How long will a knee infection stop me riding a bike?

Septic arthritis and riding don’t mix.

Strapped into the CPM (controlled passive movement) device – exercise without effort. Three weeks after first symptoms.

This post is not to chase an “oh poor you” kind of reaction, but just to record somewhere searchable on the interwebs, the response I had to a major knee infection, and how it affected my riding, just in case anyone else gets this rather nasty thing.

Septic arthritis:

The Mayo Clinic has this to say about it.

This is what I have to say about it.  Ouch!

I’ve made this bullet pointed list, distilled from my nl;dr ravings because I feel that if you are reading this it’s because you have been struck down by yourself, and you simply want a heads up on the headlines of what’s ahead.

Me:

70 years old, fairly fit, active but I have never been to a gym.

ACL right knee about 30 years ago.

First arthritis symptoms 6 years ago

Avid biker in my youth, and since I turned 60. 

Bought a fs e-mtb 3 1/2 years, for comfort more than adventure.  I/we mainly ride off-road trails, and the “e” bit lets me do the St James,for example.  The Ghost Road probably won’t be an option – too hard.

Knee pain varies from mostly quite mild to irksome irksome. Biking helps, walking kills it – 5km is a long walk ending with a swollen knee for the following week.

Timeline:

  • Day 1 :Right knee hurting more than usual, and I tripped over a couple of times with my right foot dangling. Put it down with too many times up and down the stairs. (We have a house on a steep slope).
  • Day 2 : Swollen and hurting to the point where I avoided stairs. Had to stand around all afternoon at my birthday party and it hurt like hell. Painkillers to get some sleep.
  • Day 3 : Doctor visit. Says it might be infected, prescribes antibiotic, recommends come back in a couple of days if it’s not improving.
  • Day 4 : Sleeping pill to get to sleep because the Dichlorfenac was bouncing off the pain, a first for me ever.
  • Day 5 : Doctor aspirates my knee, got some fluid for testing
  • Day 6 – 7 : Worsening pain, increasing swelling
  • Day 8 : I go to the emergency clinic to try to score some heavier duty pain killers. Their doctor took one look, told me to not eat or drink anything because she was calling the hospital to get them to look at. She had diagnosed septic arthritis immediately.
  • Hospital does the quick blood tests and staffs an operating theatre at midnight to flush my knee out. My CRP was 300+ , the inflammation indicator where  10 is a warning, 50 is quite bad, and 300 is spoken of in tones of hushed awe.
  • The swelling was rated as “severe”, for reference.

    My knee, a few days after the second flushing, still swollen and v. painful.
    My knee, a few days after the second flushing, still swollen and v. painful.
  • Week 1 in hospital : Another flushing. Very grateful for the freely dispensed morphine. Just able to walk with crutches and nurse assistance.
     
  • Week 2 :  Or maybe a few days more. Much pain, stopped the morphine pills because i hate feeling dulled out and nauseous. Throwing up on the head surgeon during the morning rounds was the trigger. CRP dropped from 130 to 75, then plateaued at around 50 for a week, prompting the medicals to suggest a third, major open knee surgery. I told them that that would make me deprressed a difficult and that I would rather wait it out for a few days and thankfully they agreed
  • Week 3: Gradually improved. Very grateful for the view. At the end of the week I could bend 90 degrees and the CRP was down to 25 so they sent me home with an IV system to keep the antibiotics flowing for two more weeks.
  • Week 4: Still not able to take any weight on it, especially down stairs.  Got an exercycle and after about a week I could make it do a full turn, but still bloody sore.
  • Week 5 & 6 : Improving mobility on the exercycle with 20 minutes a day on  and at the end of the week I did a 6km ride on the real bike.
  • Week 7:  Started physiotherapy with very gentle exercises only. Built up to 20km rides every second day with occasional backward steps keeping me off my feet for a day. Able to stand for a few hours doing some wood turning, but then another lockdown forced me to stop that so I did workshop things at home for entertainment. Stairs are great therapy, combined with a bad memory to make me go up and down ten times as often as a younger bloke with a decent mind.
  • Now:  2 1/2 months after the first twinges of pain, I am able to contemplate longer rides, walk up and down stairs without making funny faces, and if i concentrate, I can stand up from the couch without making old man grunts.

All in all I don’t recommend septic arthritis.  Dr Google describes it as “rare and needing to be treated as an emergency” hence the initial midnight surgery, and physios and other nursing friends have reacted to my description of my initial symptoms with much more urgency than my ex-doctor did.

 

 

 

 

 

 

 

 

 

 

 

 

New Brooks B17 Saddle

Brooks again, of course

The old Flyer had almost become uncomfortable, and I had wanted to replace it ages ago before we did the Europe trip but it was invisible to my bum, so it stayed on the bike. Until I noticed it, and then …

Update: First ride, 56k first 40 were OK and I was glad to get off at the far end and to sit on the ferry home. It feels very hard and slippery, which I recall the Flyer felt like when brand new, and I can feel the bumps which will mould into my shape over the next few rides.
Thank goodness for padded shorts, well thank GroundEffect anyway.

2x to 1x conversion

Simplifying my drive train

 
WZ2358 is the product code at The Bolt Shop in Archers Rd for their 3/8 x 5/8 x 16g Flat washer steel zinc, recorded here in case I need to do it again, and because they were as exact a fit for the longer chainring bolts I needed to let me move the new chain ring over to improve the chainline …

OK, One thing at a time.

 

The Shimano Deore XT front derailleur was a dog on my bike, even though Jill has an identical bike and hers works perfectly. 
Mine once needed to be physically ground to shape to let it move far enough to move the chain to the granny gear, and it would never stay adjusted for long, even when I did manage to get it working. It didn’t matter mostly, because I spend far more of my time in the high gears anyway, so I decided to scrap the whole thing.

Before - the new ring has to be positioned between the two existing rings.
I rode a few 100 km using only the large ring to test the idea and it worked fine with a 38 tooth ring at the front, although very noisy in the lower gears, so I looked for my options. Since I already had an FSA crankset with a 104BCD spider, I opted for the custom made FSA Megatooth wide-narrow 38 tooth, but it would need to be offset towards the centerline of the bike, midway between the two rings in the original crankset..

BBT-18_002

For my set up I needed the slightly hard to find BBT18 toolto remove the crank set, so that I could get to the chainring bolts with my

BBB-BoldGrip-Chainring-Nut-Wrench-BTL32L-Internal-Black-Silver-NotSet-2977453202
BBB BoldGrip Chainring Nut Wrench BTL32L from Wiggle.

Part of me quite likes owning tools that are specifically for one job only.

Chainline!

Our bikes have Boost axles so the chainline needed to be a few mm further from the center line than with a regular axle, 52mm according to , so I had to hunt down the above-mentioned washers. It only took an hour or of trial and error to get it right, 3 on the inside and one on the outside because the bolt was 1mm too long. The Ask A Bike Mechanic group on FB assured me this was going to be OK, but I’m carrying around that little wrench in my toolkit for the next 1000km or so.

3 washers on the outside
1 on the outside

Tubeless!

Easy peasy

They’re not meant to be used with tubes
 

Thus chided the very patient Elisabeth Foot from Schwalbe when I had complained that my “bullet proof” G-One All rounds were in fact thorn magnets.  She also recommended Big Ben Plus or Marathon Plus MTB, but both came in only 2 inch versions and I wanted at least the 2.25″ our  bikes came with, as well as the lowest rolling resistance I could get.

 

When I got home from our 3 months around very mixed surfaces all over Europe I decided to give tubeless a go.  We had been using Schwalbe Rocket Rons and Racing Ralphs, and had about 8-10 flats and had replaced one tyre so it was time to try something new. I’m still not sure that the G-Ones 60-584 (27.5×2.35) are going to be the all-rounders I need, but I have them, they are Tubeless ready, or Tubeless Easy as Schwalbe brands them, so they will do for starters.

 

However, Orange sealant proved to be the first stumbling block, along with Gorilla Tape, both highly recommended by various Facebook groups, and both unobtainable in NZ!  What’s the point in luxuriating in Sunday shopping hours if you can’t buy anything except by shopping online, usually from those closed-on-Sunday European emporiums. By the time they had arrived I had seen enough youtube videos to be an expert, although I was fully prepared to visit my LBS to have them do it properly after I had failed, so I launched into installing them.

The best advice gleaned from all those videos was

  • remove the valve core before seating the tyre to allow for greater airflow
  • give the rim a quick light spray of silicon lube before pumping which allowed the tyre to seat well without even that satisfying pop
  • save  a few bucks by cutting a valve insert out of an old tube instead of buying new custom one. (not the best idea it turned out)

  https://www.youtube.com/watch?v=zI9DM34LHAo  

The first attempt went well.  New G-Ones are devilishly hard to get onto the rims, they seem to be tighter than any other tyre I’ve fitted, but once on, and without sealant to begin with, they eased up onto the rims with a nice tight fit after the recommended quick light spray of silicon. I have a good pump (Topeak Joe Blow) and even though I’m no longer young and fit I could seat these big balloons  without raising a sweat.  I left them overnight, noticed that one was deflating slowly and worked out that it was my chopped down valve insert leaking, gave it a 50km test run to make sure, then replaced it with a proper one.  That’s a messy job with the sealant splashing everywhere but luckily it cleans up well with a damp rag, and the properly made insert works a treat.

 

 

August, 2019

After slipping around a bit on the mud and grass one day last week I decided to change back to the knobblies.  The Rocket Ron I had on the front had been hammered by thorns during our tour around Europe last year and it had one hole bigger than a matchstick, one ordinary hole and several small leaks around the sidewalls.  Orange Sealant worked exactly as it should, it fizzed and bubbled and needed an pump up a couple of times but then it settled down with every leak well and truly plugged, and I added an extra squirt the next day and they haven’t even gone down at all in a week.  I’ve got a Racing Ralph on the rear now, and even though the knob in the middle are mostly gone, they make a helluva whine on the road after the luxury quiet hiss from the G-Ones. Noticeably a bit slower too, but not enough to worry me.

The old stuff was dead easy to remove from the tyres too, because Orange forms a skin right around the tyre, and it all just peeled off in sheets.  I haven’t used other sealants, but I’ve seen photos of how they ball up and form big lumps, but there was nothing like that.  I probably could have left it on, except for the rims which I would have had to clean carefully before re-installing, and I’ll do that in future. I left it on the wheel rims though, figuring it would help keep things airtight.

Croatia

Too brief, so friendly

 

I’ve given up trying to keep maps. The GPS logger wasn’t behaving and Croatia has infected me with a very comfortable lack of organisation and orderliness.

 

Some friends on Facebook have recently accused us of being fantastically organized . If that were true we would have known that Croatia does not use the Euro before we crossed the border. We might have have known that to visit the museum in the salt pans on the border that you need to have your passport because we might have known that there is border control between Slovenia and Croatia, and that the road to the museum takes off between the two passport points. We might not have learned that the traffic on their main roads is deadly, but that the people are the friendliest and most generous you could find anywhere once they step out of their cars.

 

However travelling our way, finding out where we will be staying a couple of hours before we arrive at the most, quite often sorting the details of the route as we arrive at the next village, is the most rewarding and entertaining way to get around this country. As one recently returned refugee told us, “ I lived for years in Holland and I couldn’t stand the level of organisation. I came back because I love the improvisation of life in Croatia.”

 

Organised travellers would not have stumbled upon the stone shelters known here as kazun, utterly similar to the borries we chanced upon in Provence, they would be unlikely to find the Roman pottery and villa ruins that were open to walk through on the almost unmarked trail around part of the coast, or the small Roman theatre in Pula because they would have paid to go into the coliseum (we didn’t) and not made the effort to go  the top of the hill, or if they had, would have paid to go into the castle there rather than find their way around the back of it. Improvisation rules.

 

We did have an itinerary. Down the coast to Pula, ferry hop down the islands to Korcula, hang out there until it was time to get a ferry to Italy’s east coast, then make our way up to Venice where we could pack up the bikes, send the batteries back to Cologne where they could be included in the next shipment to NZ, and catch our flight.

 

Guess what? A lot of the ferries don’t take bikes and they had stopped running in early October anyway. The weather became less bike friendly and the traffic had terrified us, so all our planning came to nothing luckily, because we decided to hole up somewhere attractive instead of Pula, found ourselves at Bale up in the hills on the back roads, an untouched old stone village with the world’s most generous hostess (free second night, free dinner, snacks and even stored our bikes in her tiny living space to keep them safe and dry), and were treated to a spontaneous concert on the street by Klapa Valdibora, an a capella group of blokes who had recently won a competition in Paris.

 

We biked up through the smallest, quietest roads we could find for a day or two to pick up the Parenzana bike trail which follows an old rail track to Trieste, soaked up some more Croatian style friendship and generosity, and finally hopped back into Slovenia to wait out the next bout of rotten weather before making our way back into storm beleaguered Italy. Venice has just has the worst floods since 1966.

 

Plans are good, itineraries are useful I’m sure but they wouldn’t have helped us discover a real Croatia that exists not very far under the cloak of seaside tourism.