When it came to their everyday health problems, my grandparents along with all the other old folks I knew talked about three things — gallstones, hemorrhoids and gas.

Sure, there were more serious problems, like a weak heart, but there was not much a doctor could do about those. You lived with them the best you could until they killed you.

And no one talked about sex problems. What for? That was nobody’s business. Besides once you started to go downhill in that department, there was nothing anyone could do to fix it.

Rejuvenation has become a part of the vocabulary of aging. Today there is something older people can do about sex — Viagra — just as there is now something that heals bad knees — knee replacement. Both allow old folks to do things that they have not been able to do for a long time.


the aging process


So is a knee replacement like Viagra? Absolutely not and for reasons that say something important about what it is like to grow old.

This, as it turns out, is not an abstract question for me because I am having knee replacement surgery next week (I will miss a couple of columns).

So I have thought a lot about that Viagra/knee replacement question. Here is my answer: Viagra makes getting old seem too easy. The knee replacement process has it right.

You can see this difference by looking at the way that Viagra ads and knee replacement literature talk about sex.

But to understand this you first need to understand limping.

It used to be that limps told clear and simple stories.  Seeing someone with metal arm crutches attached to unwieldy, full-length metal knee braces meant one thing: polio, dredging up really frightening memories of childhood epidemics.   A lucky survivor, but what a way to spend the rest of your life.

At the other extreme were those temporary limps. “I twisted my knee.” No big deal.   It will get better on its own. “For God sake, rest it,” my grandmother might have said. “Run it out,” your football coach would say.

Then there was the “trick knee,” something you had for a long time and was going to be with you until the end. The trick knee became a part of getting old, like a bum ticker.

Each of these kinds of limp stories had a clear arc and a predictable end. The twisted knee hurts but soon gets better on its own while trick knees and polio braces last forever. Not much a doctor needed to do or could do to intervene and change these stories.

Today thanks to knee replacement and changes in attitudes about aging, limp stories have become more complicated with a different ending.   A trick knee (“live with it”) turns into a surgically replaceable knee (“It’s osteoarthritis, and with knee replacement surgery and physical therapy we can…”).

So it is much harder to guess what the limp is about.

Many people at my gym limp because they need knee replacement. Others hobble the same way because they are recovering from knee replacement. Some walk normally because the replacement has completely healed, others because they have no bad knees at all.

Here is a story about a 60-something married couple that I see at the gym. It shows how complicated limping stories have become:

For many months the wife limped until she had knee replacement. It went well and soon, after some post-op limping, they were traveling again. Then the husband began to limp until he got knee replacement. Again good results, normal activity. Then they both started limping again because of their other knees. They’ll take replacement turns again with travel in between.

So over the long term this couple’s surgeries will rejuvenate them, but it’s an up and down process with plenty of pain and postponed gratification. It involves a delicate and shifting balance between restraint and rejuvenation, work and play, and it never really ends.

That’s not the vision of rejuvenation Viagra ads describe.

The makers of Viagra are selling instant rejuvenation. Process? What process?  With Viagra the guy takes a pill and an hour later he is back to his old tricks. End of story, so go for it!

Knee replacement sex information, on the other hand, reads like a super-cautious variation of a Cole Porter tune:

Birds do it.

Bees do it.

Even people with new knees do it.

But carefully. Very very carefully.

The picture on the cover of Kaiser Hospital’s “Getting Ready for Knee Replacement” pamphlet is of a gray-hared guy with male pattern baldness. He is the retired neighbor who helps you carry in in your Costco order. This Neighbor Bob may be sexually attractive, but only to older women and only then if he still drives.

The former Kaiser pamphlets used to have graphic how-to illustrations of sex after replacement. Don’t get too excited. The woman in the picture wore a bathing suit that my mother would have worn, with a rubber bathing cap, in the 1950s. Still, there was at least some sort of specific discussion of positions.

Kaiser’s most recent advice, “Common Questions About Total Hip and Knee Replacement Surgery” is very different. It uses no graphics at all and is even more indirect and guarded.

In fact the information sheet says nothing specific about sex at all. It never even mentions s-e-x by name:


Usually the hip and knee is stable enough for non-strenuous activity in 6 to 12 weeks. For females lying on your back helps prevent stress on your new hip and knee. For knee patients avoid putting your full weight on your new knee. Do not apply force on the knee in any direction. Do not kneel or squat. ”

This advice might be about how to have sex, but it also could just as well be about how to use a walker.

If Viagra gives you a bright green light for sex, Kaiser gives you one of those four-way flashing orange intersections where no one is quite sure what to do so she just stumbles cautiously forward as best as she can.

In fairness, the knee replacement literature is talking only about the early stages after surgery. But that’s the point. The rejuvenation that comes from knee surgery has stages.

It involves a process that involves ups and downs, good days and bad days, experimentation and disappointment.

So even if it cheesy, the knee replacement information paints a more realistic picture of what growing old today is all about — the adventurous, uncertain combination of rejuvenation and restraint, amazement and disappointment. Be happy but be careful.

In my grandparents’ day people were more likely simply to passively accept old age. That made them older faster. Today it’s common to go too far in the other direction and romanticize old age, you know, “80 is the new 50.” That wishful palaver tips way too far toward the Viagra view of growing old.

This Viagra view is a Pollyanna, but the knee replacement view of life is the real thing. The combination of promise and pain that knee replacement offers is a much more realistic description of what it’s like to grow old today. It’s a microcosm of what happens when new tools meet old bodies.

But, hey, an orange light is not so worrisome if you also get a green at least once in a while.

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