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"Middle age: the time when you'll do anything to feel better except give up what's hurting you."
~ Robert Quillen
"You can live to be a hundred if you give up all the things that make you want to live to be a hundred."
~ Woody Allen

Ironic, isn't it? 

Admit it -- you're probably rolling your eyes because you think that I think I'm still middle-aged, aren't you??  OK, I'll admit that I still haven't fully come to grips with the concept. Logically I know that I'm well past that life stage since turning 60 earlier in the year.

Even middle age sounds old to me. There's another saying about it taking ten years to get used to how old you are. In my case, I think it's more like twenty!

Our buddy Matt sent us a collection of cartoons about aging entitled, "Mother Goose Tells the Truth About Middle Age: A Collection of Wise and Witty Poems for Adults." It was written by  Sydney Altman and illustrated by Marty Riskin. Here's one that humorously "illustrates" how fast the years can sneak up on you:

Fifty-four. I wish!

This journal entry is a continuation of the last two: why osteoarthritis probably makes it imperative for me to give up what's hurting my knees -- ultra running and walking -- and move on to the Next Third (hopefully 40%) of my life without it. I'll write mostly about my revised fitness training here and talk more about the psychological impact in the next entry. I'll also write soon about some of the physical challenges Jim is facing this fall that have impacted his running and other activities.


Arthritis affects about 70 million Americans, according to the Arthritis Foundation. That's a huge number, nearly 23% of our 308 million population!

When I was diagnosed with osteoarthritis I learned that there are about 100 different kinds of arthritis. Osteoarthritis, caused primarily by aging and overuse of the joints, is the most common form of the disease with estimates of up to 27,000 sufferers. Jim's probably got it, too, although he hasn't had an official diagnosis yet from a rheumatologist. With thousands of Baby Boomers easing into their 60s now, that numbers is bound to increase.

Me on my 60th birthday; with a gait like that, it's no wonder my knees are worn out!

Women are affected more by osteoarthritis than men and require more total knee and hip replacements than men. The angles of their hips and the increased motion in their joints make women more susceptible to this type of joint deterioration.

Besides my female Q-angle, I can add genetics (family history of osteoarthritis) and thirty years of long distance running/walking/pounding to reasons why I have had joint deterioration the past 12+ years; I started noticing it at age 48 when the joints in the fingers in my dominant hand started swelling. I didn't become aware of any knee problems until my mid-50s.

Running long distances has been fantastic for many of my body systems (brain, heart, lungs, bones, etc.) but it hasn't been kind to my susceptible knee joints.


Jim and I attended a seminar at Carilion Clinic recently that was presented by one of the Roanoke Orthopaedics doctors. He talked about various treatments for osteoarthritis, including the importance of exercise and maintaining a healthy weight.

We felt out of place in a room with so many overweight, older folks (we're not old!!) who could barely hobble around, but the information was helpful in a scary kind of way and we came out feeling better about our own current states of health.

One of the brochures attendees received from the Arthritis Foundation has a great message:

What to Take for Arthritis Pain?
Physical Activity: The Arthritis Pain Reliever.

Not drugs, but physical activity. Imagine that!!  It drives us crazy that so many people just want to take pills to solve their problems and don't want to exert themselves. (Yes, I realize in some cases that drugs are the only solution. I'm not talking about those people, just the lazy ones.)

During the lecture I hand-wrote "endorphins!" below the message on the cover of the pamphlet. You can see it below:

I've always joked that natural endorphins are my drug of choice. I'm as addicted to the mellow relief they give me while I'm running or walking long distances as I am to the sensual delights of being outdoors in beautiful places.

It's always taken more than 30 minutes for me to reach that pleasant physical state, however.

This booklet obviously isn't written for ultra endurance athletes: it recommends "gradually working your way up to 30 minutes a day, three or more times a week." That sounds laughable, even pathetic, to someone who has been 'way beyond that for most of her life. It won't be funny any more, however, if I get to the point that it's a struggle for me to do even that little amount of aerobic exercise.

Perspectives sure change depending on your own circumstances!


The Arthritis Foundation does encourage more sedentary folks suffering from arthritis pain to lose excess weight and practice regular moderate exercise -- and that's a great message. The pamphlet emphasizes that physical activities like walking, swimming, and cycling help people feel less pain, move more easily, do more activities, feel more energetic and positive, and keep their muscles, bones, joints, and heart more healthy.

Since the Foundation encourages low-impact activities, there is no mention of running or fast walking, let alone running or walking for hours at a time. Bummer! Same message I got loud and clear from my knee doc.


Recent views along the Roanoke River Greenway

The lecturing orthopedist then focused on knee and hip replacement surgery. Although we know several folks who've had total knee or hip replacements over the last decade the details in this seminar about surgery, recovery, and what you can expect to do afterwards were still an eye-opener for us.

I like to be optimistic about still being able to do some running after I get my knees (eventually) replaced. But even if I'm able to retain a high level of fitness until I go into surgery, being fit doesn't guarantee I'll be able to run with metal and plastic knees.

This orthopedic surgeon and others I have talked with in the last five years all say that current versions of total knee replacements cannot withstand the impact of running for very long, even on softer surfaces. This is what the American Academy of Orthopaedic surgeons website says about expected activities after surgery:

More than 90% of individuals who undergo total knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement will not make you a super-athlete or allow you to do more than you could before you developed arthritis.

Following surgery, you will be advised to avoid some types of activity, including jogging and high-impact sports, for the rest of your life.

With normal use and activity, every knee replacement develops some wear in its plastic cushion. Excessive activity or weight may accelerate this normal wear and cause the knee replacement to loosen and become painful. With appropriate activity modification, knee replacements can last for many years.

The orthopedist conducting this seminar said that current knee replacements last for ten years for 98% of the people who do only low-impact activities after surgery. Eighty-five percent can expect them to last for twenty years.

That was actually good news to me -- I thought ten years was the max, and with the goal of living to 100, I wasn't real keen on the idea of getting three or four knee replacements ON EACH KNEE!! The lecturing orthopedist said that most surgeons won't do replacements more than twice per knee because the surgery is so hard on the heart. I'd guess that's pretty dependent on a person's health and  fitness.

I asked the orthopedist at the seminar about getting both knees done at once, as some people do -- fearing they'll never get the second one done because the first surgery/recovery was so intense. Apparently none of the surgeons in this area will do both knees at once because of the extra stress on the cardiovascular system; they may do the knees two weeks apart, but even that makes PT more difficult and prolongs recovery.

Although I've heard anecdotal evidence of runners continuing to run long distances after getting knee or hip replacements, I don't plan to even try unless the devices have significantly improved when I need them.  The runners I've personally known who have had total knee or hip replacements have not been able to run comfortably afterwards even though they had been very fit individuals prior to surgery and really wanted to continue to run.

I can still hike up the trail to Stewart's Knob along the
Blue Ridge Parkway; coming down is harder!

The biggest take-away for me at this seminar? I want to delay surgery as long as I possibly can!!

If that means being a good girl and eliminating most or all running NOW from my repertoire of Favorite Things to Do, I'll stop even though it's not easy to give up or severely limit the activity that has been my major passion for the last thirty years.


Yeah, there's a good alternative for me!!

After my serious bike crash in August, that's kind of a standing joke now with our family and friends. At least I lived to joke about it.

Cycling is supposed to be a great non-impact aerobic sport. I've ridden bikes since I was a little kid but it's never been my primary sport. There are just too many mechanical hassles with cycling -- and I'm a lousy mechanic. It's a lot easier to put on a pair of running shoes and hit the trail. And cycling just doesn't get my heart rate up like running or vigorous walking.

Mid-November along the Roanoke River Greenway

I've been doing cross-training as an adjunct to my running for the last thirty years -- weight work, yoga, walking, hiking, road and mountain biking, pool running, occasional swimming, snowshoeing,  and cross-country skiing  -- but none of those activities "do" for me what running "does" for me mentally and physically. They just aren't as pleasurable because they don't produce the same level of feel-good endorphins. Some are more complicated and some don't get me outdoors..

Maybe I've just haven't done them for long enough stretches at a time or learned how to do them properly because I wasn't sufficiently motivated to do so. It's clear that I have to give other aerobic activities a chance now that long distance running is pretty much out of my list of sensible things for me to do.

It's such a drag to be sensible!


When Jim and I went in for my knee consultation in late September with Brent Johnson, the orthopedist I talked about in the last entry, we revisited his recommendations for acceptable physical activities for someone whose knees are shot.

Roanoke River Greenway on a recent gray day

As both an athlete himself and a sports medicine specialist, Dr. Johnson knows how difficult it is for athletes, especially distance runners, to modify or give up their passion. He laces (pun intended) practical advice with humor and analogies so his messages get across to patients. We clearly understood his comparison of the brain to computer software that has to be reprogrammed when new physical problems, like my worn-out knees, throw a monkey wrench into our lifestyles.

The message I got is that I have to update my mental software to a newer version! As hard-headed as I can be, however, maybe it's the hardware that needs updating . . .


Dr. Johnson can base some of his advice to patients like me on personal experience. He has one knee that is bone-on-bone and has had to modify his own physical activities.

As soon as he mentioned doing more cycling to take the impact off my knees, I rolled my eyes and related the sorry tale of my bike crash in August -- and the irony of nearly killing myself on a simple little bike ride, an activity that seemed so much less risky than many of my mountain running (mis)adventures over the years..

He could definitely relate. He wryly commented that every time he thinks about increasing his bike training he hears about or sees yet another cyclist in his practice who has had a bad crash . . . and he doesn't go out to ride!

It's low impact -- until you wreck!!

He and several of our other Roanoke doctors told us the story of a well-publicized "worst-case scenario" that we missed while we were gone over the summer. One of the local orthopedists went out for a ride on his bike after doing some repair work on it at home. Apparently he didn't reattach the back brake properly. While zooming down his steep driveway to the street, he applied the brakes and only the front ones worked. He somersaulted over the handle bars, landed hard -- and is now paralyzed.

He's alive, but life as he knew it is over.

That's just one example -- of too many -- of a ride gone really, really bad. We have friends who've barely survived nasty bike wrecks, too, and it has changed their lives both physically and psychologically. One of our Montana friends, Rex, has called himself "Wrecks" ever since a car ran him down during a popular relay race near Billings several years ago. At least he was able to retain his sense of humor despite all the surgery required to piece his 60-year+ body back together.


I have to admit that I'm more nervous about riding either one of our bikes since my crash. The older I get, the less risk I am willing to take with my life. No longer do I feel as invincible as I did even five or ten years ago. The more hairy adventures I live through, the more I realize how short life is.

You'd think that would perhaps give me the courage to take on more risk, but it's had the opposite affect on me.

Roanoke River Greenway

Riding a bike, especially on a road with traffic, is fraught with danger. I'd love to cycle on the nearby Blue Ridge Parkway but Jim nearly has a stroke every time I mention it. The segments near Roanoke are used by locals for commuter traffic. Nearly everyone speeds to work, school, shopping. Even the tourists don't go the legal 45 MPH speed limit on the parkway.

I really like my Terry road bike but I have very limited options around Roanoke for riding it safely. The country roads where we live are too narrow, hilly, dangerous (even in a truck!) to even consider. So are any of the residential streets in town.

The only place I've found that is both paved and safe is a 5-mile section of greenway in town along the Roanoke River. Unfortunately, two parts of it have been under construction since we've been here this fall and only three contiguous miles are practical to ride. The scenery is nice but it gets really boring going back and forth repeatedly on that little section!

Add in clueless pedestrians, little kids, and dogs at the end of 6-foot leashes and you can imagine how frustrating a bike ride can be to someone who's trying to get in an aerobic workout.

Roanoke River Greenway -- for just a moment I can ride fast when no one's around.

Neither of us has ridden Jim's mountain bike since I crashed it. I'm understandably a little skittish since I don't know if a mechanical problem caused my crash (I still have no memory of what happened). Jim has ridden it a little and doesn't think there's anything wrong with it but we really need to take it to a bike shop to be examined professionally so we both feel more comfortable riding it.

Since I need to find one or more new sports to keep me sane, I'd like a new trail bike that fits me as well as my road bike and is a step up in quality from Jim's low-end bike. Maybe Santa will bring me one! I have no desire to ride on gnarly trails (my reflexes, balance, and skills aren't that good) but I'd like to be able to ride fairly smooth dirt roads and trails so I can get away from traffic. Jim can ride his trail bike on roads with me but I can't ride my bike on trails with him. We could have even more quality time together if we both had trail bikes!

(There's some RV humor. Remember that eight to nine months of the year we live together in a little camper!)

We plan to take both  of our current bikes with us on our winter trip to the Southwest. There are several good trails and both paved and dirt roads that we know about in the areas where we plan to camp in Texas and Arizona and it will be fun to find new ones.

BTW, I got a sturdy new helmet (above). I'm still curious where my old one ended up after it fell into South Mineral Creek after the wreck and washed downstream. I like to think it's well past the Grand Canyon by now . . . 


Since receiving the bad news about the condition of my knees two months ago, I've been doing mostly walking as the primary substitute. It's the closest I can get to running without running and if I do it hard and long enough, it produces those endorphins I crave -- and does good things for my cardio, respiratory, and other systems.

Of course, Dr. Johnson even warned me about doing fast or long distance walking. Although it has less impact than running, it's still 2-4 times the impact of regular walking. I prefer to walk and run on softer surfaces, so that helps lower the impact compared to paved surfaces.

Recent view of Wolf Creek Greenway

There's another part of the greenway (above) that Jim and I often use for running and walking. It is composed of finely crushed rock over dirt and follows a pretty creek that Cody can play in as he tags along with us. It's also fairly flat and farther removed from traffic than the paved sections of the greenway downtown. It's much easier mentally for me to do repeat out-and-backs on this segment while walking or running than it is to do repeats when cycling on the short paved section of the greenway system that I showed in the cloudy photos farther up in this entry.

(If the city ever gets the entire greenway done, it will be a great place to run, walk, and ride long distances, but so far it's just a bunch of short, disjointed segments. Most of the delay is due to the enormous cost of having to cross the Roanoke River several times along its length. By the time the whole system is finished, we probably won't have a house here any more.)

I have not completely stopped running. There are two main reasons: I'm addicted to it (!) and I don't want to lose all of my aerobic fitness.

I still have a resting heart rate in the low to mid 30s. My breathing rate is very slow. My blood pressure is low. I'm real proud of those stats and would like to continue to amaze my medical providers for as long as possible! If you've been an endurance athlete for very long and you've had mishaps or surgery, you know exactly how distressed they get in the emergency or operating room when your pulse dips under 50 BPM -- until you remind them you're a runner.

Then they usually get it. Not always.

Another part of the Wolf Creek Greenway

What I've been doing in recent weeks as a compromise to both save what precious little knee cartilage I still have left AND retain as much of my fitness as possible is my own special version of "hill repeats."

During each walk on the Wolf Creek Greenway or local trails, I run up 8-10 hills for a total of one or two miles within a 4-8 mile walk. Here's my rationale:

  • So far, the bones in my knees only rub together and hurt going down, not up.
  • There is less impact running uphill than flat or downhill.
  • It takes more effort to run uphill, so it's the fastest way to increase my heart rate.
  • I remember my running coach telling me 25 years ago about the advantages of rocking my heart rate back and forth from high to low during short repeats on the track.
  • Hill work makes my legs stronger.
  • Even these short (for me) bursts at higher intensity still make me feel like a runner!

Since learning about my knee damage at the end of September, my weekly mileage from both walking and running has ranged from only 15 to 27 miles per week, down appreciably from earlier in the year. The longest single run/walk has been about eight miles. Most of it has been on flat or undulating dirt trails; some has been hillier terrain at Explore Park, Chestnut Ridge, Stewart's Knob, and the Appalachian Trail. We get bored with the greenway all the time, despite nice diversions like this:

Everybody likes Cash and Presiy, two of the horses that live next to the greenway.

I thought they wanted CA$H until I realized that's the name of one of the horses!
The owners want people to put the horses' treats into the buckets. A second one says PRESIY.

Cycling has ranged from 6 to 27 miles per week, most of it on the relatively flat, paved greenway. If I had safer opportunities for cycling outdoors, I'd do a lot more of it.

In addition to those outside activities, I've also been going to the YMCA every other day to use weight machines (core and upper/lower body) for about 40 minutes each time. On days when I don't walk or bike outside, I walk or cycle inside for 20-60 minutes. I do 20-30 minutes of pool running (with no impact) once or twice a week. One of these days I'll probably incorporate some elliptical workouts, too. (There's only so much time in a day, even when you're retired.)

I also stretch and do yoga, abdominal crunches, and push-ups at home every day, throughout the day. And I'm still doing maintenance PT at home for my shoulders several times a week (I had rotator cuff injuries last spring). All that takes from 40-60 minutes a day.

At my age, my "job" is to stay as fit and healthy as possible for as long as possible. I learned that in the book Younger Next Year! Go find a copy if you haven't already read it.

"The idea is to die young as old as possible."
~ Ashley Montagu

Good plan!

In the next entry I'll talk more about how all this is affecting my psyche.

Happy trails,

"Runtrails & Company" - Sue Norwood, Jim O'Neil, and Cody the Ultra Lab

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2009 Sue Norwood and Jim O'Neil