I’m a bionic cyborg. I’ve been a cyborg for a while. Recently I wrote that I was looking forward to my bionic future. And to the pain, suffering, and stupidity that would accompany my transition. Well, it’s done. I’m a bionic cyborg and the pain, suffering, and stupidity are past and were far below expectations. Here’s the story.

TL;DR

At 74.68 years old I got my knee replaced by Dr. Wolfgang Fitz at Brigham and Women’s Faulkner Hospital. In at 9:00 AM on Tuesday. Back home, walking with crutches, Wednesday night.

A little more detail:

Tuesday:9:00 AM I arrive.11:50 AM wheeled off to surgery1:26 PM I’m in recovery2:22 PM awake4:05 PM out of recovery5:30 PM walking (with a walker)Wednesday:7:02 PM I leave8:30 PM I’m home (at Alyssa’s)

It’s Sunday night as I write this, and Monday as I edit it. My brain is not 100% but good enough to write this; I’m in no pain sitting or walking; and I’m walking without a cane. (Though carefully, for short distances, on level ground).

But still!

Now the full story

In the beginning

When I was in my 60’s and tried to kneel for a tea ceremony in Japan I found that my right knee was not kneelable. When I tried, my knee produced a spike of agonizing pain. But how often did I have tea ceremonies? No biggie.

A year or two later my knee gave out while I was shoveling the driveway. I fell to the ground and literally screamed. Yes, I know what literally means. The doctor told me I had a torn meniscus. It had ragged edges that were getting caught between the bones as they turned and…yeeeaaaaahhhhhhhh! But how often did that happen? Turns out that the answer is “often enough.” After few near-screams I opted for arthroscopic knee surgery to get the ragged edges cleaned up.

A few years later, I hurt my knee again. They did X-rays, told me that I was bone-on-bone in my right knee and a candidate for knee replacement. But there were other options. I took another option. They injected corticosteroids and hyaluronic acid, a knee-grease made from rooster combs. After some weeks I was able to move normally. But the problem would only get worse over time.

I year or two later I hurt my knee again. I got the injections, but they did not take, so I started making appointments with surgeons. Their schedules were backed up for about three months which was a good thing because by the time I was able to see my first surgeon, time or the injections had gotten my knee back functioning. But still.

About two years ago I injured my knee again, then hurt my back. The combination put me in the emergency room twice in two weeks. I never go to the emergency room. Never. It took me several months to recover from the back and longer for the knee. Plenty of time to see surgeons.

I’d learned, from dealing with Bobbi’s back pain, that I could only get answers by talking to a lot of people, reading a lot on the web, and asking questions that extracted information a bit at a time. I saw six surgeons before I saw Wolfgang Fitz, the doctor that I eventually picked. Five of them were mostly useless. I’m sure that they knew things and could do surgery like champs, but I wanted someone I was confident in, not just someone with a certificate. Most told me little that I hadn’t already learned from Wikipedia. One exception, Dr. Stephen Walsh in Bangor, told me that I was bone on bone in one compartment, but not the whole knee. So I could get a partial knee replacement rather than a total, with less cutting, faster healing, better flexibility. But there were tradeoffs. I might later need a total anyway. He walked me through the imaging so I could see what he saw. Why didn’t any others suggest that? Or propose it and then explain why they rejected it?

I really liked Dr. Walsh—he was a bright, personable guy whose undergraduate work IIRC was in engineering. He had my kind of vibe and I seriously considered him if I could not find anyone in Boston that I liked. I asked him about the tradeoffs between Bangor and Boston, and he was helpful a second time. He said that in Bangor I’d get more personalized care, and in Boston, the latest technology. I asked him what that technology might be, and he told me about Conformis—a customized knee implant built on a 3D model from a CAT scan of my knee. For a tech guy, that sounded at least interesting.

Many vectors point to Dr. Fitz

So I Googled conformis and found conformis.com and a lot of links to background reading. I learn that they had some early problems, long since solved. I looked for surgeons who used Conformis. None in Maine. In Boston there were many, and Dr. Fitz was one of them. This was his third time on my radar. Jacques Gagne, at the rehab center at Blue Hill Memorial Hospital, had both his knees done by Fitz. ProPublica is a public service organization that—among other things—scrapes Medicare data and produces scorecards for surgeons and hospitals based on outcomes for six different kinds of surgery. I’d looked to see who was good for knee surgery, Brigham and Women’s was, and still is the best in Boston. And Doctor Fitz was the best at Brigham and Women’s—and in Boston. So Conformis. Jacques. ProPublica. All pointed Fitzward.

Meeting Dr. Fitz sealed the deal. Of all the surgeons—seven of them now—he was the only one who gave me this sensible advice: whatever else I did, exercise my knee until surgery. I was getting surgery sooner or later, and it would speed my rehab. He told me to get on a recumbent bicycle, starting tomorrow, set it to zero resistance pedal for half an hour and increase resistance a week at a time. Made total sense. Why was he the only one who said that?

He also told me that he could do my knee now—I was qualified—but it wouldn’t give me much benefit. I wasn’t feeling any pain, and my range of motion was about as good as it would be post-surgery. I might also wait for it to get worse before he made it better. He also told me that a partial knee was possible, but he wouldn’t make that decision until he had better imaging. So I decided to wait. And I got on my bike.

About six months later the knee went again. I put myself in Dr. Fitz queue, three months long, hoping that my knee would recover by the time he got to me. He scheduled me for imaging at Brigham and Women’s Faulkner hospital—to decide on a partial and to capture my knee for Conformis. Afterwardhe called me and said that my knee was too far gone for a partial. So total it was. In another couple of months. If it didn’t get better.

It didn’t get better. It got worse. I could still walk long distances, but after five to fifteen minutes my knee would lock up and I’d find myself limping. I could stop, then painfully bend my knee to unlock it and then walk some more, but more painfully. It was annoying. And did I say painful? Painful.

Preoperative

Dr. Fitz scheduled me for a preoperative visit two weeks before surgery at Faulkner. They were very thorough. They started with series of videos that introduced some of the staff, told me about the facility, and what I should expect during and after the procedure. Two very capable, smart, and personable ladies took a thorough medical history, including all my medications. I got an EKG. They drew blood for a panel of tests. They took swabs to check for MERSA and told me that I’d have antibiotics prescribed if the tests were positive. They told me that ( with, what I think was admiration) Dr. Fitz was very particular about how things were done and he got great results—which I already knew from my research. I went upstairs and got new X-rays of both knees.

Before I left they gave me a detailed set of instructions. Stop these medications a week before surgery. These are OK to take until the day before. This is OK on the day of. Nothing to eat after midnight. Only water or clear liquids the morning of. Nothing three hours before. Not even water, which I nearly slipped up on. They gave me a hexachlorophene soap solution with instructions to shower with it the last two nights before the operation and the morning of.

No worries

Was I worried? Not really. I knew there was a risk, and I knew that it was low. Besides, I’d stopped worrying about dying on 9/11. I was flying that day. The night before I had decided to stick with my original ticket, a low-cost one-hopper through Chicago, rather than spending a few extra bucks of my employer’s money and switching to the United non-stop from Boston to Los Angeles that I would usually have taken and that would have landed me early, in flames, in the World Trade Tower in New York. When I got off the plane in Chicago and saw the towers in flames my first thought was “Argh! That could have been me.” My second thought was “If it was me, not my problem.” So I stopped worrying about my own death. It’s never going to be my problem. Dying might be my problem. Other people’s deaths might be my problem. But me dead? Not my problem at all.

Operation Day

The weekend before the operation the whole family got together for Labor Day weekend in Chebeague Island Maine, where we’d spent many lovely weekends with our friends Tom and Peggy Rothschild and their family. Bobbi was now 75. I would soon be (if I didn’t die). So the kids thought it would be nice to celebrate this way.

Daniel, Dana, and baby Siena flew in from the coast. Mira, John, and their kids, Kaya Lucas, and Tasman drove up from Acton. Alyssa and Konrad and their kids Michael, and Sylvia drove up from Somerville with Daniel, Dana, and Siena. It was great to have everyone together in this wonderful place full of family memories and to introduce the new members of the family (all of the kids and most of the husbands) to the Island. I idly thought that if I did die the next week it would be a poetic ending. The whole family gets together to see me one last time. Then I sail off into the great unknown— as sadly Tom had 10 years ago. This was the kind of the strange fantasy that my mind conjures up from time to time. Nothing serious. Kind of amusing to me. But I did not share this with the kids until now. One or two might have been amused. Most would not have been, and probably still are not.

Bobbi and I drove down to Boston on Monday with Dana, Daniel, and Siena, spent the night at Alyssa and Kon’s and on Tuesday, bright and early, we took a Lyft to Faulkner. As usual, I got in the front seat to talk to the driver and see what I could learn. Ebrick was from Haiti. He had a strong accent and a ready smile. He’d been in the country for eight years, worked as a driver for another company and drove for Lyft to pick up extra money. After years of painful headaches, he’d gone to the hospital and found that he had blood leaking into his brain and that he needed surgery. The surgery was done at Brigham and Women’s. He’d left surgery with garbled speech, sometimes unable to even find the words he wanted to say, so he went to rehab to learn how to talk again. He recovered. I’ll say! He talked nonstop. Fortunately, Ebrick had healthcare through his regular job. Otherwise, this father of two and productive worker would be in continuing, agonizing pain, or dead or—well, who knows.

At two minutes before 9:00 Ebrick dropped us at the Faulkner, and I was ready for the next part of my journey.

Which I will tell you about in the next post.

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