Steve's Mountain Bike Page
Turlock, California

I had a total knee replacement on my right knee June 1st, 2007 and a total knee replacement on my left knee July 10, 2007. Click here for more information on total knee replacement. Click here to see a drawing of the knee replacement components. Here are X-rays of my knees. 

I ruined my knees many years ago by running too much. After my fifth surgery I took up mountain biking in May of 2000. I was doing remarkably well and my knees were doing fine until May 2001 when both went out again. After six months of no improvement I had surgeries six and seven on both knees again in November of 2001. I got back on the bike in 2002 and I managed to ride at least once a week until February 2007. In May of 2007 MRIs confirmed I had absolutely no cartilage under either patella so knee replacement was my only option. I had one knee replaced in June and the other replaced in July of 2007.

August 20, 2008. I saw my orthopedist for a "one year" follow-up to my knee replacements. X-rays showed the implants are fine, there has been absolutely no wear on them, nor any kind of allergic reaction, and they are as good as they could be. One the down side, the doctor confirmed I have patellar tendonitis in both knees from doing too much riding too soon, and it could take several months of no riding and physical therapy to get it under control. If I ever get back on the bike again I hope I have the sense to take it easy and build up very slowly. I've also recently been in the hospital more than once, and for more than one undiagnosed problem. So I guess it is time to step back and get some serious medical attention anyway. 

July 7, 2008. In the past few days I have come to the realization that the pain in both knees is not from my surgeries. I am fairly certain I have patellar tendonitis from doing too much riding. In the first two weeks of June I did about eight rides totaling at least 200 miles. Given that I normally rode only once per week for 25 - 30 miles, it is not surprising that the tendons have become inflamed. Obviously, taking three drugs during my rides was a big mistake. It masked my pain, allowing me to ride much more than I should have. Those drugs no longer mask the pain, so rather than risk further damage I have to bite the bullet and just stop riding for a while. I hope it is not long but I know it can take many weeks or even months to heal such an injury. It's quite a bummer to be off work for the summer, yet not be able to ride, and I may not get to ride at Tahoe for a second consecutive summer! 

June 22, 2008. Since my last entry, in which I described doing five rides in eight days for about 125 miles, the knees have been really sore. However, I've always wanted to ride in beautiful Sedona, AZ. It would soon be too hot to ride down there so I took a quick road trip there and did three consecutive rides. By the last ride the knees were really killing me and they have been hurting a lot ever since. After doing Downieville yesterday, which really caused quite a bit of pain, I think I need to take some time off. Despite taking lots of narcotic pain relievers and many Motrin, they hurt almost as much as before my surgeries. Hopefully some time off the bike will settle them down.

June 1, 2008. A year ago today I was lying in a hospital bed with indescribable pain, and an IV of morphine and a couple other tubes in me, after having the ends of my tibia and femur sawed off and replaced by cobalt caps with polyethylene surfaces, and the underside of my patella resurfaced with polyethylene. Adding to my already considerable anguish and pain was the knowledge that somehow I had to recover from this in time to have it done again in just six weeks, on the other knee. The past year has been quite difficult and I seem to be among that small group that will require more than a year to fully recover. Although I still have sufficient pain to warrant taking oxycontin twice a day, I began biking again early this year. I take an additional narcotic pain killer, plus four Motrin before each ride and I have little to no pain while riding. But the knees get pretty sore afterward, and for the next few days. However, there is no comparison to the pain I used to suffer and I am certainly glad I had both knees replaced.

Last Memorial Day weekend I did 25 miles at Annadel, CA, on Saturday, and then 30 miles at Auburn, CA, on Monday. With my one year anniversary upcoming I decided to see what the knees could really take. So I did two more 25ish mile rides in the next few days for a total of four rides and 100+ miles in one week! I generally discourage counting miles, since every trail is different, but these are my most common rides and they have been GPS'd to death by dozens of people. I'm not very fast and my technical skills, previously pretty meager anyway, are now even worse since I'm terrified of falling on my knees. But four long rides in one week, regardless of mileage, is certainly a major milestone for me. Today I did another 25 mile ride at Annadel, CA,  which gave me five rides totaling about 125 miles, in just eight days. 

April 20, 2008. I have been doing a pretty tough 25 mile ride at Auburn, California once a week for the past two months. I was actually ready to do a much longer ride yesterday, but for the first time ever I forgot my water bladder. I have started doing a second ride each Tuesday at New Melones. So last week I got in three rides totaling about 55 miles, in an eight day period. It's been years since I could do multiple rides in one week. And motivating myself for that second ride is not easy because each Tuesday morning I have to lead a Botany class field trip, which puts a good bit of stress on the knees. But if I want to improve my fitness level for the rapidly approaching season at Lake Tahoe I need to ride more than once per week. I saw my surgeon last week and he is quite pleased with my progress. I thought my range of motion was still pretty pathetic but he was generally satisfied. He'd like me to get about another five degrees on my right knee, which, despite being my first replacement, seems to be behind the left. He said biking is about the best thing ever invented for the knee and he wants me to keep at it. I have every intention of doing so!

March 28, 2008. I went out to New Melones yesterday to see if I could ride twice in one week. I was feeling pretty frisky so I tried going up the Tower Climb switchbacks, which I quit riding in 2002 because it hurt my knees too much. I was doing really well but I stalled and fell over the side of the trail on a really steep part. Both the bike and I did a side somersault and I rolled over on my head and landed on my back. Later in the day my neck and left foot started hurting, so I went to the doctor this morning. X-rays showed no break in the foot but there was a suspicious spot on one of my neck bones. So they put one of those foam collars on my neck and sent me off for a CT scan. I sweated it out until nearly 5 pm, at which time I got the call that there was no break. I was supposed to have a stress test a few days ago so I had to stop taking Oxycontin, which I've been on for the past seven months. Well, I discovered I'm addicted to it and I had such severe withdrawal symptoms that I had to cancel the appointment. I also discovered my knees hurt more than I thought, and riding the exercise bike was not very comfortable. So I'm back on the Oxycontin, at least for a while. I have not slept in many months and practically every bone in my body aches  when I get out of bed. I thought it might be my medications or perhaps my sleep apnea. But I woke up in the middle of the night a few days ago and I realized it was my mattress. I talked to my chiropractor and he suggested a Tempur-Pedic mattress, the expensive foam type used in hospitals for bed-ridden people. Yes, it was expensive, but it really works! I feel so much better already. And with a 20 year warranty it could be the last mattress I ever have to buy!

March 16, 2008. The past two weeks I have been able to do a fairly difficult 25 mile ride at Auburn, California. The knees generally feel fairly good while riding, and even the next day they aren't too bad if I take it easy. But a few days later they get much worse. Yesterday was a particularly difficult ride because it became quite cold and wet, and the slippery trails made the climbing much more difficult. I have been terrified of falling and yesterday I had my first fall, and a good one at that, on my right knee. Of course I was wearing knee pads, but it still hurt. I am seriously allergic to neoprene and high percentages of polypropylene, and finding serious knee protection has been very difficult and costly. I finally found some knee pads I am not allergic to, but they have been cutting my knees to shreds. My range of motion is still pretty poor and the knees still hurt by afternoon every day. I still have not been able to ride more than once per week. But I guess I'll have to settle for what I can do. 

January 13, 2008. After my last ride on December 26th I waited a few days and the knees felt up to another ride at New Melones. That seemed to go well, so on January 1st I rode there again, this time with clipless pedals on my '07 SJ. But the ergonomics of a recumbent  must be quite different than a real mountain bike because I barely had the flexibility to use the clipless pedals. On the recumbent exercise bike I've been able to move the seat forward with my knees right to the handlebars. So I rode mostly unclipped. That was very discouraging and I am quite concerned that I do not have the flexibility I thought I had. On top of that the knees became quite sore and I had to lay off the bike until today. I did about 90 minutes today on my '05 SJ using flat pedals and I'll have to wait a few days to see if there are any ill effects.

December 26, 2007. I've barely been out of town the past 10 months so I decided to take a drive out to New Melones on Christmas day. I took my bike should I get up enough courage to ride a trail. However, for the first time ever I forgot a critical piece of equipment, my helmet. It did not seem very wise to try my first trail ride in 10 months without a helmet so I rode on pavement for about 40 minutes. That didn't go too badly and the next day I did not seem to have any lingering effects from it. So today I went back out there with the intention of riding a trail for 30 - 40 minutes. I put some flat pedals on my backup bike, put on some new heavy duty knee/shin pads, and I set out in about 40 degree weather with freezing cold winds. I was pretty scared the first few minutes and every rock and downhill seemed out to get me. However, I eventually relaxed, felt pretty comfortable, and I ended up doing 90 minutes. Sure it was pretty slow and I used my granny gear quite a bit. However, I made every single hill climb, and I only stopped a few times to take photos. It was a lot easier than I had imagined it would be after being off so long. While pushing up the hills I had a strange sensation I had never felt before, no pain under my patellas! I hope I didn't overdue it. Obviously the implants are fine, but I hope the supporting tendons and ligaments were not too stressed. I'll know in a day or two if this was a mistake. I only stopped a few times to take photos, here they are.

December 11, 2007. I saw my surgeon yesterday and he says the implants are perfect and perhaps the best he's ever done. Here are X-rays of both knees. The only thing I can do now is manage the pain with medication, allowing me to keep up the home physical therapy and exercise bike. I'm now at five and six months post surgery. Six months for recovery is fairly typical, but one year is not unusual. I have a feeling I may be one of those "one year' people. It's hardly perceptible but I know I am slowly improving just from doing routine tasks, such as putting my socks on or getting in and out of my car, which get a bit easier everyday. 

November 15, 2007.  Well, the riding around the neighborhood didn't last very long, perhaps 10 - 14 days. The knees became quite inflamed and sore, so I had to stop riding. They are still quite sore and I'm getting pretty discouraged.

October 23, 2007. A few days ago I replaced the clipless pedals on my backup bike with flats and I rode around the neighborhood for 15 minutes. Since then I have gradually worked up to 45 minutes. When I first get on the bike I can barely make a full revolution, but the knees quickly gain more flexion. Despite wearing a helmet and knee/shin pads, I feel extremely fragile and shaky, and every car, person or dog who comes within 100 yards of me makes me very nervous. The knees need a lot of icing afterward to calm them down. Riding a trail seems months away.

October 8, 2007. I saw my surgeon today and he is pleased with my progression. I have plenty of flexibility in both knees and I walk fairly normally. But the first new knee lags behind the second, and any more than 15 minutes on the exercise bike or 20 minutes of walking brings on a lot of pain. I have mostly manageable pain with oxycontin, but serious pain without it. The doctor said the pain usually lasts 3-6 months, but for some it can last a full year. I'm just coming up to the third month for the second surgery and into the fourth month for the first surgery. Having both surgeries done so close together has no doubt lengthened the healing process. But once they heal I'm done. On the bright side I asked the doctor how much mountain biking I'll really be able to do and he said "unlimited", the materials have been tested for millions of cycles for a 400 lb. man. So I asked if I could ride 30 miles three times per week? And he said "of course"

September 23, 2007. About a week ago the inflammation subsided, I began to get a hint of improvement, and I have indeed improved in the past week. So I began to increase my stationary cycling and walking by a miniscule amount every few days. The knees have gotten slightly stronger, but the first new knee is lagging considerably behind the second.

September 10, 2007. The new pain reliever, oxycontin, has helped a bit and electrical stimulation of my quads has helped to strengthen them. However, two days ago I tried doing about 30 minutes of walking and I have been in considerable pain since. I really didn't feel up to teaching a full load yet so I dropped one of the classes I was teaching. I'll have to make it up in the spring.

August 29, 2007. I saw my surgeon today and he was very pleased with the new knees. Despite my pain they are functioning as they should. Some of the pain is not unexpected given how little time I had between the two surgeries, which put a lot of stress prematurely on the first new knee. But he thinks much of the pain is just due to the fact that my quads are still incredibly weak, so the knees do not track properly and they have little support. I have been in a "Catch 22" situation for quite a while. The knees hurt too much to do my PT seriously, which then makes them weaker and more painful. The doctor gave me a more powerful and longer lasting pain medication, oxycontin, and he ordered some changes in my physical therapy. But he said my knees had absolutely no other problems internally, so if I could get some strength in my quads they should do well. 

August 14, 2007. I thought I was feeling pretty good a few days ago so I upped my stationary biking to 10 minutes twice a day and I also walked without a cane for 15 minutes outdoors. Both knees became extremely painful and I had to cut out several home PT sessions. I am becoming quite concerned that after nearly two and a half months, even my right knee is still in serious pain.

August 7, 2007. I made a mistake on-line and failed to renew my pain medication. After going 1 1/2 days without it I realized I still hurt quite a bit and I could not even sleep without it. After straightening out the prescription I needed it so badly that I decided to try driving myself to the drug store. Fortunately it is fairly close to home so I made it, despite having a manual transmission. 

July 28, 2007. Here is what both knees looked like, right knee at day 57, and left knee at day 17.

July 25, 2007. I started outpatient physical therapy again at Golden Bear Physical Therapy in Turlock and we pretty much started over with the left knee while also doing some work on the right knee.

July 23, 2007. I saw my surgeon's assistant and he seemed pretty happy with the surgery, and the staples were removed. 

July 13 - 22, 2007. With two bad knees I was not as mobile around the house as previously, but the rehab progressed fairly well. I walked down the block with my walker and then returned using my cane for the first time. Here's is what my knee looked like on day six.

July 13, 2007. Since my right, first new knee, was not fully functional I did not do as much walking around as I would have liked to before being discharged from the hospital today. Tommie Lou got me home and in my recliner. But before she left I wanted to make sure I could get around. Good thing I did, because I could not get out of the recliner! It took a lot of effort for both of us to get me up. We then got my computer chair, raised it way up, and I sat in that for a few days until I could get in and out of the recliner. Tim came by later in the day to stay with me.

July 11, 2007. The physical therapist got me up and walking around a bit. However, since my right knee was only six weeks out of surgery, it was pretty difficult walking, and I did very little. However, I could definitely tell that this knee would progress more quickly than the first one, and I made 100 degrees of flexion on the CPM machine even before leaving the hospital.

July 10, 2007. Surgery day for the left knee. I arrived at Stanislaus Surgical Hospital (SSH) at about 5:30 am, accompanied by my good buddy Linda, who has taken me on my last five surgeries. I met my anesthesiologist and I asked to be put under immediately after I signed all the appropriate papers. However, for some reason I didn't go out and I was still awake when I got into the surgery room. Again Dr. Michael Purnell, of Modesto OrthMed Center implanted the DePuy Orthopaedics Rotating Platform knee. Linda had to work that day so I had another good buddy, Tommie Lou, come by after the surgery to hear what the surgeon had to say post-op. Again, the damage was quite substantial and we did the right thing by replacing the knee. I was awake by 11 am, most of the rest of the day, and I definitely had less pain than the last surgery.

July 6, 2007. I saw my orthopedist's surgical assistant (who assisted with my last surgery) today and we decided to proceed with replacing the left knee next Tuesday, July 10th. The new knee is still a bit swollen and not quite as flexible as we would like (108 degrees). He preferred 115 degrees of flexion, but otherwise he seemed to have no reservations about proceeding. I've been able to walk around without a cane for 2-3 weeks, but with a slight to moderate limp that varies throughout the day. I've also been able to drive for about 2 weeks and I don't really have much pain except when I really try to force my stretching exercises or when I can't find a suitable sleeping position. But I have resisted taking pain medications except just before my PT sessions. 

But the new knee is already performing better in some PT exercises than the remaining damaged left knee, e.g. leg presses and partial squats. A week ago I was having serious reservations about continuing on and I wish I had 1-2 more weeks of PT. But given surgery room scheduling backlogs, that was not possible. However, I have been improving nearly every day in many ways and it is time to get this over with. I figure if they can do two knees at once I'll certainly be much better off now than if both were done at once.

July 5, 2007. I have been walking without a cane for 2-3 weeks, but sometimes with a bit of a stiff limp. The PT has been paying off since I could bike quite a bite better, most exercises seemed much easier, and I got 108 degree range of motion.

July 26, 2007. We are moving into a new Science building this summer and I had to go into work to clean my office and get my things ready for boxing up. Despite a still stiff knee, I had little trouble driving. 

June 18, 2007. I had my first of thrice weekly PT sessions at Golden Bear Physical Therapy in Turlock. The folks there are really nice, knowledgeable, and not so into the "no pain, no gain" philosophy of my home Physical Therapist. I actually look forward to sessions with them, whereas I dreaded sessions with my in home PT.

June 17, 2007. I felt fairly self-sufficient so Tim headed home. I think I walked three times for 40 minutes out doors and I also rode the bike for 30 minutes, three times that day. 

June 15, 2007. A biking buddy had loaned me a trainer to place my own bike on but it seemed a bit too awkward and dangerous to use so I had Tim buy me a pretty nice recumbent trainer from Costco. Today I managed to do get complete rotations on it so I did about about 15 minutes on it. Here is a photo of me literally on about my second or third rotation.

June 13, 2007. The staples were removed and this is what the incision looked like the next day. I think I had graduated from my walker to a cane about this time.

June 5, 2007. My home Physical Therapist arrived and he said my muscles were already plenty strong and resisting increasing my range of motion. So for the two weeks of home PT we concentrated almost exclusively on increasing my range of motion, which was pretty limited. On June 12 I finally reached the max, 110 degrees on the CPM machine. Here is a photo of what my incision looked like that day.

June 4, 2007. After being laid up for four days, getting into the car and getting home was fairly difficult. Linda stayed for a while until Tim (UncleMTB) showed up. The logistics of setting me up at home proved to be more difficult than we had anticipated.

June 2, 2007. I seem to recall the major pain subsiding by noon and not long after that a Physical Therapist (PT) got me up and walking around! It was a strange feeling but once I convinced myself that it could be done, and with very little pain, I did several laps around the reception area. However, getting in and out of bed was extremely painful. The hospital only had 23 beds, mostly two to a room, but there were only a handfull of patients. So the service and attention was quite good. My room mate had undergone bilateral knee replacement a few days earlier. I had tried to get both of my knees done at once, but after seeing what my roomie had to go through I'm glad I didn't. Despite having surgery several days before me, he was still confined to his bed. On my second day he had a lot of problems with blood loss and attempted blood transfusions, and even as I was leaving on the fourth day he was still being prepared for more blood transfusions. I'm very squeamish and with several tubes sticking out of me I was having a difficult time coping with just my own problems. 

June 1, 2007. Surgery day for the right knee. I arrived at Stanislaus Surgical Hospital (SSH) at about 5:30 am, accompanied by my good buddy Linda, who has taken me on my last four surgeries. She is a wonderful, kind and compassionate person and I could think of no one I would rather have with me. I usually get pretty worked up and I have had serious panic attacks in the past, so after I met my anesthesiologist I asked to be put under immediately after I signed all the appropriate papers. So I do not recall meeting my surgeon, Dr. Michael Purnell, of Modesto OrthMed Center. He implanted the DePuy Orthopaedics Rotating Platform knee.

According to Linda post surgery the doctor said that once he got in there the damage was quite substantial and we did the right thing by replacing the knee. I remember little of the rest of the day except calls for several different medications, trying to find the one that worked best to relieve excruciating pain. I seem to recall that both Morphine and Demerol were used. My knee was wrapped in a moderately rigid foam type cast with ice water constantly circulating around the knee. The whole leg was also in a CPM (Continuous Passive Motion) machine, which constant extends and flexes the knee. Periodically the angle of flexion is increased as more is tolerated. The movement is generally rather soothing, until it reaches the peak flexion, at which time it really hurts!

May 25, 2007. In the past week my knees seemed to have given up. Despite a more powerful pain reliever I've been in almost unbearable pain, staying off my feet, and icing the knees for most of the day. I have to take a double dose of sleeping pills and go to bed with ice on my knees to get to sleep, and I do not sleep for very long. If the first surgery were not one week away I'm not sure I could survive. I am also concerned about getting the other knee to the next surgery on July 10th. I can only hope the new knee will help me cope with the old one for another six weeks. 

May 14, 2007. I got the results from my MRIs today and there is absolutely no cartilage left under either patella. Quite frankly I am relieved to finally hear that. The only option is total knee replacement and I have the first one scheduled for June 1st. The second one is scheduled for July 10. I asked for double surgery but there are many good reasons for not having them done at the same time: risk of infection using the same tools for both procedures, loose fat deposits in the blood or something like that, under anesthetic for a much longer period, much greater blood loss, much slower and more difficult recovery, etc. But it is a moot point anyway because the next available surgery date for doing both at the same time is also in mid July (they need to schedule double the amount of time). 

I'm in a lot of pain, I have trouble sleeping, and I need to get on this ASAP. I feel very comfortable with this surgeon, he has done thousands of these, and he uses prosthetics which provide the greatest range of motion and should last a lifetime. He also wants his patients to bike and he has no problem with real XC mountain biking. He would just be concerned about aggressive DH, which might cause a severe blow to the side of the knee. Anyone who knows me knows I can't do that stuff anyway. 

But regardless of whether I can bike again, I need to have this done. Pain relief and at least a semi-normal life are my immediate goals. But based on what my surgeon says, as well as what I've heard from many other bikers with knee replacements, I think I'll be biking again. I been overwhelmed with the support I have received from the mountain biking community and I thank you all! A very special thanks to Russ Sears, who encouraged me to seek another orthopedist!

April 23, 2007. I saw a new orthopedist today. He thinks my knees are pretty good, still reasonable cartilage, about half as normal. And otherwise very structurally sound and strong. He reviewed the images from my past surgeries and he thinks all the pain is coming from under the patella. The bad news is that there is no way to fix that without knee replacement. However, he thinks knee replacement of an otherwise fairly healthy knee just to fix the patella is pretty drastic. He said further arthroscopic surgery seems pointless, and since over the years I have tried everything possible he would have recommended, it appears there may be only two options, do nothing or replace the knees. There seems to be no middle ground. I'm going to get an MRI as soon as possible which might show what's going on under the patella.

However, on the bright side, he wants his knee replacement patients to bike, including mountain biking! He is confident the new materials will last most people a lifetime. However, next time I have to be clear what he means by mountain biking. Some people think it means riding five miles on a bike path a couple times a week. But he is a sports medicine physician and I suspect he knows what I'm talking about.

But I do feel very comfortable with him and although we didn't discuss it too much pending the MRI results, it seemed he is willing to replace them if I'm really certain that's what I want. But right now I have no idea what to do. Hopefully the MRI can help answer that.

March 29, 2007. I've "fired" my orthopedist and I have an appointment with a new one on April 23. The knees really haven't improved at all in the past few months and I have to take prescription sleeping pills to help me sleep at night. I take four different prescription and non-prescription pain relievers and anti-inflammatories as soon as I get out of bed in the morning, but they do very little to ease the pain throughout the day. However, I seriously doubt I'll go for the knee replacements since that would probably be the end of biking. I am hoping we can try another round of arthroscopic surgery first. In the meantime I am going nuts, I am very depressed, and I'm just trying to hang on until April 23. 

March 3, 2007. I saw my orthopedist two days ago, he gave me cortisone injections, and he presented a good case for waiting on the knee replacements. He does 150 a year so at least I know he has plenty of experience. He told me it was not possible to resurface them when they wear out and they only last about 15 years. And more importantly, as they wear out small fragments from the surface get near the bone and start dissolving it away. That's called osteolysis. So that "revision surgery" involves taking off even more bone. This certainly sounds much different than what another mountain biker with an artificial knee told me. I have also talked to a Bay Area orthopedist who does 400 knee replacements per year and he said biking would not be a good idea. If I can't bike after replacement then I might be better off waiting and just riding when I can. 

I've been doing a lot of homework on this and as I expected, and my orthopedist confirmed, I am not a candidate for the minimally invasive technique (MIS) because my bones are too big. I would require bigger devices, which are too big to get through a small incision. And since my left knee has been opened up twice I have considerable scar tissue, which also prevents using the MIS technique. X-rays showed that although I have less than half the normal cartilage, there is still a reasonable amount and I am not yet bone on bone. I've asked my primary care physician to send me to an orthopedist who does the Stryker technique another mountain biker told me about. In the meantime I am getting a more powerful anti-inflammatory, a more serious pain reliever for nights, and some prescription sleeping pills to help me sleep. I have had these flair-ups in the past for 4-6 weeks, but not in quite a while, not this badly, and not lasting so long. Perhaps if I can get the inflammation down I can ride for another year or two. 

February 27, 2007. The knees have been hurting more than ever lately, sometimes intolerably so.  I have been off the bike since February 3rd. I am now convinced that knee replacement is my only alternative and I am waiting to see an orthopedist. 

February 2, 2007. The year 2006 turned out to be my best biking year ever. After recovering from overdoing it at the end of 2005 the knees held up fairly well. They still hurt most of the time but I managed to get in one big Saturday ride every week until the middle of December. I rode at high altitude in the Sierras from June though October and I did some pretty tough rides (The Punisher), as well as several of 40 - 45 miles. The knees still hurt a lot the next day and a good bit the following two or three days. But I discovered that taking it really easy the next day (not mowing the lawn, etc.), sitting around icing them all day, lots of Motrin, Tylenol Arthritis and an occasional prescription pain reliever made a big difference. Also, after my last surgeries I gave up pulling up on the pedals because it hurt. However, while climbing at Annadel in May the knees hurt so much I decided to start pulling to lessen the pain. It worked quite well and I soon began concentrating on pulling on the pedals rather than pushing while climbing. This technique has really cut down on the climbing pain and I attribute it to allowing me to add one mid week ride at New Melones fairly often. I became a bit faster and gained more endurance so I upped my mileages considerably. But by mid December I had overdone it again, was in serious pain, and I had to skip a couple weeks and get some cortisone injections again. I still know total knee replacement is in my future all too soon, but I've received some encouraging news from two other mountain bikers. Russ Sears has had great results from his knee replacement and he has given me information on the techniques and materials his doctor used. Recently I also met 72 year old Badass Bob who was racing again only three months after a total knee replacement. I'll wait as long as possible but this is encouraging news.

December 28, 2006. The knees have been hurting quite a bit since late November and I've had to skip a few weekends of riding. I finally got in to see my orthopedist, who gave me cortisone injections in both knees. 

January 9, 2006. Since I had a good bit of time off over the Christmas holiday I was bored and I got a bit cocky. I rode the usual 31 mile route at Annadel on December 24 and then did 22 - 23 miles or so at New Melones on the 27th and 29th. This is the first time I've ridden three times in one week in several years and it was a big mistake. The knees started hurting by the 30th and they got nearly unbearable the 31st. Fortunately my orthopedist was working on January 2 and he got me in immediately for some cortisone injections. Within two days the inflammation greatly subsided and I did an easy three hour ride at New Melones, stopping frequently to take photos, on the 7th. Hopefully they will be OK and I've learned my lesson. I've been able to get away with an occasional second ride in one week but three rides is definitely too much. 

August 15, 2005. Today I saw my doctor and after I explained my reaction to the last injections he has recommended ceasing all Synvisc injections. As the literature has noted, and both my doctors have confirmed, the likelihood of an adverse reaction seems to increase the more injections you receive. And I have received 30, probably more that just about anyone. Both my doctors have seen similar, and even much worse reactions, some requiring immediate medical attention. My current doctor suggested that after 30 Synvisc injections my body may have developed an immune response, much like to a bee sting. He is concerned that another injection might induce anaphylactic shock. Needless to say I am done with Synvisc injections. I'm really bummed about that since they have provided a good bit of relief over the past three years. Next week he will try some cortisone injections. We did briefly discuss total knee replacement but he didn't think it would be wise to mountain bike after total knee replacement. 

August 10, 2005. The day after my last Synvisc injections on the 8th my knees really started to hurt, I could barley walk, and by the evening they felt worse than ever! I couldn't even sleep after taking two Darvocet. All I could think about was this is the end of my biking. So I spent most of today researching the problem and I called my former doctor, who has given me a total of 30 injections over the past three years. Apparently about 3% of patients get serious inflammation and/or pain after an injection, and the probability increases the more injections you get. I've probably had more injections than just about anybody. However, the studies showed, and my former doctor confirmed that the pain should only last a few days, and no more than one week. So that has given me some hope, and I am cautiously optimistic. For now I'm taking lots of Motrin and Darvocet, and icing very frequently. Even if the pain subsides by the 15th, my next scheduled injection date, I have decided to forego more injections at least one more week. If I get this much pain again then I will probably give up on these injections. Coincidentally, today I met a co-worker who is just three months out of a total knee replacement. He is pain free, moving quite well, and he said he wished he had done it sooner. I'm still going to put that off until absolutely necessary, i.e., when I can no longer ride at all and all hope of recovery is gone. 

August 8, 2005. I just started my sixth series of Synvisc injections today. Due to insurance changes, I have a new doctor, he uses a different injection technique, and it really hurt! I'm not looking forward to the next two in the following weeks. On the brighter side, I have been able to slip in an easy three hour ride at New Melones on most Wednesdays since the beginning of this year. It has really made a difference in my fitness level, but I'm still way behind most everybody else I ride with. Buying a really good light and starting night riding was one of the best decisions I've made. 

December 9, 2004. I just started my fifth series of Synvisc injections today. Three days ago I saw my elbow surgeon and he said I could resume biking and that I should try some light weight lifting. I actually rode nearly two hours at New Melones (GH) last weekend anyway. The arm is healed enough that I can't hurt it, but it will get inflamed to let me know if I overdo it. I still can't bomb downhill too fast because that puts a strain on the forearm muscles which were cut. I've started doing some light weights mostly just to get back full range of motion. Yesterday I bought a Niterider Flame Thrower HID + LED headlight so perhaps I can work in an easy weekday ride to speed up getting back into shape.

October 21, 2004. Today I had an ulnar nerve transposition on my left elbow. The area from the elbow to two outside fingers has been numb/tingling for well over two years now and it recently became nearly unbearable at times. The doctor said the ulnar nerve was compressed, possibly from "trauma to the elbow", and if I let it go much longer I could lose use of the muscles in my left hand. Even after seven knee surgeries, I always get pretty worked up about any surgery. But I couldn't risk losing the use of my left hand and that front brake.

 Elbow incision photo graphic content.

My best buddy Linda, who took me to my last four knee surgeries, accompanied me again. She kept me together until I got to the hospital and received a sedative, which put me out fairly quickly, saving me from two hours of working myself into a frenzy while awaiting the surgery. Although I usually have a lot of trouble coming out of the anesthetic, it wasn't too bad this time. The surgeon always comes out afterwards to report how it went and what to expect. However, I've never recalled even one post-op report because I'm always too groggy. But from what Linda says I always seem cogent and I ask intelligent questions. According to her I asked how long until I could bike and he said perhaps four weeks. That is surprising news because he had initially told me it would be at least six weeks. But perhaps he thinks mountain biking is like road biking. The procedure involves detaching the muscles at the elbow joint, re-routing the ulnar nerve, and then reattaching the muscles. Since muscle attachments are cut it can take several months for full recovery. As most of you know there is a lot more braking and use of the forearm muscles on the trails. I'll just have to wait and see how it goes. So far I have very little pain and I can move all my fingers. But even mildly squeezing a toothpaste tube caused quite a bit of pain. Thanks again Linda! I don't know what I'd do without you.

Ironically, I have not missed a single weekly ride since mid January of this year. I've had some bad knee flare-ups but backing off by doing just three hour rides at New Melones (GH) got them under control enough to do some pretty amazing rides this past summer. 

May 18, 2004. I've been riding once a week fairly consistently since mid January and I just finished my fourth series of Synvisc injections last week. For about the past five weeks I've been doing a 25+ mile loop at Annadel which involves about 3,000 ft. of climbing. After the recent injections the knees felt pretty good so I pushed my luck a bit by staying in a slightly higher gear than I normally do on the long climbs. That was a mistake since the knees are still quite sore three days later. Hopefully they'll recover soon and I'll have better sense next time. 

January 2, 2004. The knees have really been hurting for about the last 18 days so I haven't been riding. Walking, even wearing my knee braces, and even sitting, they hurt. I'm very getting concerned and discouraged.

October 27, 2003. For the past two months the knees have been quite sore so I've been riding 2-3 hours every other week, mostly locally. I finished another series of Synvisc injections last week and the knees felt good enough to ride a bit more seriously. With the time change and winter fast approaching in the high country I did one more trip down the Cannell Trail and Plunge two days ago. For the most part the knees were OK, but I over did it on a few occasions.

August 20, 2003. The knees are really hurting lately. I usually have to take two Darvocet for a couple of nights after a big ride but I've also had to take some during the day lately. My goal was to make it through the summer and I almost made it. I'm going to stop riding for a while and hope they get better. 

May 18, 2003. It was exactly one year ago today that I got back on the trails following double knee surgery and a one year layoff. Except for two periods of 1-2 months, I've been able to ride at least once a week. The knees currently feel about as good as they have in a long time. I must still wear knee braces all the time but at least I don't have any non walking pain nor throbbing at night. It could be that the Synvisc injections are now kicking in and/or the fact that I've been doing some strengthening exercises twice a week (straight leg raises with ankle weights), stretching, and taking a liquid glucosamine/chondroitin supplement. When the knees felt this good last summer I rode three times a week and it finally caught up to me, necessitating a one month layoff. This time I'm going to try to restrain myself and hopefully at least make it through the summer.

March 6, 2003. Surprisingly, my insurance company gave approval for a second series of Synvisc injections and I had the first one today. The knees have been bothering me quite a bit lately and I'm beginning to question how long I should continue biking. Ignoring knee pain and continuing to run up to 100 miles per week many years ago led to this problem. I'm getting concerned about causing even more serious long term damage. 

February 1, 2003. I'm currently on another strong dose of Prednisone (the last for quite a while my Dr. insists) and anxiously awaiting an emergency visit next week to the Dr. who gave me those Synvisc injections last summer. I don't know if he'll do them again. However, I've had enough experience with these knees to know this is very serious. Although I currently "own" two bikes (my GT awaiting a frame replacement, and my new Specialized Epic Disc on order) I have no bike and I can't ride anyway! Bummer.

January 23, 2003. My knees have been killing me the past week or so. Since my bike frame cracked and I'm waiting for a warranty replacement I can't do any riding anyway. Once my components are transferred to the new frame I will be selling that bike. I ordered a Specialized Epic Disc but that will take perhaps as much as a month to arrive. Therefore, I won't be riding anytime soon anyway. I hope the month layoff will allow the knees to improve. I don't know why I'm buying a new bike when I'm not even sure I'll be able to ride it. However, I have to do something to keep my hopes up.

November 14, 2002. It's been about four weeks since I last rode, I just finished a two week dose of Prednisone, and it is the one year anniversary of my last surgeries. I tried riding about 45 minutes along the canals outside of town. The knees didn't improve once I warmed up so I didn't do anymore. I'm going to try going out a little bit every other day and see what happens. No trails for a while. 

October 28, 2002. About eight days ago the knees started hurting quite seriously again. Not the everyday type hurting I always have, but more serious, like the times they've gone out on me in the past. I've been off since then and I'm taking massive doses of Motrin and icing them several times a day. I see a doctor in a few days and I'm going to beg for a steroidal anti-inflammatory. I hope the problems are not starting over again because my surgeon had no idea what to do next.

September 17, 2002. Three days ago I repeated my 34 mile ride in the mountains above Lake Tahoe and the knees still feel pretty good. I haven't worn my knee braces in about two weeks. The knees still ache a bit by the end of the day and I have to take it easy going down stairs. I still have to wear the braces while biking (I tried a few minutes without). There is no way to know if the cartilage is still peeling off with each ride. I'll just have to continue riding until the knees let me know when to stop.

August 31, 2002. After doing 34 miles at 8,000 - 9,000 feet, with about 2,500 feet of climbing, above Lake Tahoe two days ago the knees feel as good as they have in more than a year. They still ache a bit but I haven't had to wear the braces for two days now. I hope it keeps up!

August 10, 2002. The knees seemed to start improving earlier in the week. I went for most of two days without wearing the braces and I'm only taking Motrin once a day in the morning. On my ride at Fort Ord today, which involved major sustained climbing, they felt really good. Perhaps the Synvisc is kicking in or the riding is strengthening the knees, providing more support. I hope it keeps up.

July 3, 2002. I had my last Synvisc injection today. It can take 8-12 weeks to get the full affect, if any, so I'll just have to wait and see what happens. After my last ride on June 24 the knees really ached for about a week. I've pretty much adjusted to having pain when I walk without knee braces, but I can't take aching throughout the day and especially in bed at night. I'll try riding in three days to see if that was just a one time thing or it's all starting over again.

June 21, 2002. Since I had no adverse reaction to last weeks injection, I had Synvisc injections in both knees yesterday. Supposedly it can take one or two months to feel improvement. Coincidentally, the doctor's nurse had them two years ago and she says they really helped her.

June 15, 2002. It has now been nearly 24 hours since my first Synvisc injection in my right knee and there is no hint of allergic reaction. The treatment consists of three injections at one week intervals. If no problems arise I'll get injections in both knees the next two times and one in the left knee after that. I'm not supposed to bike for three days after each injection so I'll have to bike between Tuesdays and Thursdays the next few weeks.

June 3, 2002. Yesterday I did a little over three-hour ride at Salmon Falls. I stayed in the small front chain ring and walked the very long and steep hills. The knees were a little more sore than usual but pretty much the same by this morning.

May 27, 2002. Despite only a one day layoff, I did the same route at New Melones (GH) as I did May 25, but slightly less than 2 1/2 hours. The knees took quite a while to loosen up so perhaps I may be overdoing it. The knees continue to bother me quite a bit when I stand or walk without wearing braces so I will go ahead with the Synvisc injections.

May 25, 2002. Although the knees were a bit sore during the middle of last week, they calmed down and permitted me to ride for 2 1/2 hours at New Melones (GH). Once they warmed up they felt pretty good. Yesterday I got notice that the Synvisc injections have been approved. If they provide even the slightest extra cushioning I will be pleased. 

May 18, 2002. It's now been one full year since I last rode on a trail and six full months since my surgeries. I figured I had nothing to lose by trying a short (two hour) ride on the trails at New Melones (GH). It went pretty well so I've started updating the rides page.
Update May 20, 2002. So far the knees feel no worse, perhaps even slightly better. I'm now cautiously optimistic and I'll try the trails again on May 25. 

May 1, 2002. I haven't ridden at all since at least mid March. I'm not hurting as much and I can walk down stairs much better than before. I went to the orthopedists office today to get approval to try the Synvisc injections I rejected last fall. Since I'm desperate I figure I have nothing to lose by trying them. It should take a few weeks to get the approval.

March 4, 2002. After photographing the Iron Angel Mountain bike race yesterday I have been inspired to wait until mid May, which will mark one full year off and six months since my surgeries, before giving up on riding. I have done several nearly 30 minute rides on pavement the past few days and kept up my leg exercises. I'll just keep at it and see how things go.

March 1, 2002. After a week on Methylprednisolone, lots of Motrin, and taking it easy the pain has gone and I'm back to just aching. I've just been doing the prescribed straight leg raises every day and they seem to be helping. Perhaps I'll try a few light weights soon. I don't know when I'll try the bike again. 

February 8, 2002. I rode along the canals for 80 minutes one week ago and all the pre-surgery pain and throbbing at night has returned. I'm stopping all activities that affect my knees until the pain goes away. It affects my sleeping, normal everyday activities and my job. I'm getting very discouraged. Biking again seems impossible. At some point in the near future I'm going to have to give up and sell my brand new bike. If anyone is interested in it send me an email.

January 31, 2002. The past week I've done a one hour ride and two nearly 90 minute rides on the dirt roads along the irrigation canals in Turlock. I stay in a moderately low gear and if I ice the knees afterwards I have little or no new aches or pains the following day. Both knees still ache a bit throughout the day whether I bike or not. Today I saw my surgeon, hopefully for the last time. He seemed very pleased, and he was quite optimistic since healing generally takes six months and I'm not even half way there yet. Unfortunately, he could not answer the $64,000 question....will the patellar cartilage peeling continue in the future? However, he said I shouldn't let that concern affect my lifestyle, try the trails when I feel ready. My right quadriceps are about gone and I wouldn't even think about trying a hill now. However, perhaps in a month or two.

January 17, 2002. My surgeon told me to wait eight weeks before trying biking. The time was up on January 11 so I did an easy 20 minutes on a stationary bike that day. It wasn't too bad so I did 20 minutes again after a day off. I'm now riding outdoors on my bike every other day. I'll probably try one hour tomorrow. The next day the knees hurt a bit but not much more than not riding at all. Right now I can't imagine getting on a trail. I'll just have to wait and see what happens.

December 20, 2001. For the past month my knees seemed to be healing. The left one felt fairly good and, although the right one still gave me trouble going down stairs, at least it didn't hurt anymore. However, both have been aching the past two days. I saw my surgeon today and he said I'd have setbacks. He still thinks I'm doing well and he wants me to do some very simple exercises. He said I should try light biking in three weeks. I'm already tired of the aching and I'm not very optimistic I'll ever ride much again. We'll see.

November 20, 2001. I've been walking, very slowly, without crutches for the past three days and I have a good bit of pain in my right knee while standing if it is not tightly wrapped. Today I saw my surgeon. He seemed pleased and he thinks I'm doing a lot better than after my two previous surgeries. During the surgery he performed patellar shaving (chondroplasty) by smoothing huge areas of flaking cartilage from under both patella's. Cartilage is sensitive, and once injured (probably from my running years ago), it may peel, like old paint. The doctor also removed a large plica, a fold of tissue in the lining of the knee joint. Here is a link to information on plica syndrome and a quote: "Chronic plica problems develop when the medial plica is irritated by certain exercises that involve repeatedly bending and straightening the knee, such as biking or using a stair machine". Here is an encouraging quote from that site "Since your knee can function just fine without the medial plica, expect a full recovery". The current plan is for me to do absolutely nothing for one full month to allow all the tissues to heal and then to slowly start rehabilitation. However, given the tendency for my patellar cartilage to flake off, I'm skeptical that I will ever do much mountain biking again. I am not supposed to even think about it for at least three months. Below are a few images, click on a thumbnail for a larger view.

Update: when the steri-strips (used in place of stitches) were changed I was reminded that I am allergic to them. For more than a week both knees have had massive, oozing, and itchy poison oak-like rashes.

Click on an image for larger view
Left patella flaking cartilage should be smooth	Right patella flaking cartilage should be smooth	Plica (X) in right knee

November 14, 2001, Surgery Day.  It's about midnight, I just woke up from a long drugged sleep, but I need to move around to get rid of the lingering anesthetic still in my system. Despite having both knees done at once I feel pretty good and I can get about reasonably well on just two crutches. I took a serious sedative on the way to the hospital and that, coupled with the fact that they immediately prepped me for surgery, made it a lot easier and less stressful than my five previous surgeries. My good buddy Linda, who accompanied me on the last two surgeries was again a godsend. At the pre-op visit with the anesthesiologist she made it clear that I always take a long time to come out of the anesthetic, and I usually get quite nauseous. In fact, the horrible anesthetic experiences are the worst memories from all my surgeries. I once had a full week post-op stay in the hospital due to problems with an anesthetic! Perhaps the anesthesiologist made some adjustments because this time I came out quite quickly, and with little of my usual nausea and side effects. Post-op I was too groggy to remember anything the surgeon said. However, according to Linda, he seemed quite pleased. There was a lot of damage under both patella's so he smoothed a lot of cartilage, took out many fragments (of what I don't know) and he really stressed that this time there would be an "aggressive rehabilitation", whatever that means. I hope it means some serious biking. Linda asked about future mountain biking but he was rather noncommittal. She couldn't tell if he was referring to the near or long term. I want to compliment all the staff at the Same Day Surgery Clinic in Modesto for making a previously traumatic experience quite tolerable this time. I especially owe my buddy Linda more than I can possibly repay for her help and moral support, both pre and post op. I see the surgeon for a post-op visit on Nov. 20th so everything should become clear at that time. I should also have some internal pictures of my knees to post.

October 23, 2001. Today I saw my local orthopedic surgeon. He agreed with me that the Synvisc injections would probably be a waste of time. They only treat symptoms, they are not a cure. I'm scheduled for arthroscopic surgery on both knees on November 14. It will involve smoothing damaged cartilage under both patella's, searching for the "loose body" in my right knee, and whatever else shows up while he is in there. I am very excited that I may be near a cure, yet I am already a bit scared. Three of my previous five operations were arthroscopic and I didn't feel a thing. However, I am an unabashed sissy when it comes to blood, cutting, needles and IV's, and I always have a tough time coming out of the anesthetic. I'm really looking forward to getting back on the bike so I hope this works.

October 12, 2001. Today I saw the knee specialist in San Francisco. An x-ray taken at a different angle revealed a "loose body", that could be a small bone chip or something similar, in my right knee. However, he couldn't be sure what it is. He recommended trying injections of Synvisc while also scheduling arthroscopic surgery for both knees. Hopefully my orthopedic surgeon will agree and we can get moving on this as soon as possible. 

September 26, 2001. I have an appointment with a knee specialist in San Francisco in about two weeks. The chiropractor said biking would be good for my back and it was time to test the knees anyway. Last weekend I did 90 and 120 minute rides on the dirt roads along the canals out of  Turlock. It was great to get out and I felt fine. However, the knees have hurt quite a bit since then. This is the first time I got the new bike dirty.

September 12, 2001. I just finished one week on another dose of Methylprednisolone. Perhaps my knees have improved slightly, however, I still can't walk without discomfort. I'm still waiting for the new physician referral but I haven't pressed my doctor since my back went out recently. I herniated a disc many years ago and a recent x-ray showed the disc has almost completely degenerated. Although my back is much better, I couldn't ride now even if I wanted. I'm reminded of what Mickey Mantle once said "If I had known I was going to live this long I would have taken better care of myself".

August 23, 2001. Still no real improvement in my knees. I saw my orthopedic surgeon today and he admitted he didn't know what else he could do for me. He is arranging for me to see another specialist in San Francisco. 

July 12, 2001. The past two days I've felt like perhaps some healing is taking place. I even rode around town a bit yesterday. I finally got to see the orthopedist who did my last two surgeries. He didn't think it was time to operate yet, and based on the photos of the inside of my knees, he didn't think it would do much good anyway. He gave me a shot of cortisone in the worst knee (dosage limitations prevented him from doing both at once), and a prescription for Methylprednisolone (a powerful steroid). I'm quite squeamish, but contrary to all the horror stories I've heard about cortisone shots, it was no big deal. 

June 9, 2001. My new frame, a GT iDrive 3.0, to replace my cracked XCR-3000 came in today. It's pretty nice. I want to thank the guys at GT and Fun Sport Bikes in Modesto for the quick service. I couldn't resist taking it for a very easy 20 minutes around the neighborhood. It is evident, however, that I have a long way to go before my knees will be ready to do much more.

June 5, 2001. I have been getting iontophoresis and ultasound at the physical therapist. Today I started on Prednisone, a powerful anti-inflammatory steroid. Coincidentally, I discovered a crack in my bike frame last week which rendered it un-rideable. Fortunately it has a lifetime warranty and GT is sending a new frame. Needless to say, I'm pretty bummed out.

May 20, 2001. My knees were still a bit sore from the 16th but I went on a big ride in the mountains near Briceberg with Jim and a young downhiller named Ben.

May 16, 2001. While doing some seated calf raises in the gym I got sharp pains in both knees.

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