Pedal to the Metal.

Meeting ‘Bones’…..or Doc

Just before our holiday my orthopaedic review finally happened so I got to meet the bloke who is going to replace my old left partial knee replacement with a new whole one. Jokes about ‘Bones’ (Doctor McCoy from Star Trek) aside as his name sadly isn’t McCoy although he is most definitely a Bones. Even I was a bit shocked at the state of my knee as seen on an X Ray screen and Bones was a bit surprised that i’m still cranking out 7500 steps per day most weeks ; i’m having a break this week as I walked so much during our holiday and it’s so warm here that walking is only feasible very early or very late in the day.

Bones, as I now think of him, was gracious enough to praise my 10 Kg weight loss as it was the on the day I met him and even more pleased when I was able to assure him that I intended to get to below 90 Kg prior to surgery and am actually aiming for more. If my recent posts have seemed a bit self congratulatory then firstly I apologise but I hope iv’e acknowledged how far iv’e got to go ; i’m aiming for an eventual weight of around 75-80 Kg so as of today iv’e got a good 20 Kg still to go or many more notches on my belt. What that means is that iv’e done tolerably well so far but between now and surgery (approximately 6 months) I have to do better ; press pedal firmly to the metal with the weight loss.

Here’s what I have to do :

In brief : what i’m doing now only better. The longer version is that I want to be as light as I can possibly be in 6 months, as fit as I can be and as low an anaesthetic risk as I can be : in my mind they all go together although I find it helps to think about each aspect separately. As of mid June 2026 I find it a daunting challenge : i’m tired after a hard sprint with the workshop project so we’re using Jackie’s leave to go and have a break away for a couple of weeks – it’s only after that that I begin.

Weight Loss.

If I continue at the same kind of pace and weight loss as iv’e achieved so far then I could predict a 22-24 Kg weight loss by the time I come to surgery : that’s ok although I would prefer it to be 25 Kg or greater. Why that’s my goal is that the lighter I can be on a total knee replacement then the longer it’s likely to keep functioning. The way the surgeon presented it to me is that he estimates that 1 kg change in body weight equates to 5 or 6 at the joint thus the lighter the better. Iv’e gone most of the way towards maximizing my weight loss through dietary means although I do still have a couple of tricks to play :

I have eliminated most sources of dietary sugar – mainly in the form of biscuits but also cakes – aside from my one eccles cake per week habit. What iv’e kept though without realizing it until recently is a high glycaemic load from bread, pasta and white rice ; I never got that white rice can be such a problem. The first trick then is to reduce those but they will remain part of my diet, Reducing to one slice of bread per day – every other day as toast to go with my usual poached egg breakfast is a simple change as is halving the amount of pasta I use when I make a pasta and marinara sauce based dinner.

The other trick that iv’e only just started to employ once again is to fast once per week although what i’m thinking of is fasting as normal but having a protein ‘dose’ during the fast ; this being of low glycaemic load and is said to help with the otherwise anticipated muscle loss from fasting. The final trick, for now, is to continue with my usual eating and fasting daily windows (intermittent fasting) and increase slightly my daily fasting window.

Maximizing the cardio sweet spot.

Up to a month before my surgical consultation I was keeping to 7500 steps per day or usually 45000 per week. What happened is that I went ‘lame’ on one knee and then the troublesome one and it took me a while to build up to 5000 steps per day : I don’t think that’s adequate but it might be the longer walks that are giving me such a problem. On holiday I averaged 9-10 thousand steps per day but then Dorset is slightly flatter than our part of Cornwall. One thing i’m wondering is whether I should really crank up the volume with my walking as my current knee joint only has to make it through another six months at which point I have to take a recovery break post surgery.

Minimizing surgical risk.

When I was a student nurse, some time in the last century, we often had to answer exam questions about what we called then post operative complications and largely we tended to write what we’d been taught in lectures or what we had seen, by chance, on hospital wards. We were mostly wrong of course !. Nowadays we know quite a lot more about post surgical risk because the subject has had some attention and there are even specialist nurses that deal with the more well known and serious problems ; the example i’m thinking of is DVT/Embolism which is partially avoided by early post surgical mobilisation and the routine use of specific anticoagulant medicines,

Just as with my days as a CICU charge nurse when it was normal to get post heart surgical patients out of bed on the day after surgery, and also get the patients to do what they really didn’t want to do which is to stand up and take deep breaths – anyway I fully expect to have to get up and take a few tentative steps on my first post operative day – that’s assuming that I haven’t had an intraoperative CVE (Stroke). I’ll most likely be wearing a natty pair of compression stockings which I know from previous experience will itch like mad before I get home possibly as early as day two – being at home is much better as i’m more likely to get some sleep !

Surgical risk is largely taken care of as iv’e already discussed medicine management with Bones ; thus I know that i’ll be coming off one anticoagulant (clopidogrel) a week prior to surgery but going on another instead (Rivoroxaban). What i’m really talking about here is anaesthetic risk and post surgical home risk – specifically stroke risk and falls risk at home.

Minimizing intraoperative stroke risk and stair/falls risk.

Risk is, at it’s heart, a very mathematical subject and the kind of surgery that i’m having is much lower risk than for example heart, vascular and neurological surgery ; according to some articles between 0.1 and 1 %, I’m at slightly higher risk due to having had a previous stroke but once again slightly less because those strokes weren’t in the previous 9 months. Preexisting conditions are given as a risk and uncontrolled hypertension is one although, once again, iv’e been well under control and even now i’m on a reducing dose of anti hypertensive medicines, due, I suggest to my significant change in diet and exercise ; if anything i’m in slightly better a metabolic state now compared to when I had my first knee replacement.

Of greater interest is that iv’e been using crutches around the house and they are a real problem and a real risk on the stairs : we have typical stairs for a cottage of it’s age and only a partial handrail one side thus where stair/falls risk is highest – at the top – I have nothing to hold onto, One of the few practical changes I have to make is that of adding a small section of handrail right at the top of our stairs.