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.