The California Files

Makoplasty and Me

The newspaper where I’m employed has been carrying an advert from a local hospital touting the advantages of a surgical technique called Makoplasty, which it advertises as being less invasive than traditional surgical methods.

“Come on in for a seminar on this new procedure,” the advert invites.

A comment on this seems in order, since I have recent experience with this procedure.

Makoplasty is orthopedic surgery using robotics. A machine controlled by a physician armed with a computer uses a robotic arm to do whatever it is it’s supposed to do, and supposedly does it with great precision, efficiency and effectiveness.

In my case, the procedure was a partial knee replacement. And in my case, this was done at the hospital that now is running the Makoplasty advert.

Four years ago, I underwent a total knee replacement using the traditional method – the knee is opened with a 12-inch incision and the surgeon goes to work manually. This is not easy stuff, but I worked at recovery and was home in 36 hours and out hiking Scotland’s moors, without discomfort, in four weeks.

Two months ago I had a partial replacement in my remaining knee done by the same surgeon and at the same hospital, but this time using Makoplasty. I was home in about 30 hours. But recovery has been very difficult indeed, with discomfort levels that remain much higher and more prolonged than I experienced in my previous surgery.

What got me thinking about all this, I think, was this business of Makoplasty supposedly being “less invasive.”  

Yes, the incision required for this procedure is much smaller than for the older type procedure – 4 inches longitudinally atop the kneecap instead of 12. But Makoplasty also required, at least in my case, a pair of small incisions above and below the knee, four in total. I’m not sure, but I suspect that each pair were for a drain and a camera, two pairs. The traditional surgery did not require these.

As far as I can tell, that’s the big difference – those four small incisions and the shorter major one. Once the knee is open and visible, the surgeon still has to grind away material to resurface the ends of the joint and prepare those ends to accept whatever appliance he’s installing in the knee. What does it matter how this is done? What does it matter if this is done by a robot or by hand and eye? However you slice it, it’s still somebody in there grinding away, filing away, on your bones. There will be consequences of this.

As I’ve noted, my recovery from this procedure has been nowhere nearly as rapid as recovery from the older, supposedly more invasive, procedure. Mind you, I continue to have complete faith in my surgeon, one of the very best in the business. It’s just that knee surgery is tough.

So here’s my take: If you’re pondering knee replacement and your physician says he/she plans to use Makoplasty, be aware. Makoplasty may indeed have its advantages. It may indeed work wonders for some people. I do not think it did that fo rme,. But reduced invasiveness - I mean really, truly, reduced invasiveness - that isn’t one of them. That, I think, is corporate hype.

If I had it to do over again, knowing what I now, I think I’d have lobbied for use of the traditional method for my partial replacement, the method in which a very skilled orthopod like mine does everything by hand. I don’t know if that would have aided my recovery. But I doubt it would have been much worse.

-JFT

 

More Fun with Old Cars

I drove from the Los Angeles area down to Palm Springs to visit my old pal Paul Aragon yesterday morning. He is in town from his home in the Portland area to do some work on a vacation condo he and his wife own.

Seemed like a good time for a visit and lunch, right?

So I hopped into my car – Monday is one of my two days off every week – and headed down there.

The car, 30 years old, with more than 150,000 miles showing on the clock, ran just fine the whole way. Well, almost the whole way.

Just as I reached the outskirts of town, right on Palm Canyon Drive and the road that goes up to the tram, there's a light. I stopped.

Just as the light turned green, the car’s engine coughed and died. It flat would not restart.

Good lord, 110 miles from home, stranded in the middle of what’s basically a retirement and golf community. Who ya gonna call?

Fortunately, there is something I’ll call the “Porsche network.” It consists of a bunch of enthusiasts and shops who know everything about these cars.

One of those shops is a place called TRE, in Van Nuys. Dave owns it, Jeremy is the service manager. They have come to know my car very well indeed. I called, reached Jeremy, and told him what was going on. We figured out that we had ignition failure. No spark.

I asked Jeremy if he knew of anyone in the Palm Springs area who worked on P-cars. Luckily, he did: A guy called Steve Floyd at Desert Performance Motorsports in Palm Desert. Steve and his guy Jim diagnosed a dead ignition module, just as we thought.

That's where the car is now - I've gotta be at work today, so I rented a Mazda2 and drove home.

They've sourced a new ignition box and are waiting for that, and the matching coil, to arrive from a supplier in San Francisco.

This presence of knowledge and skill is an important reason, if you’re going to mess with an old car, for messing with one like mine.

When I bought my car a couple of years ago, I seriously considered going with a BMW 2002 instead of a 911. I really like those little cars, plus they're relatively simple and easy to work on. But the community of P-car people and service, plus the availability of parts, convinced me to go the way I did.

Because of work commitments, I won't be able to return to PS to get the car until Friday, a day I go into work in the afternoon. But when I do, I'm hopeful that the car will be good to go for the foreseeable future.

I'm just glad this happened on a trip when Laura was not along. She’s a champion person, incredibly patient, takes problems in stride. But I would not want to have subjected her to a breakdown, roadside diagnosis, a trip to a shop in a tow truck and all the rest. Plus the enormous bill, which I haven’t told her about just yet….

I just hope we have our car problems behind us for awhile. None of this is good for my confidence in this car.

Oh – in the meantime, Paul and I had a great visit – lunch at Tommy Bahamas and a visit to the Planes of Fame museum, which is packed with gorgeously restored WW II military aircraft, including a B-17, which I was able to get into and explore. A good day in spite of that danged car.

 -JFT

 

Dinner is Served!

We’re lucky enough to be part of a social circle that involves couples spending time with each other over dinner. OK, so far, so good – a lot of people do that, right?

So Laura asked our friend Derek Dickinson, and his partner, Mike, over for dinner this past Sunday evening. Derek said, “Great! I’ll cook. Let’s plan on a dinner for eight.”

We figured that meant he’d grill steaks, do a salad, bake some potatoes or something, and that would be that.

But no.

Derek, a former restaurateur, showed up at this house a few moments ago, 3 p.m. sharp. With a chef. And a sous chef. This bunch is creating, in our tiny kitchen, in our tiny house, a four-course experience in fine dining. Laura is a great chef. But we’ve never, ever, done anything like this. Hell, we never would have thought of it – it’s just so over the top.

The menu? I just happen to have it right here:

Four different pass-around hors ’d oeuvres, including bacon-wrapped dates, quail eggs and caviar, miniature Maryland crab cakes with papaya/basil relish, and foie gras on brioche toasts.

Next, shrimp and avocado cocktail martini.

Next, the entrée – rack of New Zealand lamb with scalloped potatoes, asparagus and Bordelais sauce.

Finally, Valrhona chocolate soufflé.

Wines? Oh, my, yes! Plus we have folks coming who like martinis, and at least one who likes single-malt Scotch. So add those, as well.

To accomplish this, Derek and company have hauled a whole lotta restaurant supplies and equipment into the kitchen. I will take photos as we go along, but mostly I’m going to stay out of the way.

Oh, the cats? I just checked on them. They’re stashed away in our bedroom, out of harm’s way. They don’t much care for company or for disruptions of their feline routines, so we’ve moved food, water and the ever-important cat box in there with them.

Guests, scheduled to arrive at 5 p.m. were right on time.  They included our pals and sometime traveling companions John and Nancy Vogt, and another set of pals, also a dedicated pair of foodies and killer chefs, Bob Baker and Charlene Chaloner.

The food was fabulous, the company was charming and interesting, the conversation was, to say the least, lively. We broke up at about 9:30 – and we found that the kitchen had been cleaned. I like the way this all works.

Left-overs?  You bet! The fridge has plenty of stuff still sitting there, just waiting for lunches. Life is good!

-JFT

My New Knee

I’ve been staying quiet the last two days. Here’s why:

After about a month of planning, and considerable discomfort over a longer period, yesterday at 6 a.m. I was admitted into Glendale Adventist Medical Center. At 7 a.m., I underwent surgery for what’s called a Makoplasty, which is a partial knee replacement using robotic equipment.

Surgery took about 45 minutes, my doc told me this morning.

It actually went quite well – well enough that when I told him I was coming home today, he said OK to that crazy-assed notion.

Here’s what it looked like just before they kicked me out the door at 1 p.m. today, Tuesday. And yes, if you would like to see it fullsize in all its post-surgical glory, click on the image.

You will see that the incision is about four inches long, and that there are small punctures above it and below it. They were made to accommodate cameras and drains, I think probably.

This incision is much shorter than the one this same doc – a wizard named Philip Merritt, hence those initials there to mark the knee he'd be working on - did on my left knee in 2008. That one is a full 12 inches long, the better to accommodate the significant hardware required for a total replacement.

As you might imagine, I’m really pleased to have gotten away with this less stressful procedure. I’m also pleased that the good people at work are being patient with me. I’ll take today and tomorrow off, and work as usual on Thursday. Well, not exactly as usual – I’ll work from home so that I can minimize stress on that new knee, which is a bit stiff and a little sore. Not bad, though; not bad at all. After many years of struggling with both knees, I should be good to go now until I’m too old to care.

-JFT

Modified Suspension

Oh, your chassis isn’t handling quite the way you’d like it to? Modify the suspension.

It’s not hard to do. Swap out old parts for new, better parts.

And this is what I’m about to do.

Tomorrow morning, 7 a.m. sharp, the procedure starts. My mechanic will let me down off the lift after about an hour of work and I will be equipped with a new right knee, one that is made of steel, with Teflon load-bearing surfaces.

Whether I get a partial replacement or a total remains to be seen. My doc says he won’t know for sure until he gets in there and has a look at what, exactly, is going on.

I’m hoping for a partial and so, I think, is the doc. I had a total four years ago, and let me tell you, I quite happily would wish this sort of thing on my worse enemies.

On the other hand, if my doc decides a total is what’s required, that’s OK too. I would be quite happy to have him fix whatever he can while he's got me in his repair bay.

So, new suspension, new hardware for that human component that allows a leg to totally articulate free of complication.

Downside? Loss of maybe 10 to 12 degrees of flexion. Also, airport security people already freak out when their examinations, their ministrations, reveal that yes, I’ve got a metallic artifact about my person. So metal in two places on my person probably will excite them even more.

Good. It’s good to keep them interested, I think.

I rather suspect that they feel at least some small sense of relief when they discover that it's just a distinguished older gentleman with steel suspension components in his pantleg.

And I feel a sense of relief when my suspension works the way it was designed to work.

-JFT

The Passing of a Warrior

Friday, March 9, a man I’ve known for 45 years died. His name was Donald J. Noe. He was the grandfather of my two sons. But he was much more than that.

Don flew B-17 bombers, Flying Fortresses, over Germany during the war. At age 19, he was commander of one of those incredible airplanes, flying out of an airbase at Great Ashfield, England.

To see the story of one of the planes he flew, go here, if you want – but below the link is the important part:

http://www.b17warhorse.fws1.com/whats_new.html

Please note this footnote, which will tell you a bit about Don:

 “On July 8, 1944 - Lt. Donald J. Noe flew his first combat mission as co-pilot on the crew of the “War Horse.”

“It was on this mission - the 15th for the crew of the “War Horse” - when Lt. W. W. Dutt was hit by flak. The “War Horse” was severely damaged and fell from formation - more than 10,000 feet - before the pilot and co-pilot gained control to pull out of the dive and fly the crippled bomber back to Great Ashfield on three engines.

“On August 6, 1944 - Lt. Noe's bomber was damaged on a mission to Berlin. With dead and wounded on board, utilizing the four engines to maintain elevation and direction, he flew his B-17 back to Great Ashfield without use of rudder and elevator control. All control cables to the tail had been cut by a ME-109 that all but sliced the bomber in half behind the radio room in the waist area.

“At Great Ashfield, the dead and wounded were thrown out using ‘Dead-Man’ cords to open parachutes - then after heading the bomber out to the English Channel, Lt. Noe bailed out.

“It was later learned the B-17 turned and crashed into a house in England. The bomber and house were destroyed but no one was hurt on the ground. The lady of the house happened to be in church that day.”

Also this, from another link, which would seem to provide a bit of detail about the third airplane of Don’s that was shot up:

http://www.100thbg.com/mainpages/crews/crews4/gilbert.htm

Excerpt:
“Hi Sam, after receiving your telephone call and also calling both Jan Riddling and David Julian (Dad flew on Lt Gilbert Crew as NAV) I think we have this figured out. Your dad was originally assigned to the 385th Bomb Group (H) based at Great Ashfield in England. On August 6, 1944, while flying in AC 337528 named “Lady Luck,” they were hit by flak.

“With a damaged aircraft, the pilot, Lt. Donald J. Noe, was able to nurse the plane back to England and crash-land the plane at [Thelnetham]. Records say the crew returned to duty and the B-17 was salvaged.”

After flying his missions and dropping tons of high explosives on Germany, Don quietly managing a Ford dealership in Los Angeles.

At one point he returned to England with a group of former airmen, his brothers in arms. He combed through the field where the house that his plane destroyed once had stood and found shell casings, metal fragments, engine parts and much more.

He told me, in one of a series of letters that he wrote to me, that he’d spent the intervening years convinced that the crash had killed the house’s occupants. He was hugely relieved to learn that this was not the case – he had harbored a tremendous sense of guilt over this.

In all, Don had three B-17s shot out from under him. Rarely did he talk about his experiences - except occasionally after a couple of Christmas Eve cocktails. It’s been a very long time ago, with much very dirty water under the bridge, but I seem to remember that Seagram’s 7 Crown whiskey was the tipple of choice. That, and Miller High Life beer, which he taught me to drink.

He would take down the box containing his flight jacket, complete with nose art on the back, and a D-ring from his parachute rip cord – the one he pulled to bail out over the English Channel, I seem to remember - and show the contents to family members. Then he’d put everything carefully away. We might not see it again for years.

Because of distance and much more, I’ve not seen Don in years. Because of distance and much more, I will be unable to attend his services, no matter how much I might like to. I feel badly about that, but some things just cannot be helped.

But I will be thinking of him as he is laid to rest. And I will salute him, in my own way, with a shot of Seagram’s 7 Crown. He deserves that, and much more.

All in all, Don Noe was a hell of a man, a member in good standing of the Greatest Generation. May he rest in peace.

-JFT

 

My Work Here Is Done.

“Arrgh! It’s my first lesson of the new year, and I’m already ready to kill my student!”

Yes, that would be my banjo instructor John David today.

Hey, all I did was ask a question! Or two. Or maybe three.

And maybe I did respond to his answers by saying, “Yeah, but….”

And he went nuts! Go figure.

Actually, it was kind of satisfying, in a “My work here is done” kind of way.

The good thing is, I’ll get him another crack at him next week, when he’s recovered from this week’s trauma. So maybe my work here isn’t quite done yet.

But it's good to know that I haven't lost my touch.

-JFT

New Year's Summer Day

What's going on here? It's Jan. 1. The dead of winter. But the thermometer in our back garden indicates that it's 84 degrees at 2:30 this afternoon. Tomorrow is scheduled for more of the same.

I hate this! The Rose Parade and the Rose Bowl, broadcast from a city that is very nearby, will be viewed by millions of couch potatoes, a great many of them stuck in God-forsaken places like the Midwest, the East, and Washington State. I'm talkin' rain, cold, snow all the time.

They see this weather, the bastards all move here. No wonder the state has gone to hell in a handbasket.

But today I did my duty in the hope of much crappier weather.

I washed my car. That almost always brings on a downpour. We can only hope.

- JFT

Who Are All These People and Why Are They In Our Way?

We drove up to the family ranch for Christmas, as usual. The trip up was relatively painless, probably because we traveled on Christmas day. Ah, but the trip home was a different story.

Usually, the 315 miles from ranch to home takes us four hours, 15 minutes: set the cruise control for 75 mph – that’s a safe five-over, mind you – and let the miles roll past. This time the trip took us a little more than six hours.

The ranch is 10, maybe 15 miles east of Interstate 5. As soon as we left the local ranch roads and hit I-5, we encountered mile upon mile of stop-and-go Boxing Day traffic - an endless and flow of cars as thick as something flowing from a faucet. Traffic would come to a complete stop, and it would stay stopped. Then it would move slowly for awhile. Then stop again. Faucet on, faucet off.

We figured there must be one hell of a wreck somewhere up on front of us. Carnage. Mayhem.

But no. It was just an excess of vehicles, far more than the freeway could handle.

It was worse than traffic here in Lost Angeles. It took us about 90 minutes to reach a spot called Santa Nella, which we usually reach in about 30 minutes.

So just south of Santa Nella we jumped off of I-5 and took route 152 east to Highway 99. This was quite busy, but at least it flowed well.

 Traffic got heavy again when 99 and 5 joined, just north of the Grapevine, and got really heavy through Valencia and over the Newhall Pass. We were able to dodge around some of this by using the truck lanes.

Finally we were home. And damned glad to be there. The cats, however, were indifferent, reminding me of my eldest son.

 I think we’ll think twice before we again try to drive anywhere on any holiday weekend.

 -JFT

Why basses are Bad in Alabama

My friend Carolyn Roth Sutton moved a while back to Alabama. Probably moving into that state isn’t nearly as common as moving out of it is – she and her husband Jim went there to be closer to his family.

Now Carolyn, whom I’ve known since boarding school – her pop was principal of the boarding school to which my parents sentenced me – is a pretty good picker. And her husband plays bass.

What she tells me is that whenever folks gather in a back yard there for a bit of music, they always keep a long-handled hoe handy.

It seems that for whatever reason, snakes are attracted to the thump of a string bass. Play the bass, a bunch of rattlesnakes come calling. Just what you need, right?

She says when that happens, people kill 'em, skin 'em, cook 'em and eat 'em.  But I think that rattlesnake is a delicacy I can do without.

Seems like a pretty good reason, to me, to avoid the bass, avoid back yards, and avoid Alabama altogether. But what do I know?

-JFT