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"In the universe there are things that are known
and things that are unknown, and in between, there are doors."
~ William Blake

Jim is suddenly faced with a major "unknown" -- whether his running days will be over much sooner than he hoped they would be.

The news we got this afternoon came as a shock to both of us during a lengthy consultation with an orthopedist in Durango about Jim's continuing knee problems since his bike accident last November. I'll describe that in a minute.

Approaching Molas Pass (elev. 10,910 feet) from the north on US 550

We left our campsite in Silverton about 11 AM. Cody had to stay home because of the predicted heat in Durango (about 90 F.), which is several thousand feet lower in elevation. It was warm in Silverton, too, but Cody was fine inside the camper with the windows cracked and the Fantastic Fan turned on. We have enough shade on the south and west to keep the Cameo from getting too hot inside.

The long drive down US 550 was gorgeous with the bright blue sky, glistening white snow on the mountain peaks, light green aspen leaves, and dark green pines. We saw waterfalls we’ve never seen before and lots of yellow flowers (not all of them dandelions) and blue lupines.

I took the first eight of the photos in this entry during our trip to/from Durango today while Jim was driving. What beautiful scenery!

Snow-covered mountain peaks just beyond Molas Pass; there are nice campsites around here.

This is a major trip -- over 60 miles one way to the doctor's office south of Durango -- so we ran several errands while we were out.

We dumped trash and got a NetFlix movie at the post office in Silverton. Then we headed up, down, up, down, down, down to Durango. At the north end of town Jim washed the truck and got a Subway sandwich. We drove to the south end of town and ate lunch in a pretty little city park by the Animas River.

Lots of folks were out enjoying the warm sunshine -- picnicking, walking, running, cycling, rafting the river but I didn't take any pictures of them.

We still had over an hour to kill before Jim's appointment.

We filled two containers with gas for the generator and got diesel for the truck (diesel prices ranged from $3.85 to $3.99/gallon in Durango), bought a new roof vent for the camper at an RV shop across from Walmart (it cost $20 for our little misadventure with the trees at Sam's Club Monday night), and shopped at Walmart.

We were able to buy several other things for the camper cheaper at Wally World than at the RV store -- new wrap-around mats for the outdoor steps, a power strip, two more vinyl tire covers (to protect the tires from the sun), and an extra length of hose for water.


Durango Orthopedics is in the same medical complex as the city's hospital, where we got to spend several hours in the ER after my serious bike wreck on South Mineral Creek Road in 2009.

Today we arrived a little ahead of time so Jim could fill out paperwork required of new patients. The purpose of the appointment with Dr. Scott was to see if he can do something about Jim’s very sore knee. Our orthopedist in Roanoke, Dr. Johnson, made the referral last week and faxed Jim’s records, including the MRI results from last November, to Dr. Scott.

View from Coalbank Pass, elev. 10,640

Jim also typed and printed out a chronological summary of everything that has happened to his knee in the last seven months --  his bike accident, meniscus surgery and recovery, continued attempts at running, physical therapy/deep tissue massage and chiropractic adjustments while we were in the Houston area in February and March, and a steroid injection in late March.

Jim's knee felt good after the steroid shot he got March 28. It began hurting a week after the Jemez 50K race in mid-May and he wasn't able to train like he wanted to for the Bighorn 50-miler last Saturday. He dropped down to the 30K race but his knee hurt so much during and after the event that he’s still limping four days later.

Dr. Scott was initially quite pessimistic about being able to help Jim.

It would have helped if we’d taken the MRI disc with us on this trip but we didn’t think we’d need it; it's sitting in our house in Virginia. All Dr. Scott had were written reports re: the X-rays, MRI, surgery, and follow up visits in Roanoke, and it took a while for him to understand the entire sequence.

He did ask Jim lots of questions and listened to his complaints, injury history, etc. and seemed to do a thorough physical evaluation of where the pain is located. The entire office visit lasted at least an hour, much of it with the doctor.

Dr. Scott ordered an X-ray of Jim's knee and was able to pull up the pictures on the computer as soon as Jim returned to the exam room. It showed about two-thirds of the cartilage on the inside (medial side) of his right knee as on the left knee – he’s lost 30-40% of the cartilage that should be there. That’s where the pain is.

Here's the kicker -- Jim’s not bone-on-bone like I am, but the doctor very pessimistically forecasts Jim will need a knee replacement in two to four years!! That shocked both of us, because Dr. Johnson had indicated after the MRI done last November that Jim has only “mild” osteoarthritis.

On the X-ray it still looks like there is plenty of “space” (cartilage) in that knee, but X-rays don't show the whole story.

A second problem is the torn meniscus and subsequent surgery. With less of the meniscus “donut” to cushion the joint, the load/weight on the knee isn’t distributed evenly. Jim’s mechanics are different and the head of the femur is more stressed. That could be part of his pain; an MRI can help confirm that suspicion. 

A third problem is a probable medial collateral ligament (MCL) strain or sprain. Jim may have gotten that at the  Jemez race, with its rocky, uneven footing. It’s not related to the meniscus but is located over it. Dr. Scott says it should heal with rest and a brace.

A fourth potential problem is further tearing of the meniscus. Only an MRI can determine that, and it will be hard for Dr. Scott to know if it’s the same tear Jim had in November, or subsequent damage, without seeing the first MRI. We will try to get a copy of it sent out here from Dr. Johnson's office.


This is Dr. Scott’s list of treatments:

  •  rest and observe the knee (no running, but didn’t say how long);

  •  brace on knee to allow MCL to heal faster (it allows flexion but not sideways torque);

  • MRI (we pretty much had to beg for that; it seems reasonable to me that a current scan will show further damage to the knee in the last seven months);

  • cortisone shot (he does not recommend that because it just covers up the problems and doesn’t address them);

  • may need another look through arthroscope if the above solutions don’t help.

We'll proceed with the first three this week.

Jim was fitted for the knee brace today and will wear it for several weeks to allow the MCL to heal, if that's part of the problem. The nylon fabric brace wraps around his knee and snugs up with Velcro. There is a cut-out for the front of his knee to allow more flexion.

I took the next two photos later in the summer while Jim was wearing the brace cycling:

An MRI is scheduled in the same office on Friday afternoon. Dr. Scott will call with results and Jim may or may not need to return to his office before we leave the area.


Jim’s pretty bummed, of course. This may well end his ultra running career, at least if he wants to postpone knee replacements as long as possible. Dr. Scott advised that cartilage loss is faster once it starts to go -- after an injury, with aging, or both in Jim's case -- and the stress of running on pavement or trails exacerbates the loss even more.

It's the same message I've gotten from Dr. Johnson in Roanoke about my Granny Knees.

And also like Dr. Johnson, Dr. Scott recommends cycling instead of running. We didn’t ask about Jim's prognosis for long-distance hiking/walking yet.

As you can imagine, we had a somber drive back home through the mountains.

I can empathize and sympathize with Jim. I know how much he is hurting both physically and psychologically. Two years ago I had to face the fact that I can't/shouldn't run any more because of a lack of cartilage in my knees but I had more warning than Jim did because my problem is caused by osteoarthritis and not an injury.

Running addicts like us don't ever want to hear that we might soon have to quit doing one of the things we most enjoy in life. Hearing it so bluntly and unexpectedly is tough. We hope Jim recovers well and the doctor's assessment is wrong.


When we got back to Silverton late this afternoon we treated ourselves to an early supper at the Brown Bear restaurant, one of the few restaurants we've visited over the years in Silverton. We simply don't eat out much.

We were disappointed to find that the price of our favorite entrée (chicken breast, rice or potato, hot veggie, salad bar, and yummy homemade wheat bread) has gone up $2 from last year but it’s still a pretty good deal and the food is tasty. We’ll probably not eat there as many times as we did when the price was lower.

Jim immersed himself in the movie "True Grit" in the evening and I worked at my computer. You can bet our thoughts kept going back to what we heard in Dr. Scott's office earlier in the day.

Cody-pup did fine while we were gone. He was jumping up and down like a ping pong ball while I was outside getting his supper. A couple driving out of the campground saw him and stopped. The man observed that Cody must be pretty hungry. I laughed and said yes, his supper is four hours late!

They were amused to watch Cody inhale his food like he always does, even when it isn't served late.

Campers have a fire going right next to the overflowing creek this evening;
the main channel is to the left, out of sight in this picture.

I walked Cody over to the creek about 8 PM. Yikes! It’s even higher than it was last evening. On this relatively hot day, a bunch of snow in the nearby mountains melted. It should be interesting to watch the creek the next two weeks -- from the safety of our "high and dry" campsite.

Next entry: let's go see what South Mineral Creek Road and the Ice Lake Trail look like . . .

Happy trails,

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

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© 2011 Sue Norwood and Jim O'Neil