Date: 2018-07-25
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Miles today: 0.0

It¢s been six weeks since I returned from the Trail in failure, defeated by my knees once again. There was no physical therapy miracle this time, probably because I had already incorporated the physical therapy exercises I was taught two years ago into my daily warmup routine. The physical therapist and I both agreed to end the sessions after three meetings. The sharp pain has pretty much receded, leaving me with aching and occasionally burning pain in both knees. I love the terms that orthopedic surgeons use to describe pain. Aching, burning, sharp and so forth. It is like a wine tasting without the buzz. How is your pain today? Fruit forward with lots of blackberry, a hint of lingonberry, and lingering tobacco and asphalt. I describe the pain as Muzak, a constant irritant, with occasional clashing cymbals if I go down stairs or stand up from a chair. I can ignore the Muzak unless I wake up at night, and then it¢s like a repetitive Little Drummer Boy, pa rum pum pum pum, playing in my knees.  I¢ve returned to my daily home exercises (physical therapy, dynamic stretching and foam rolling) and walking down to the Y five or six times a week. That half-mile walk is not pleasant, and I feel like I¢m walking in slow motion, with a greatly reduced stride length and cadence. As is usual for me during a hike, both my upper body and legs lost muscle strength, confirming that I started the hike with greater strength than I needed, always my goal. My range of motion and flexibility is unchanged. Needless to say, I¢ve had to limit the leg exercises. On the advice of the physical therapist, I exercise to the point of just being just shy of pain. Sometimes that means no leg presses or leg extensions at all.  There have been days when I couldn¢t even walk the half-mile and have just stayed home. This week is much better. My upper body strength is just about recovered and I¢m able to do my circuit routine, reducing weight on the leg stations and speed on the elliptical trainer. My knees are not close to being hikeable yet and my walking around town is greatly limited. It is starting to drive me a little crazy.Last week, I was finally seen by the orthopedic department at the University of Vermont Medical Center. After x-rays, I met with a nurse practitioner who saw little evidence of cartilage damage and didn¢t feel that knee replacements were indicated. I asked what my options were, and after going through the standard list of weight reduction (I¢m not overweight), physical therapy (done that), braces (check), cortisone injections (ineffective for me), non-steroidal anti-inflammatory drugs (as needed), strengthening (not an issue), and low-impact exercise, she was left with the suggestion that I moderate my activity. In other words, I should act my age (67), give up hiking, and take up competitive rocking. I was not pleased and only after I insisted did she refer me to a surgeon for a consultation. The first available appointment is two months out. I stopped at the liquor store on the way home. Remember the gin-soaked golden raisins craze several years ago for the relief of arthritic pain? It works even better without the fruit. The radiologist¢s report I¢ve since received shows moderate arthritis in the patella femoral compartment and lesser degeneration in the lateral and medial compartments. Surprise, surprise!  It¢s not all in my head. I need new knees, not a new head.The day after the UVM visit, I filled out a ¢contact me¢ card on the website of Mansfield Orthopaedics, affiliated with Copley Hospital in Morristown, about an hour¢s drive away. They have a great reputation locally. They phoned me Wednesday afternoon, took a complete history, emailed me a consent to release medical information form, and have me scheduled with a surgeon at the end of August. The woman I spoke with understood my objectives and matched me up with a surgeon who is a hiker. UVM uses the Smith & Nephew knee replacement system, which is a fine off-the-shelf joint and the one I had selected five years ago. Mansfield uses the ConforMIS approach that uses imaging scans to create custom implants to resurface joint surfaces as necessary and also to correct alignment problems. Their results have been impressive, with significantly faster recovery, greater bone preservation and less trauma. Most of their knee replacements are done on an out-patient basis. We will see how the consultation goes, but for the moment I am greatly encouraged and feeling much better about life! My hope is new knees by Christmas, a test hike next summer,, and if all goes well, another Appalachian Trail Thru-Hike attempt in 2020. I am not ready to sit and rock just yet.  It hasn¢t been all pain and misery since returning. Being with husband Tom again is a true joy. And I had the pleasure of hosting Willow for several days over the Independence Day holiday. I met her at the trailhead at Manchester Center, Vermont, about 2-1/2 hours away. She left much cleaner, a few pounds heavier from good food and drink, and with a pack several pounds lighter. I might not be able to complete my thru-hike, but I take great comfort that some of my gear will. My Zpacks Arc Blast pack fits Willow perfectly and she will enjoy the Zpacks Solplex tent!  I¢ve given some thought to how I will approach my 2020 thru-hike, assuming successful knee replacements. Yes, it is silly to plan such a venture at this stage, but it makes me feel better if I visualize a hike. That¢s how I got through 30 years of tax seasons before retirement. I will do the hike as a flip-flop again, but this time I will start 167 miles south at Rockfish Gap, the southern end of Shenandoah National Park, so that my feet are fully calloused before I get to the nasty Pennsylvania rocks. I will try to time my arrival in Harpers Ferry to coincide with the Flip-Flop Festival. I enjoyed that this year. I hope my cousin Rocky Raccoon can join me once again for at least the start. I won¢t make many changes to my gear, except that I will start stoveless. I will substitute Mountain Laurel Design¢s H2O Sleeve Pack for my Zpacks Multipack to hold my in-camp items. It weighs 0.8 ounces and also works as a daypack for travel and towns and should fit nicely along side my bear canister in the top of my pack. Willow uses one. We learn from each other.I¢ll let you know if I get new knees and journal again in 2020, but don¢t look for the book-length entries of this year!