Saturday, December 3, 2016

Open Comment Forum: Your Turn to Speak!

We haven't done one of these in a while, it appears, and they have been hugely popular (much more than my blog posts, I must confess).

So go ahead: Discuss whatever you want to below. It's open mike night at the SMK blog. :)

If -- and by no means feel bound by this -- but if you're looking for a subject to kick things off, what about this, for those of you who have had surgery:

If you could do it over, would you? What do you wish you had known going in that you know now? What's the most important thing you would pass along to others thinking about having that same procedure done?

Okay, I'll step aside and get out of the way now. Cheers!

Sunday, November 20, 2016

That “I’m Just Getting Old” Misconception About Knee Pain

As many of you know, I have Google scrape the web daily for news about knee pain. Recently the search turned up a column from the Flathead Beacon, a newspaper out of northern Montana. There are two huge national forests there; it looks like a beautiful place to live.

The writer is a devoted outdoorsman worried about how many more bird-hunting expeditions he has left in his failing knees. “I have become increasingly aware that there’s a hunting life expectancy in this body of mine,” he laments.

He had surgery on the right knee after a marathon quail hunt about 15 years ago. Then the second knee started going downhill, and what can you do? Here’s the money paragraph that had me ready to slap my palm against my forehead:
When knee No. 2 went south this spring, my doctor speculated that I just had joints built in a way that eventually wore out that knee cartilage. Like the right knee, the left seemed to just fail over time. It started aching last spring, after a casual jog with my daughter. It was fine the day of the run, but I couldn’t walk the following morning.
First, I’d get a new doctor. Yes, aging does have an effect on our bodies; that’s undeniable. But properly cared for knees don’t have to wear out over time. More typically, they fall apart because of benign or not-so-benign neglect.

Notice that the left “start aching last spring, after a casual jog.” I don’t know what happened, but a picture comes to mind, of someone attempting a little exercise after a relatively inactive winter and too many holiday treats consumed.

Of course the knee probably wouldn’t hurt during the run; that’s the problem with cartilage. But the next day – oh yeah – you’d feel it, full force. And if it was occasionally unhappy before, that casual trot could be the tipping event that pushes you into the land of chronic misery.

To be fair, the writer seems to understand the crux of the problem:
But the 10 to 20 pounds I’ve been trying to lose since, well, forever, that’s no longer a matter of just trying to look good.
If you’re carrying an extra 20 pounds (most men who say they want to lose 10 to 20 actually need to lose more like 20 to 30), you’re begging for knee trouble. If you do everything right, your knees may be fine. But you’re at risk if you lurch between sedentary and active states. What you need to do is obvious, though hard: Lose weight. That’s one piece of advice no one would dispute.

Sunday, November 6, 2016

That “Come to Jesus Moment” About the Strength of Your Knees

A “come to Jesus moment” (which originally meant that moment when you accept Jesus as your savior) has entered the popular vernacular to represent more broadly an epiphany or a flash of enlightenment.

Have you had your “come to Jesus moment” about the strength of your knees?

Not having this moment, I think, is a great impediment to getting on track with a successful plan of long-term healing.

What happens is you muddle along, believing the right things, doing many of the right things, but they’re all geared for a knee that’s about two or three times as strong as your knee actually is.  You may not realize it, but your progress is constantly being undermined.

It’s all because you don’t realize how weak your bad knee is. So you’re always being careful, but you’re also often outside of your proper “envelope of function.”

When my come to Jesus moment came, I remember thinking: “No, no. My knees aren’t really that weak. It’s impossible. I can’t be that bad.” But then I remember this sick feeling, “Yes they are, and yes you have to accept this. You have to start at the bottom to get to the top.”

That’s when I started walking around a swimming pool every ten minutes. Walking, then resting, walking, then resting. Nothing more strenuous than that. And after a few weeks, I noticed that I was getting better, but at the same time, it was depressing to realize the depth of the hole I was in.

Still, if you ask me, “When did you really get on a  long-term path to healing?”, I would identify walking around that swimming pool as the beginning. The later successes built off that. But to start there, I had to have a “come to Jesus moment” about the strength of my knees.

Have you had yours?

Saturday, October 22, 2016

ACI vs. Microfracture, Revisited

I originally wrote this post, which garnered a good deal of attention, about these two procedures.

I said that if forced to choose between the two, I’d rather have the less-invasive (and less-expensive) microfracture, which may even be more effective. In the comments section, several people disagreed. One commenter said that, over the long-term, ACI (or autologous chondrocyte implantation) leads to a better result.

Uh, maybe not.

This study (published in August in the reputable Journal of Bone and Joint Surgery) looked at large lesions treated with either ACI or microfracture. The 80 subjects were evaluated after 15 years (a suitably long timeframe, I think all would agree).

Check out the highlights:

* There were 17 failures in the ACI group compared with 13 for those who had microfractures.

* Total knee replacements: six in the ACI group, three in the microfracture.

* X-ray evidence of early osteoarthritis: 57 percent in the ACI group vs. 48 percent in the microfracture.

Luckily I don’t have to choose between either. But if I did, I think I’d stick with my original answer.

Saturday, October 8, 2016

Knee Pain and the Weather

Here’s a rather in-depth article about the relationship between pain and weather. The authors pored over a lot of different studies to reach their conclusions. Which are ...

That the link betwen the two is unclear. Actually, to be more accurate, it appears rather weak.

They looked at a number of painful physical conditions, from arthritis to migraine pain. I’m going to stick with the osteoarthritis end of things, as that’s what those of you with bad knees care most about.

Why should the weather influence perceptions of knee pain in the first place? Some theories:

* When bad weather moves in and barometric pressure drops, the surrounding air pushes on the joint with less force, allowing tissues to expand and causing uncomfortable pressure.

* Or, an alternative theory is changes in barometric pressure “may augment cytokine pathways.” More cytokine activity may damage host cells.

* A combo of rain, cold temperatures, and low pressure may cause pain by increasing swelling in the joint.

I encourage you to read the whole article, if you want more. I’m going to jump to the conclusion and in particular this line.
Studies that typically report the strongest correlation between meteorological phenomena and onset of pain are often poorly designed, utilizing self-report mail surveys and small sample sizes, not blinding participants to the research hypotheses, or relying on subjective memory recall.
Okay, that’s not hopeful if you’re trying to prove a connection between weather and pain. Still, the authors note that the issue is far from settled. At the least, certain individuals could be more sensitive to changes in the weather.

I’m not sure myself. I did think my knees were a bit crankier in Hong Kong when a big storm was nearing. And weather effects on one level make sense to me: the lousier the weather, the more likely you are to be unhappy, and there is a definite link between depression and pain.

What about everyone out there? Do changes in the weather affect how your knees feel?

Saturday, September 24, 2016

If Your Doctor Can’t Figure Out Why Your Knees Hurt ...

You might want to get a bone scan to  look for abnormalities.

The more I watch Dr. Scott F. Dye speak (thanks to TriAgain for yet another link), the more I’m convinced that knowing what's going on with the bone behind the cartilage is often critical to understanding knee pain. That’s what Dye thinks, and he makes a good case.

He attacks a lot of the received wisdom on what causes knee pain. He’s refreshingly unorthodox. For instance: what surgeon hates surgery? But he pretty much does, except for limited instances, and he appears to favor the least amount of surgery possible.

He’s also almost vitriolic in his dislike of structuralists. You know, the dozens of doctors who tell you your problem is because your kneecap is mistracking. I remember my first orthopedic doctor cited this as a reason for my pain, then when I queried him further on the point, he kind of mumbled it away. That’s probably because my kneecaps sat quite normally in their groove on my X-ray. So he probably realized that that standard argument was absurd.

Dye also doesn’t think much of blaming cartilage defects for your pain. On this, I’m not quite convinced – the cartilage does attenuate forces traveling through the joint, and if it’s damaged or missing, well, that seems significant. And Dye himself (through self-experimentation – now that’s dedication!) identified the synovium as being highly innervated, and a possible source of knee pain. So perhaps fragments of damaged cartilage could migrate through the synovial fluid to the synovium, irritating it?

Still, in his defense, he claims to have grade three chondromalacia in one of his knees – and it’s totally asymptomatic. So maybe I’m guilty of overselling the line “heal your cartilage.” Even so, I think my program for getting better would have fit a lot of his criteria for what makes sense for fixing bad knees: go slow, and stay within your “envelope of function.”

Curious about Dr. Dye, and what the heck I’m talking about? Check out these links:

Why You Need to Know About the “Envelope of Function”

What Implications Does “Envelope of Function” Have for Designing a Plan to Beat Knee Pain?

Scott F. Dye on Why Your Knee Pain Diagnosis Stinks (And Why You’re Not Getting Better)

Sunday, September 11, 2016

Decoding What Those Crackly Knees Mean

I found this research study interesting and wanted to share:
Engineers are developing an acoustic knee band equipped with microphones and vibration sensors that can listen and measure sounds inside the joint — and could lead to a way to help orthopedic specialists assess damage after an injury and track recovery progress.
Hmm. Apparently the listening device on the knee band was created by combining microphones with piezoelectric film, which is very sensitive to vibrations. The microphones are placed against the skin.

Of course all knees make noise: pops, creaks, crackling. Often these are benign. But when you have knee pain, they're called "crepitus" and take on a new significance. It turns out, even if the noises are hard to make sense of, there is at least one message in there:

An injured knee makes markedly different sounds than a normal knee. “It’s more erratic,” according to Omer Inan, an assistant professor of electrical and computer engineering at Georgia Tech. “A healthy knee produces a more consistent pattern of noises.”

Inan, in recording the sounds knees make, has encountered challenges. Fluid that surrounds the joint interferes with sound waves, and moving your knees causes its own kind of noise that can drown out other noises that are more important.

As someone who listened hard to his injured knees, I’m interested in what they find. I do think knee sounds are meaningful, but I also think it’s very hard to figure out that meaning.