Bionic Boomers and the Perfect Storm

Joining the ranks of bionic-boomers, I had a partial knee replacement in April. It’s all the rage according to the press. In the weeks leading up to the surgery it seemed as though every rag or mag I picked up had an article about baby boomers “demanding” knee, hip, or shoulder replacements. As has become typical with such stories, baby boomers were cast in the role of selfish, reality-denying individuals who get what they want and won’t take “no” for an answer. Typical of the tone in such articles is the following, “Across the United States, baby boomers’ passion for competing in marathons, triathlons, basketball and tennis has worn out knees, hips and shoulders in middle age. As a result, this group is undergoing joint replacement sooner to get on with their lives.”

As someone who has never competed in any of those events I find the assumption disingenuous. No doubt there are the Type-A’s who are clamoring to feel 20 again but in my humble opinion baby boomers are getting joints replaced because of a Perfect Storm of health insurance, technology, and education in the 21st Century. My knee surgery would have never occurred without those three blessed items and I’m certain many baby boomers agree.

My knee two days before surgery

My knees began disintegrating in my late 30s when I noticed a subtle grinding and occasional click. I was an avid golfer at the time and insisted on walking the course when I could. Golf is hardly the high-impact sport implied by the articles I have read. My knees disintegrated more from genetics than high living. My problem is arthritis of the kneecap, a rather specialized version of knee arthritis afflicting 8-10% of those who present with osteoarthritis of the knee. Like the charming Agnes Gooch of the delightful movie Auntie Mame when people ask what I did that caused this problem I can say simply, “I lived.” My fraternal grandmother had the same problem and my 42-year old niece is starting to notice the symptoms. For those of us with this type of knee arthritis problems come primarily when climbing stairs, hills or inclines.  Squatting or getting up from chairs isn’t much fun either. Walking is doable although that was also becoming difficult as the years progressed.

I suffered with pain for many years and used conventional treatment (medication, physical therapy) to good effect but time was not on my side. Eight or nine years ago my doctor proclaimed that knee surgery was in my future. “You’ll know when,” he sagely intoned. That “when” occurred in January 2011 while engaging in the pedestrian activity of making my bed. As I pushed on the mattress with my knee (dumb, dumb, dumb) there was a searing pain that nearly took me to the ground. X-rays showed a gigantic bone spur on the top of my knee cap. The image brought to mind a Viking boat outfitted with a large battering ram because that had been the net effect. The bone spur had rammed into the soft tissue around my knee and was very effective at crippling me for several days.

This was two weeks before a scheduled medical mission to Haiti. A shot of cortisone and RICE therapy (rest, ice, compression, elevation) helped me decide that I could do the mission and I did, but not without great discomfort. There were stairs everywhere in Haiti and more than once I had to stop mid-flight because the pain was so severe. I flashed on the story that my mother would tell about Grandmother Annie hoisting herself up the stairs at night “on her bum.” My mother’s assumption was that Annie was worn out from raising ten kids and was too tired to climb the stairs but I painfully realized the truth — she couldn’t climb the stairs because it was simply to painful to do so. In Haiti I realized that Annie’s knees were now in my body.

The trip convinced me that the time had come to do something. Bit by bit I had been letting go of the things in life that I enjoyed because of the pain I experienced from my knees. Golf and hiking had slipped away and now my knees were threatening to end an experience that I had come to love, medical missions to foreign countries.

Fortunately I had the means to do something about it. Make no mistake, if health insurance, either private or Medicare, didn’t exist we would not see the baby boomers clamoring for prosthetics. It wouldn’t matter how good the technology might be, without the means to pay for it I doubt that many of us would take the plunge. My insurance company was billed $39,000 by the hospital and $17,000 by the surgeon. (The amount that was allowed by the insurance carrier was different, of course, and that’s a topic for another day.) There were numerous other charges from doctors I don’t recall seeing plus home care after surgery and physical therapy for seven weeks. Without the guarantee of some payment these procedures would not take place. No doubt there were cutting edge treatments in Annie’s day but there was no money to pursue them and Medicare was only a dream.

The third factor of this Perfect Prosthetic Storm is education. Baby boomers are highly educated and the tools at hand are extraordinary. The internet provided not only endless articles on knee surgeries — both technical and general — but it also provided the means to compare physicians and facilities, at least here in the State of Florida. During one of my endless Google searches I came across and found a treasure trove of data that was invaluable. Much to my delight I was able to find a section at that site entitled  “Hip and Knee Replacements” and it gave comparisons of doctors (number of surgeries performed broken down by facilities). If you’re having a knee replaced do you want a doctor that has done 40 in the last year or 160! Another site was able to tell me if registered doctors had been sued for malpractice or any other legal action. Armed with this education I was confident going into surgery and this, I believe, contributed to its success.

The bionic knee, four days after surgery

And if I needed any further evidence of the importance of all this web searching in reaching my determination it was provided to me on my last day of physical therapy. The closing 15 minutes of each session was spent on a table with an ice “blanket” wrapped around my knee. Cold water is pumped through this high tech blanket and light compression applied to the knee. On this last day I had company on the neighboring table, a rather frail late-70s-something lady who I had frequently seen during my six weeks of sessions. She was not having a good day and I noticed that she seemed less competent than she had been in previous sessions. Her therapist noticed too and had her get on the neighboring table so he could “have a look at your knee.” Whatever he saw was enough to shift him into action. He placed an “ice blanket” on her knee and told her to “relax while I try to reach your doctor.” We started to chat and she relayed the sad story of her knee surgery. She was in her third month of PT, I was in my sixth week and graduating. She wished she could “walk as well as you do.” I tried to be encouraging but as she chronicled the problems following surgery — a blood clot, hematomas, a trip to the ER after she was released to home, weeks of pain — it was hard to be a cheerleader. But what made it all the more chilling to me was her doctor. You see, her surgeon had been my doctor for eight or nine years. It was he who had sagely intoned, “You’ll know when.” And when I did know when I was prepared to go with him to the operating table. After all, I had been treated by him for all that time and he is a nice guy. But after I returned from Haiti and met with him specifically to discuss surgery things began to change. He dismissed any consideration of a partial knee replacement and went a step further declaring that my left knee was “about a year behind my right” so I might want to consider a bi-lateral knee replacement. Gulp!

I left the office shaken but still with confidence in my doctor. A friend encouraged me to seek at least a second opinion and it was her encouragement that sent me back to my internist for a referral to another surgeon. With the help of the internet I was able to compare doctors and, in the final analysis, there was no comparison. The new surgeon with whom I consulted saw what the first surgeon didn’t, arthritis that was seemingly confined to the kneecap. He recommended a partial replacement, on one knee, with the option to do a total knee replacement if warranted. It wasn’t. He did the partial, which took him about four times longer than a total knee replacement would have because the partial replacement must be fitted to existing knee components, a total knee is just it says, a total knee. I’ve been told that some surgeons can replace a total knee in about twenty minutes.

But I’m lucky. I have probably 95% of my original knee, and, as my surgeon said, “God makes better knees than I do.” My recovery has been excellent and even though there is still some tenderness I can walk up stairs with much less discomfort. Oh, and there was no sign of deterioration in the other two compartments of my knee.

So, through a Perfect Storm of health insurance, technology, and education I am looking forward to a better life, happy with the simple joys of climbing stairs and being out of pain. This bionic baby boomer is, once again, grateful to the times in which she lives. ❧

A little buzzed on Percocet but smiling!

Cock-eyed Optimist

The evening news gave me two reasons for optimism tonight. Oh, there was some awful news, as usual — Greece is spiraling towards collapse and threatening to take a lot of the Western world with it. In Afghanistan the outgoing ambassador took the war-ravaged country to task for not being grateful enough, a reasonable assessment given our $2 BILLION investment PER WEEK! How long can we maintain that and fix things here at home at the same time?

But two items caught my attention and gave me reason to hope. First, laws governing mortgages for first-time buyers are about to change. The new regulations will insist on 20% down and the mortgage payment cannot be more than 36% of the buyer’s debt ratio. What does that mean? Quite simple, your monthly mortgage payment cannot exceed 36% of your combined monthly payments for your car, credit cards, utility bills, and anything else.

As the song says, “Everything old is new again.”

When my husband and I bought our first home in 1984 this was very similar to the regulations that were in place. It was not a requirement to put 20% down but if you did you avoided mortgage insurance which was expensive and a hassle. We had to borrow money from dear friends to meet the magic 20% but we made it. And the percentage to debt ratio was then 35%. I recall being annoyed about that and was convinced it would sabotage our chances. But we got our loan and our $600 a month mortgage.

A reporter tonight interviewed a realtor who applauded the moves. She stated that during the real estate boom the percentage to debt ratio could be as high as 64%. Essentially that means that for every $100 dollars you make, $60 could be obligated somewhere else leaving $40 per hundred to go your mortgage payment and pesky things such as food and gas. Not much breathing room…as a lot of people have found out. Another recent news story featured a couple in California who bought a $750,000 home. He was a fireman, she a secretary. He became disabled and now they are in default, their house worth less than half of what they paid for it, and who is to blame?  Well, they blame the system and I suppose that is reasonable. But isn’t it also reasonable to ask how a fireman and secretary thought they could afford a $750,000 house?

Well, I’m not here to play the blame game. This is my cock-eyed optimist blog and I am optimistic that lenders will have some tools in their quiver to look at a couple and say, “Gosh, maybe you need to re-look at how much you can afford.”

Michelle Obama and Nelson Mandela at his home in South Africa

My second optimistic moment came when this picture of Nelson Mandela and Michelle Obama was shown. Look at these beautiful people. Mandela is 92 and has lived to see the fruits of his labor harvested again and again.  The First Lady, with her beautiful children at her side, is only beginning to experience that harvesting but I have no doubt that her life, should she be fortunate to live as long as Mandela, will also have a long list of accomplishments. But in this moment, captured for all time, we see yet another grateful child of the global civil rights fight, paying respect and homage to a great leader. God bless him for all he has done and Godspeed to her for the promise she exudes. ❧

AIDS, Anniversaries and Attitudes

AIDS has been in the news lately.   Newscasters solemnly declared June 5, 20011  was “the 30th anniversary of the AIDS epidemic that took so many lives and remained a mystery for so long.”    Can epidemics really have anniversaries?   After all, no one is really sure when AIDS began. Some link it to the Belgian Congo of the 1950s.  Was Patient Zero the sailor from Norway or the Canadian flight attendant?  Either way, surely that marks the “anniversary” of AIDS.

But our 24/7 news cycle does not play well with complicated maybe-this-or-maybe-that stories.  So, in our typical Amero-centric fashion, we have declared the anniversary of AIDS based on a 1981 publication of the Center for Disease Control (CDC), Morbidity and Mortality Weekly Report, which reported on five cases of Pneumocystis carinii pneumonia (PCP) in young Los Angeles homosexuals.  The newscasters spoke as if AIDS was a thing of the past, like D-day or even polio. The broadcasters adopted their most sincere and compassionate voices.  Images of long ago demonstrations flashed across the screen, Rock Hudson’s frail countenance was seen ever so briefly, and the aptly named Magic Johnson — 20 years on in his private battle with HIV —  was backdrop for the news that protease inhibitors, coupled with education on safe sex, have slowed the virus to barely a crawl compared to the horrific days of the 1980s when it seemed that HIV/AIDS would find us all.

Robert Randall – 1992

In my own world the “anniversary” of AIDS resonated more personally. It fell just three days after a true anniversary — the death of my husband, Robert Randall on June 2, 2001.  Robert had AIDS. He was diagnosed in late 1994 and died in 2001.  That gift of seven years was clearly the result of protease inhibitors, the AIDS cocktail, that arrived on the scene in 1995.

At the time of diagnosis Robert had just six T-cells, the immune system’s worker bees that help us fight infections of many kinds.  Average T-cell count is in the thousands but HIV, the virus that causes AIDS, directly attacks the T-cells which renders the victim’s immune system vulnerable to all manner of horrible ailments and afflictions.  In those early days of the AIDS epidemic it was not unusual for AIDS patients to have pneumonia, a rare skin cancer called Karposi’s  sarcoma, fungal infections of every variety, and even a blinding disease called cytomegalovirus. And that is just a few of the ailments listed by the CDC.  The early victims of AIDS died truly awful deaths.  And to add injury to insult they were often isolated and alone, tucked away in the farthest corner of hospitals, sealed in rooms with large warning signs and attended by medical workers dressed in protective gear that rivaled the spacesuit images we were viewing in the popular movies of the time, Alien and E.T.

Robert was spared most of that.  At the time of diagnosis he did have Pneumocystis carinii which the doctor treated with an inhaled drug called pentamidine.  As for treating the HIV, the primary drug at that time was AZT, which fell into the category of the treatment-is-worse-than-the-disease.  Robert politely declined.  We had personally known many people who used AZT and, in Robert’s opinion, it had not bought anyone the additional time that was worth the punishment.

Several months after his diagnosis, for reasons that are still unclear, Robert’s gallbladder died.  AIDS related?  Probably not. Medication related is more likely. Either way he was gravely ill and was scheduled for emergency surgery. The gallbladder was removed and the surgeon declared he had seen nothing like it. Necrotic and pocked with lesions. Big mystery but we had no time to think about that. We were literally in the midst of moving back to Florida to be near family.  Within a short time of arriving in Florida,  Robert developed pancreatitis and none of the doctors could figure out why. His pancreas, normally a small organ, was inflamed to the size of a child’s football.  He was in agony.  All treatments failed and there was talk of “just a few days.”  Finally he was placed on TPN – total parenteral nutrition.  He took nothing by mouth for three months and received all of his nutrition through an infused bag of vitamins, saline, and lipids.

It was the emerging internet that finally solved the puzzle. I found a study which stated that in an exceedingly small number of cases pentamidine — used to prevent PCP from recurring — could cause pancreatitis.  In retrospect it was probably what killed his gallbladder.

Our book, published in 1999.

It was a long fight  back from the pancreatitis but when he arrived there was new hope.  The AIDS cocktail had arrived and Robert, having stood on the precipice twice in less than six months time and looked into the darkness of death, was ready to give it a try.  It was a good move.  In the next six years we would have many happy times and we would write a book of our experiences in the medical marijuana world (Marijuana Rx: The Patients’ Fight for Medicinal Pot ).

In the end he died not of AIDS but of lung cancer.  He had smoked two packs of cigarettes a day for more than 25 years. He loved his tobacco.  Did the AIDS accelerate the lung cancer? Quite possibly but we’ll never know and it ultimately doesn’t matter.  Robert is gone.  I’m certain of that and I know the precise date and time.  Anniversaries are good in that way. ❧

Weighty Questions


Recently my niece’s mother died. You can see her in the forty year old picture to the left, holding my niece who, obviously, was a toddler at the time. Also in this photo is my niece’s father (my brother) and her Great-Great Aunt, who was born in 1885 and was about 84 years old when this picture was taken. Of the four only my niece remains. Her mother and father died relatively young, each in their late 60s.  Her Auntie lived to be 92.

A famous poet once noted that “any man’s death diminishes me because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.”  Lofty words and quite true.  But there can be no question that some deaths are harder than others and the death of a mother is devastating. Oh, life goes on and most of us are able to function following this inevitable life-event. But something changes.  It doesn’t matter how old you are, how close or estranged you might have been, that first realization that you are without Her is a moment of inconsolable sorrow and you become a different person.  You are an orphan.

Cut adrift, without the anchor of a mother, we move on and we re-assess our lives. This is where my niece now finds herself. Or at least that is the impression that I have taken from an email that she sent to a half dozen family members in which she shared some personal feelings about her mom’s passing, her love for her family and then asks each of us:

    • What is life all about?
    • What is most important to you?
    • What have you learned to be true?
I immediately responded to my niece that I would like some time to think about these questions but wanted her to know that I understood the pain and sorrow that was no doubt at the root of the questions.  It is just over two weeks since her mother’s death and I know, from both personal and professional experience, that two weeks is not enough time to fully process the death of someone so dear.  In my work as a hospice grief specialist I deal with bereavement on a daily basis and see every imaginable reaction to it.  My niece’s reaction — to question the meaning of life itself — is not uncommon.  What is uncommon is her openness in asking such weighty questions.  I credit her mother with giving my niece the confidence to ask these things. Too often I see the bereaved struggling with these very same questions but completely unable to articulate them because family or society deems such questions as “silly.” Just the opposite is true but our culture, for the most part, gets a bit squirrelly when asked “What’s it all about?”

So, dear niece, I will try to answer your questions.  I’ve chosen this venue for several reasons. It’s a new “blog site”  and needs some “meat” which your questions most certainly provide. It’s a public forum (which I hope you don’t mind) and I like bringing this type of dialogue to the public.  Who knows, maybe someone else will chime in with a comment or two.  And perhaps, in the future, we can re-visit this blog page and these questions to see how our views may have changed and where our lives have taken us.

Because life is most certainly a journey and that is my answer to your third question: What have you learned to be true?  I have learned that life is a journey without maps, MapQuest or any other handy guide except the God-given gift that resides between our ears. There are some who might respond that religion gives us the road map for our lives but I have also learned that religion is man-made and therefore suspect.  Faith, on the other hand, seems instilled in us from the moment of conception and can, I believe, be a guiding star.  Like the North Star, faith can be true but faith is also vast and multi-faceted.  Our hearts and minds must always be open to absorb the changes that our life journey gives us.

It is those changes that are the answer your first question: What is life all about?  Life is about constant change. Indeed, the only constant in life is change. It is the one thing you can count on which is why living for the moment becomes so important.  I love the expression — “New York minute.”  That’s what life is, a “New York minute.”  Some will say a minute is a minute, quantifiable and steady. But in the vast continuum that is our universe our time here is even less than “a New York minute.”   So, live large!  Be bold!  Know that the universe is our home.  Gaze at the stars and know that you are a part of that greatness.  As a wise woman once said:  We are star-dust/We are golden/We are billion year-old carbon.

I’ve saved the hardest for last: What is most important to you?  For me there is no single answer to this.  My family, and by extension the friends that I love so dearly, are very important to me. Robert was most important to me and in some ways he continues to be.  But your question suggests a time frame of “now” which is, in fact, the answer. This moment in which I am writing to you is the most important thing to me.  And, in a few minutes when I finish and move on to my next project, that will be the most important thing to me.  You are a smart lady and you catch my drift. The only thing that I really have is now, this time, this moment and that makes it the most important thing to me.  It may sound like a lot of hippie-dippy stuff to some folks but it is true for me.  The hardest times of my life have been when I have moved away from this philosophy, times when I get too anxious about the future or the past.  Of course each of these time frames deserves attention but they are not the most important.  It’s the iconic “BE HERE NOW” and it works.

So, there you are. My answers to your three questions.  I hope that your request has brought you what you are seeking. And remember, your mother has become part of the star-dust once again.  She is shining in her new existence and will always shine for you. Just remember to look up. ❧

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