Endangered Teeth--High School & College

  We were at a high school assembly, waiting for the program to begin.  A classmate, Ruth B.,  sitting a row ahead, was turned  around talking to us in the row behind.   Another girl, Lea, was sitting in a chair in our row with her feet propped against the rungs of a chair next to Ruth's, and pulling the back of that chair toward her.  Ruth was turned around, and I remember she was laughing, when the back of the chair slipped from Lea's grasp and smashed into Ruth's mouth, neatly (in a sense) snapping off her two front teeth.  Chaos ensued.

I'm a freshman in college where gym class is mandatory for at least two years: you could escape the third mandated year if you got an A in gym.  (Not me).   Gym class was eternal; we had to engage in every sport ever heard of at the time, for a period of time, all in the interest of a well rounded education for the teachers we were all supposed to become.  From the main campus we had to walk almost a mile, or so it seemed, to Brubaker Field, the Quad between dorms designated as one of the"athletic venues."  The sport of the week was golf: that meant a group of 20 or so female students who'd mostly never held a golf club before practicing their swings in an enclosed area.   I think we were even told to keep our heads down.  The girl next to me was Prudy, a small intent girl who was on Dean's List.  Suddenly,a scream, then several screams, and Prudy fell to the ground with her hands to her mouth.  But not before I saw that her whole face was covered in blood.  She had been struck square  in the face with the full force of another girl's club.  Not only did she lose teeth, but her face was split open.  I never learned the full extent of her injuries, but she never did return to college.  . 
 

Decisions and Incisions

Let's evaluate: a decision is the selection between two possible actions, while a choice is the selection between two or more objects.  But the line blurs when the selection of an action may involve an object, a foreign object at that.  C.S. Lewis  said "Crying is all right in its own way while it lasts, but you have to stop sooner or later, and then you still have to decide what to do."  There is a lot of truth in that when people are faced with two equally tough choices, they make a third choice, which is to do nothing. 

Part 10: The Knee-Date Set but Mindset?

  The knee is to be Biomet's  Signature replacement, which utilizes MRI technology to create personalized positioning guides, the guides using advanced technology to help surgeons accurately position the knee implants.  To put  it bluntly, the MRI will allow the surgeon to saw off less of the ends of the tibia and femur.  That procedure may still occur only in a parallel universe, but the MRI is easy enough.  So that appointment is easily kept.
   I showed up at the designated  location a little early.  I have undergone two MRI's of  hourly durations, completely enclosed for the entire times, for much more ominous explorations, so a 30-minute MRI did not faze me.  After leaving all metallic belongings outside the room, I entered to meet the technologist.  She seemed quite detached, probably bored, describing the procedure by rote.  A brief description, not mentioning how she would be observing or how she could be contacted  if necessary, as I recalled being told during my previous experiences.  Today's MRI was divided into 4 parts, the first two involving only the legs, and proceeded uneventfully.  The third part meant being fully enclosed in the machine, and started out okay, but after a few minutes, things got heated.  I mean literally heated; hot air seemed to pour out of the machine and my head began to feel  very warm and flushed.  The noise was overpowering, as always, but after a time, it seemed so wrong that I spoke into the speaker advising of the heat.  No reply, which I may not have been able to hear, but she did not come into the room, and allowed the MRI to run its course.  I was at the point of preparing to extricate myself from the thing, but I didn't want to risk wasting  what had already been done.  When the technician did re-enter the room, to prepare for the next, and last, part of the series, I told her how uncomfortably hot the machine had been.  At first she said she didn't know what the cause could be.  I commented that if she didn't know, who would, and asked if  the machine could be malfunctioning.  She didn't think so, she told me, in her don't-give-a-damn monotone, and added that sometimes people do complain about the heat, and then added that the machine was scheduled for maintenance that day.  Yikes.  I said it felt like the fan wasn't working, and she asked if the fan had been on for the other parts of the procedure, including the last section just completed. She's asking me?  Yes, I could feel the air circulating when the fan was on, but not during the fully-enclosed part of the procedure.  She seemed unimpressed, and told me we were finished and I could leave.  She said this from the other side of the room, like she had other  things to do. 
  As I left, I did report my experience to the front desk, where there were two women, who also couldn't have cared less.  The service agent  for the machine was in the building at the time, I was told, that they service the machine every 2 weeks.  A little late for me, and for those other folks who sometimes complain about the heat.  My personal opinion is that the technician was out of it, and had forgotten to turn on the fan, as well as neglecting to respond to my message.
     I considered reporting my experience to the management, but decided against it.  In the event that I do follow through with the surgery, I don't want to be labeled a difficult patient.  They'll probably come to that conclusion soon enough anyway. I won't have another MRI at that site, though I don't think that's part of the procedure anyway.  I just hate it when people don't do their jobs. 
     Speaking of that, I had to return to the lab in Troy today for a do-over because they forgot to do one of the tests ordered for my follow-up appointment.  On my way home, I stopped at the Medical Records Department of the hospital where other lab tests were done, and I learned from reading the report that some of the tests were invalid because of hemolysis, meaning that  the idiot who drew my blood tore through the veins.   I mean, medical care is not like stacking cans in a supermarket, and those people do a pretty profesional job. 

Knee Saga Part 9--The Office Visit

I kept the appointment, in East Greenbush, driving myself there without giving anyone advance notice.  As I've indicated, I need to husband my resources for as long as possible. I filled out the paperwork, underwent a series of X-rays, and then met with Dr. C.  Since I tend to put myself into a catatonic state when I'm a patient, I honestly am unable to describe his appearance.  I recognized him from his picture, but that's all I could say about what he looked like.  He did appear to be one of those larger than life individuals, not just in his physical stature; his bio mentioned he played football for 4 years at Columbia University.  He seemed to possess an incredible energy and presence, in a low key way, an unusual descriptor for  a doctor, at least in my personal experience.  He spoke for a while and then asked me into the viewing area to see the x-rays.  I always hate that; I don't like to see pictures of any part of my body, especially knowing of the defects that were found.   Not much cartilage there, he pointed out, nor there, bone spurs here and here and there, worn knee puts strain on leg, etc. etc.  Back in the office, he went over the findings, and courteously, it seemed to me, suggested that I talk it over with my family, and then advise what I wanted to do.  At this point, I said I knew what I wanted to do;  if I left without coming to a decision, I figured I would not go back.  That's been my history, unfortunately.  "You can make the necessary appointments at the front desk,"  he said, and then in a nice touch, if I needed to contact him, wrote his secretary's number on his card, so as to "avoid the hell that is our telephone system."
  I have the date set for the surgery so all that remains is to overcome  about 20 hurdles before that that can happen.    TBC

Knee Saga Part 8--The Rationale

The  only grandparent who was alive when I was born was my mother's mother, who died when I was 12 years old.  In most of my memories she sits in her chair by her kitchen window, drinking tea from a bowl, crippled by what was then called rheumatism.  She used a cane when she walked:  when we were little, Nanny sometimes would walk with Helen and my mother to check out the gardens and the fruit trees, and whatever animals were on the property.  Earlier there had been chickens and goats, and later on only a dog and cat.  She walked slowly with effort; I never knew her to move about freely, even though she was "only" 78 when she died.  I think her hips might have been the most severely affected, but her knees were most likely not in the best shape either. 
   My mother loved the outdoors; she could not feel at home when confined inside.  When she was still in her teens, she was hired to work  at the Shirt Factory in Lansingburgh, operating a sewing machine.  She told me she couldn't stand it, and never went back after the first day.  She had to have access to the outdoors.  My mother actually liked physical labor; she enjoyed working in her vegetable garden, and a special pleasure was raking.  She used to walk all over the village, taking my sister and me with her on summertime evening strolls; later she would walk to Sara's house, and of course to the post office.  The time came, though, when her knees threatened her mobility. My father drove her to Dr. S. in Mechanicville.  He injected her ailing and failing knees with cortisone over  a period of time. Initially she regarded the injections as miraculous, but sadly the effect did not last and her knees continued to  deteriorate.  She no longer walked through the village, her garden grew smaller over the years, and in her later years she took to sleeping downstairs to avoid the climb to her bedroom.  My mother was a brave and strong woman; the closest she ever came to complaining was to remark, frequently,  "I'd be all right if it wasn't for my knees."   I believe she would have opted for knee replacement if it had been available to her, and I think she would be in favor of me having it too.  Anything I have of value came from my mother, so I think I will do what I think she would want for me.  That is why I made and kept the appointment with the doctor  who was rumored to be not only the best orthopedist in the area, but the best looking.  Who could resist.....TBC

Knee Saga Part 7--The Action

  Suspicious of being so intrigued, I related to my husband the incident of the wonder orthopedist, Dr. C.  "Oh, he said, "Don has gone to him, but he has to wait and go back or something or something...."  He is not good with  details, particularly where medical lore  is involved.  So the next time I saw Don, I asked him about his visit to Dr. C. Don says that "All the  guys at the Y sing the praises of Dr. C."  and that's why he was inspired to make an appointment with him. Don had not yet kept his return visit because of other issues, but the first words out of his mouth were, "He is a really handsome man.  And if a man says that about another man, you know it must be true."  Intrigue has now transformed to burning curiosity, so I googled his practice and found a picture of him.  YeGads!   They say the camera doesn't lie, but some things just do not ring true.  So what to do about my worsening knee?  Why, schedule a visit with Dr. C. of course.  I need to find out some things for myself.  TBC  (The Visit)

Knee Saga Part 6--The Temptation

Pondering, pondering---you think life's easy?
  I  go to a polling place on Election Day to deliver lunches to the election inspectors, one of the 6 sites in the election district.  A woman is there extolling the success of her Total Knee Replacement.  She says she had been confined to a wheelchair, unable to walk until her operation about a year and a half ago.  I go over to talk to her, which she is more than willing to do.  She is proud that she now walks with no trace of a limp, and she skips around some to show how flexible she is.  She attributes it to her diligent rehabilitation, which she was inspired to do by her deep respect for the surgeon who operated on her knee, Dr. C.  She tells me that she highly recommends him, and goes on to say that he is the most handsome doctor that she has ever seen.  Then she adds that he is the most handsome man that she has ever seen.  I must say I am intrigued.......TBC

Knee Saga Part 5--The Dawning

Your knees don't allow you to run anymore, but who cares.  It's kind of unseemly at this age anyway.  You can't walk as far without the clinking noise starting up, but you don't actually need to walk very far after all. You, as your mother used to do, latch on to a grocery cart as soon as possible: it makes walking much easier.  Then you seek out shopping carts in department stores; it's amazing that dropping your purse in that little black cart makes shopping so much easier, with proper balance being restored.  You avoid at all costs taking the stairs in the company of others; who wants to be seen two-footing down each step.  Going upstairs is not so hard as long as there's a handrail.  And almost all places have elevators or escalators, so you don't have to strain yourself pretending you can descend a staircase without effort.  (You'll pay later.)  But one day you're in the library checking out a book when your knee makes such a loud pop that the librarian is startled.  Nothing, you say.  Again in a public place, you're standing in front of a ledge, almost but not quite a seat, when suddenly without your consent, you're sitting on that ledge.  Surprising, but not painful.   Another morning, you're walking down the hall when without warning, your knee locks in place, refuses to bear any weight.  Scary, but it soon goes away.  What may, possibly (not sure yet), be the last straw occurs when you are making a purchase at Boscov's when there is a loud explosive noise and your knee slides out of place directly into the cashier's desk, with a thud.  The cashier asks, confused, what happened and you answer something like you slipped.  You don't exactly know what has happened, but your guess would be that your femur has slipped off your tibia.  There was no pain; could all your nerve endings be destroyed?  Not likely, but still you wonder. 
   Not a single person in the world knows what the sum of your experiences has been; you have found your health issues to be a topic of non-interest to others.  The saying goes that no one cares about your troubles and many are glad you've got them, so keep your own counsel.  The young and the beautiful, the famous even if flawed, may have an audience, but not your average elderly.  So you ponder......TBC

Knee Saga Part 4--The Reality

   There used to be a renowned pediatrician, whose name has slipped my mind.  His advice was to be kind to your children so that they would grow up willing to show you the way to the bathroom when you were in your dotage and needed their help.  I remember thinking that was funny, a joke, but not any more. I used to embellish the advice by saying my children would visit the Old Folks' Home every Sunday, but this is even less funny now, and not even realistic.  Aging has turned out to be a lonely and isolating path.  Few people remember you from the days when you had the status and the power of youth and mid-age, which has left you and been transferred to  the next generation.  There is no saving grace about declining looks and abilities, and nothing is good about dealing with geriatric conditions, or even non-age related conditions when they appear in old age. Nobody wants to be a part of that.  I used to hate the show with the Sinclair dinosaurs dumping grandparents off the cliff when they'd outlived their usefulness: it seemed absurd, but maybe too much a premonition of things to come. I've read that there is a dearth of doctors entering the geriatric field,even though the need has continued to expand.  All that sagging flesh and deteriorating body parts--Yeecchh. 
  Mindful of all the above, I am closer to making a decision about my orthopedic future.  While I have little that may be gained, I have even less to lose.  My only wish is for sudden closure if things go wrong, but I'm not too eager to put that in the hands of others either.  When you've been alive all your life, it's strange to think of not having life anymore.  It is all you've ever known....TBC

Knee Saga Part 3--The Revelation

So, for my own purposes only, I've reviewed the history of my knees, possible traumas from before any chronic problems developed, and my  attempts to resolve the early symptoms as they occurred. There was never any mention of even potential knee surgery until that visit with Dr. L when he dropped the TKR bomb, saying in no uncertain terms that it was called for, but hey, let him know.  After that shock, because after all, I'd never had surgery of any kind (except for outpatient in 2003), I mostly ignored my knees. When I visited my son in Boston, we walked throughout much of the city, including the entire Freedom Trail, where he lived, through the Boston Commons, wherever the Gay Parade had been held, to Faneuil Hall, Quincy Market, Rose Kennedy's church--all the good places.( Although the time we were there when they opened the Big Dig to foot traffic, I stayed in David's house while he and his father took the trip through the tunnel, about 2 1/2 miles or so.  I remember looking out the open window and watching one of the Holy Day street fairs in the Italian section of town.)  At that time, I was still walking a lot, and my knees only ached the day after extensive activity, so it was easy to ignore.  Besides I had a job, Dave was occupied with his job, my sister was going through her own agonizing experiences, and I couldn't even fathom someone's dealing with caring for me. 
  By 2007, I had finally secured health insurance in retirement, thanks to hard work, union assistance and watchdog attrition, so that worry was taken off the table, but I was still not motivated to exchange what I could call a minor inconvenience for major surgery.  But the more restricted you are by physical abilities, the smaller your world grows, and the more diminished you become as a person.  Until a person has been there, has begun to age, there is no way to know how willing others, the un-aged, are to accept your decline.  The brutal reality is that you are completely responsible to make the decision as to whether to go gently into that dark night, or try to prolong the inevitable, no matter for how long.  The hard part lies in assessing what the prorated value and cost would be.  With my mother gone for many years, and with the recent loss of my only sister, I find myself placing a different value on the odds. If the risk ends badly, few are left who will be bereft, acknowledging the inevitable,  so the risk is mine alone.So I am now contemplating the formerly taboo surgery from a different viewpoint.    TBC

Knee Saga Part 2--The Mystery

In order to find out what that clicking noise in my knee was, I decided to go to a doctor, not an easy thing to do because I'd been under the exclusive care of a specialist for an entire year, and so was out of touch with other doctors.  I stopped in at one of those medical clinic facilities that was open on Saturdays, and the doctor I saw ordered on-site x-rays.  The doctor read the report at the same visit.  He was very kind and sympathetic, which is kind of disturbing in a doctor.  He advised me to see an orthopedist or, even better, a rheumatologist.  So I did, making an appointment with one from all those years ago when I'd had temporary knee swelling. The doctor still had  my records, 10 years ago as it turned out, and, after reviewing the forwarded x-rays,  he said something about being surprised that I was still  walking around.  I still wasn't in any real pain, but agreed to the glucosamine supplements he suggested.  I did try them for a while, but I never really believed in them as any real cure for knee problems.  So after a few visits, I stopped going to that doctor. 
   After some time passed, I developed a new knee problem:   they started to ache at night, interfering with sleep.  So I made an appointment with an orthopedist, this time in Clifton Park.  He was all business. After I'd undergone extensive x-rays, again on site, the doctor entered the room and the first thing he said to me was, "What is the worst thing I could tell you?"  He went on to give me the answer:   bilateral total knee replacement, which to his mind was a rather simple matter.  After a few months, I'd be in great shape.  "Let me know," he said.  "You need me more than I need you."  I can't remember what I thought about undergoing the surgery, but I knew this was not the time for it.  That doctor did administer 2 sets of cortisone shots, which, miraculously, ended the knee pain from that time right up to the present.  No more night time aching.
   While I was then too young for Medicare, I was covered by employee health insurance, but since I was considered to be a part-time employee, and paid only for the hours worked, the result would be that if I couldn't work, I would not be hired for the next year, and would not have health insurance.  At the time, I was fighting a battle for eligibility for health insurance as a retiree, something no one in my employment category had ever achieved, I was told.  I thought logic was on my side, and as it turned out, I did later succeed in getting health coverage in retirement, after some help from the teachers' union and after the business manager who had denied my claim retired.  A hard fought victory, but one that took time.   TBC

Knee Saga--The History

One of the questions on the form was "Have you ever injured your knee?"  I answered no, but over  a lifetime there are bound to be many injuries, many forgotten, and others not recalled after recovery took place.  I know I fell on my knees trying to learn to rollerskate on a pair of hand-me-down rollerskates that strapped on over your shoes, and which also tended to release and throw you down on the concrete.  I seriously injured my right knee another time ice skating on frozen backup next to my house, when the tip of my skate caught in a crack on the ice, causing me to twist my leg and fall on my knee.  The knee hurt, and remained swollen for quite a while.  Another time I fell off a toboggan which ran over my leg, with 4 other people on board; I remember thinking I had broken my leg, but after a while--days or weeks---the swelling went down and I could walk again without pain. I was a passenger in a car which crashed into another and my right knee sheared off a knob under the dashboard, causing my knee to be cut and bruised.  But when you're young, injuries heal, and you never think of lasting repercussions. 
     As years went by, there were several times when a knee or two caused difficulties.  On one occasion, I had to visit a doctor because my knee inexplicably swelled up just before a family trip to Florida;  the doctor drew out a lot of fluid and prescribed a knee brace, which I wore for a day or so, but definitely not on our trip.  I don't remember which knee exactly,but I suspect it was my right knee, again. 
    Shortly before  our 20th class reunion, my knee was bothering me; I can't exactly remember in what manner, but I visited an orthopedist in Troy,who had been recommended by my kids' pediatrician.  There I received an injection of some type, probably cortisone, but at the time, I wasn't into medical treatments that much, so didn't connect with the procedure.  I do remember it was very, very painful, as if my knee were being nailed to the table.   Afterwards, I walked all over Troy trying to find an outfit to wear to the reunion; no luck there, so I drove over to Cohoes Mills and bought a trendy black jumpsuit.  The fit was perfect right up to the day of my reunion, when I noticed my stomach was protruding  a little, uncharacteristically at the time.  I learned later that I should not have been walking on the injected knee at all, much less all over 2 cities. Also, I should not have received the injection :  the reunion was in July, and my youngest child was born in February of the following year.
    And so it went:  my knees would ache the day after I'd been dancing while wearing heels, which of course was the only way to dance back then.  They'd swell up when I used to work with kindergarteners and kneel by their desks---no pain, just swelling.  The solution was simple:  take off shoes while dancing, don't kneel for extended periods.  No lasting effects.
    Until, that is, the day I was walking into a school, down a longish driveway, and I heard a clicking.  I thought I had a stone in the sole of my shoe, but came to realize the sound was coming from my knee.  And that was the beginning of trouble.    TBC