Knee Replacement 6: The Pre-op Amuse-Bouche

With an Olympian-turned Tour de France bicycle racer turned-surgeon in my metaphorical team car, I felt like I was finally rolling down the road to new knees, but first I’d have to have some warm-up suffering to get me ready for the real ordeal. In professional cycling, many teams in the pro peloton will grind through the mountains of the 11-stage Tour de Suisse to prepare for the major suffer fest of the 21-stage Tour De France, which happens a few weeks later.

The 2025 L’ablation de la Rate was my Tour De Suisse.

A year of various experiments to stabilize the platelet count within my blood (platelets equal clotting, and clotting is a much-desired response to eight-inch incisions) has failed, and the next step is the removal of my spleen. To me, this sounded like removing the oil filter in your car to extinguish that little change-oil light on your dashboard, but I was focused on new knees and would do almost anything to get them.

With just a few weeks to go before the multi-stage 2025 Prothèse du Genouthe, I rolled into a crowded hospital in Murray, Utah, where an overworked staff couldn’t wait to wheel me back out the front door. New to organ removal, I may have been a difficult patient. They may have called me something like that to my face. When I pointed out that if pleasant patients were desired, they might consider following their own protocol and not forget to give the prescribed pain killers to the post-op, pain-in-the-ass patient behind door number three. When I suggested this, the nurse denied that it had happened, then looked again at my chart and said, Well, that wasn’t my shift.

She got me my pain meds, eight hours late, and quickly managed the discharge papers.

I reminded myself that I was learning to suffer and went home to hone my craft. Turned out, it came naturally. The writhing, the moaning, the grinding of teeth. I had already mastered all the basic moves.

A few days later, I was ready for the next round, this time with my dentist. With less than two weeks to go before the kick-off of the Prothèse du Genouthe, I saddled up in the dentist chair to have my teeth cleaned. After the cleaning, there would be X-rays and scans to ensure that I was in good dental health and wouldn’t need any major work done for a year. It’s an infection thing. I hadn’t researched it at the time. All I knew was that I needed to have my dentist sign a form, a bit like a permission slip before a field trip, that would attest to my dental readiness.

You need good teeth to get good knees. Who knew?

My dentist, Dr. Tom Brickey, is an old friend—I’d once played on a beer league hockey team with him, and I’d coached his favorite nephew for a few years—and he’d taken care of me and my family for twenty years. Glad to help out, he got me an appointment quickly and was just about to sign the permission slip, when he saw something in one of the X-rays that he didn’t like.

Fuck, fuck, fuck, he mutters as he pulls me into a small alcove where we can look at scans of my mouth together. Just what I didn’t fucking want to see, he says. When your dentist is a hockey buddy, you’re allowed to converse like hockey players, even in the dentist’s office.

You see this, he says, pointing to the screen. That’s an abscess.

And that’s a problem because?

Well, that’s basically a pocket of pus caused by bacteria, and if the bacteria get into your bloodstream, it can infect your new knee.

And that’s obviously bad.

That’s bad.

Later, I will read up on it: it seems that, unlike natural tissue, an artificial knee joint has no blood supply to deliver immune defenses, so infections there are extremely difficult to eradicate, and if that happens, the surgeon will need to remove the new knee, put you on weeks of antibiotics, and start all over.

That’s very bad.

There are also other issues in my mouth but I trust Brickey to come up with a plan and don’t focus on the details. Twenty-four hours later, I get to work on my suffering prowess again.

The L’Arrachage de Dents is my Paris–Roubaix.

Open wide. Drop down into the drugs. Hold on for the ride. Brickey yanks two teeth—and I do mean yanks; my neck will later be sore from the wrestling match of molar against man—and makes an incision on the other side of my mouth to snip off a nerve root that’s grown back. Evidently, I’m able to walk out of the office with my wife, who drives me home and will later report on the strange things I say while under anesthesia. None that I remember, and thankfully, none that are dire enough to warrant divorce.

Then I get focused on round two of post-op suffering. Despite previous experience, I’m no better at the writhing or the moaning, but at least I have fewer teeth to grind. We are starting to develop a system to manage the meds—a notebook and various vials sit on the kitchen table—and we painstakingly (see what I did there) note every pill popped and the attending time.

A week later, I’m back in the chair, and Tom is saying that the healing went very well, which must mean that my platelets did their job, and I now have a signed permission slip for the main event.