Low tide at the Oregon Coast

There was an unusually low tide last week, minus 2 to 2.5 feet, and we went over June 22nd to go tidepooling. Our destination was Gold Beach, on the rocky southern coast of Oregon, and our tidepooling was at Myers Rocks about 7 miles south of Gold Beach. We hoped to see nudibranchs, commonly called sea slugs––a canard, since many are so elegant and beautiful. [See Oregon nudibranch photos by others: 1, 2, 3, 4, several species, video.] But those are mostly found further north. We did see lots of sea stars, anemones, and smaller creatures, as well as a dead sea lion that had been washed up.

I posted a set of about 50 photos to a gallery on mobileme.com but was frustrated in being unable to add long enough captions, so I am using some of the photos, in smaller form, here with comments, our best efforts at identification, and a few photos found online. On mobileme I recommend using the “mosaic” viewing option from among those at the bottom of the screen; this will show thumbnails at the right, and you can click on any one to see it full-size, then either return to the mosaic view or continue in slideshow form.

Traces in the sand

The receding tide left most stretches of sand flat and smooth as can be; other places, where the water swirled out past rocks, had wonderful ripple patterns. And then there was this odd thing sticking up like a soft-serve “ice cream” serving.

It was about about 10 inches tall, surrounded only by flat sand. Must have been an alien sand castle, and the builders left no tracks.

Other tracks were seen.

A few of the barnacle-covered rocks bore odd sandy structures, sometimes in a ring shape.

Something held this together, but what?

I did come across (but took no photos of) one that had crumbled a bit and when I examined a chunk it was still puzzling; mostly sand, with occasional fragile vertical rootlike things, connected to one another minimally if at all. Drawn away by things my naked eye could better appreciate, I didn’t examine this more closely but I hope someone may tell me more. There are some questions google can’t answer: googling “odd clumps of sand with rootlike things” doesn’t get much result. But of course a marine biologist, hearing that vague description, could immediately give me some likely candidates, and by asking a few more questions, probably identify it decisively. Score one for the human brain.

Sea Roaches, Barnacles, and Sea Stars

On another barnacled rock we found a scuttling little creature that made me think of a cockroach, and indeed turns out to be a Sea Roach or Rock Louse (perhaps the species Western Sea Roach, Ligia occidentalis). [Our identifications are the best we could do in a couple of hours at home, comparing our memories and photos with our field guides, including Ricketts & Hedgepeth, and also searching online, but they are open to revision. Leave a comment if you have suggestions or more information, please.]

There were Acorn Barnacles (a large group of species, barnacles without stalks)

and Gooseneck Barnacles, among Blue Mussels

The most numerous creatures were Sea Stars, Pisaster ochraceus, generally known as the purple ochre star or ochre star (comes in brown, orange, and purple) and anemones, mostly Giant Green Anemones, Anthopleura xanthogrammica, which get their bright coloration from symbiotic, single-celled algae living within them.

Sea Stars get stiff and hard when the tide goes out, but their flexibility is evident from how they shape themselves to the rock.

The mouth of the Sea Star is in the center, on the underside (oral side); it eats by everting its stomach through the mouth, enveloping and digesting its prey; it can pry open shellfish like clams with the hydraulically powered “suckers” or tube feet on its strong arms. The creatures inside the whelk shells being held next to the mouth, below, may be today’s lunch. Sea Stars themselves are a preferred food for sea otters.

Closer view of the tube feet.

Below, a closeup of the top side of a Sea Star; this is the aboral side, “away from the mouth”. (Not a typo for “arboreal”!) The white things are the so-called spines though they are just little nubbins really. More about Sea Stars, 1, 2.

Mollusks and others

Here’s a chiton, perhaps Katharina tunicata (Black leather chiton), about 1.5 inches long. Its familiars, whoever they may be, have nicknamed it “Black Katy”; knowing this, you too can be on casual terms with a mollusk!

These are primitive creatures, protected by overlapping segments of shell that flex enough so that they can move over uneven rocks and even curl up into a ball. Most eat algae that they scrape off the rocks beneath them using a radula, a hard sawtoothed band also found in predatory marine snails and squid. The Pacific Northwest is home to the world’s largest chiton, the Gumboot Chiton, up to 13 inches long and red as a brick. Wikipedia tells us that chitons were eaten by Native Americans, prepared like abalone: beat the large “foot” part until it is somewhat tenderized.

The wormlike thing (above and to the left of the chiton) is unidentified; our research turned up lots of possibilities, including some types that run 90 feet in length and maybe twice that (thus perhaps being longer than a blue whale!), but no way to tell for sure.

Another more familiar mollusk is the whelk. When you find whelk shells not firmly attached to rocks, they usually are empty ones that have been taken over by hermit crabs, but we found this one that had come loose but still had its original inhabitant. The visible part is the foot that mollusks use to attach themselves.

The bright red-orange creature below (we saw only one) is, we think, Ophlitaspongia pennata (Red encrusting sponge). Sometimes found with it is “a well-camouflaged little red nudibranch (Rostangea pulchra) on it or Rostangea’s red spiral eggcase”. But we didn’t see those.

Plant life revealed by the low tide

Sea Grass,

Kelp (actually not plants but algae, see below)

an unidentified vining sand plant,

and Sea Palms (Potelsia palmaeformis).

These Sea Palms, enlarged here, actually looked like silhouetted seabirds when I took the picture. Only when I enlarged it on the computer did I see what they really were. Wikipedia tells more: “Potelsia is a genus of kelp. There is only one species, P. palmaeformis. It is found along the western coast of North America, on rocky shores with constant waves. It is one of the few algae that can survive and remain erect out of the water; in fact it spends most of its life cycle exposed to the air. It is an annual, and edible, though harvesting of the alga is discouraged.” This made me look further, since if I ever knew that seaweeds were algae, I had forgotten. On algae, the Big W says “Algae, singular alga, (Latin for “seaweeds”), are a large and diverse group of simple, typically autotrophic organisms, ranging from unicellular to multicellular forms. The largest and most complex marine forms are called seaweeds. They are photosynthetic, like plants, and “simple” because they lack the many distinct organs found in land plants. For that reason they are currently excluded from being considered plants.” So, all that explains why these seaweedy things were up so high––the tide was low, but not so low that these seapalms would have been normally submerged, and I wondered about that. And now you know that if you want to call somebody really simple, you’d better liken him to an alga rather than a potato.

Birds and mammals

The bigger offshore rocks are nesting grounds for various sea birds, but none came near us. We were passed by a group of enthusiastic sea bird researchers in chest-high waders and rubber boots, off to climb one of the rocks and poke into nest burrows,

and later that afternoon we saw many Brown Pelicans, either on their way along the shoreline, or actually circling and diving for fish. Cormorants came for the fish too, riding the swells farther out than the diving pelicans, until they saw what they wanted. Also in the afternoon, as we walked and looked for agates (pretty rocks collected, many; agates, 3), we watched two seals close inshore, looked like a mother and youngster. All of these were beyond range of our cameras, but wonderful to see. It was sunny, hardly windy at all, and pleasurable to alternate between having warm bare feet above the surf line, and then chasing the churn of retreating sea-polished rocks and getting caught by knee-high icy waves.

WARNING: Next are several scenic photos, then a section of pictures I took of the dead sea lion we found on the beach as we left. If you do not want to see these, stop at the picture of the sunset.

Gravity has its way with an anemone, when the water is not there to support it.

Another thing I learned while writing this, and as a logophile I found my ignorance embarrassing, is that there is no such word as anenome. I thought maybe anenomes were the flowers and anemones were the sea animals with toxic stingers, but anenome is as non-existent a word as George W.’s “nucular”. These,

and these,

are anemones too, land plants rather than marine animals: Anemone coronaria (top) and Anemone narcissiflora (bottom) Photos from Wikimedia Commons.

Steller Sea Lion, Eumetopias jubatus, dead on the beach

This sea lion bore several wounds that could have been the result of shotgun slugs––ocean fishermen resent the voracious consumption of salmon and other species by sea lions. In recent years, both this species and the California sea lion (Zalophus californianus) have gotten lots of bad ink and acrimony for their opportunistic predation on salmon when the fish bunch up at the dams on the Columbia River, on their way to reproduce and die. Of course the losses to sea lions are miniscule compared to the damage caused over the past century by overfishing, dams blocking rivers, and habitat destruction from logging (which damages fish breeding habitat in various ways including erosion that silts up rivers and streams).

We also thought these might be wounds made by sea gulls pecking their way in to eat what is, for a bird, a huge miraculous mountain of meat. But a fish and wildlife guy that we talked to later said the carcasses must be “pretty ripe” and rotten before a gull can pierce the thick skin. We wanted the f & w people to know, partly in case these were bullet wounds, and the man we talked to said they would send someone down with a metal detector. Both species of sea lion are protected by law.

This was a sad thing to see, especially if the death was caused by humans. If the animal had been alive we would of course have gotten it whatever help and protection we could. But it was too late for that, and what we were left with was an unusual opportunity for a close look. So what follows is not ghoulish or callous, though it may be unpleasant viewing for some.

The Steller Sea Lion is quite different in appearance from the California Sea Lion. The former has a blocky head and thick neck. The latter is sleeker, more gracile, with a slender muzzle, and is the model of what we think of when we hear the phrase “trained seal” although of course “true” seals––such as harbor seals––don’t have the ability to rotate their hind legs forward and “walk on all fours” that a “trained seal” demonstrates. True seals have to lunge and wriggle, on land; sea lions actually walk. Steller Sea Lion males may reach lengths of 11 feet and weigh 600-1100 kg (1300-2500 lbs). This specimen (sex unknown) was only about 6 feet long. The photo below shows the small external ear which is a distinguishing feature of the group of species known variously as eared seals, fur seals, or sea lions (Otariidae).

The closed eye, the lid of which appears swollen and damaged, is at left; the little comma-shaped ear is in the upper right.

Above, a view from the back shows one of the large holes. There were 5 holes visible. It seemed to us that none were close enough together to be wounds from the teeth of some big sea-lion-eating predator, such as an orca. Large areas of orange-ish skin are visible where the fur is gone, perhaps worn off by rubbing against the sandy bottom. The animal’s tiny tail can be seen between the two rear flippers. I took some close-ups of the claws visible on these flippers:

and here, on the other rear flipper, which was more damaged .

I found it hard to appreciate what they might have looked like in life, but was able to find a great photo online taken through the glass at the Sea Life Center in Seward, Alaska.

It was still hard for me to visualize the use of these claws, since they do not stick out past the end of the flippers, nowhere near. But here’s another great photo of an aquarium sea lion scratching, from flickr, and you can see how the flexible flipper can fold to allow the claws to stick out and scratch that itch. I cropped the photo to zoom in on the flipper. I think this is a California Sea Lion, based on the narrower snout.

Finally, the front flipper of the Steller Sea Lion found dead near Myers Rocks.

To end on a less somber note, there is a protected set of offshore rocks, called Rogue Reef Rocky Shore Area, about ten miles north of where we were: “More than 1,800 threatened Steller sea lions (45% of Oregon state total) use this reef, forming the largest pupping site for this species in the U.S., south of Alaska. Over 300 harbor seals are also found here. Approximately 4,000 common murres and more than 500 Brandt’s cormorants nest here” too.

In fact,

These rocks are part of the Oregon Islands National Wildlife Refuge which includes all of the state’s coastal rocks, reefs and islands (a total of 1,853) and two headland areas and spans 320 miles of the Oregon coast. All of the island acreage is designated National Wilderness, with the exception of 1-acre Tillamook Rock and Lighthouse, and public access is closed, to protect the birds and marine mammals.

Thirteen species of seabirds nest on this refuge [along the length of the state], including Common Murres, Tufted Puffins, Leach’s and Fork-tailed Storm-petrels, Rhinoceros Auklets, Brandt’s, Pelagic and Double-crested cormorants, and Pigeon guillemots. Harbor seals, California sea lions, Steller sea lions and Northern elephant seals use refuge lands for breeding and haulout areas. [Source]

Neat (but voracious) caterpillar, Orgyia pseudotsugata

We found this caterpillar on a ground peony in our garden this morning.

It is the larval form of the Douglas Fir Tussock Moth, Orgyia pseudotsugata. They are, like most caterpillars, voracious eaters and can have a devastating effect on Doug fir forests. Spraying, of pesticides or pheromones such as microbial insecticide Bacillus thuringiensis, and insect growth regulators, is often used against tussock moth infestations. Human activities, such as monoculture forest plantations, suppression of forest fires, and elimination of potential predators, have encouraged tussock moth proliferation.

We were able to make a pretty firm identification of the caterpillar thanks to a terrific book, Lepidoptera of the Pacific Northwest: Caterpillars and Adults, by Jeffrey C. Miller and Paul Hammond. [Forest Health Enterprise. H.J. Andrews Publication Number 3739. December 2003. The authors work at Oregon State University in Corvallis.] Each page has a good photo of the caterpillar and adult forms of one species, with descriptions of appearance and ecology, such as what plants they are likely to be found on. Great book! Your tax dollars at work!

You can view or download the book as sections in pdf form. This moth is on page 175 of this pdf section. The book, an oversize paperback, is published by the USDA Forest Service, and was available several years ago (& still may be), free or very cheap, from
Richard C. Reardon rreardon@fs.fed.us
USDA Forest Service
180 Canfield St.
Morgantown WV 26505

Here’s a photo of the cocoon form, woven around dead Doug fir needles. [Photo by William M. Ciesla, Forest Health Management International] Lots more information and photos of Orgyia pseudotsugata here and here.

The Douglas Fir (Pseudotsuga menziesii) is an extremely common forest species in the West, a primary source of lumber, and is the state tree of Oregon. Notice the distinctive cone. [Image from Encarta.]

Total knee replacement surgery, the second time around: learn from our experience

Nearly three years ago my husband had Total Knee Replacement (TKR) surgery. It’s drastic and major surgery, which people usually only choose when the pain from osteoarthritis becomes intolerable. And, it was not done properly so that last month it had to be re-done! Perhaps our experience can be useful to others.

Why do knees need to be replaced?

Generally because of pain and restricted motion caused by loss of cartilage (which cushions and separates the bony parts of a joint) and growth of bony “spurs”. This is labelled osteoarthritis. Other causes, like trauma, rheumatoid arthritis, and infection, account for a minority of the 300,000+ TKRs each year in the US.

As to what causes osteoarthritis, that is less understood than previously thought, when it was all blamed on “wear and tear”. The knee is the largest joint in the body, and bears the complete weight of the body at each step we take, so it is indeed subject to lots of “wear and tear”. Common-sense risk factors include types of high-stress activity in work or sports, injury, obesity, infection, stiffness from lack of activity, and age (since cartilage becomes more brittle with age). However, not all elderly people develop arthritis and some who do have no significant pain. This is why I said above that knees need to be replaced, not because of osteoarthritis, but because of pain and reduced range of motion.

The biologic factors leading to the deterioration of cartilage in osteoarthritis are not entirely understood. Many experts believe that osteoarthritis results from a genetic susceptibility that causes some biologic response to injuries to the joint, which in turn leads to progressive deterioration of cartilage. In addition, the ability to make repairs becomes progressively limited as cartilage cells age.

Although osteoarthritis generally accompanies aging, osteoarthritic cartilage is chemically different from normal aged cartilage. As chondrocytes (the cells that make up cartilage) age, they lose their ability to make repairs and produce more cartilage. This process may play an important role in the development and progression of osteoarthritis. [Emphasis mine. Source: www.healthcentral.com ]

What’s involved in Total Knee Replacement surgery?

The x-rays below, from the site of a prosthetics manufacturer,

show views of a knee before and after surgery. On the left, cartilage loss has caused bone-on-bone contact: very painful. Bone spurs or bits of broken bone floating around can also cause pain in the deteriorated joint. On the right, an artificial knee joint (prosthesis) is in place. (These are not x-rays of the same knee; in fact, looks to me like one’s a left leg and the other is a right leg.)

Here are some views of prostheses. To install them, the ends of the two long-bones of the leg, tibia and femur, are sawed off (removing “usually between 2 and 12 mm” according to one source) and the artificial joint is affixed with cement, screws, etc. The work involved in removing bone and attaching the prosthesis involves considerable force and power tools. Note that the knee-cap, as well as muscles and ligaments, must be carefully moved aside to install the prosthesis. [Picture sources: 1, 2, 3 ]

There are many patented designs for artificial knee joints, and these illustrations are for general example only. Surgeons have their preferred models; many were developed by orthopedic surgeons, and those surgeons tend to prefer the ones they have an interest in. Choice of prosthesis isn’t something the patient can weigh in on, we don’t know enough, but you may want to find out if your surgeon has a financial interest in the one he is going to use; if so, perhaps a second opinion would be valuable on the pros and cons of various types as applied to your individual case. Most insurance will pay for a second opinion for major surgery.

Research continues for better, longer-lasting designs and breakthroughs are regularly announced with fanfare––but some don’t fulfill their original promise, as with teflon-lined joints which wore away much faster in practice than lab tests had predicted. You will have to rely on the experience of your surgeon.

You can see photos of the stages of knee surgery (not for the faint-hearted) here, on a prosthesis company ’s site.

Our experience

Surgery #1, 2006

Now, back to my husband’s case. Dan had knee pain for years that ruled out unnecessary walking, as in hiking or walking for enjoyment, and interfered with sleep. There was bone on bone contact and perhaps bone spurs or growths from osteoarthritis. In August 2006 he underwent total knee replacement surgery by an established older orthopedist in our area. Afterwards, the surgeon came out to me in the waiting room and told me that the operation had taken half again as long as planned because they had “run into something unexpected”. Later, when we knew more, that remark would have much more significance to us. The “something unexpected” was apparently the result of a broken leg at age ten, that had caused greater reliance on the other leg (the one that received the TKR).

The surgery was brutal, with terrible bruising all over the leg, and post-op pain and swelling were severe. From the beginning, the prosthesis felt loose and insecure, sometimes the knee buckled, and after the post-surgical pain subsided, he was still in pain sufficient to make walking difficult. At each visit with the surgeon Dan raised these issues and was told to exercise more, and that it would get better with time. Two years on, that hadn’t happened, and the surgeon then agreed that the knee was a bit loose and offered to go back in and “put a shim in it”.

At some point after the 2006 operation, when it became apparent that it had been unsuccessful, I began to research the subject. Immediately I found that it’s common practice now to use Magnetic Resonance Imaging before TKR, rather than merely relying on x-rays. MRIs provide an exact and minutely detailed three-dimensional picture of the joint. The data can be used to make a 3-D visualization that can be rotated. This way the surgeon knows exactly what to expect; the prosthesis is customized, if necessary, beforehand; the surgery is generally shorter and the incision may even be smaller. (Other advances, such as computer-assisted orientation systems to guide the surgeon in positioning the prosthesis during surgery, may also be used.) Nothing like this was done in Dan’s case, and we didn’t know to ask about it. We know now that the original surgeon does have access to an MRI, in the hospital across the street from his office, and used it to look at Dan’s hip after the bad artificial knee began to cause a lot of pain in his hip, back, and other knee. But he didn’t use it for the knee needing replacement.

Surgery #2, 2009

Finally, after the remark about putting in a “shim”, we began to look for another surgeon. I searched online for someone who used MRIs and computerized techniques for joint replacement and who was experienced in what I learned is called “revision” (re-do) of TKRs. (Some surgeons, including the only other ones in our area, won’t touch someone else’s failures.) I found a surgeon who met these qualifications, about 4 hours drive from where we live, and we went to see him. The first thing he did was to get a full-leg digital x-ray, which surgeon #1 had never done. He showed us the x-ray, and used software to examine the precise alignment of the prosthesis. It was 7.5° out of alignment. In effect, his lower leg-bone had been detached and then put back on at a different angle from the upper leg. For over two years the first surgeon had taken no steps to examine the results of his surgery, other than feeling the knee.

We liked what we saw here, added to what we already knew about Surgeon #2’s experience, and proceeded with the preparations for a revision.

In late May Dan went through the revision surgery. Pry off the old, shave off a little more bone, affix the new.

When the surgeon met with me afterward in the waiting room, he had troubling things to report but they weren’t about what had just taken place. He told me that the prosthesis he had removed was badly installed. He actually used the word “sloppy”––and you know how rare it is for doctors to criticize one another’s work! The lower part was out of alignment both front-to-back and side-to-side; the upper part was supposed to be stabilized by the bone growing into it on all sides, but this had not taken place (he remarked that he did not use this model because sufficient bone regrowth often failed to occur). So this artificial joint had been loose and seriously mis-aligned, with every step stressing both parts of the prosthesis, the ends of the bones, the muscles/ligaments/tendons, and the other joints involved in walking (back, hip, other knee). It was clear, said the surgeon, that this had been causing Dan considerable pain, and he felt confident that the new prosthesis was going to be a great improvement.

Today is post-op day 19, and there is no comparison between the two post-op experiences. The day after the surgery they got Dan on his feet, and the first time he put his weight on the new knee he said that it felt more solid than the old one ever had. The next day he was walking the hall, slowly, and walking without hip pain for the first time in ten years. Bruising of the leg is minimal, the incision is shorter, and pain is less. The first time he was using fentanyl patches, very heavy opioid painkiller, and was still in too much pain. This time it is Tylenol-3 every 4 hours, and ultram (tramodol) occasionally when needed.

The incision is closed with superglue, covered with crossways lengths of what looks like strapping tape: no staples to distort the skin and then have to be removed. He was able to take a short shower on post-op day 5. Last time the first shower was not permitted nearly so soon and he was in so much pain he had to sit down on a plastic bench in the shower. This time, he was easily able to stand and feel secure. He’s in pain, but not nearly as much as last time, and the solidity of the knee makes it possible for him to get around the house carefully but confidently, only occasionally using his walking stick for stability (and to keep the dogs from bumping him).

Like the first time, the anesthesia was a spinal block (not general anesthesia) but the new surgeon added a femoral nerve block. As I understand it, the spinal keeps pain messages from reaching the brain during surgery; the femoral block keeps the nerves immediately affected by the surgery from registering pain which gets the nerves excited even though the brain doesn’t hear about it. It’s supposed to lessen post-op pain and it certainly seems to do that, especially for the first 24-36 hours.

There is swelling, but it’s not bad unless he keeps his leg bent too long while sitting; last time he was still mostly in bed for at least 2 weeks, and the swelling was severe from above the knee to the foot. Perhaps this is related to another difference in surgical procedure: this time a drain was placed near the incision with a receptacle attached which had to be periodically emptied of fluid, partly blood. Before the drain was removed, 1200 cc of fluid had been collected. The first surgeon did not place such a drain, the leg continued very swollen, and at the two-week check-up the surgeon had to use a syringe to remove at least 200 cc from the still very swollen knee. Doing this is risky because in raises the risk of infection, which would be a dire complication.

At this point the future looks very good for this new knee, and we are talking about being able to get out and hike with our dogs again. I still have limited energy (fibromyalgia) but more than I used to, since getting off of methadone which I took for pain.

Lessons learned

The parts of our experience that I think may be useful to everybody facing joint replacement surgery are these:

Research and ask questions. Get a second opinion.
This is major surgery which will shape your everyday life for the next decade or more. Revisions are to be avoided: not only because of pain and expense, but each surgery removes a little more bone. Don’t be afraid of getting a second opinion, even if your orthopedic surgeon seems great. Believe me, if your orthopedist were going in for brain or heart surgery, he or she would ask around, not just take the first name in the phone book! Insurance generally covers second opinions for major surgery.

Educate yourself about the surgery in general: what can go wrong, and why? what are the different methods?

In choosing a surgeon, standard advice is to find someone who has done this particular surgery a lot and does it regularly. That’s good advice, but incomplete. Our first surgeon had lots of experience and he performs knee replacements regularly. But based on results and what we’ve learned since, this fellow has not kept up with new methods: MRI’s, femoral nerve blocks, post-surgical drains, etc.

Of course nothing is better just because it is new. Some things provide an advantage even the layperson can evaluate, such as the use of MRI’s to see exactly what the joint and surrounding bone look like, so that the operation can be planned using that information. There’s no real downside for the patient in providing better information to the person doing the cutting and sawing. As for the high-tech implantable prostheses used in TKR, there’s always something new coming out, which may or may not be better. You can at least ask a surgeon how long he has been using the device he intends to implant into your body, what the failure rate is, and when and why it fails. Does it fail to be stabilized by bone growth, or do components or surfaces wear out? Does it loosen in 2 – 5 years, for whatever reason? Do particles get ground off and act like grit in a bearing?

Read up on the subject and you’ll get an idea of what to ask. Take notes on your reading and your concerns, and bring them with you; then take notes on what the doctor says. Have someone else come along to help by writing things down, reminding you of questions, and in general giving you moral support. The doctor is the expert, but your body is what’s at risk; don’t be timid about asking. In my mind, a doctor who won’t answer my questions fully, as fully as I want, doesn’t get my business.

Also ask what to expect after the surgery. Surgeon #1 kept stringing us along, telling us that things would get much better. Now we hear from others that isn’t really true, that you “know” right away. And indeed the bad job felt loose from Day 1 and never changed; the recent revision felt solid from Day 1. Certainly, telling us for 2 years that there would still be improvement, was unrealistic (charitable interpretation) and dishonest (blunt interpretation).

More information on Total Knee Replacement

There’s an encyclopedia-style summary of the procedure, risks, failures, etc. here that looked good to me, and another page on this site deals with TKR revisions (re-doing the TKR).
Wikipedia also has good information.

How to reduce the chances that you’ll need knee replacement surgery

It’s no fun, really. And you’ll get stopped by airport security for a special check, every time.

Photo from Wikimedia Commons.

Here’s the advice from the National Institutes of Health––

How Can People Prevent Knee Problems?

Some knee problems, such as those resulting from an accident, cannot be foreseen or prevented. However, people can prevent many knee problems by following these suggestions:

Before exercising or participating in sports, warm up by walking or riding a stationary bicycle, then do stretches. Stretching the muscles in the front of the thigh (quadriceps) and back of the thigh (hamstrings) reduces tension on the tendons and relieves pressure on the knee during activity.

Strengthen the leg muscles by doing specific exercises (for example, by walking up stairs or hills or by riding a stationary bicycle). A supervised workout with weights is another way to strengthen the leg muscles that support the knee.

Avoid sudden changes in the intensity of exercise. Increase the force or duration of activity gradually.

Wear shoes that fit properly and are in good condition. This will help maintain balance and leg alignment when walking or running. Flat feet or overpronated feet (feet that roll inward) can cause knee problems. People can often reduce some of these problems by wearing special shoe inserts (orthotics).

Maintain a healthy weight to reduce stress on the knee. Obesity increases the risk of osteoarthritis of the knee.

What Types of Exercise Are Best for People With Knee Problems?

Ideally, everyone should get three types of exercise regularly:

Range-of-motion exercises to help maintain normal joint movement and relieve stiffness.

Strengthening exercises to help keep or increase muscle strength. Keeping muscles strong with exercises – such as walking up stairs, doing leg lifts or dips, or riding a stationary bicycle – helps support and protect the knee.

Aerobic or endurance exercises to improve function of the heart and circulation and to help control weight. Weight control can be important to people who have arthritis because extra weight puts pressure on many joints. Some studies show that aerobic exercise can reduce inflammation in some joints.

If you already have knee problems, your doctor or physical therapist can help with a plan of exercise that will help the knee(s) without increasing the risk of injury or further damage. As a general rule, you should choose gentle exercises such as swimming, aquatic exercise, or walking rather than jarring exercises such as jogging or high-impact aerobics.

So there it is, same old thing: exercise and lose weight. If you really really do not want a titanium and plastic knee, losing weight is probably the best thing you can do. “Data from the first National Health and Nutrition Examination Survey (HANES I) indicated that obese women had nearly 4 times the risk of knee osteoarthritis as compared with non-obese women; for obese men, the risk was nearly 5 times greater.” Moreover, if you already have knee pain, losing even ten pounds can significantly reduce both pain and the ongoing deterioration of the knee. Being only 10 pounds overweight increases the force on the knee by 30-60 pounds with each step. You don’t need to reach your ideal weight; any reduction will help. And maybe that will be encouragement enough to keep going, slowly, losing weight and feeling better. (Thorough discussion of weight loss and osteoarthritis, here.)

Changing the American Health Care system

I responded to an email from moveon.org today, which wanted me to sign a petition to my Senators and Representative stating:

Full petition text:
“I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.”

My convictions on this matter are different from moveon.org’s and from the position that Congressional Democrats like Baucus are putting forth, and so in the area for appending comments to be sent, I said:

Actually, this petition misrepresents my beliefs on this issue, based on 63 years of observation.

The single payer option is what we must adopt. A separate “public health insurance option “ will burden the taxpayer with the most expensive patients while the private plans take the profitable healthy younger patients. We have let this happen with FedEx and the Postal System, and private charter schools and public schools. The tax-supported option ends up with the mandate of accepting the part of the market that is least profitable.

We all know that the health care mega-corporations and industry groups will promise *anything* now, like a person being waterboarded. Five years from now will they be so devoted to the health of every American? No chance. And once this process is over, we are stuck with it—there will not be the political will to make substantial changes for another generation or more.

Mind you, I don’t think there’s much chance of a single-payer option coming to pass. American politics runs on money, and who’s got more of it than the “medical-industrial complex”? Americans have more passion and energy to invest in American Idol than in their own health and survival.

What the US now spends on health care

Here are some interesting figures, from the National Coalition on Health Care, a non-profit coalition bringing together “large and small businesses, the nation’s largest labor, consumer, religious and primary care provider groups, and the largest health and pension funds”, with 2 former presidents as Honorary Co-Chairs, Bush the first and Jimmy Carter. So their figures are likely to be well-researched and certainly not wildly radical.

National Health Care Spending

In 2008, health care spending in the United States reached $2.4 trillion, and was projected to reach $3.1 trillion in 2012.1 Health care spending is projected to reach $4.3 trillion by 2016.1
Health care spending is 4.3 times the amount spent on national defense.3

In 2008, the United States will spend 17 percent of its gross domestic product (GDP) on health care. It is projected that the percentage will reach 20 percent by 2017.1

Although nearly 46 million Americans are uninsured, the United States spends more on health care than other industrialized nations, and those countries provide health insurance to all their citizens.3

Health care spending accounted for 10.9 percent of the GDP in Switzerland, 10.7 percent in Germany, 9.7 percent in Canada and 9.5 percent in France, according to the Organization for Economic Cooperation and Development.4

footnotes refer to these sources:

1 – Keehan, S. et al. “Health Spending Projections Through 2017, Health Affairs Web Exclusive W146: 21 February 2008.

2 – The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2008 Annual Survey. September 2008.

3 – California Health Care Foundation. Health Care Costs 101 — 2005. 02 March 2005.

4 – Pear, R., “U.S. Health Care Spending Reaches All-Time High: 15% of GDP.” The New York Times, 9 January 2004, 3.

Small Oregon Port hosts giant cruise ships

Astoria, Oregon, is a port town of about 10,000 at the mouth of the mighty Columbia River. It’s rich in history, and calls itself “the oldest American settlement west of the Rockies”. Lewis and Clark wintered near here at a fort they built after reaching the Pacific in 1805; the town itself began as a fur-trading site for John Jacob Astor; it is the site of the Astoria Column, a 125-foot (38 m)-tall column with an observation deck at the top and a spiral frieze all the way up depicting events of Oregon history; fancy Victorian homes dot its hills, remnants of the fortunes that were made in lumber, shipping, and salmon fishing. But it’s a small port these days. Many big cargo ships bypass Astoria, going up the Columbia to off-load at Portland, and timber exports have declined. For years Astoria has been wooing cruise ship traffic, putting $10M into piers to accommodate the larger cruise ships. The Port has organized volunteer “cruise hosts” to lead tours and make visitors feel at home.

This year the preparations really paid off, as ships cancelling their planned stops at Mexican ports due to the H1N1 flu are looking for alternatives, and Astoria was ready. The scheduled 13 ships stopping in Astoria expanded to 21 for the season, and one of the biggest pulled in on May 12 for a few hours. Royal Caribbean’s Mariner of the Seas is 1,020 feet long and carries 2,700 passengers. The Port’s marketing director said that about 80% of cruise passengers generally disembark when the ships stop.

There were tours for all sorts of interests: history and bicycling at Fort Clatsop (the Lewis and Clark overwintering site which has been re-created in replica, with historic re-enactors); galleries, shops, and restaurants; the Columbia River Maritime Museum; Seaside and Cannon Beaches; “Shot in Astoria”, a tour of locations where movies have been recently filmed; a refurbished 1920’s vaudeville and movie theatre; the great view from the Astoria Column, high on its 600-foot hill, and more. And just walking around taking in the river, the ocean, the hills and the city, is worth a visit.

Top of the Astoria Column, photo by Terry Richard/The Oregonian.

And perhaps best of all was eleven-year old Tyler Delay selling messages in a bottle! Are they bottles for the visitors to toss in the ocean, having added their own notes inside, or mysterious ones that Tyler has scoured up himself in years of beachcombing? Guess we’ll have to go to Astoria to find out.

Photo by Ross William Hamilton for The Oregonian, accompanying The Oregonian’s article (from which most of this information is derived). Sorry this photo isn’t as good as it should be; it wasn’t part of the online article and was scanned from the newspaper.

Hydraulic mining scars, wildflowers, dogs, and poison oak, a short early-summer walk in the Siskiyous

We took our new English Mastiff Jack for his first off-leash walk in the woods this morning. He is a 3 1/2 year old rescue who has been with us for nearly a month now. He has settled in very well, comes when called at home even if he is barking at the UPS guy, and so we thought he was ready for an off-leash ramble. Our elderly female Rhodesian Ridgeback went too.

The nearby Gin Lin Trail is named for a Chinese mine owner and “traces the remains of a late-nineteenth-century hydraulic gold mining operation in what was known as the Palmer Creek Diggings, now a part of the Rogue River National Forest.” [more info]

Hydraulic mining used huge pressurized streams of water to turn hillsides or mountainsides into slurry that could be run through sluice boxes to trap the gold. The photo below shows a large-scale operation in action, somewhere in this area of the Oregon Siskiyous, in the latter half of the 19th century. For scale, notice the tiny figure of a man wearing a white shirt, tending the left-hand water hose.

The tremendous destruction takes geologic time, not human time, to heal. Huge clefts are made in the land, piles of big rocks and new hills of “processed” dirt are put anyplace convenient, and the subsoil brought up doesn’t support plant life as well as the now-buried topsoil did. All this is easily seen along the Gin Lin Trail.

Miners followed “pay streaks” of gold that might be only a hand’s-breadth wide, through the ground, making ditches like this.

The picture below shows a steep slope of discarded material. Both the angle of the slope, and the composition of the material itself, are hostile to plant growth. Even on the top where it is closer to level, trees and shrubs are not as numerous or healthy as in undisturbed areas.

And here’s some of the big river rocks moved as the mining went on.

The gold being sought had been deposited by watercourses running down to the river below, seen in the background of this picture.

Looking over the fence, from the same spot as the previous picture.

The dogs had a good time, and Jack stayed close and came when called, as we expected.

Because of the mining, it isn’t the best place for wildflowers, but we saw a few. This is Elegant Cat’s Ear (Calochortus elegans); the common name refers, I believe, to the fuzziness and triangular shape of the flower petals. This doesn’t show the plant’s leaves but there’s a good photo on Flickr that does.

Lupines don’t mind disturbed soil as much as many other plants do.

I think this is the Yellowleaf Iris, Iris chrysophylla.

And below, Iris bracteata, Siskiyou Iris. [caveat: I’m no expert on wildflowers so my identifications are not guaranteed! This USFS page has photos, range maps, and descriptions of the Pacific Coast iris species.] In our experience, this yellow-flowered iris is less common around here than Iris chrysophylla, the Yellowleaf Iris.

Below is my least favorite native plant around here, the glossy-leafed Poison Oak, Toxicodendron diversilobum.

In spring its leaves are usually glossy like this, and may be reddish too. On another plant it would be attractive but to me, the shiny fresh leaves are as ominous as the froth on a bodysnatcher pod.

We found it along most of the trail, flourishing as if it had been thickly planted and then fertilized and tended. If only my plants at home looked so good! Ravines were choked with it, and of course the dogs wanted to go running down into such places. I don’t think I’ve ever gotten poison oak from a dog’s coat, in all these years of living here, but there’s always a first time. I’ve often gotten it from secondary sources like clothing or even the touch of someone else’s hand. (In a post last year I described something that helps lessen the itching and make the blisters go away faster.)

The damned stuff was everywhere. Every plant visible in the photo below is poison oak.

Finally the trail ahead was overgrown with it and we gave up and headed back. The dogs ran ahead, enjoying the downhill rush, and got out of sight as we neared the small parking area, where I heard excited voices. It turned out to be the teenage park maintenance crew and their adult supervisor, cruising the areas to do things like gather up garbage strewn around by animals during the night. They were excited by the sudden appearance of a dog who outweighed most of them, and Jack had been pleased to see them but hadn’t bowled anyone over or been a pest. He’s a sweet affable guy except when defending his home turf, and even then has a good sense of proportion.

We loaded up our tired dogs, filled their water dish in the car, and headed home.

Thirsty dogs drink from the birdbath.

More about credit cards, debt, pyramids, and eschatology

My recent post “Why I’m canceling my Bank of America credit card” brought a comment pointing out that cancelling credit cards can adversely affect one’s credit score, perhaps making it difficult to borrow for cars and houses. That may well be true, but it seems to spring from a view of credit and debt quite different from mine. Rather than dump this on the hapless commenter as a reply, I’ll say it here.

First, the companies have no incentive to restrict credit, and I expect they’ll soon be back to sending out credit apps to dogs and kindergartners. When the banks lose money through extending credit unwisely, they raise rates on the rest of us to recoup. Worst case, as now, the taxpayers bail them out, they buy each other up, write off debt, get tax breaks for losses. So I think people can safely cancel all but one or two cards, and still be able to use credit to make major purchases.

Second, I’m hoping that ordinary people, who DO have an incentive to learn from the present debacle, may start restricting their debt to large necessary items. Cars and houses usually do require going into debt. But I’m old enough to remember life without credit cards; my mom had a metal “charge-a-plate” for Macy’s, and there was layaway at some stores, but no credit cards. If you wanted something you saved up for it. If you couldn’t afford to go out to dinner, you didn’t go. To those accustomed to incurring chronic credit-card debt for indulgences, such a life may seem a bleak prospect. But actually I recall very few people growing despondent for want of cruises, concert tickets, and designer handbags.

Back in the 1980’s when I saw items at an Oregon department-type store bearing tags that said “Want me? Buy me!” and a credit card logo, I viewed it as a dangerous & selfish attitude to cultivate. Along with it came the re-definition of human beings as “consumers”.

The present economic system is a pyramid scheme because it is predicated on continual growth. We do not live in a world of infinite resources and space, therefore neither population nor consumption/production can continue to increase forever. Business interests, and even the administration, expect increased consumption to get us out of this depression. If it does, it can be only a temporary fix.

I know there are a lot of optimists out there who say not to worry about dismal stuff like the economy, climate change, and all that, because the world is going to end in 2012 (Mayan Calendar theory) or “soon” (some Christian fundamentalist theories). But I just can’t be that optimistic. Call me crazy, but what if we’ve got those Mayan numbers just a little bit wrong? Or some translator introduced an inaccuracy into the Book of Revelations? What if God has changed His mind, and now thinks it might be amusing to see how His little creatures manage with these challenges? We just can’t know. Better to keep our eyes on the ball, as it were (in this case the planet & its inhabitants) and not count on the Umpire calling the game on account of End of Time.

Why I’m canceling my Bank of America credit card

Going through a pile of mail last week I came across two items related to Bank of America.

First, the AARP newsletter had a short article about a guy collecting unemployment in (I think) New Mexico. The state issues the monthly amount via B of A debit card. When this fellow had questions, he was charged for the phone call to the bank; when he makes more than one withdrawal in a day he is charged a service fee. The amounts are small––but then, so are unemployment benefits. And whatever the amount, the fact that the bank levies these charges on unemployed people (who also have to pay taxes on their benefits) is appalling. The state also should take action, should have negotiated a different setup, but it is the Bank of America that is profiting from people for whom every dollar is precious.

Second, I received a tender missive from Bank of America, announcing that the interest rates were being raised. “The standard rate for new and outstanding balance transfers is increasing and will use the Variable Rate formula with a margin of 11.72 points” yielding an annual percentage rate (as of Feb. 2009) of 15.72%. New and outstanding purchase balances will have the same rate, and the rate for cash advances will go to 25.74%.

They calculate this rate by using the highest US Prime Rate over the preceding 3 months, as published in the Money Rates section of the Wall Street Journal. Can anyone say, “The odds always favor the house”?

Yes, banks perform a service. They must make a profit. But this is far beyond a fair profit. Banks now levy multiple charges, at least one on every stage of a transaction. Businesses pay a percentage of each transaction for the credit card processing. Every credit card user pays interest on amounts owed, sometimes even when paying the balance off in full each month. There are big late fees. Some banks (Chase, for one) have started charging a monthly maintenance fee for “processing payment and statements” [Wisebread blog].

Our local credit union issues us a VISA debit card, with no fees unless we get cash advances from an unaffiliated ATM. The credit union covers overdrafts (checks) for us by charging a line of credit so that we never will pay a bounced check fee. The credit union was not part of this reckless orgy of greed on the part of financial institutions, which has caused our economic crisis, and for which we ordinary folk are paying at every turn: taxpayer bailouts to the institutions who profited, massive unemployment, foreclosures, blighted lives as families become homeless and food pantries empty their shelves to gobsmacked crowds of the nouveau poor.

Screw the banks. Use cash, join your local credit union (credit union membership is now usually based on locality; you don’t need to work for a school, a certain corporation, or belong to a certain union, to join). And if you close an account or credit card, be sure to let the bank know exactly why. We are already paying plenty for their dishonesty and incompetence.

“Bank of America helps build strong communities by creating opportunities for people — including customers, shareholders and associates — to fulfill their dreams.”
Kenneth D. Lewis
Chairman, CEO and President 1