6 Weeks After Surgery

Well, not quite; my first appointment with Dr. Wang since surgery fell three days short of the actual milestone.  Not that I cared;  it felt like a get-out of-Florida-jail-early card! Although I had to admit I would miss the opportunity to choose between swimming in either a nearly always empty outdoor Olympic-size pool ($4) or the Atlantic, free but less attractive now because of the seaweed and rapidly warming waters of the impending hurricane season. I had resumed my aquatic exercise in mid-May, swimming 20 laps the first time and working up to 40 today, just 10 short of "normal," without any problem.

Lake Lytal Aquatic Center, West Palm Beach

Dr. Wang must have viewed my "screens" before entering the examination room. He barely glanced at my exposed knee, which had healed so remarkably that the continued swelling was more visible than the scar. I'm not sure what I expected from our encounter, but he seemed to be looking for validation that going for the partial instead of full-knee replacement had been the right decision. Was he concerned about second guessing by me or another orthopedic surgeon? I acknowledged that I hadn't experienced any sharp pain in my right knee since the operation, but I also asked if the stiffness ever would go away. He assured me it would lessen with time.

My major takeaways from the five minutes we spent together were: 

• "You're no longer under any restrictions, but listen to your body."

• "Most people get what they need out of physical therapy within six to eight weeks.  If you're concerned about your extension try pressing down on your knee as hard as you can while you're resting your foot on an ottoman or another surface. You won't hurt it."

• "Mobic is a pretty benign anti-inflammatory.  Nadzeya can give you another prescription and an order for more PT in New York if you think you need it."

It's weird.  I had gone from being adamantly opposed to pain medication to fearing its loss.  And a scrip for PT felt like a security blanket.

47 Pianos here I come.  In a compression sock, which Christine had assured me was all the range among millennials.  When I told her I had lived in the same apartment since 1978 she asked me if I had a fireplace because "wasn't that how they heated homes back then?"

1 Month After Surgery

After three sessions of out-of-home physical therapy, I hit a speed bump, perhaps because I'd been working myself too hard with up to five miles of biking and three miles of walking on my off days.  After whining to Christine, the no-nonsense clinic manager, about continuing stiffness and moderate pain in my knee despite frequent icings, she suggested I try reducing my daily activities and reconsider my decision a week earlier to forego any painkillers.  "Remember," she admonished, "you just had your KNEE replaced."

It had taken me more than a week to get my first appointment at ApexNetwork Physical Therapy.  I knew the location--just over the intracoastal from the Folly--well because of its proximity to the spot where I park my bike when I swim in the ocean.  Even more importantly, the building had indoor and outdoor staircases of four flights which enabled me to practice going up and down. I'd told Christine during my preliminary evaluation that stair-climbing was my number-one priority before returning to New York City.

The actual PT began with ten minutes on a stationery bicycle, followed by exercises I'd already mostly been doing at home thanks to Ariele and Matthew. Both Christine and Summer, the other young therapist, and Ingrid, a pleasant and extremely conscientious intern from Pittsburgh, spent as much time on their computers documenting their efforts as they did providing special equipment and mostly telling me how to work my quads. They also massaged my right knee and provided range-of-motion manipulation in addition to electrical stimulation and machine icing.  

I started to realize that my expectations, shaped by the positive professional feedback I had received to date, might be a tad unrealistic, recalling what Summer had mentioned at our first session:  returning to "normal" would take months, not weeks, even though I had undergone only a partial knee replacement.  And what even constituted "normal" anymore, given the fact that I will be 72 in September, just four months from now?  Age-related fatigue the year before already had decreased my swimming distance from a mile (72 laps) to 50 laps.  Perhaps I would need to reduce my biking and walking, too.

At the same time, my attitude about the benefits of professional PT became increasingly ambivalent.  My routine didn't include any stair climbing and I wondered if the other patients--including a frail woman I called Miss Daisy because of the Black driver who picked her up in a BMW luxury sedan--were exercising at home as consistently as I was, often twice a day by the pool, avoiding the sun by switching sides from morning to afternoon.  The outdoor set-up couldn't have been sweeter.

Still, I decided to stick with professional PT for at least as long as I remained in Florida. While I'd always insisted I didn't need a personal trainer to exercise, there's no question that Summer's encouragement while measuring my flexion and extension at the end of each session DID help me push myself harder. And the location gave me a regular opportunity to climb stairs on my own both before and after therapy which, more than anything else, convinced me I was ready to return to New York.

2 Weeks After Surgery

I won't lie:  during my first post-op visit at the Hospital for Special Surgery, I couldn't wait to tell Ms. Zhylinskaya that I had stopped taking all pain medication, including meloxicam, an anti-inflammatory.  

There was other good news to report, too:  

• On her fourth and last visit, Ariele had showed me how to resume my regular morning push-ups (100) and sit-ups (300) by positioning a chair to help me get up from the ground. 

• "Thank you for making my job so easy," Chella, the home nurse, had said when she discharged me three days earlier.  

• Before releasing me from home services, Matthew, the young PT evaluator who informed me that his position required a doctorate, noted that my flexion had improved by ten degrees. "You still need to work on your extension, though," he added, eager to show me a few more exercises.  For one, he assumed a prone position on the couch in the Florida room to work his legs with the red resistance band he had given me.  The scene could have served as the opening for gerontological porn movie, at least in the mind of this Dirty Old Man.

Before I had the opportunity to share any G-rated evidence with Ms. Zhylinskaya, she marveled "Your recovery has been awesome" and directed me to the X-ray room. Fifteen minutes later, we were looking at my "screens" on the computer where the metal plate that had been attached to my right femur looked like the arbitrary borders the British had established for Iran in the Middle East.

A comparison of my knees before and after surgery showed significantly more cushion between my patella and femur.

December 2024

April 2025

Ms. Zhylinskaya then removed the bandage from my knee, exposing the six-inch vertical incision for the first time.  "It's healing well," she observed.  "The stitches will dissolve on their own and you don't have to worry about getting it wet when you shower.  Just keep it clean with a little soap and water."

"Can I resume swimming?"

"Not until four weeks, after all the scabbing disappears."

I left with a prescription for up to 24 sessions of physical therapy and assurances that booking a return flight back to New York for the day after my six-week follow-up with Dr. Wang would not be a problem.

1 Week After Surgery

Old routines die hard.  My recovery had progressed sufficiently to accompany Chris to Walmart for our weekly grocery shopping which increased my distance-walked by the end of the day to more than two miles.  AND I drove the Folly Chariot home, which came as a real relief because it meant that transportation to my first follow-up visit at the Hospital for Special Surgery and out-of-home PT visits wouldn't be a problem with both Chris and Thom gone in just a few days.  

Constipation was no longer a threat because I stopped taking oxycodone two days earlier with a literary assist from Demon Copperhead.  His descent into opiate addiction after a knee injury had been both a timely and resonant cautionary tale in spite of Ms. Zhylinskaya's pre-surgical exhortations to "stay ahead of the pain."

My energy level had increased, too:  I purchased ingredients for both tapenade and chopped liver in anticipation of a visit from Patrick and Marty Saturday night.  They were in Palm Beach for the Easter weekend.

4 Days After Surgery

When the in-home physical therapist didn't contact me on Monday, I called Pinnacle Home Health Care.  The squeaky wheel gets the oil.  Ariele got in touch almost immediately. And irritatingly, three times, to schedule my first appointment in a couple of hours.  Her flakiness didn't encourage optimism, nor did I care that she had fallen behind schedule because of a weekend trip to Aruba.  I definitely was in Grumpy Old Man mode.

But by the end of our first session, my attitude had softened.  She and her blond pony walked me through a set of more challenging exercises and she followed up with an e-mail that included video links to each of them.

I do enjoy the company of a personable, pretty woman who asks me for my chopped liver recipe.  I even felt comfortable enough to offer some unsolicited advice, after she compared me to her grandfather when I refused to consider the purchase of home PT equipment on the grounds that I probably would be using it only for a few weeks.

"You might want to hold off on comparisons to your grandfather," I teased.  "Some of your clients may be sensitive about their advancing age."

Not that Ariele would have much reason to empathize.  I would have guessed she was in her early thirties but during one of her four increasingly pleasant and productive visits, she mentioned that she had a 24-year-old son!

Thom, who had flown to New York the morning after my surgery for work, would have loved her, too.  Ariele was well-put-together in black Lululemon yoga pants and perfectly manicured nails that matched her lavender top. 

"Who's your new best friend?" Chris asked after Ariele left the second time.  He had heard us discussing the mind-expansion benefits of travel.

2 Days After Surgery

What a difference a day makes, and not in a good way.  The anesthesia administered at the hospital finally wore off and I definitely needed the walker to do several laps around the Folly pool.  

"Everybody crashes on the third day," Chris observed.

Fortunately, we had grocery-shopped just before my surgery, and he had a week of meals planned.  All I really had to do was read, nap and watch video.  North Woods, Demon Copperhead, Life After Life, Big Boys, Schindler's List, and Small Things Like These provided worthwhile diversion for the first two weeks.  In spite of a guest appearance by Sissy Spacek, my favorite actress since Carrie (and wonderful as always!), I just couldn't get through Dying for Sex.  Didn't some of us live through that already?

1 Day After Surgery

Chella, my Haitian home nurse, looked genuinely stunned, when I answered her knock at the door.

"Where's your walker?" she asked.

"I forgot to use it," I said sheepishly.

Chella took my blood pressure, a little elevated, and examined the incision, recording the results on a tablet that she also asked me to sign. After double-checking to make sure that I was taking my medicine as prescribed, she left, assuring me that "Everything is looking very good," on her way out the door.

Her entire visit lasted around 15 minutes.  

Matthew, my home physical therapy evaluator, arrived half an hour later in a vehicle considerably more modest than the Mercedes Chella had driven.  He took some baseline measurements of my "extension" (how straight I could extend my leg) and "flexion" (how far back I could bend my knee), two words I initially confused but which would become important indicators of my recovery.

"Your flexion is already at 100 degrees," he reported.  "That's pretty good for a day after surgery."

I told Matthew the exercises provided by Maddison, the virtual HSS physical therapist, weren't very challenging.  He suggested a few others, allowing me to shoot video instructions, and leaving behind a red resistance band he retrieved from his car.

"Your regular therapist will call you next week to set up some sessions," he explained.  "Would you like two visits or three?"

Gung ho, I opted for three.  It seemed recovery was going to be easier than I anticipated.

Knee Day

The closure of A1A due to the presence of you-know-who nearly made me late for my 9:30 appointment for knee surgery, the event for which I'd put my life on hold since December.  I refused to discuss the future pending its outcome.

A very well put together woman of a certain age ushered me into the surgical waiting room.  In no time at all, we were discussing the pros and cons of life in Palm Beach.  She told me she was sorry to have sold her home in the Hamptons more than a decade earlier.  "Things have changed here so much since then," she sighed.  Until she expertly hooked up an IV to my left arm, I had no idea she was a nurse but the initials R.N. on her name tag confirmed it.  A hat would have crushed her perfectly coiffed hair.

She was observant, too.  "Is that Dupuytren's disease on your left hand?"  

"Both hands, actually.  I held up my deformed finger and palms.  I've already had two needle aponeurotomies on my left one.  As you can see they didn't do much good."

She recommended a hand surgeon at HSS.  "He probably can do something for you," she encouraged. I noted his name on my phone, but shuddered at the prospect of more surgery.  The condition hadn't got a lot worse in the four years since my last needle aponeurotomy.  It mostly interfered with doing my push ups, and Dr. Berkman had suggested a successful hack:  instead of trying to flatten my hands on the floor, grip a small pair of dumbbells while doing them.

Stephen Nygard, MD pulled apart the curtains to explain how he would administer the anesthesia, first using the IV and then giving me a shot in the back after I was wheeled into the operating room.  He also told me they were running 45 minutes behind. Fortunately, they had let me keep my phone but I couldn't really concentrate.

A man was recovering from his surgery in the curtained room next to me.  I overheard a nurse giving him instructions before eavesdropping on a tense conversation he seemed to be having with his wife.  "You know you don't have to do everything yourself right away," she admonished.  "Just let me try it!" he said, dismissively.  Lengthy silence.  "OK then, you do it." 

Dr. Wang arrived.  "So we're going ahead with a partial replacement on your right knee," he said, smiling. 

"Do I have a choice?" I replied, a little stunned.  "I thought we decided that was the right course."

"We did, but a patient can always change their mind.  I showed your screens to a colleague and he agreed you make an excellent candidate for a partial."

"Then let's stick with that," I said.  He marked my right knee with a marker and left me wondering if the consulting doctor was the Irish orthopedic surgeon Dr. Berkman had described as "the whale" at HSS and who had been booked too far in advance for me even to consider.

The nurse returned and urged me to try urinating one last time.  Even though I hadn't had anything to eat or drink since the night before, I still managed to pee a little.  Dr. Nygard was waiting outside when I opened the door and escorted me back to my gurney before replacing the IV bag with the first dose of anesthesia and telling me to count backward from twelve.

He seemed like the kind of guy you could joke with.  "Will I be awake to meet the robot?" I asked.  "If we hurry," he said.  I was wheeled into a very bright room with more people than I would have expected in green scrubs.  "Where's the robot?" I asked, loudly. Several people laughed and somebody pointed out a nondescript piece of machinery over my right shoulder.  

Did I really say (or just think) "You could at least have painted a happy face on it!"

*  *  *  *  *

I came to in a sunny room with Chris seated by my gurney.  "Dr. Wang called to say everything had gone fine," he reported.  "I asked if that meant I should come get you but he said somebody else would call about that."  It seemed like somebody had made an erroneous assumption about our relationship.  I had listed him as my ride, not my emergency contact.

A narrow bandage, about a foot long, ran vertically above and below my knee.  I still couldn't feel much other than some stiffness.

A pleasant woman dressed like a nurse offered me something to drink.  I took coffee in lieu of Coke Zero and all the cookies that were offered.  "We can't let you go until you pee," she said.  I used a walker to go into the bathroom but my bladder hadn't filled sufficiently so I kept drinking and asking her questions until it did.  She had emigrated from Cuba, an interesting contrast to my morning nurse.  Both women gave me a hug when it was time to go.

I was able to get into the Folly Chariot, already loaded with a walker for home use, without difficulty.  The mid-afternoon coffee made me more talkative than usual on the ride and when we got back to the Folly.  In fact, I had more trouble falling asleep than getting around the house, although I was thankful I had purchased a plastic urinal at Walmart to avoid the long walk to my bathroom a couple of times that night.

Virtual PT

Nobody at the Hospital for Special Surgery holds your hand, that's for sure.  How can they, when everything is done electronically, supplemented by occasional phone calls from people you've never met?

A pleasant HSS representative called to schedule some "virtual" physical therapy prior to my surgery.  She seemed flummoxed when I asked if it would be possible to do it in person.

"You can, but this way the physical therapist will be able to actually see any potential structural problems inside your home."  She also gently let me know that I could use the same portal to pay my outstanding $1,000 bill.  I had opted out of text messaging after getting one too many reminders two months prior to my actual surgery.

"Wouldn't it be better to wait until I've received the necessary surgical pre-clearance from my doctor?"

"Of course," she replied.  "Let me check on the status of that for you when I get off the phone."

It's a good thing she did:  either my doctor's office forgot to do a necessary blood sugar test two weeks earlier, or HSS never ordered it.  I had to go in a second time the next day.  Ms. Zhylinskaya had called that SNAFU right, although the required "MAKO protocol CT scan without contrast" had gone smoothly enough at the Good Samaritan Medical Center across the street from HSS.  I thought this was the pricey out-of-pocket item but the young, light-in-the-loafers technician set me straight.  

"No, Medicare covers the scan, but probably not the robotic arm," he guessed when I elaborated.

 "Don't ever get old," I counseled while putting my pants back on.  

"Are you kidding?" he laughed.  "I broke my tibia in multiple places a couple of years ago in the Dominican Republic."

How?

"I was cliff jumping into the ocean with a girlfriend.  I didn't leap out far enough past the rocks.  It was an 18-foot drop."  He needed somebody like I had in Rio before I went hang gliding.

I wasn't happy about having to wait several minutes before Maddison Dischino, PT, DPT appeared on my screen, mostly because I had been instructed to sign on to the portal ten minutes prior to our appointment.

Ms. Dischino cheerfully explained what to expect after surgery, beginning with two weeks of in-home PT, and the likelihood of PT continuing for another six to eight weeks in a clinic.  She also e-mailed a pamphlet with suggested exercises.

Of course I had questions, first and foremost how my Achilles tendonitis, which had been getting better, might affect my PT.  She recommended that I purchase a "night splint" which I could continue to wear post-surgery so long as someone could help me put it on and take it off.  I ordered one from Amazon immediately.  If I had done my homework, I could have saved myself $25.

When I told Ms. Dischino I was going to be on my own for nearly a week after my home PT ended and asked if would be able to walk to a local clinic for PT, she advised me to limit the distance to 1.5 miles.

For the record, she never asked for a virtual tour of the Folly, perhaps because I already had answered several structural questions on the portal.  Nor did she follow-up on her offer to determine if I would be eligible for virtual PT program through HSS. 

"I'm sorry, I thought my administrative team had gotten back to you," she apologized when I e-mailed her two days later.

Experimental Procedure

Dr. Wang called to discuss the MRI taken two days earlier.  The imaging already had been uploaded to the Hospital for Special Surgery patient portal.  It provides three-dimensional views of the affected body part and you can watch the results like an experimental movie.  Imagine black and white footage of a highly agitated lava lamp in motion and you'll get an idea.

"It pretty much confirms what we saw on the X-ray," he explained.  "Your arthritis is mostly confined to the right knee cap area which makes you a good candidate for partial replacement."

"What happens if it doesn't fix the problem?" I asked.

"We can go back in and do a full replacement if we have to," he answered.

Thinking ahead, I reasoned no matter the outcome, it would give me a road map for what to do about my other knee.  Although some cartilage remains on the left side, it seemed to hurt as much and as often as the right knee where the osteoarthritis is more visible.  If I wasn't happy with the partial knee replacement, I could opt for a full replacement in the left knee and then compare the results.

I hung up with a plan.

An hour later, while I was shopping for groceries in Walmart, Dr. Wang's office manager called to break the bad news.  

"There will be a $1,000 charge not covered by insurance for the robotic arm that will assist Dr. Wang in the surgery."

"Why doesn't Medicare cover it?" I asked, a little taken aback at the cost even though it seemed a small price to pay if it means I get to stay in my apartment.

"It's considered an experimental procedure."

"Oh."

Second Opinion

"I've got to tell you, I feel like I'm cheating on Dr. Ranawat," I confessed.  Dr. Wang barely grinned.  Who knows what the internal politics at the Hospital for Special Surgery are like?

New X-rays hadn't been necessary.  My visit had begun with a young man who re-entered the answers to questions I already had answered online, and Nadzeya Zhylinskaya, a very blond physician's assistant, asked most of them again.  Say something once, why say it again?, a line from a Talking Heads song, definitely doesn't apply in American health care.  Nearly every person you encounter asks you for your date of birth to make sure you're the patient they think you are.  Sure, it's a way to make an identification, but Joe thinks the protocol has become a bit dehumanizing.

After explaining my reason for seeking a second opinion, I put Ms. Zhylinskaya, who once worked at the  Hospital for Special Surgery in New York, on the spot.  "What would you do if you were in my position?" She thought for a minute.

"It's probably easier to get the necessary tests and the pre-surgical clearances done in New York because HSS can take care of it all.  Here you're on your own.  But do you really want to spend a couple of months recovering from your surgery in New York if it's a cool and rainy spring instead of down here where you can go outside for a walk whenever you feel up to it?" 

Ms. Zhylinskaya made a good point.   At the same time, she reminded me of a drug rep for Purdue Pharma.  Her refrain to "stay ahead of the pain" in recovery seemed excessive.

Initially, my consultation with Dr. Wang didn't differ materially from the one I had with Dr. Ranawat but by the time he left the examination room I decided to have the surgery in Florida, although I still had a question.  As if he'd been reading my mind, he re-entered while I was tying my shoes.

"You know, given the fact that the only pain you're experiencing has been confined to the knee cap, you're a really good candidate for a partial knee replacement."

"Yeah, Dr. Ranawat mentioned that but I didn't want to hear any more about it."

"You might want to consider it.  Recent studies indicate that outcomes are just as good. Some of my patients who opt for a full replacement are less satisfied than those who don't because the surgery is a lot more invasive and they experience discomfort in areas where they didn't feel it previously.

I nodded while recalling Dr. Ranawat's ambivalence about partial knee replacements in our earlier, albeit brief discussion.

"It would significantly reduce your recovery time," Dr. Wang added mildly.  Say no more, I thought.  Once again, my desire to return to New York outweighed almost everything.

Dr. Wang briefly described patellofemoral arthroplasty.  It sounded like he would be putting rubber bumpers on my knee cap. A tongue twister came instantly to mind:   rubber baby buggy bumpers, probably not your typical reaction.

"Why don't we do a MRI to confirm your arthritis is limited to your knee cap and then decide what course to take?" he suggested.

"Sounds good," I replied.  Either way, we scheduled the surgery for April 11, his earliest availability.

Complication

Stubbornness inflicts more pain at my age.

While prepping the Folly for "tenting"--that's how you get rid of termites in Florida--I carried a batch of fairly heavy scalloped concrete edgers from the front yard to the shed in the back wearing flat shoes with no support.  My right heel began to hurt almost immediately but I soldiered on, just as I did several days later when I walked half a mile in flip flops to use a remote shopping mall restroom on our rainy return from Sarasota. Even driving was painful afterward.

A month later I still was limping around, even after substituting more swimming for the five-mile walks I usually took three times a week.  I finally made an appointment to see John Levin, DPM, a podiatrist.  X-rays of my right foot indicated both a bone spur and an inflamed Achilles tendon.  Dr. Levin, not quite a decade younger than me, prescribed a heel lift, stretching exercises and icing three times a day.

"I'm worried how this condition might affect a partial knee replacement if it lingers."

"You should be," he said, before rolling up his khaki pants to reveal what appeared to be several long, stitched incisions on his own right leg.  

"I'm three weeks out from a complete knee replacement," he announced proudly.  Skiing and biking had kept him in good shape.  He was already back at work and his movement wasn't noticeably impaired--at all!

"Wow, that's really encouraging," I said.  "When I mentioned my conditon to the orthopedic surgeon, he referred to it as a soft tissue injury and didn't seem too concerned."

"It's all connected, and if you're not able to walk easily before your surgery, it may interfere with your recovery.  Sometimes doctors are too focused on their own specialties."

I left Dr. Levin's office determined to follow his course of treatment rigorously for the next six weeks.

Primary Care Consultation

After Paul Goldstein, MD, my primary care physician in New York City for nearly 30 years, decided to go the "concierge medicine" route--don't get me started--I found one in Florida, Andrew Berkman, MD.  He had treated the twin sister of a former colleague who lived in Lake Worth and loved him.  More importantly, he met my two criteria in choosing an internal medicine physician:  he was Jewish and he practiced near my home, if only for three months of the year.

During our first consultation in 2021, I leveled with him.  "I'm looking for you to keep me in good health until I'm 75.  I don't plan on living much longer that."  If Dr. Berkman was shocked, he didn't let on but he got the message.  I haven't heard a peep from him about getting another colonoscopy, which I put at the top of my "Never Again" list when I turned 70, just above re-painting 47 Pianos.

I arrived for my annual visit with an agenda:  where should I have my right knee replaced, New York or Florida?  

"Ten years ago I would have told you to have it done in New York, but health care in the West Palm Beach area really has improved.  You probably can find an orthopedic surgeon just as good here," he said while entering some information into his computer. He pulled up the orthopedic surgeon listing for the Hospital for Special Surgery.  Little did he know I had done the same thing prior to my office visit.

After scrolling through the choices and noting the guy with the best local reputation, he zeroed in on John L. Wang.  "This is the guy for you," he recommended.

I'd already chosen him for a second opinion on the basis of his bio and his availability. My New York City dermatologist advised me to look for an affiliation with the University of Miami when seeking local health care.  Dr. Wang, who completed his orthopedic residency there, checked that box too.

I made an appointment as soon as I got home.