Dancing with Shiva

Arthroplasty

What a wonderful word. You can really get your tongue around it. Arthroplasty refers to an orthopedic medical procedure wherein joints are surgically disarticulated, bones are rearranged with power tools, bits of steel, titanium and plastic are inserted, reassembled with glue and heavy-duty staples, and followed by months of rehabilitation. Believe it or not, it is (usually) an elective procedure. Wonderful word. Fun to say; not so much fun to experience.

I've gone three rounds with arthroplasty and it has become somewhat of an obsession. Please indulge me for wanting to share my experiences.

If nothing else, arthroplasty is a great word to use every November 19.

First Dance

I had my first experience with arthroplasty in 1998 when I had my left knee replaced. The knee was completely worn out as a result of losing my ACL around 1959. In 1998 this f surgery was very invasive and caused a lot of trauma to the quadriceps muscles. In my case, the incision was about 11 inches long.

Despite the passage of time, I remember the rehab pretty clearly. The goal of rehab is to regain range of motion. After the surgery, the much abused quads tend to grow internal scars and adhesions which restrict flexibility. The rehab exercises break up the internal scars and adhesions. One of my most vivid memories was twice daily exercises to bend my knee by laying on my back on the floor with my left foot flat on a wall and letting gravity (later augmented by various tools) pull my foot toward the floor, thus bending my knee.

As you might imagine this process was be pretty painful and required a lot of codeine. I was listening to a lot of old John Coltrane recordings at the time, particularly "My Favorite Things", a classic American holiday song. Coltrane and his accomplice, McCoy Tyner had their own ideas about this tune. In my opiate addled mind, I could imagine Coltrane and Tyner as Shiva the Destroyer and Shiva the Creator, breaking down the simple melody of "My Favorite Things" and creating it anew. As I grimaced against the pain, I could imagine the same processes of destruction and creation taking place in my leg.

The other vivid memory of the rehab was France beating Brazil 3 to nil in the FIFA Word Cup final in France. Allez les bleus.

Second Dance

My second experience with arthroplasty was about a year later in 1999 when my left hip was replaced. I had broken the hip on my second skiing lesson in 1991, just as Desert Storm was unfolding. The hip (actually, knob on the head of the femur) was screwed back together, but getting the blood supply to he bone is difficult in these cases. By the time I had finished the knee replacement rehab, avascular necrosis had taken over. The surface of the bone was wearing away and shedding bone debris into the joint. 

Hip arthroplasty is a lot less invasive than the knee procedure. There was not much rehab and very few painful dances with Shiva. I sat on our lanai and wrote a paper about bigeye tuna at Cross Seamount.

The United States Women beat China in a shootout for the 1999 FIFA word cup at the Rose Bowl in California. Brandi Chastain rocks.

Third Dance 

My third experience with arthroplasty was just last month. I had my right knee replaced in December of 2013. Over 500,000 knee replacement procedures are done every year in the United States, and the procedure has evolved into what is now euphemistically called "minimally invasive surgery" (MIS). The University of Washington Orthopaedics and Sports Medicine Department serves up informative web site about MIS. My procedure was not exactly the U of W procedure, but the incision is only 7 inches long, 4 inches shorter than in 1998.

Here is what my new knee looks like from the front.

And from the side; notice the staples.

So while the procedure spares some trauma on the quads, and is therefore less invasive, it is still pretty gruesome. If you don't like graphic gore, don't click on this link to the U of W site showing someone else's knee surgery in progress.

So far, the rehab has been pretty easy. Oxycodone had replace codeine as the pain-killer of choice. After two weeks, there wasn't much pain; I gave up opiates so that I could enjoy wine with friends over the holidays. A month from the surgery, I'm walking pretty well with about 130 degrees of motion and not much pain. Coltrane now seems a bit intense for listening while doing the exercises, so I'm to listening to simpler stuff, Jimmy Reed and John Lee Hooker.

The first two dances were wonderfully successful and have given me 15 years of mobility. This third dance is not finished, but I'm making really good progress. I look forward to many more years of walking in the rain forests of Hawaii, the deserts of Utah, and the monuments of Rajasthan with Karen.

There are no epic sporting events to watch on TV at the moment so, I'm streaming  Breaking Bad on Netflix. (Walter Whites understands the medical enterprise.) I have a faint hope that the Kochi Winter Games or perhaps even the Superbowl may prove epic.

Next Dance

Creation and destruction is a classic dualism. These are the processes that drive all life, from the cells in our bodies, to the grand biogeochemical cycles on Earth, to the evolution of the Cosmos. One never stops dancing with Lord Shiva; to stop the dance is to die.

I intend to keep dancing with Shiva until I dance my prostheses into my grave.

Wow Indeed

The Saturday May 10, 2013 Honolulu Star Advertiser (a.k.a. the Amortizer) featured the headline "WOW!" in huge bold type on the front page. Two stories were featured above the fold.

The first, and to my mind the most important, story was is the much publicised increase in atmospheric carbon dioxide above 400 parts per million. The rate of increase in CO2 content continues unabated and is confirmation of the global lack of commitment to renewable energy sources. Wow number 1.

The second story concerned the plans by the developer cabal to build a massive cluster of high rise buildings to be built in conjunction with the planned transit stops in the Kakaako region of Honolulu. The Sierra Club like the idea because it gets housing off agricultural land into high density urban areas. Well maybe. The article goes on to describe the many planned pedestrian-friendly amenities.

The Kakaako area is only slightly above sea level now, and as the CO2 article mentions, the sea level is rising. The streets of Kakaako will probably be below sea level by the time all this stuff gets built. The rail will be elevated. Will the pedestrian- friendly amenities also be elevated, like the High Line park in Manhattan? Or will Kakaako residents be issued snorkels for use when walking about? Now number 2.

Kudos to the staff of the Amortizer for so ironically juxtaposing these two news items to bring attention to the short sighted planners who bring us Honolulu's future.

Wow indeed.

Horn Please

On the Road in Northern India, October 2012

We used many modes of transportation on our OAT Heart of India tour - planes, trains (including the Delhi Metro), buses, taxis, tuk-tuks,  rickshaws, boats, camels, shanks mares, and even hot-air balloons. But the tour was essentially a road trip, and our daily life was centered on a big white tour bus. I love road trips especially in a bus. One sits up high and has a great view. Impromptu stops are possible, and on and OAT trip, highly likely. Streets and highways of India offer a window into the life of the country and display the inevitable contrasts and contractions of a rapidly developing economy and rapidly changing society.

Transportation in India is fully optimized. Almost every conceivable mode of transportation is utilized, everywhere. Roads are used for transportation of goods and people in whatever conveyance seems appropriate.

Cow herders in Rajasthan move their herds between summer and winter pastures along highway 84 (the main road between Delhi and Jaipur), mostly on the shoulder, but sometimes in the left ("slow") lane. There are oxcarts in busy roundabouts in New Delhi. Cows are everywhere - in big cities, in small towns, in the  countryside; on main roads, in narrow ancient streets, in stairways leading to homes. In Europe, bike racers refer to median dividers, speed bumps, cross walks as "road furniture"; cows are the "road furniture" of India.  It is not uncommon to see a group of cows dividing the direction of travel by laying about in the middle of the road, or marking the edges of the road by moseying along along the shoulder, or simply crossing from one side to the other ("Why did the cow cross the road?" ... "To make the truck blow its horn.").

Indian cities are ancient, and so are many city streets. The Chandi Chowk bazaar of Old Delhi, between the Red Fort and the Jama Masjid, was one of the celebrated wonders of the ancient world. The area retains this heritage in New Delhi; it is a vibrant market area, its narrow ancient streets still crowded with shoppers and merchants. It is certainly no place for a tour bus, but walking, pushcarts, rickshaws, donkeys are just fine.

Rights of way are not clear with this diversity traffic. Every truck encourages the vehicle behind to "Blow Horn", or more poetically to "Horn Please". So, you may hear the occasional toot of a horn. At times, it seems as if it is the horn that makes the vehicle move. Our always helpful tour leader provided the following rough guide to Indian horn etiquette:

Cars: Short blasts (urgent) indicate supremacy, i.e. in clearing dogs, rickshaws and pedestrians from path. Long blasts (desperate) denote supplication, i.e. to oncoming trucks "I am going too fast to stop, so unless you slow down we shall both die," In extreme cases, this may be accompanied by flashing of headlights (frantic).

Single blast (casual): "I have seen someone of of India's 1.2 billion whom I recognize", "There is a bird in the road which at this speed could go through my windscreen", or "I have not blown my horn for several minutes."

Trucks an buses: All horn signals have the same meaning, "I have an all-up weight of approximately 12.5 tons and have no intention of stopping, even if I could". This signal my be emphasized by the use of headlamps.

10th incarnation of Shiva was an articulated tanker.

You might expect a lot of aggravation and hostility given all the congestion and honking, but altercations are rare. There are 1.2 billion people in India, and getting along seems to be a priority. People behave good-naturedly about delays and congestion. The cow crossing the road, is not on a personal mission to disrupt your day. It is simply crossing the road,