TO CUT or NOT TO CUT???

TO CUT or NOT TO CUT???

LESSONS LEARNED BY AN EVOLVING BIONIC MAN 

The longer we live, the more likely that we will face that time when our aging bodies will break down or be injured and require orthopedic surgery.  It's a tough decision resulting in pain and discomfort for at least 6 months and up to a year for major surgeries such as a hip, knee or shoulder replacements.  

I speak from experience because, during the past twenty years, I have chosen to be cut 4 times, beginning with a shoulder rotator cuff repair,  followed by hip and knee replacements, and most recently, a total shoulder replacement.  I have no doubt that I would now be either dead or knocking on heaven's door without my orthopedic surgeries.

Spectacular medical advancements in orthopedic surgeries have dramatically improved the length and quality of life for millions of individuals worldwide, but it's not always been this way.

FADE AWAY   

While growing up in Grand Rapids, Michigan during the 1940's and 1950's, I remember the older generation-- men in particular-- exhibiting orthopedic issues, beginning in the 30 to 60 year age range.

The majority of them were active in their teens and into their twenties with recreational sports such as softball, basketball and tennis, and many experienced sports injuries that never healed.

Many were sidelined as coaches and spectators as limps and restricted movements eventually led to crutches and canes and ultimately wheelchairs.

And after a while, most faded away into their homes to await the Grim Reaper.   I assumed at the time that this was a somewhat normal development of aging.

MIRACLES OF MODERN MEDICINE

Fortunately, during the past 60 years, the senior population has increasingly been able to experience rejuvenation and longevity benefits from orthopedic surgeries.

Sports medicine's highly publicized and spectacular surgical successes with top amateur and professional sports celebrities over the recent decades has granted great credibility to the value of orthopedic surgeries.

Orthopedic statistics reveal that 1 out of 4 of Americans have a musculoskeletal impairment.  Back pain, by far,  is the leading reason for an orthopedic appointment, followed by knee, shoulder and hip issues. (statisticbrain.com).

THE BEGINNING

My first experience with orthopedic surgery occurred in my mid-fifties when my left shoulder became increasingly dysfunctional and I could not lift any amount of weight overhead.  It was caused, I suspect, by a jerky toss while serving a tennis ball.

Since I am right handed, it was not a significant impairment and I foolishly waited a couple of years as the shoulder joint deteriorated until rotator cuff surgery was the only alternative.

LESSONS LEARNED 

NUMBER 1:  If you have an injury or pain that impacts your normal mobility and functioning that does not significantly improve with rest and gentle stretching within 4 to 6 weeks, it is time for a medical consultation.

Our bodies' capacity for self-healing is quick and remarkable...unless there has been major damage which prohibits restoration.  For example, the rotator cuff of my shoulder had been torn so that the muscles were no longer attached and thus could not grow back together.

I had waited too long for shoulder surgery, and although it provided relief and improved function, fifteen years later, it is again a problem and may require surgery again,  And that shoulder even appears permanently deformed because I had waited too long for surgery.
                                                                                                                                                                 
MY BORN AGAIN SURGERY                                

In my early sixties, I began to resemble those crippled seniors of my childhood memories.  I walked with a glaring limp and had to pull myself upstairs with handrails, which was embarrassing since I was working at a gym as a Personal Fitness Trainer at the time.

X-rays revealed a disintegrating hip joint which required replacement. Unfortunately, it would cost me somewhere in the neighborhood of 40 to 60 thousand dollars to replace.  I had neither the financial resources or health insurance to cover any of it.

So, I limped about for 2 years awaiting eligibility for Medicare.  On the day after my 65th birthday, I was in an operating room having my hip replaced.

The surgery was absolutely REJUVENATING.   Within 2 months, my limp disappeared and I returned to the tennis courts and normal mobility!

Both of my hips had been diagnosed as needing replacement and I chose the left one since it was presenting the major pain and impairment.  During rehab, however, I matched the rehab exercises of the new hip with the other hip... to achieve equality and balance between both sides of my body.  I have continued this protocol to the present time and the recommended replacement of my other hip has not been necessary for 12 years now.

As  I approached my 70th birthday, I was hobbling around again. The culprit was my left knee, which was subsequently totally replaced and has functioned pain-free for over 6 years now.

At that time, my other knee had also been diagnosed as needing replacement, but I first consulted with a friend, Dr. Joe Pugleasa, a non-surgical orthopedic physician, who concluded that the knee joint still had integrity but the muscles supporting the knee joint leg critically needed strengthening and stretching exercises.

I followed his recommendations and the pain in my knee steadily diminished and the knee has been good for the past 6 years.

NUMBER 2:  Physical Therapy (PT) can be very helpful and is a good first alternative to a scalpel intervention.  In my case, PT stretching and strengthening exercises have prevented recommended replacements for both a hip  (12 years) and a knee (over 6 years).


THE HEARTBREAK AND REJUVENATION OF 2017

As the year  2017 approached, I was eagerly anticipating the holidays and the forthcoming year.

At the age of  76, thanks to Merrilee, my tennis skills were steadily improving.   And Merrilee had signed us up as members of a local tennis club where I would have ample opportunity to practice and improve.  Our membership would begin January 1 and I was really excited.

About a week before Christmas, a nagging pain in my right shoulder, which I was trying to ignore, erupted into excruciating pain while serving during a tennis match.  The result was nerve pain, the most intense I had ever experienced.  I thought that I might have shingles.  Any movement on the right side of my body initiated an overwhelming jolt of nerve pain.  Even walking was painful. 

Playing tennis was totally impossible and as relatives showed up over the holidays, I could only raise my one good arm to wave goodbye as they departed daily for the tennis courts.

Merrilee & Julia Keller

After a week of the pain worsening and finally accepting the reality that any reduction in pain required medical intervention, I scheduled an appointment with my primary physician who suggested an immediate appointment with an orthopedic surgeon.


A medical evaluation revealed significant tears and refraction in three of my four rotator cuff muscles, which allowed the humerus (arm bone) to move out and away from its socket resulting in significant pain and loss of shoulder function.  Surgery was the only answer.

FINDING AN ORTHOPEDIC  SURGEON

All orthopedic surgeons are not created or trained equally.  Most seem to specialize in particular surgeries, such as backs, hips, knees or shoulders.  There are also specialists for ankles, feet, wrists, and hands. 

It's advisable to find someone who has successfully performed hundreds, even thousands, of the surgery or procedure you are needing.  

Of course, you can certainly research surgeons on the Internet, but perhaps the best way is to ask around.  Within your circle of friends and associates, you will likely hear of some good candidates.

ENTER IVAN LENDL

Fortunately, we currently live in a community where tennis great, Ivan Lendl, resides.   Merrilee happened to encounter him and asked about the best shoulder surgeon available in the area.   He provided us with the name of Dr. Carl DiLella.

Dr. DiLella 

Our initial meeting with Dr. Carl provided a bright light at the end of my dark tunnel of constant pain and immobility.  As a fellow tennis player, he understood my desire to return to playing tennis following surgery. 

Dr. Carl is one of a  select few of orthopedic surgeons in the country trained and experienced in a new surgical procedure called a "Reverse Total Shoulder Arthroplasty".  Dr. Carl had successfully performed this shoulder replacement surgery hundreds of times and it was obvious that it would be the best solution to my badly torn rotator cuff.       

Instead of returning the arm bone to the destroyed rotator cuff area for repairs, the surgeon goes to where the arm bone had naturally moved to an improved alignment, where a perfectly designed fitted socket, is screwed into my scapula (shoulder blade) with 4  screws. A cobalt chrome arm that fits precisely into the socket is then inserted into the upper arm bone (the humerus). 

It was the ideal surgery for my badly torn rotator cuff muscles, which will no longer be needed as the large shoulder muscle, the Deltoid, becomes the primary mover.

Although in most situations, you might want second or third opinions, and Dr. Carl was willing to give us some names, Merrilee and I knew immediately that he was the ONE to remove the pain and restore the use of my shoulder; and we immediately began the process of scheduling surgery. 

The date scheduled for surgery was set for two months ahead to allow time for physical exams, X-rays, MRI's, blood tests, meetings with a surgeon, hospital staff, anesthesiologist, etc.  This meant 2 more months of incapacitating pain which intensified with physical movement.. and after several weeks, I was already feeling the health and fitness level drain from my nearly 77-year-old naturally aging body...and depression was nibbling at me. 

It was time to take action and begin to "Prehab"!

In Part 2 of "To Cut OR NOT T0 CUT", we will reveal PREHAB, a major secret to MAXIMIZING A HEALTHY,  SUCCESSFUL RESPONSE TO SURGERY AND A SPEEDY RECOVERY AND REHABILITATION.

QUOTE:  

"How little we know of what there is to know."

Ernest Hemingway

To Cut or not to cut Part II

TO CUT OR NOT TO CUT -- PART II:  PREHAB/REHAB

PREHAB is a new word for me, although I prehabbed for a hip replacement over 10 years ago and a knee replacement over 6 years ago. It just seemed logical, and proved true for me, that being physically fit prior to surgery would result in quicker, more successful surgeries and faster recoveries.

I just recently discovered this word, Prehab, in an issue of GROWING BOLDER, an informative and inspirational new anti-aging magazine.

Dr. Robert Masson, Medical Director of the magazine, writes:
"It's a given that we'll all encounter physical setbacks as we age.  Prehabbing is the path to a faster and more extreme recovery, to active longevity--and it positions us to be able to say "yes" when the opportunity arises."

Because of fiery pain that stabbed me whenever I moved,  pre-surgery exercise was a real challenge. 
                                                                                               
The solution was to extricate our recumbent stationary bike from storage where it had remained since we moved from Boston a few years ago.  I had used it for exercise during the long New England winters and also for prehab and rehab during my hip and knee replacements.   

I could barely walk without pain, but I could pedal vigorously and develop a significant level of physical fitness.

Pedaling a bike is one of the best exercises for our bodies.  It is a totally healthful, even therapeutic, NON IMPACT exercise that increases cardiac circulation throughout the body.  The stationary bike is particularly good for the legs, where blood flow tends to slow and pool, especially as we age and move less. 

Pedaling provides outstanding heart and lung benefits and is considered to be an excellent heart disease preventative.

Have you noticed that stationary bikes are considered therapeutic exercise equipment and are found in Fitness and Physical Therapy settings and on the sidelines at football games?

Although stationary bike pedaling focuses on the large leg muscles, you can experience total body fitness by using stretch bands for the upper body.

We placed the stationary bike in our living room in front of the large flat screen TV and sound system.  We prefer a recumbent style because it is so user-friendly.  It is a healthy alternative to just sitting and vegetating in a chair. 

TIME IS ON YOUR SIDE
                              
The most frequent excuse for not exercising is "not enough time", but if you have the time to sit and watch TV, read newspapers, magazines, and books, check emails, facebook, file your nails, etc. you can do all this and more while pedaling a stationary bike. 

Multi-Tasking Activity Table

PREHAB

About 2 months before surgery, I began daily pedaling sessions with the goal of accumulating mileage to bike from our home in Vero Beach, Florida to Key West over 300 miles away.  I reached Key West and was halfway back to Miami on the morning of my surgery when I pedaled my final 5 PREHAB miles.

PHOTO OF FLORIDA MAP showing biking route to Keys and halfback... 

PREHAB INTO REHAB

Following surgery,  I continued to pedal to Miami where I headed West to Naples and then North up the coast of the Gulf of Mexico to the Orlando area where I pedaled East to return home to Vero Beach.  My recovery was significantly ahead of schedule and Dr. DiLella referred to me as his "superstar."

Photo of Map of entire route

I  continued my tour of Florida's Atlantic and Gulf coastlines by heading North on the Atlantic coast to Jacksonville where my simulated journey turned West across the expansive Florida Panhandle to Tallahassee and Pensacola. 

I then pedaled East and South along the Gulf to St. Petersburg and am now headed the East to return home to Vero Beach to complete a tour of Florida's coastlines. 

BIKING STATS:

Beginning in January of this year I have pedaled a total of  2.100  miles.  Each session has averaged a pace of 4 minutes per mile with varying resistance and intervals of intensity.

I am now addicted to daily pedaling and its super fitness benefits and plan to continue with my new habit with new destinations. 

CONCLUSIONS OF "TO CUT OR NOT TO CUT"
  
I feel profoundly blessed to be living at this time in history when modern medicine is able to provide extraordinary opportunities to extend the length and quality of our lives. 

The generations before me were not fortunate enough to benefit from the miracles of orthopedic surgical interventions which have dramatically enhanced the quality and extension of my life.

Although orthopedic surgery has become amazingly advanced with minimal invasion and even immediate recovery in some instances, most major surgeries take a year or more for a full recovery for most people.  

However, if you are properly PREHABBED and rehabbed, you will be able to resume normalcy much sooner.  I was back on the tennis courts within three months or less for all of my major surgeries, including my recent shoulder replacement.  

Many people who try "to get by" with a bad back, hip, knee or shoulder have had to give up their favorite sports or activities.   All four of my surgeries were necessary to continue playing tennis, hiking, biking and most recreational activities that make my life enjoyable. 

Yes, surgery is PAINFUL, GREATLY INCONVENIENT, COSTLY and DANGEROUS, but the alternative of delaying action often results in increasing pain and immobility.  Plus an injured body part adversely affects the movements of your total body as it compensates for the injured part and the ultimate result is neither pretty or happy. 

THE VALUE OF PHYSICAL THERAPY (PT)  

Many orthopedic issues can be resolved with Physical Therapy.   Treatment focusing on strengthening, stretching, massage and education can resolve many problems, especially if  X-rays do not reveal any significant structural damage.

I have already mentioned that, personally, PT exercises have prevented recommended surgeries for a hip (12 years) and a knee (7 years). 

CONCLUSION

In conclusion, when answering the question of  To Cut or Not To Cut? The essential question to yourself is about the QUALITY OF YOUR LIFE.

If the problem does not significantly subtract from your mobility and participating in and enjoying your favorite activities, you may choose to live with a minor problem, such as a "bum" non -dominant shoulder for example, and avoid the painful and costly inconvenience of surgical intervention. 

However, it would be advisable to first consult with a physician or physical therapist about the long-term effects of avoiding surgery. 

NO REGRETS

I have not regretted my 4 orthopedic surgeries, which have  "youthenized" me and promoted my "growing young" efforts.

And at the age of nearly 77, I'm so pleased to say that the last time I felt as fit and healthy as I feel now was nearly 20 years ago...and my surgeries have made a major difference!  

And although I don't like thinking about it right now,  I suspect that I will once, or twice, or even thrice again be faced with the choice of to cut or not to cut; and my decision will likely be:  CUT-AWAY! 

"Begin doing what you want to do now.  We are not living in eternity.  We have only this moment, sparkling like a star in our hand and melting like a snowflake." 

Francis Bacon 

                                    

Bomb the Health out of our Enemies

BOMB THE HEALTH OUT OF OUR ENEMIES

Envision a sky filled with tiny parachutes dropping Snickers and other candies and goodies on enemy populations in Syria, North Korea and Afghanistan.

It's hard to imagine anyone hating and wanting to kill someone who gives them a Snickers...don't you think?

If the purpose of war is to win the hearts and minds of our foes; and if the way to a man's heart is through his stomach, this approach could lead to diplomacy and bloodless PEACE!

There is nearly an infinite number of possibilities for candy and snack bombs.

Twinkies and Cracker Jacks with a prize inside could be real hits! Fast food empires, such as McDonalds, could drop french fries and preservative infused hamburgers.

The United States is by far the world's leading producer of incredibly tasty foods.  

Our gigantic food companies have perfected taste.  Many even have scientific labs that manipulate ingredients--sugar, salt and unhealthy fats--to find the perfect Bliss point in the tastes of their products.  The tastes are sublime--like manna from heaven--and the high sugar content is many times more addictive than cocaine.

AN ULTIMATE VICTORY?

If the purpose of war is to kill our enemies, then you just have to be patient.  A diet of sugar and fat laden foods and fast foods have been shown to lead to obesity, diabetes, heart disease, cancer and an early death in the U.S.  With two out of three Americans of all ages being  overweight, obese and diabetic,  our nation has the worst health and highest medical expenses in the world. 

THE GOOD WILL BOMBING PROJECT

We should be delighted to bomb our enemies with our "manufactured foods"--and they, too, will die a slow, tortuous death of obesity, diabetes, heart disease and cancer, but will die happy. 

This tasty Project could become very popular!  Countries will be lining up to be on our enemy list!

Perhaps?  Just perhaps, it could be a major deterrent to warfare and its horrible death and destruction.  Just think about it.