Thanks Aturpin

You've been an inspiration.  It's wonderful that you wrote as much as you did, and attracted so many comments from other people.  You may not believe this now, but 58 is VERY young.  But some day you will believe it.   I do understand the possibility of the femur not knitting together.  Remember that aniother big consideration in the whole healing business is general state of health and fitness.  And there aren't may 20 year olds who are as fit as I was a few months ago, but the longer I wait, the less fit I get.

I believe that no matter what I do, I will have at least two major surgeries on this knee.  I trust my ortho implicitly.  He does not think I am in enough pain now for a knee replacement, but the lateral compartment of my right knee has no gap and is basically Grade IV, and so if I am to have a DFO, it cannot wait.  Strong muscles are all that have kept me going for years, but the pain is discouraging me from the kind of exercise that it takes to stabilize the knee, thus a vicious downhill spiral.  I have a number of friends who have had knee replacements, and if I were a normal person, that's probably what I would do. 

But I'm not a normal person.  I know that nothing I do will guarantee that I can go back to doing what makes me happy, but my ortho has told me that I have a DFO is basically the only shot at it.  His assistant is still playing singles tennis 19 years after my Dr gave him a DFO.  That's pretty lucky, I think, but out of the question with a knee replacement.  He tells me that if I want to run, a DFO is my only chance.  And much though I would like to run, going on adventures is what I want most.  In the last 40 years, I have been in 71 countries and 48 states.  And every trip I have been on has been strenuously physical.  I have had the most amazing adventures in my life.  I can't sit by a pool and drink Mai Tais.  And the knee is in such poor shape now, there is no way I could go anywhere satisfying.  I need a knee I can rely on.

So I look at a DFO as doing two things.  One, even though the recuperation from a DFO is 6 months of low quality life, waiting for a replacement would be more like a year or two of low quality life before the ortho would do the replacement.  I can no longer bike more than 15 miles without a serious risk of a bad evening of pain.  So any sort of daily life or adventure I would enjoy is basically out of the question for the next couple of years if I wait for replacement.  And I would probably push things too hard and make a further mess out of my knee. 

So two, it seems to me that a DFO at least gives me a shot at doing something satisfying for the next ten years, things I couldn't do (apparently) with a mechanical knee.  And if ithe DFO fails, well then I'll probably have a replacement at about the same time I would have had it had I just waited and not done the DFO.  And as opposed to youngsters like you, if I get ten years of quality life out of a DFO, that's probably 50% of my actuarilly remaining life span.  Morbid perhaps, but certainly a consideration. 

My doctor told me the following.  The reason I'm confused as to what to do is because there is no right answer.  He told me to get as much information as I could, then "put on a pair of rose colored glasses , find the place I feel comfortable, and go for it."  In other words, there is no guarantee about anything in life.  And so I have chosen to gamble on having some more wonderful adventures in my life, and if I lose the bet, well, at least I tried. 

The DFO is scheduled for December 9.  And believe me, I have thought many times "what the *** am I doing?"

Thanks for writing.  Any hints on things you would recommend to make recuperation in a Wisconsin winter living alone more bearable? 

I have to say the thing about your blog I found most amusing is that after two months you said it felt like two years, but after two years you said it felt like time had flown by...

I had to laugh when I read your response.  After reading the blogs, and thinking about things a little, ok, maybe more than a liittle, I have been trying to get the Ortho to say the following things are "medically necessary".  He gave on one, a hospital bed.  I only have one bed in the house, and it's on the second floor.  I intend to live on the first floor for the first couple of months, even though it means sponge baths, not showers.  Or maybe crawl up on my butt every once in a while for a shower.  I have been on crutches twice before, and climbed stairs, but with a cast on I wasn't so worried.  When I broke my ankle, I had my cast bingie corded to the pedal of an exercise bike 4 days after the break, with the doctor's blessing.  But with what is essentially a broken femur, even though screwed and plated. the risk of climbing stairs seems too high.  so hospital bed in the diniing room.

I also read about people's fears of getting on a regular exercise bike.  I hauled out my old crutches and gave it a try with one of my bikes on a wind trainer.  That is also too dicey for me.  The Dr. would not approve a recumbent exercise bike as medically necessary (i.e., covered by insurance) even though exercise bike is part of recovery therapy - because he has never prescribed one before.  So I just got back from the bike store where I put down my own $$ for a recumbent exercise bike, including crank arms where you can adjust how far out the pedals are.  Pedaling one footed is going to be hard, I discoveredand a shorter arm should make that easier.  I would go nuts without some sort of regular exercise.  I have been practicing a little with my old crutches to make sure I have the balance, and I want to start using the one legged bike routine before surgery. 

I also read where people complained about not being able to carry things.  I was going to have a friend make me a little cart I could tow, but it occurred to me that a wheelchair with a table was a better choice.  A wheelchair should also make it easier to access things in the fridge, stove, etc, because I will have two hands free.  And it would let me take a "walk" in the winter.  Even when the walks are all shoveled there are still slippery spots.  Sound familiar?  The Dr.'s assistant told me I wouldn't need that because I could be dropped off underneath the overhang when I went for Dr. or PT visits.  She didn't get the concept that I want to be outside recreationally somehow!  And amazingly a friend called today to ask if I wanted to borrow the wheelchair her father used before he died.

Like I said, I am so pleased to have runinto your blog.  It's nice being able to get this stuff all organized well before surgery, and get a little no risk practice before doing it for real.

Thanks for the encouragement.  And never say die, is my motto.  I have twwin friends who are 73, ski aeverything at Sun Valley (on an all season pass, they liive there allwinter) , bike the big mountains in Europe and play a mean game of singles tennis.  Inspiration.  So I may be 58, but I figure I have to make plans for at least 15 or 20 years of being active.

Thanks again.  Appreciate any more thoughts.  Not to mention encouragement. 

Don't know if anyone is reading this any more, but I have a couple thoughts to share. Had distal femur osteptomy on my right leg on Decmeber 9.  People at hospital were wonderful, the food was even good.  Surgery went exactly as planned.

Doctor wanted me to walk flat foot with 50 to 75 pounds on the operated upon leg right from the start.  That actuallly made getting things done around th house easier, as I could stnd on both feet without crutches and just lean hard to the left.  Always stayed in a left hand corner with something like the edge of the counterrtop to grab, but being flatfooted on both feet made balance pretty solid.  I have a number of friends who have been very helpful, two particularly so.  Nancy brought me bags of ice every morning, and Leslie has been cating me around.  I'm doing PT ath the hospital and they have a courtesy van. 

Just got back from first doctor visit.  too early to see bone growth 12 days post surgery, but on the other hand everything is as it should be at this stage.  He increased the range of motion on the brace from 30 degrees to 60, much easier to get into a car.  Doctor told me that it would normally be 6 to 8 post surgery before I lost the crutches and brace.  After reading this blog I'm counting on 10 and anything less will be a plus.

Mainly the purpose of this messageis to thank everyone again for their reports, so I went into this having some idea what to expect.  This is an operation you have to approach with a zen like attitude.  Knowing roughly what to expect has made it easier for me to be patient and it feels like the first two weeks have actually gone pretty quickly.  The trick now is to maintain that attitude.

thanks again
tom

Dear Aturpin

You probably have better things to do by now than to read this blog, but in case you are, I would like to quote to you from your post of Nov 8 "While I have always heard, and my doctor has reitterated, it is best to keep the original parts as long as possible, surgery at 58 can be more difficult to recover from."  I have been a little reluctant to post until I had some solid evidence, but here is my current status report re my 12/09/10 DFP

Based what was happening in PT, I was able to was able (with safety of a hand rail on one side and a crutch held on the other, each increasingly loosely held), from the fourth week after surgery to the fifth, I was able to transition to walking – over obstacles, and up and down a single stair – totally on my own power.  The next week brought walking all over the PT room, pulling against a rubber hose held by the PT, using just a non-weight bearing crane. 

The next week I stopped using the brace and crutches at home, even the cane for brief walks. 

For the first 4 weeks after surgery, I was using a recumbent bike powered only by the non-operated left leg, getting up to 90 minutes.  In weeks 4 and 5, I did exercise bike with two legs. Quickly going up to 60 to 90 minutes, and transitioning from recumbent exercise bike to regular bike on wind trainer.  I could easily clip in and out of the pedals. 

I made an appointment  with the surgeon for yesterday, 6 weeks and a day after surgery.  The doctor came in before any x ray had been taken.  He said I had come in too soon for an x ray to be relevant.  I told him that based on what was going on in PT and in the rest of my life we needed an x-ray.  He said ok, and 10 minutes later he was back in the room x ray on the wall, admitting I was right.  The bone was completely healed and I no longer needed the brace (except if there was snow or ice), crutches or any further x rays.  It had probably completely healed in 5 weeks, maybe even a little earlier.  I lost almost no leg strength.  Still need work on range of motion.

I have a good surgeon, I worked hard (and I am probably a bad person for posting this).  Still lots of work to go.  Up stairs foot over foot is a piece of cake, but down...

Thanks again for your diary. It has been of immense help.  I keep going back to it.  In the next few days I will try to post some advice for people doing this totally on their own, expecially in wisconsin in the winter.

Aturpin

Thanks for the update and glad you are doing well.  I had my DFO on 12/9/10 and have checked back to this post from time to time during my recuperation to see how you were doing at the same stage. 

Since my last post in late January, progress has continued to be fairly rapid, although slowed down a bit by the ice and snow.  February consisted of walking and exercise bike, eventually getting both up to 2 hours with both.  Considering both were indoors it was a bit boring.  By mid February I was shovelling my own snow, sometimes over 12 inches at a time.  I'm sure the doctor wouldn't have approved. 

In late February I had another doctor appointment.  At that point he told me that the bone had healed so well he couldn't tell if it had been 3 months or 3 years since the surgery and that there was no reason for further x-rays.  Even the scar had virtually disappeared.  He made me promise to wait until at least April until I biked outside, but I started on March 3 with a 15 mile bike ride in the snow.  By mid March, when we had a nice day (by our standards here in Milwaukee) I did a 50 mile ride.  That one ached a bit by the end, but no problem after I got home.

By the beginning of April, four months post surgery, I could no longer really tell I'd had the operation, save two things.  The operation site ached if I biked hard, the doctor saying it was normal and that I needed to form a bursa next to the TI plate so the IT band and muscle could move more smoothly over the plate.  And, strangely, I couldn't sit in a chair with my leg at a 90 degree angle (think movie theater) for more than 20 minutes or I would ache so much I would have to get up and leave.  Other than that life was almost perfectly normal, walking stairs, whatever I wanted to do. I was remodelling the basement carrying 50 pound boxes of tiles down a flight of stairs.

It has taken a while to get some speed up on the bike because I didn't want the leg to ache too severely.  I did do a hilly century in June, about 7 months post surgery, with no trouble.   

It is now 9 months post surgery.  I got mugged on the bike path last week, punched in the face.  It didn't knock me over, and I sprinted to safety at 28 about miles per hour.  Pretty lucky, but it showed that the strength was there, at least if the adrenaline was flowing hard enough.     The ache I was experiencing when biking hard is only barely noticeable and no hindrance at all.

I wasn't able to run pre surgery, but the doctor indicated I would be able to do so post surgery, very moderately.  I haven't run more than a few hundred yards, and calling it "running" exaggerates substantially.  I have another appointment with the doctor on Friday and we'll chat about what makes sense. 

Bottom line is that I'm almost exactly back to where I was pre-surgery except the knee doesn't hurt, and I tend not to push quite as hard, not because I can't, but because I want my real knee to last as long as possible.   

So I want to second your notion that there is there is light at the end of the osteotomy post op tunnel.  Hope you are all doing well out there, and it would be interesting to see how things turned out for other people.  And thaks again to Aturpin for starting this blog.  I t has been most helpful.

September 14, 2012.  21 months after DFO.  Just got back from 16 days of bicyling from Vienna to Venice.  About 800 miles, well over 100,000 feet of climbing, frequently 15% grade or above.  I'm not as fast as I used to be, but then again I'm 60 years old.  The important part is the only time during the trip that my DFO made any difference was going through the TSA security.  I had to push hard to get over the passes in the Alps and Dolomites, but no pain in the knee or leg.