural physical response to trauma.  Your body is telling you to go hide in a cave, shut up and don't move until you are `all better.'  `All better' can be a variable period of time but not less than 4 - 6 weeks.  

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So, today, 26 days after total knee replacement surgery, I decided to get the bike out and do open road training.  (See first paragraph above for link).  

The flattest training route in the area is a 16.2 mile out and back with 750 feet of climbing.  No pain.  No stiffness.  My stamina is very, very compromised but not such that when I finished the 16.2 mile route .... well, I wanted to do another out and back.  I didn't simply because I am an enemy of the ultraracer's mantra: too much is never enough.  

I am supremely lucky, fortunate and blessed.