The Starting Blocks

Yesterday was very much a day of contrasts.  The day started off with achievement and disbelief of the ease of my progress.  Part might have been due to my preparation but I attribute most of this early success to advances in surgical procedures.  The physical therapist came to get me up on crutches and I was able to walk close to 600 feet by the end of the day.  I was actually encouraged to put as much weight on my leg as I could tolerate.  The biggest challenges were the weakness in my knee and my fear of pain.  Later in the day the occupational therapist came to make sure I could take care of myself when I get home.  Putting on socks, and figuring out how to get into a bathtub to take a shower were just a couple of the tasks I needed to master.   I did so with confidence.                           

My confidence was short lived.  Pain blind-sided me.  It was like getting hit by Chance Sumner or Brian Kirkland (Quad Rugby Super Stars).  This sudden PAIN is attributed to the affects of the femoral block wearing off.  Patients are instructed to rate PAIN on a scale of 1 to 10.   When PAIN gets to be a 3 you are supposed to request PAIN meds.  With the sudden onset I went from 3 to about 15 in about 20 minutes.  It takes about 45 minutes for the meds to kick in.  When you take PAIN meds at level 3 you are able to keep up with the PAIN. When you don’t take the pills until you get to 10 then

It is like falling behind by 3 touchdowns in the fourth quarter.   Let’s just say I finally caught up but had to go into quadruple overtime to claim victory over the PAIN.

Things were much better today, even though I experienced one of those de-humanizing events.  The occupational therapist who showed up was a very attractive/cute 20 something year old.   Her task was to make sure I could take a shower on my own.  Thank god I am happily married and in my late forties.   Let’s just say that darn hospital gown gave the OT a show.   I hope I didn’t scar her for life.  Things eventually got better and I got my walking papers.  Yes can you believe I am sitting in my own recliner in my own house.  

Anyone want to start a pool on when I will start getting on my wife’s nerves.

More tomorrow.

My morning started early as the alarm rang out at 4:30 a.m. Wednesday, November 12, 2008.  As I crawled out of bed and headed to the kitchen I remembered I could not have anything to drink or eat.  I would have to live without the quenching glass of water and fix of caffeine until sometime after my surgery. Directions said I could not have any food 12 hours before surgery and no drink after midnight.  I redirected myself towards the bathroom to shave shower and brush my teeth without swallowing any water.   The scariest part of the morning, including the actual operation, was waking my wife at 5:15 a.m.  The mistake of the day was not getting her up in time to enjoy her cup of coffee.

After being admonished for my poor judgment, we were off to the hospital.  Thirty minutes later we arrived at Porter Hospital.  Wow, Porter is like checking into a hotel, not a hospital.  Very modern and it does not smell like a hospital.  After checking in and waiting for a brief time, I was off to the pre-op area.  Here I was reintroduced to the wonderful hospital gown. The hospital gown has not changed a bit.  You would think with someone would event something better after all of these years.  We can send messages email and text message through the air but not figure out how to properly cover the human buttocks.  Modern advances in medicine would eventually be the theme of the day.

Next came the fun stuff.  A very friendly pre-op nurse made me feel as comfortable as possible as she found a vain to put a IV in.  As my leg was being shaved and washed the anesthesiologist, Doctor Nightingale, explained my options.  He said a nerve block was the usual practice.  The inject the leg at the hip first then later make an injection in the lower spine which blocks your nerves.  They would also give me something that would put me to sleep.  General anesthesia would not be used.  I have had numerous operations and all have been with general anesthesia.  General anesthesia is much harder on your body, organs and brain.  You are usually unconscious and or groggy for hours after surgery.  I just wanted to make  sure I would not here, see or  smell any part of the drilling, cutting etc.

I was wheeled to the operating room which is kept at a very cool temperature to reduce germs.  I was quickly covered by a preheated blanket and transferred onto the operation table.  I heard someone mention the procedure would be video recorded.  I was given some type of injection in the IV in my arm which would make me relaxed and sleepy.  I was sat up on the side of the table and was told to lean on the nurse.  A needle injected something into my lower back and the next thing I remember was waking up in the recovery room.  I was surprised how quickly I regained my senses.  I soon realized I could not feel anything below my waist.  NO PAIN!  I was a little worried that I could not feel my male parts so I used my hand to see if it was all there.  To my relief it was and still is there.  I did find the dreaded catheter attached.  This is one of the parts of surgery that is quite de-humanizing.  You definitely have to check your ego at the door.  

Surgery was scheduled to take about 90 minutes but I was to extend this time by 45 minutes.  I always do things big!  I had lost more movement in my knee than most people so I was told it took longer to “loosen things up”.  My orthopedic surgeon, Douglas Dennis told me he appreciated challenge.  I did put him behind schedule though.  I think he had 3 other joint replacements on his schedule for the day. One before me and a couple after.  This is a light day for him.  Dr. Dennis is headed to Panama where he and his team will perform 70 plus joint replacements in 3 days for individuals who do not have access to these procedures normally.

Surgery started at about 9:15 a.m. and when I woke up it was about 12:00 p.m.  and I was in the recovery room.  I was taken up to my permanent room by 1:00 p.m.   No nausea and NO PAIN!  This was the result of not using the general anesthesia.   The “block” would keep the pain away through the night.  I was able to eat dinner and actually stand up with a walker by evening.  In between I had a perpetual motion machine which would bend and straighten my knee.  Again there was no pain.  The machine was removed when the physical therapist came to show me exercises and stand me up. 

Again, Porter is more like a hotel than a hospital.  They provide room service. They actually have a menu with good food which you can order from anytime between 7:00a.m. and 7:00 p.m.

Salmon with veggies, rice, a salad and carrot cake.  I was actually hungry again before 7:00 p.m. so I was able to order a turkey sandwich which was also good.  Breakfast was ok but the coffee was terrible!  Luckily my wife Cherlyn  brought me some Starbucks.

Physical therapist showed up early Thursday morning to get me up on a walker.  I was able to put quite a bit of weight on my leg with only moderate pain.  I did take some percusets before therapy began.   I was able to walk 300 feet.  The PT said I did better than most.  I would graduate to forearm crutches in the afternoon.  I also had an occupational therapist show me things I will need when I get home.  Most of this I had previous experience with so I did not really learn  anything new.  We did make sure I could get down and up from the toilet and later I practiced transferring onto a shower bench in the bathtub.     I am supposed to go home tomorrow.  The pain pills are kicking in so until tomorrow…

In the next couple of weeks I will be sharing my experience with knee replacement surgery.  You may wonder what this has to do with athletic excellence and promoting integrity in sports nutrition.

Let me tell you a little about myself and maybe you will see the connection.

I have lived with the challenges of rheumatoid arthritis for 46 plus years.  I have never let the arthritis limit me.  I have been a coach as well as an athlete.  For 10 years I competed on the international level in the sport of quad (wheelchair) rugby.  You may know this sport from the movie Murderball.  I experienced firsthand the preparation, dedication and perseverance needed to  successful  achieve a goal.  For knee replacement surgery to be successful, I will need all three.

Preparation

Just like any athletic endeavor, you must prepare for knee replacement surgery.  Doctor diagnosis came first.  After that there was the approval of my health insurance company and figuring out what expenses I will have to cover myself.  Every doctor appointment comes with $30 co-pay and I must pay a $350 co-pay to be admitted into the hospital.  I cannot forget the preparations at work and with the business my wife and I own.  At work I had to apply for FMLA leave and plan who was going to cover my duties while gone.

There has also been physical preparation.  My workouts have been focused on building upper body strength and core strength to enable me to use crutches. I did a lot of accent and descent of stairs using forearm crutches.  This actually gives a good core workout because it requires the use of core muscles to keep your balance.  Try balancing while only placing weight on one leg and two crutches.

You also use your lats, pecs, traps, triceps and biceps.  Nutrition has been very important too.  I had to maintain lean muscle mass without putting on any extra weight.  Good body chemistry has been a must.  Supplements and diet must prepare the body for stresses put on the body. Supplementation must also help keep my immune system strong.   I will include information on specific  supplements I use in future updates. 

I am about 12 hours away from surgery as I write this.  I have had numerous surgical procedures so I have a lot experience.  I am  not sure if this experience makes me any less apprehensive.  I don’t have fear of the unknown but my memory serves me to well.  I remember the needles, tubes, bandages, medications and pain.  I also remember all of the dehumanizing things like hospital gowns, eating hospital food, sleeping in a hospital room and being totally dependent on others.

I am confident that it will all have a successful outcome.  Join me in my adventure the next 6 weeks.  I will make updates when I able.

Recent JAMA Study Findings Raise New Concerns
about the Safety of Bisphenol A (BPA)

You may have heard about the potential harmful effects of BPA, a chemical modifier commonly used in some plastic containers and the linings of some canned foods. Now, a new study published in the Sept. 17, 2008, issue of the Journal of the American Medical Association (JAMA) highlights BPA’s potential health risks, reaffirming the importance of Shaklee’s commitment to BPA-free packaging as a part of our longtime emphasis on consumer safety.

British researchers Lang and colleagues report the results of the first major epidemiologic study to examine the health effects associated with BPA and show that higher urine BPA levels are correlated with higher prevalence of cardiovascular disease (coronary heart disease, heart attack, and angina), diabetes, and liver enzyme abnormalities. The cross-sectional study of 1,455 adults, intended to be representative of the adult U.S. population, found double the normal risk for heart disease and diabetes, but also discovered no association with any other health effects. The investigators also indicate that these findings add to the evidence suggesting adverse effects of low-dose BPA on animals but emphasize that independent replication and follow-up studies are needed to confirm both the findings and whether the associations are causal.¹ An accompanying editorial also suggests that U.S. regulatory agencies should follow recent Canadian government decisions and require aggressive action to reduce human and environmetal exposures to BPA.^2,3

In 2007, the Centers for Disease Control and Prevention (CDC) published results that BPA had been detected in the urine of nearly 93% of those tested, a finding indicating widespread exposure to BPA in the U.S. population. This analysis looked at urine samples obtained from 2,517 people ages 6 and older who took part in CDC’s National Health and Nutrition Examination Survey (NHANES) between 2003 and 2004. Females had higher levels than males, and children had the highest levels, followed by teens and adults.⁴

Common Exposures from BPA

BPA is a chemical produced in large quantities primarily for use in the manufacture of polycarbonate plastics and epoxy resins. Polycarbonate plastics typically are clear and hard and have many applications, including use in certain food and beverage packaging such as water and infant bottles, as well as compact discs, impact-resistant safety equipment, and medical devices.

According to the CDC, about 7 billion pounds of BPA are produced worldwide each year, and the Centers’ analyses have found that 93% of Americans have detectable levels in their urine.^4,5,6 Animal studies have linked high levels of BPA to increased risk for diabetes, brain damage, developmental abnormalities, certain precancerous changes, and a variety of other health problems.^{7, 8, 9} The cause of the increased risk has not been fully determined, but various theories include BPA’s potential action as a hormone disruptor or modulator.^{4, 9}

Two studies conducted earlier this year provided possible explanations of the recent findings published in JAMA. In April, Spanish researchers reported that BPA caused pancreatic cells to increase their production of insulin in mice, leading to insulin resistance, a precursor of diabetes.¹⁰ A separate study at the University of Cincinnati showed BPA inhibits the release of a key biochemical that protects humans from metabolic syndrome, a collection of health risks that increase a person’s chances of developing heart disease, stroke, and diabetes.¹¹

Government Positions on BPA Safety

The FDA has long argued that there is an existing margin of safety that is adequate to protect consumers—including infants and children—at the current levels of exposure. However, others point out that the FDA’s conclusions are based on selected studies and don’t adequately consider studies that found adverse effects.⁹ Earlier this year, the National Toxicology Program explained in a preliminary report there was some concern that the chemical posed a risk to fetuses, babies, and children, as emphasized in this latest JAMA study.¹² Specifically, researchers and public health activists also are calling upon the U.S. government to consider alignment to a recent action by the Canadian National Public Health Agency, which in May 2008 released a report calling BPA a potentially harmful chemical.

Reducing Exposure to Harmful BPA

Although there are no official recommendations for reduced exposure levels set by leading public health organizations, there are important steps consumers can take to minimize BPA exposure. The following are a number of simple suggestions to help you reduce your BPA exposure and are based on recommendations from the Environmental Working Group (EWG).^{13, 14}

Basic Tips to Reduce Exposure to and Intake of BPA

• Avoid Reusable Polycarbonate (labeled #7) Plastic Water and Baby Bottles. As a general rule, avoid water bottles and baby bottles labeled #7, which tend to be hard and clear. Many reusable water bottles are made of polycarbonate plastic—including many of the popular colorful plastic water bottles—that leaches BPA into the water. Choose polyethylene or unlined aluminum bottles instead. Use glass baby bottles instead of plastic, and always discard damaged plastic containers. These are better choices for you, your family, and the planet.
• Avoid Polycarbonate Plastic Food Containers and Tableware. These may also be labeled “PC” underneath a plastic code #7 in the recycling triangle on the bottom of the container. Representing a better choice are usually the BPA-free plastics with the recycling labels #1, #2, or #4 and #5. Be aware that BPA can leach from the plastic into foods and beverages, especially when the material is heated or used for long periods of time. Opt for ceramic, glass, or other microwavable dishware. Soft or cloudy-colored plastic containers do not contain BPA.
• Minimize the Use of Canned Foods and Canned Drinks. Until industry reformulates the lacquer lining of metal cans, limit your consumption of certain canned foods such as tomato sauces because the high acidity causes more of the chemical to leach from the lining of the can. Choose fresh or frozen foods or those in glass containers or bottles. The recent study by EWG found BPA in more than half of the 97 cans of brand-name fruit, vegetables, soda, and other common canned goods that were tested.
• Ask your Dentist for BPA-Free Sealants and Composite Fillings. Some dental resins are free of, or low in BPA. Ask your dentist if he or she knows about BPA and ask him or her to use low- or no-BPA dental compounds.
• Avoid microwaving or heating any food in plastic containers or canned food. Heating any plastic materials may release plastic modifiers directly into food.

Be well!

Dr. Jamie McManus, M.D., FAAFP
Chairman, Medical Affairs, Health Sciences & Education

References:
1. Lang IA et al., Association of Urinary Bisphenol a Concentration with Medical Disorders and Laboratory Abnormalities in Adults, JAMA. 2008; 300(11):1303-1310. 2. Vom Saal FS et al. Bisphenol A and Risk of Metabolic Disorders. JAMA. 2008; 300(11): 1353-1355. Published online Sept. 16, 2008 (doi:10.1001/jama.300.11.1353). 3. Environment Canada. Draft Screening Assessment for The Challenge: Phenol, 4, 4’-(1-methylethylidene) bis-(Bisphenol A). Chemical Abstracts Service Registry No. 80-05-7. Environment Canada Web site at http://www.ec.gc.ca/substances/ese/eng/challenge/batch2/batch2_80-05-7.cfm. 20084. 4. Centers for Disease Control and Prevention (CDC). National Health and Nutrition Examination Survey Data 2003-04. Hyattsville, MD: U.S. Dept. of Health and Human Services, CDC; 2007 and special CDC Fact Sheet, May 2008. 5. Centers for Disease Control and Prevention (CDC). Third National Report on Human Exposure to Environmental Chemicals. Atlanta, GA: CDC; 2005. 6. Calafat AM et al. Exposure of the U.S. population to bisphenol A and 4-tertiary-octylphenol: 2003-04. Environ Health Perspect. 2008; 116(1):39-44. 7. Richter CA, et al. In vivo effects of bisphenol A in laboratory rodent studies. Reprod Toxicol. 2007; 24(2):199-224. 8. Wetherill YB et al. In vitro molecular mechanisms of bisphenol A action. Reprod Toxicol. 2007; 24(2):178-198. 9. Environmental California. Bisphenol A Overview. At www.environmentalcalifornia.org., accessed 9/08. 10. Ropero AB et al, Bisphenol-A disruption of the endocrine pancreas and blood glucose homeostasis. Int J Androl. 2008 Apr; 31(2):194-200. Epub 2007 Oct 31. 11. Eric R. Hugo et al, Bisphenol A at Environmentally Relevant Doses Inhibits Adiponectin Releasefrom Human Adipose Tissue Explants and Adipocytes. Environ Health Perspect doi:10.1289/ehp.
11537 available via http://dx.doi.org/ [Online 14 August 2008]. 12. National Toxicology Program (NTP). Draft NTP brief on bisphenol A. NTP Web site. http://cerhr.niehs.nih.gov/chemicals/bisphenol/BPADraftBriefVF_04_14_08.pdf. April 14, 2008. Accessed July 5, 2008. 13. Oregon Environmental Council at http://www.oeconline.org/our-work/kidshealth/pollutioninpeople/solutions/bpa. 14. Environmental Working Group (EWG).Review more specifics at website of the Washington, D.C.-based Environmetal Working Group at http://www.ewg.org/reports/bisphenola , A Survey of Bisphenol A in US Canned Foods, March 2007.

http://www.youtube.com/watch?v=TxExxkWQOlU